Making a greater impact in the community is a dream for many medical professionals. Alicia Backer, PTA has spent the past 7 years developing a culture and a clinic that is focused on doing just that. In this episode, Nathan Shields interviews Alicia as she shares what her clinic does to find team members who share their mentality and are ready to do some of the things they do to integrate themselves into the community. Alicia and her team have generated a fun culture that looks forward to working and playing together. Their patients sense that and gravitate to them as clients.
I’ve got Alicia Backer, PTA, out of Thief River Falls, Minnesota. Alicia, thanks for joining me. I appreciate it.
Thank you, Nathan, for having me.
I don’t have a lot of PTAs on the program but you wrote a great article in the April IMPACT Magazine about becoming a community alliance champion and you had some good insight that I liked. It spurred some thinking on my own and thought it was worthwhile to bring you on and talk about the things that you brought up in the article and want to get into that. Before we do that, tell us a little bit about you. Where you’re coming from? What you’re doing nowadays?
I’m from Thief River Falls, Minnesota. It’s up in the Northwestern corner. We’re pretty close to Canada. It gets pretty cold up here. Most people don’t think there are humans that can survive this element but we do. I work at a private practice outpatient clinic. I live in a town that’s approximately 9,000 people. It’s pretty rural. We have a lot of outside communities that come in to see us, too. I graduated from the Physical Therapy Assistant Program in 2010. I’ve been in a physical therapy community for several years now and had some good experiences in a few different settings that gave me some of the knowledge that we’ll talk about. I have 5 kids, step kids, 2 of my own and 3 step-kids. It keeps me busy outside of all the other stuff that I do at work and for different parts of the physical therapy world.
Do you do something in your clinic that provides a lot of outreach to the community? Your article was about community alliances. What things are you doing then in terms of reaching out to the community in your setting? Your supervisor allows you to reach out. I’m assuming you have different aspects that you’re involved in the community. What do you do?
I’ll take it back a few years before I started working in private practice. I worked for a larger outpatient clinic in a hospital setting. While I was a part of that setting, I never was involved in marketing opportunities. I wasn’t involved in the process of planning it, what it meant, I didn’t care. It was much more based on productivity and seeing lots of patients. I didn’t have any knowledge at all working in private practice but once I started working here, we’re community-based. We have a high percentage of direct access patients. Instead of marketing to physicians, we spend more time marketing to the community. There’s a large employer in town that probably has about 6,000 to 8,000 employees that has a great insurance policy and they give us a high percentage of their direct access business.
We’re involved a lot with them. We partnered with them to create a work readiness program or injury prevention program for their business which was a huge step in the door for people getting to know us by coming in and being present and giving them that program. We do a number of things in the community. We put on the raises and we host chamber events. A lot of our employees are coaches in the community. There are a lot of things outside of the marketing box that we do that you don’t necessarily think are marketing. It’s not paying for marketing. It’s being present. It’s your time rather than money.
Is there an expectation in your clinic that you do some of those things that you lead out and either generate the race yourself outside of the ownership, taking responsibility for the team members in the community, certain things in the name of the clinic?It only takes to have one person that's not coming to things or isn't fully engaged to bring down the morale. Click To Tweet
When we hire our people, the expectation is pretty much set in the interview. That is a big part of what we do and what makes our clinic successful and a part of our culture. We have a pretty unique culture. When we hire people, we make sure that they know the community events that we do. It’s not required but it is a volunteer. We look for people who are very highly engaged and high achievers that are looking to also do that type of stuff. We have a great team. There are eight people that work here. Everybody is excited when we do events. It makes it fun. It doesn’t make me worried when I delegate tasks because I know everyone’s going to follow through. I’m not great at delegating. I like to do everything myself. That also helped me learn more about the right way to go about marketing because involving your team, which are your huge stakeholders in this. It’s huge in your success.
It’s part of the interview process. It’s coming from the culture you’ve generated. I would assume if your supervisors or the owner was hiring somebody and they shied away from doing community events and weren’t that excited about it, they’re just not a fit. They’re not going to come in the first place. The fact that you bring it up in the interview process sounds like a huge part of it. You guys know who you are and you’re looking for a certain type of person.
When we hire people, I can’t say that we wouldn’t hire someone based on that solely but it does sway to us pretty heavily in one direction or the other because we have made that mistake in the past. It does end up not working out in the long run. You feel like when you have all the team members on board, everything feels good. Everybody’s enjoying it. Things are going well. It only takes to have one person that’s not coming to things or isn’t fully engaged to bring down the morale.
Those people probably self-select more than anything. They’re very, “I don’t fit in. This isn’t a fit for me.” It seems obvious, maybe like a natural party-wise, but the fact that you guys make it part of the initial process, you’re upfront about it. It sounds like there’s not necessarily an expectation that the team members are going to generate community-based events but the people need to be excited about doing so.
That’s an option, too. We can probably hear passion projects or people work on passion projects. That is what we say to them. “We want you to be involved but you’re never required to plan anything but if you want to, you’re more than welcome to do so.” We welcome all the ideas and creativity. Anyone who brings something to the table, it’s always talked about. You never shut it down because there’s always a way that you can figure out how to make it work.
The fact that you also have a culture that’s open to that because there are many scenarios where it is about productivity. “We’re talking about the members. Let’s move on. How can we improve?” It’s not as much about the culture so much.
We have a staff meeting every week that we hang out at lunch. It’s very informal. We talk about certain stats and stuff but everyone gets a chance to talk about whatever it is that they have to talk about that week. A lot of times, it’ll be about planning our next event. How we should make it better and what we should do or somebody will bring something new to the table that you’re like, “That’s crazy. I never thought of that but it’s fantastic.”
When you go out to these community events, what have you found are some must do? What mindset do you have going into these community events?
I always think about smiling and moving. It’s a book as well. Sam Parker has a book called Smile & Move. I don’t know if you’ve ever read it. It’s fantastic. I stumbled across it. It totally resonated with how I live. I thought, “This is amazing.” When you go to a community event, if you’re smiling, people are going to think that you’re approachable and likable. Moving means to serve people so be engaged. I don’t ever go to an event saying, “I work at Rehab Authority. I’m a physical therapist assistant. Have you ever been to PT?” It’s more like getting to know them then eventually it comes up, “What do you do?” You can talk about, “This is what you do. This is why you’re here. If you ever need us,” it’s more of a casual, “This is where we’re at. We’d love to help you,” but it’s never pushing yourself on.
You talk about this quite a bit in the article is having confidence in what you’re doing can help a lot of that. It makes it easy to smile and move if you have that confidence that lacks in our profession, knowing that we are the musculoskeletal experts. For some reason or other over the years, we’ve shied away from that. Some people might be afraid of saying that but if you go to these events knowing that you’re the musculoskeletal expert in town, your area, your niche, you name it, it makes it a lot easier to stand strongly in your space and be open to helping.
I know when the patient comes in our doors and has set up that visit or that free ten-minute consult. Once we get them in our doors, I know we’re going to help them. We’re going to do the best that we can. I have all the confidence in our staff to do that. It’s getting them there. We sell our culture and the type of people that we are by how we act and that we’re likable, you smile and we have fun. One of our core values is we have fun. That’s one of the top ones. If you get the patients in here, they forget why they’re here and the pain that they’re in. They are having a good time. A lot of times, they don’t even want to leave. It isn’t about selling what you do necessarily. It’s getting them in your doors.
Many people buy on what they feel. Buying is an emotional experience. Physical therapy is not exempt from that. I talked about this in an episode long time ago with Jerry Durham about improving the patient experience. Simply by focusing on them and the experience around physical therapy, not so much about the therapy itself can improve engagement, increase internal referrals, improve culture and an ability to have a greater impact in the community.
Culture is my favorite thing to talk about because I live in a great one. It’s easy in respect but first, you have to surround yourself with great people, which you talked about in hiring. You got to make sure. Just because they’re not the right fit for you doesn’t mean they’re not a good therapist. We all have a place that we are meant to be. Having expectations that we’re a high achieving, high energy makes a relationship. It’s all about building relationships with people then they’re going to keep coming back. They’re going to tell other people to come here. A lot of times, patients will come in because their friend has told them to come here. They’re like, “My friend said I need to come here because you are so much fun.” It’s never initially because, “You’re going to help my pain. You’re going to make me feel better. It’s because you guys are fun,” we love hearing that.
Tell me a little bit about that. It’s not necessarily related to your article but are there certain things that your owner has done to generate that culture? Whether it’s a routine. You talked about the weekly staff meetings and your agenda lens to that. You know your core values. Those are established and you probably talk about that quite a bit. What are some things that have generated this culture you’re talking about?
It first starts with good people. We have great people here. In the environment that we’re in, we have a pretty open clinic. We have two private treatment rooms. We solely use those for evals, anything that requires an enclosed room, exposed skin and then if anyone feels uncomfortable in that area. There’s a very small percentage of those people. We’re set up to have a great environment for not just us to communicate with each other but patients to talk to each other. We yell at everyone when they walk in the door and when they’re leaving. They relate us to Cheers, Everybody Knows Your Name. When they graduate from therapy, we announce it over a megaphone. We have a dance party. We have a graduation gown. We always do the extra. We have Fresh Cookie Fridays every Friday. We have dress-up days a lot where we’re dress ridiculous. They love that.
I bet National Physical Therapy Month is a month of a party for you.COVID really challenges the marketing calendar because when everything's closed down for a year, you just fall off the wagon. Click To Tweet
We have a chili cook-off and a pumpkin painting contest. It’s pretty intense.
You got the patients involved and all that good stuff.
It’s fun. We do a lot of competitions, too, like sprinting and flippers or something random. These people are crazy weird but they’re fun.
The cool thing about your open gym concept, it’s one thing to have it. The other thing is to get what we called crosstalk. It’s like shouting to the therapist on the other side of the room or having a conversation over there. Inevitably, whoever’s between me and that other person is going to get involved in the conversation, too. We’d even generate that by having a whiteboard that would have the trivia of the day. If you don’t have anything to talk about, there’s something on the whiteboard to talk about.
You can think of so many things to put on a whiteboard. Fun-Fact Friday, where we talk facts about each staff or competitions. It’s great.
Culture is so huge. You talk about culture, thinking that this is what’s going to get the best-aligned employees and retain them. It carries over. The patients feel that as well. It improves the patient experience and the desire to come. They might know that so-and-so down the street provides a certain amount of physical therapy that might be equal to, maybe even better than yours. If they simply like coming to your place more than 2 to 3 times a week, they’ll probably going to come to your place.
That’s the best part. Therapists are competitive. It’s our nature. We want to be the best.
Talk to us a little bit about the marketing approach as you talked about in the article. It sounds like you know who your niche is. Your marketing strategy revolves around where those people are most of the time. In the community or on social media, you’re spending time in those spaces.
Being so rural, we do see from 0 to 100. We see women’s health, vertigo, all the things. When we get a new therapist in our clinic or interviewing, we ask them that like, “What is it that you’re passionate about? Do you love pelvic health?” You have to cover all the niches per se if you want to maximize your success. When we go out, we have a new therapist who loves athletic rehab or sports injuries. What direction would you go to market that? If you love women’s health, where do you go to market that? How can we make that good? We take a case by case and we market to that population.
I love the wording that you use because as you bring in that person, you talk to them about where their passion is and what they want to focus on maybe but you don’t then stop the conversation. The next question is where are you going to go to find them? Many times, maybe you had this feeling as a new grad but newer grads come out thinking, “I’m going to join this clinic. Some other person’s going to provide me new patients,” and they don’t have to do any work for that.
You have to push especially if it’s a newer grad. You have to encourage them along and keep motivating them to like, “What’s the next step?” We had one here, start women’s health program. That’s an area that doesn’t have a lot of PTs are interested in that area. It’s a huge need and super rewarding. She’s working through that process. I said, “What are you going to do next?” She’s like, “I know I need to do it but I just like,” “Go. Get it done. Take action.”
I love how you set them up for that success, recognizing that they have some responsibility and accountability to develop their niche and that growth in that. This isn’t going to be handed to them. They have an active role in that. It was at the very end and there’s a lot like the last paragraph, you talked about the importance of a marketing calendar. Talk to me about that.
COVID challenges the marketing calendar because when everything’s closed down for a year, you fall off the wagon. We talk about that in our weekly staff meeting. In the year, we know in a timeframe we’re doing these things. Say around Christmas time, we always do this. We always have a Christmas dress-up week. In the summer, we always have friends and family appreciation day. We’re in the big parade in town in July. We have hosted a 5K in August. We were constantly talking about what’s next and what more do we want to do. They’re having a CrossFit challenge in town. How do we get involved in that? There are some kids that want to do a scholarship because of mental health awareness. How do we help them? You hear about something and it doesn’t always work where you can’t necessarily get involved but it’s worth giving it a try.
The cool thing is that you’re talking about on a routine basis as well and you’re looking ahead on the calendar. Say something like Halloween comes up, you start talking about it on October 27 and like, “What are we going to do in four days for Halloween?”
You don’t love it.
It sucks because we’re under the gun and there’s pressure. I’m assuming that these events don’t take you by surprise. You’re able to be fairly well prepared for them and that makes it more fun.It really isn't about selling what you do necessarily. It's just getting people in your doors. Click To Tweet
It does. When everybody is on board, it’s pretty easy.
It makes it so much easier especially if you’ve done it before. If you have some traditional things that you’re doing, you know what we got to do and what everyone’s strengths and weaknesses are, you play to people’s roles and everyone knows what they need to do. It’s also, at that time, a lot easier to add on and make it an even better 5-star, 6-star, 7-star experience.
That’s a lot of the challenge when somebody is maybe opening their own practice or looking into starting a marketing plan is they want to do so much like, “We got to do this.” You’re better choosing the populations in the areas that you’ll receive the most return from and also knowing your payer mix, where you should focus most of your energy there and then build on it. That’s what got me a little bit more knowledgeable on this subject. When I started working here, it was just one PT and I. He opened it. We quickly needed help in the front office area. It was three of us for a long time. I’m also the clinic administrator so I take some of the buffering between the rehab director and the rest of the staff.
I was doing everything. I’m an achiever and maximizer. I feel good at the end of the day if I get all these things done. If I don’t, I feel lousy about it. I wanted to do everything and be a part of everything. I used to be bad at delegating tasks because I don’t always trust the people who are going to do them as good as I can. I got to the point where I started not enjoying them as much because I was feeling tired and burnt out. I realized that I needed to rely on people and trust that they were going to do as good of a job, if not better. It did turn out that way. I did start encouraging other people to take on more roles with these different events. I have my one area that I love. I love running so I love doing the 5K. Somebody else loves planning Halloween. Delegating those tasks so that you continue to enjoy them rather than feeling like it’s a bunch of work was huge for me.
You sound like a lot of burned out PT owners that I know. It’s the same thing with most owners and maybe your owner feels the same way or he or she doesn’t feel that way because you do all that for him or her but it’s that same thing. “I got many things on my plate. I know I can do them better if I do them myself,” but then you can only do so much. For me, it had to come down to, “Could they do 80%? Would I be happy with 80% of what I could do? If that’s okay then let’s hand it off. Let’s systematize it if possible or find someone who gets excited about that.”
For me, I’m not excited about marketing, like going to the doctor’s office to talk to the doctor who doesn’t want to see me and get past the front desk person whose job is to deflect and redirect me. I don’t want to do any of that. I had a PTA, she was awesome as a PTA but when I talked to her about marketing, she’s like, “I would love to do that.” Inevitably, there are people on your team who have strengths and get energy from things that don’t give you energy and are not your strengths. You have to rely on those people. That’s how you get a diverse marketing strategy in place and expand your presence in the community.
You’re talking about the calendar. That’s where we started with this conversation. It’s revisiting it and staying consistent. You don’t have to have 50 things on the calendar for the year. Pick something once a month, big or small and try and be consistent with that then you can always add to it.
You talked about payer mix in the article in here. We’re in a business. You don’t want to go towards the low payers all the time. If you know where the insurances are that pays better and you can find your niche within those and find out where those patients live, work and breathe then that can make things a lot easier on the business.
We have a couple of businesses in town. The one I talked about who has no medical responsibility. It’s 100% free healthcare and that’s all direct access. That’s huge for us but then you also have another large employer that has a high out-of-pocket responsibility. We market to them. We want to see them but we don’t spend a ton of our energy over there. That’s why we started the program with this business because we wanted to keep them coming through our doors.
That’s smart in that way because every owner has to deal with that if they’re taking some insurance but even if they’re not taking some interest, they want to find their ideal client. That ideal client could be a certain athlete, a geriatric population, a certain patient within an insurance payer but knowing who that is and targeting your message towards them will generate more of those. It also has some carry-over to generate more patients from the other ones that aren’t your niche. We covered a ton of stuff. Is there anything else that you remember or recall from the article or from your personal experience that you think is valuable in reaching out to the communities and establishing good relationships?
You spend at what is it like the 80/20 Rule, 80% of your time preparing for your marketing plan and 20% is doing the work. You need to spend time thinking about these different things. Making sure you got good people and you utilizing your assets, using your people then get out there and find things to do that you enjoy. There’s nothing on our marketing calendar that I don’t look forward to. It doesn’t seem like work. It takes some energy. You usually are exhausted after the event’s over but I would do that 100 times before going and talking to a physician. It’s nothing against doctors but I literally would rather watch paint dry.
It sounds like based on your experience now and to flip that 80/20 Principle, you know what your 20% of work is that gets you 80% of the results. You’ve found a groove there. You have probably been to some community events where you’re like, “I won’t do that again.”
This is one thing I want to leave you with, 2020 has been challenging for everybody. We’re all coming out of it now. We’re feeling good here at our clinic, finally but everyone has gotten a little bit lazy. Getting out and about and putting in the extra effort and doing more than people expect like the whole Zoom meetings, get face-to-face if you can. Go and see people and start doing these things again and don’t just say, “We didn’t do it in 2020. I don’t know if we want to do the race this year.” Do it because you end up doing it. You realize, “This is why we did it in the first place.” It’s so rewarding.
Thanks so much for your time. Thank you for the article. If people want to read it, it’s in the April IMPACT Magazine. There’s a lot of good information in there. If people want to connect with you and maybe talk to you a little bit more about it, Alicia, how would they do that?
I will give you my email. It’s ABacker@RehabAuthority.com.
Thank you so much for your time. I appreciate it.
Thank you, Nathan.
Alicia Backer is a Physical Therapist Assistant and Clinic Administrator at Rehab Authority in Thief River Falls, MN. She started her journey in 2010 when she graduated from Northland Community & Technical College in East Grand Forks, MN.
She has experience working in various settings since graduation but has spent the past 7 wonderful years working in the private practice community. Alicia was recognized as Rehab Authority’s Administrator of the Year in 2015 and 2016 as well as being chosen as MN APTA Outstanding PTA in 2020. She has presented at numerous national conferences including PPS and CSM as well as many local venues.
Alicia has been a co-developer of Injury Prevention and Performance Enhancement Programs and has created and implemented work readiness programs. She is an editorial board member for Impact Magazine where she has authored articles on clinic culture and building community alliances and has served on a PTA Advisory Board for Northland Community and Technical College from 2017-2021.
Outside of the physical therapy community Alicia coaches women’s basketball at a local junior college and works with young athletes as a speed and agility coach. Family also keeps her busy as she chases her 2 kids, Camdyn and Josie, to all of their activities while also finding time to run, read, and enjoy friends.
Love the show? Subscribe, rate, review, and share!
Join the Physical Therapy Owners Club today:
Dr. Jamey Schrier is back, and this time he's on a tear! He is the Founder and CEO of The Practice Freedom Method, a business training for physical therapists. Jamey is not one to hold back and he's got a few things on his mind about some of the common refrains we hear in physical therapy - things regarding quality time and patient care, the need for continuing education, the PT down the street being our competition, and a lot more. Jamey talks into each myth, and proceeds to dismantle them one by one. It's a great episode to compare his thoughts to yours on the same ideas that float around in our profession. Maybe you've spoken into some of the myths and believed them yourself. If so, check out the episode and see if Jamey can change your mind.
I have a returning guest, Jamey Schrier of Practice Freedom U. He's got a lot to say about some of the common refrains we hear in physical therapy. We talked about the myths that are commonly heard, whether it’s patient care, quality time, physical therapy market or continuing education myths and stuff like that. These affect us because a lot of us will have these fixed ideas about how things are and how things should be when sometimes someone gets a different perspective or someone challenges you on those thoughts. Maybe it isn't quite as it seems that our realities and our perspectives can change when we get questioned. He talked about some of those things and the importance that we have as physical therapists to follow the mantra of the podcast and that is to ask physical therapy clinic owners to reach out, step out and network.
As people reach out to me via social media or email, I feel like I'm constantly hammering that issue or hammering my motto and that is step out of your clinic so you can be the leader and get some business aptitude. Reach out to a coach or a consultant to guide you along your paths and someone to hold your hand and more importantly, to hold you accountable. Network with other physical therapy owners or other small business owners. Somehow networking tends to help you along because the more brainpower you have on an issue in your own clinic, the easier it is to come up with solutions. Many times, people have already walked down that same path and they can provide the solutions for you when they're not readily occurring. Jamey and I talked for a while about many of the things that we've heard in physical therapy or physical therapy school. We go out of our way to try to debunk those myths.
I've got a previous guest back on again and that is Jamey Schrier. You can check his bio on the previous episode so we won't necessarily get into his story about where he came from and where he's at. Just know that he's been a successful physical therapist, a successful physical therapy practice owner and now coaches and consults successful physical therapy clinic owners all over the country. I'm excited to bring you back on, Jamey. Thanks for coming.
Thanks, Nathan. I’m excited to be back with you.
It was nice catching up with you here over at CSM. You've got some thoughts brewing and you've been brainstorming about the profession a little bit. What are you thinking about?
What's been on my mind lately is I talk to a lot of people, a lot of business owners, a lot of PT practice owners and I hear things again and again. I started to think, “Is what they're saying really the problem or is it something more?” What I mean by that is sometimes what we think is a problem in our business or even in our lives, it’s not necessarily what the problem is. It's our perspective around it. For example, you thought something was going on in your life or in your business or whatever it was, then someone says, “Have you ever thought of looking at it this way? Have you ever thought of doing it like this?” All of a sudden you’re like, “I never thought of it that way.” Prior to that new information and that new perspective, you thought the problem was X but really the problem was Y.
As I talked to more and more people about different challenges in their business, whether the challenge was around what we all talk about, “I don't have enough referrals, marketing, new patients, trouble hiring. There are no good people out there. I have trouble making money. You can't make money in this business,” all these things, I started to dive in more into what are these beliefs. What do people believe and how is that affecting what problems they think they have and is it true? I got into this whole world of belief systems and belief patterns. Another way to say beliefs is myths. What are these myths out there that from my perspective and my experience are not true? I started diving into that and then you and I had our conversation at CSM. You were like, “We should hit record on this,” because we had 45 minutes over lunch and we’ve got on so many things. That's what I'm here to talk about some of these myths that I see and have this conversation with you and with the group.
I'm excited to talk about it because I'm sure you see more of it. I hear about them but you hear some of the same talking points. You brought them all up but it's almost like people are unwilling to look past or they use those talking points as an excuse to stop and not be creative or look from a different perspective and find a way around the problem to get to the solution. They're talking about symptoms and equate it to physical therapy care. You can constantly try to work on the symptoms, but you're not getting to the root of the problem. That's why I'm excited to talk to you. I want to see where are some of these issues coming from and how can we address them instead of focusing on the symptoms over and over again.
I love that analogy. It's such a perfect analogy especially for your audience, us as physical therapists, practice owners, whether we're managers, clinicians or we own practices. You're right. We know that the best therapists do not treat symptoms. It's just part of information. What we treat are the root causes of problems. Although when someone comes into our practice and someone wants to come into physical therapy, the primary reason why they're there is because of the symptom. They're talking about the symptom and we're trying to change the conversation, change their belief and their perspective that your back pain symptom is not the problem. The problem is because of whatever distortions somewhere else. This is no different when we talk about some of these symptoms versus what the root cause of the problems are when it comes to building and growing a successful practice or whatever the different areas are within the practice.
What are some of those myths that these physical therapy owners are throwing at you on a routine basis that we need to talk about?Great technical skills are not a guarantee of clinical success. Click To Tweet
The one myth that I discovered over years, I discovered this when I first started treating and people would tell me this. I just combined all this stuff that people told me. The more time I spend with a patient, the better the care that is provided. The short way of saying that is quality care equals time. That's the myth.
The more time you spend, the better care that you're going to provide.
The more time you spend, the better care you deliver.
Thirty minutes isn't as good as an hour. If you follow that principle, two hours is better than one hour.
Treating one patient a day conceivably with that mindset is better than treating twelve people a day or eight people a day. The attitude or the idea around this is where did that come from? We are not born with that idea. Where does it come from? It may start in school. I did some research. I started asking people and a lot of our clients. I ask deep powerful questions to them around this and some other people that I've talked to at different places that I've met them. I'm like, “Where do you think this started?” We came to the conclusion that this idea starts somewhere in our training, in our education, in our school. That the more time you spend with someone doing treatment, the better the care is going to be, the better the result is going to be.
If you ask a seasoned physical therapist, a seasoned clinician, a senior PT versus someone with one or two years, and I have asked many of them, I've never met somebody that agreed with that amongst the experienced and seasoned PTs. The younger PTs, and I mean younger not in age but as clinicians, seem to believe it. Where would that come from? It would come from the younger PTs are more into school and they have the belief that, “It's going to take me longer to work with someone, but that's a good thing because that means it's quality.” The other thing is if that was true, then the more courses I take, the more clinical expertise I got, the more wisdom I gained by being a physical therapist, that would all be a waste of time.
If you have clinical expertise, the idea behind that, if you can arrive at a solution faster than someone without the clinical expertise. If you can arrive faster, you're actually shortening the time. As a therapist, I've been a therapist now twenty something years, I know when I see somebody with a back problem. I have my assessment and I can go through that assessment in minutes. I can come to a conclusion, not with every little thing going on, but with my experience I can come to a conclusion fairly quickly of where to start and then provide treatment to get this person a result quickly. All of that can happen inside of fifteen minutes. If that's the case, which would make sense because of my training and everything I've invested in to become better plus my experience and learning from my experience, that would completely blow up this idea that the more time I spent, the better care that's provided.
Part of it also is you’ve got to think of the financial. Unfortunately, we’re positively reinforced to treat the patient longer because we get paid more if we keep them around more. If they do only treat for fifteen to twenty minutes, their bosses are probably going to come down on them and say, “You've got to build more than two units.”
There is the paradox, the challenge, the paradigm, whatever the word is. There's the problem we have. The problem is our current system was born out of time. Our system was designed and entrepreneurs did not create the system. There's no way entrepreneurs would ever create time equals money, which again is another myth. In our world of physical therapy, if you accept insurances and third parties, that actually is true. Time literally equals money. The more time you spend with someone, the more codes you bill, the more money you make. That's the problem because we know as clinicians that it's not true, but the system is set up like that. The system is the problem. They're trying to address it and Medicare is trying to address a pay for performance and all of that. Who knows what's going to come of that? That's the way the system is designed, but just because the system is designed like that for us to get paid from a third party, it doesn't make it true.
When the flat rate contract started coming across my desk, I was upset about them because they were lowering reimbursement per visit than the other contracts that I had. I started coming around to, “If I'm going to get this flat rate whether I treat him for an hour and a half versus 45 minutes or even 30 minutes, that frees me up.” I can get that same amount of money and make more per hour if I actually become efficient with my care. I find that as I'm treating my family and friends, I don't spend an hour with them when they come in with their kids with some back pain. I'll do some mobilizations, even some manipulations and show them some stretches and were done in 20 or 30 minutes. I'll follow up with them on the exercises that I told them to do and see how it went. I don't need to spend an hour with them.A problem in our business or even in our lives may not necessarily be what the problem is; it's usually our perspective around it. Click To Tweet
I learned it the same way. It was interesting when I started working with people in my practice that were your typical cash people. I noticed how I would treat them, how would I work with them. I started to recognize that I would naturally work with them differently than if they had a particular type of insurance. I became very self-aware of what I was doing and why I was doing it. I started to realize that the first thing I see when a patient came in the door, and I'm just being transparent. I'm just honest in how I speak. If people want to judge me, go ahead and judge. I'm just speaking the truth. The first thing I would look at when I saw their name or their file was not their diagnosis, was not their complaint. The first thing I look at is their insurance because their insurance would dictate how I would approach them. I'm not saying that's right or wrong, I'm just saying that's what I naturally did.
I would put people into categories because I knew the rules of Medicare were different from the rules of Blue Cross, which were different than the rules of a personal injury case or an accident case or a TRICARE. The rules were different with the insurance companies. I had to make sure I was playing within the rules. I also then had this other feeling, this idea of, “I'm also a professional physical therapist. I have a responsibility, a moral and ethical duty to take care of the person in front of me.” I was always trying to find the balance of making sure I'm working within the insurance so I can get paid and also making sure I'm providing what this person needs. It's exhausting because I'm playing a different balance game.
The only time I ever felt totally free to be myself is when someone says, “Jamey, I just want to pay you to help me.” I went, “You don't care how long you're here? You don't care what we do?” “No, all I care about is you helping me get what I want,” and go back to whatever the activity or the sport or whatever. I went, “Let me remove all of these weights, these anchors, all of these issues that were preventing me from just being myself and taking care of somebody.” What I realize, which sounds like you realized the same thing, is I worked with them for fifteen to twenty minutes. We get a phenomenal result. We didn’t do all the modalities, all the exercises and all that stuff and they were happy with the treatment. They were like, “This is great.” I go, “Really? You weren't here for an hour.” “Better, I don’t want to be here for an hour. If this is what you feel I need, I’m good.” I'm like, “Everything else I don't know if you really need it but I think this is what it takes to get you better.”
That started to challenge my thinking, challenge my own belief system and question the motivations of what drives insurance companies, what drives all of this? That was the first time, this was probably over twenty years ago, that my own beliefs, my own myths were blown up. I started to question all of these things and I realized that quality has nothing to do with time. Time only has to do with money when you're delivering a third party because unfortunately, that's how we get paid. If quality equals time and time equals money, that means quality, according to this myth, equals money. There lies the biggest problem I see with our profession right now. We are saying that the more time we do, the more quality we achieve and the more money we make. Every single person I've ever talked to that is interested in growing their practice, creating this ideal of practice freedom, creating this practice that they love, having the time and money, building a team, having systems and all this stuff, that is simply not true. If you believe that, you will be stuck in a very bad place in your practice. That's why this is a dangerous belief. It's a dangerous myth.
All these students are coming out the gates. I can't tell you how many of them I have interviewed. When I asked them about where they're going to be in five to ten years, they tell me about the board certifications that they're going to obtain. They tell me about all the continuing education that they're going to do. They're going to become specialists in this and of the other techniques. I just looked at them and I'm like, “Those are great and I don't want to discourage that, but you're not going to get paid any more than what we're already getting paid.” Rarely do you see incredible technical skill equate to success or becoming a great business owner.
Debunking PT Myths: Time equals money. It does not say clinical resume equals money.
That's myth number two. If I acquire more clinical skills, I will become more successful. Clinical excellence equals success/money, if you equal success with money. That's a myth. It's coming from our academic leaders. We pushed for this idea of we want to be doctors. Frankly, the reason we wanted to be doctors is because we're pissed off that chiropractors were doctors and we never became doctors and we're on the same par as chiropractors. It's like, “So and so is a doctor, why am I not a doctor?” We feel we'd be more respected by people, which again is another false belief, if we became DPTs. I'm all for education and all of that but the problem is we didn't realize what that was going to do.
We pushed to DPTs and everyone now is becoming a DPT and becoming a doctor, which is fine, but here's the thing. We're now saying, “That's not good enough. You got to become a residency. You got to go to residency.” In other words, when you get out of school, you're not good enough with a doctorate. I came out with a Master’s initially. Now you come out with a doctorate and even that's not good enough. You've got to go back and get your clinical residency. Here's the challenge with that. These people coming out of school are coming out with more debt than you and I could ever fathom. Their belief is if I acquire these skills, I will make more money. Somebody will pay me more money.
That's a terrible belief because if you're getting paid by a third party, time equals money. It does not say clinical resume equals money. Knowing more stuff, having more factual knowledge is not necessarily going to give you a dime more. What you’re thinking is if I know more, I will differentiate myself with the other person and someone will say, “You’ve got more initials after your name. You're better. I'll come and see you.” You're making a mistake because now you're getting into this idea of branding and marketing. Branding and marketing is how you position yourself. Your resume, let's face it, nobody cares how much you know. They assume if you have a license then you know a lot more than them. If they trust you, if they feel they can connect with you and they can engage with you, they're going to come to you.
You better know what you're doing because they're not going to come to you that often if they're not getting results. Are you telling me you can't get results with a person with your DPT? Do you really need all of this other knowledge? Knowing that if you get people better faster, you're actually going to get paid less. There are a lot of alignment issues that we have with people, with seasoned PTs, with younger PTs, with business owners. This idea that the more we know, the more clinical excellence we have, the more successful we'll be, I don't know who's telling them that. I don't know if their professors were telling them that, whether their mentors are telling them that, but you and I know it's not true. It's never going to be true. It never has been true.
I think it comes maybe from years and years of our school system. If you want to get ahead, it's always been known that you're going to get at least a high school diploma. If you want to make more money, you're going to get a bachelor's degree. If you want to make more money, then typically you would want to get your Master's or post professional degree. I think it might be just ingrained as part of the system. I'm just throwing out theories out there.Nobody cares how much you know. Branding and marketing is how you position yourself. Click To Tweet
I agree with you, I think that is the reason.
It doesn't help that professors and the way physical therapy schools are set up is just the continuation of that. They're going to drill that into the students for two to three years in their physical therapy programs. When you come along as an experienced PT and say, “They're full of crap,” if you're going to be that honest, they're going to look at you like you're unethical and you're just out for the money. You're driven by profits. Unfortunately, I don't feel the APTA really supports small business owners because their focus is on many other things that we've talked about. When it comes down to it, the success of our physical therapy profession comes from the outpatient practitioners that come up with new theories, techniques, what they try and what's been successful. They can't do that if they're not making a profit.
I'd love to get into that myth. We have a lot of deep-seated issues around money. We have a lot of negative energy around money and it's not surprising because we're helpers and healers by nature. We didn't necessarily get into the field. I didn't get into this field and I doubt you did either. Our purpose and passion is first and foremost, I want to make a lot of money. That's not what prompted me to get in to this field. It doesn't prompt me to stay in the field. However, when we're talking about having a life, having a great lifestyle or if you're a business owner, having a successful business that you love, it takes money to do that. Money comes from successfully taking care of patients. If you're getting paid by a third party, you're now being challenged because that third party has its own rules that you’ve got to play by.
It's like this idea that if I want financial freedom or what we like to call in our world, practice freedom, like choice. We want to have a successful practice and we want to have a successful lifestyle. “I devoted myself to providing quality care. I want to provide quality care to my patients and I want to spend time with my family and friends. Money is not the most important thing to me.” You've heard that and I've heard that. There's more to life than just money. When people say that, what they're doing is saying that you can't have both. There were more important things in life than money. That’s 100% true. There's family, there are friends, there's the pursuit of things that we feel passionate about that lead to our happiness and a fulfilling life.
Who said that we have to sacrifice the things we love to have the things we want? Who said it was an either/or? Of all the things I've said, that's the biggest myth that we have. It gets us into a lot of trouble. It makes us have unfortunately very challenging lives. We go to school and we get out of school nowadays with six figures of debt and we realized that, “I might start off making more than some of my friends at $70,000 to $80,000 but it caps off at $90,000. No matter how many years I work unless I get into another aspect of this work like owning a business or something like that.” It's a very small window of how much money you make. You talk about investing in your education. It's going to take you years upon years to pay off this investment you made in school and to then live a lifestyle.
Doctors have been dealing with this for a long time. They might make ultimately more money than we do. They also had this idea of social status. They also have tons of bills and they live in nice houses and drive nice cars. Nobody wants to see a doctor driving on a Yugo. They've been dealing with this and now we're entering into that world because school has become so expensive but the amount of money we make is not there. When these clinicians move into being a practice owner and said, “I'm going to make a ton of money being a practice owner,” they realized that it's a lot harder than they think because it isn't about how good of a clinician you are. You have to learn about business. This is another myth.
This is the myth of, “I'm a good clinician. I'll be a successful business owner and make money and have the life I want.” That's completely not true. One has nothing to do with the other. The reason you're a good clinician is because you spend time and money and effort doing it. That's why I believe if you want to be a good business owner, then you want to put some time and effort and investment in being a good and successful business owner. It's amazing how many people say to me, “Jamey, I love everything you said. I want this but right now, I'm just too busy. Right now, I can't afford it.” It's interesting, you didn't say that when you went to school and the price tag was $60,000 a year.
You didn't say you couldn't afford it because it was accepted. Somebody sold you that ideal. Now we are getting hurt as a profession. From a business standpoint, we need more successful business people out there. Our industry is going to live and die from the small independent practice owner being financially successful. When you're financially successful, you grow businesses, you hire people and you improve the economy. You also have money to invest in other things. You have money to invest in our PT packs, political action stuff. You have lots of things you can do. You have passion projects you can get involved in. When you're struggling, you're not successful. That doesn't help anyone, including the patients you're working with. This is a much bigger impact that I believe these myths are really hurting, which is what I'm passionate about in changing our mindsets of things and changing our success paths.
I like what you're talking about how it's the successful private practice owners that are going to help us maintain through all of these transitions that are coming in with healthcare. As we get bigger, as we grow, you hate to see some of the bigger companies out there grow even more than they are. However, what they bring is a voice. When you get big enough and strong financially and you have some influence, you can be in a seat at the table. When discussions are happening, we can have a voice when it comes to some of the changes that are coming not only in our community, but with some of the insurance companies. We have an opportunity to negotiate to our benefit. With some of the directions that healthcare organizations are going, we can have a voice as to where physical therapy is going to fit. It's valuable that we'd be strong and financially successful business owners because we're not going to get anywhere by simply improving our technique.
You bring up a great point. This point around a lot of people I speak to, your small business owners, one to five clinic locations. They have a dislike or a negative emotion towards bigger companies. Your AthletiCos, your ATIs, your Pivots, your Select Medicals. They have a negative thing towards them. I ask them, “Why do you have a negative thing?” It's because they have a scarcity mindset. What I mean by that, scarcity versus abundance, is a scarcity mindset says there's not enough to go around. There's only one size pie. If three-fourths of the pie is taken, there's only a quarter left to fight for. It's an equal sum game versus an abundance mindset that says, “One plus one does not equal two.” There is plenty of pie for everyone because anytime we need more pie, we can just create a bigger pie. The bigger the pie, the bigger piece we all get. That's an abundance mindset.Money comes from successfully taking care of patients. Click To Tweet
You and I were talking about some of the facts and figures that are out there. There are 175 million people in the US that could benefit from physical therapy. Do you know how many people actually get physical therapy out of the 175 million? 8%. What does that tell me? Scarcity-minded people are going to fight for the 8% and try to carve out their little piece. If there are bigger companies coming in, they're going to get a big share because they got more resources and all that stuff. However, your point was why do we talk smack about these bigger companies when they're representing physical therapy on these grander scales?
They do have the resources, they have the money, they have the dollars. They can put it towards political action committee stuff. They can go after different insurances. They have the leverage that could benefit us because it gets more people knowing what physical therapy can do. Then all you have to do as a small business owner is differentiate yourself from the larger company so then the right people can come to you. They're making the pot bigger, they're making the pie bigger for you. By you having this negative feeling towards them is not doing anything for you. It's actually hurting you. They don't care. They don't spend any time worrying about you. How many people are out there that we could help?
They're not worried about the 8%. They recognize that there's another 92% out there. They are playing in a different pool. That's one of the reasons I got into my podcast. There’s a couple of the initial podcast that Paul Gough did where he talked about exactly this mindset. There's a much bigger pool that we can be playing in if we recognize that we could and should attack the 92% that either don't know or don't know how to get to us for their musculoskeletal injuries. When an owner considers that the person down the street is the competition, we're fighting for scraps at that point.
There are 92% of 175 million people out there that we should be looking to. The more that these bigger companies advertise in baseball parks and with commercials or whatnot, it's only a benefit because it exposes people to physical therapy and what it is. Hopefully, if they do it the right way, that's a bonus. If they can expose people to what physical therapy is, it’s something that I wished the APTA would have done more of but that's a different story, then that only benefits us because we need to start playing in bigger pools. That's branding, that's niching and that’s marketing to our key people.
Each person, as an individual, it's up to us to take the responsibility to make that happen. If you asked me, “What should people do?” If you're in business right now and you're like, “You're right. I did have this scarcity mindset. I don't want this. I want the whole thing. I want the great practice. I want the great life. I want to build my practice. What should someone do?” The answer is you don't even have to spend more money. All you have to do is take the money that you're spending on your clinical education and start putting that money into your business education. It’s the same amount of money. You're just carving it up because the more business-minded you are, the better your business is going to be. The more people you're going to serve, the better people you're going to attract to your company and hire. You're going to be able to achieve all of this. You cannot achieve anything we're talking about working 60 to 70 hours a week in your practice and treating 40 hours a week in patient care. You can't do it. You physically don't have the ability to do it.
What you have to do is start to realize that there's a better way to do it. I'll tell you the biggest challenge that you're going to have in doing this. If anyone's reading this, here's the biggest challenge you have. It's you, you’re the biggest challenge and the reason I say that is because you have very strong perspectives around things. You have very strong beliefs around how things should be. If you're not willing to at least consider other ways of doing it, you will continue to get the same results you've always have. If you like to say, “I've tried to hire people and there are just no good people out there because I tried it twice and we didn't get anybody.” If that's your mindset, then forget it. You're not going to get anybody. If your mindset is, “Maybe I didn't try every possible way. Maybe there are other ways I can learn to make my business attractive into bringing on new people. Maybe in how I do my ads or my hiring process or onboarding or training.” Whatever the case are, if you just open your mind, there are lots of people out there that can provide good stuff to you.
It's not like it's not out there, but if you just focus every day on, “This is just the way it is. I'm all about quality care and I can't have the money I want and the life I want because that's not quality care. Those other guys are just doing something wrong.” If that's your perspective, nothing will ever change. What sucks about that is it doesn't move our profession forward. That's what stinks about it. All of us have this great opportunity to move our business forward. There is a much bigger pie out there for everyone. All you have to do is make the commitment to learn how to build a business just like you did to learn how to treat people better clinically.
We didn't get the business knowledge in our school. I've told the number of people who have reached out to me via LinkedIn or via email. I said there's a pattern to it. The successful business owners follow a pattern. That is they step out of their clinics, they reach out to coaches and consultants and they network. I just see that over and over again. I'm trying to tell them. I've talked to owners who have a hard time parting with $10,000 for some coaching or consulting. You don't know how much I spent but it was beneficial to us. There was a return on your investment and it is an investment. If you're not willing to invest in the thing that is providing you life and sustenance, then your balance will stay where you're at.
I tell people, “If you're not willing to invest in yourself, you deserve what you're getting.” It's harsh. It's tough love, but here's the thing. You're investing right now, especially if you're relatively new into this PT world. You invested $40,000, $50,000, $60,000 a year. You had to work your butt off. Just because you invested that, you had to beg, borrow and steal to get into the school, work your butt off while you're in school, take the exams, pass the exams, only to get to the next year, then the next year, then they take a board and it guarantee you nothing. The school is not held accountable one bit. The accountability was all on you as the student. You had a passion. You had a desire. You had a deep belief that this is what you want and when you got out there, you realize, “I have a lot of debt. Someone's going to have to pay this debt back.” You start looking for other people to pay your debt back.
You think that the value you provide is your DPT or the value you provide is all this clinical education. That's not valuable to someone. Are people going to buy that? We have to get smart around this idea of money is what drives business. Money is not a bad thing. It's a measuring tool. I look at money very simply in my own business and my coaching business right now. I look at money in a way that the more money I make means the more people I'm serving. That's how I look at it. That's the relationship I have with money. Not this crap that money is the root of all evil. The more money you have, you must be doing something wrong. You got to wake up and start to question why you believe what you believe because you weren't born like this. People have influenced you. You better take control of what goes in your brain because there are a lot of people out there that are frustrated.It isn't about how good of a clinician you are. You have to learn about business. Click To Tweet
There are a lot of people out there that aren't making basic financial needs because of how much they've invested and how much money they're making in the PT world or how much money they're making as business owners. With 92%, hundred and some odd million people that are waiting for you to help them, all you have to do is say, “Here's who I am. Here's what we can do. Here's how I can help you.” That's what you have to do. Make yourself known and run a business that can deliver the type of care and the quality care you talk so much about and want. Create a business that delivers quality care. If you will put it all on you, you will never be able to expand. This all can be done. Everyone reading this right now, you can do this. You can have what you want. It's up to you. You have the power to make this happen and no one else can take that from you unless you allow them.
We talked so much about what happens with these physical therapists coming out of school. As business owners, we need to understand where they're coming from. They're coming out with all these same platitudes about quality care is dependent upon the amount of time that you spend with a patient. If you are asking me to see more patients, you’re all about the money and the profits. I need to get more continuing education in order to become a better physical therapist if I want to further my career. We need to know as an owner that a lot of that could be coming from the amount of students that they're dealing with coming out of school. We just need to be aware of where they're coming from. They're coming out of these academic areas. They're coming out with a lot of debt and if we're going to attract, recruit and cultivate our next leaders, it's an ongoing conversation but knowing exactly where they're coming from. The idea of first seek to understand before you're understood.
We have to understand. We have to get on the same side of the table as our staff. I talked a lot about in other areas, you might want to talk about team building. One of the biggest things that we have trouble with is we have this us versus them, this adversarial relationship with our staff, especially our clinicians and especially younger clinicians. If you go in with that attitude and they're like, “You think you know me because I'm a Millennial. You have all these things,” then it's going to create a difficult relationship. Ask questions, understand where they're coming from, and get on some common ground because you all want the same things.
That's the beautiful thing. You all want the same thing. They want mentorship, they want an ability to pay back their loans and they want opportunities. It’s exactly the same things you want. These Millennials aren’t different. They're human beings. They have certain needs. Let's understand what their needs are. Let's meet them where their needs are. Let them understand where our needs are. Get on some common ground and let's go help and serve some people. There are an amazing number of people that absolutely need what we do and we can’t have that if all of us are struggling. We can't do it.
Jamey, it's been awesome talking to you.A scarcity mindset says there's not enough to go around. Click To Tweet
You too, Nathan. I appreciate you having me on and I love always talking to you. We get into who knows what kinds of conversations. It's nice to be open and speak how it is.
If people want to get in touch with you, share with us how are they able to get in contact with you and learn a little bit more about your Practice Freedom Method.
You can go to my website, ThePracticeFreedomMethod.com. It's changing titles to PracticeFreedomU.com. They all both point to the same direction. If you have any questions specifically for me, you can just reach out to me at Jamey@JameySchrier.com. I'd be happy to help you point in the right direction and do whatever I can do to support you
You've got a book out as well.
I’ve got a book out called The Practice Freedom Method. You could pick it up at Amazon. It’s a great book. It's almost like an autobiography of my experience of how I went from being a struggling practice owner and not happy with my life but I'm smiling and pretending like I was to having a fire to eventually create an amazing team and removing myself from the day-to-day aspects of running a business like clockwork. Having what other would consider a dream and having an amazing practice and a great lifestyle. The book talks about how I did that and all of the struggles I had.
I referenced the book because one of my previous guests who has worked with you, Michele Kehrer, said she read it on a plane. It was a pretty easy read and influential on her success as well. I want to make sure you got the credit for that. Thanks, Jamey. I appreciate your time.
Thank you, Nathan.
Dr. Jamey Schrier is the Founder and CEO of The Practice Freedom Method, business training for physical therapists. After growing and then selling his multi-location PT business, for a price often reserved for businesses quadruple his size, he began teaching other PT owners of all clinic sizes how to grow and scale their practices while improving their quality of life.
Jamey now shares his proven methodology with other PT owners using timeless business principles combined with his “best practices” he has learned in over 20 years in business. He has personally coached over 70 private practice physical therapists create their dream practice, and through his book, The Practice Freedom Method and signature programs, he has helped hundreds if not thousands more. Now it’s your turn!
This is part two of my interview with Heidi Jannenga of WebPT. In the previous episode, I shared her bio and story. We discussed some of the issues related to physical therapy ownership and our lack of marketing and growth strategies. This is all related to WebPT’s report called the State of Rehab Therapy in 2018 where they surveyed over 7,000 respondents in the rehab industry. We talked about marketing and growth strategies in the first episode. In this part, we go into three of the four topics that stood out in the report but the main one being is that we’re losing money. We’re losing hundreds of thousands of dollars in our PT clinic businesses simply because patients aren’t completing their plans of care. Heidi and I talked into that a little bit as well as a couple of the other topics that came from the WebPT report. If you want to learn more about Heidi and her story, go back to the previous episode. In this episode, we’re going to move forward into the conversation and talk about the rest of the results from their report.
I wanted to go into that part of your report as far as patients not completing their plan of care. Did you recognize through your surveys what factors were involved that might be limiting people to not completing their plan of cares? Do you have some ideas through your conversations and perspective that might play into that?
Let me give the data first and then we can talk about some of the whys after. We noted that about 70% of physical therapy patients fail to complete their course of care, which we also equated to be about $150,000 for an average PT practice. Based on 2018, it was even worse. We saw the patient dropout problem to be about one in every ten therapy patients who didn't complete their prescribed plan of care. Only 10% of everybody who walks in the door completes their plan of care. With copays and deductibles being as high as they are, if we're not having that communication from the get-go with the patient of understanding, “In order to get this kind of outcome, the expectation is you're going to come for ten visits,” for them to feel comfortable in saying, “I have a $50 deductible, $10 is not doable.” “Let’s work together to figure out how do we make sure that you still get the great outcome and maybe we can figure out how to space that out over more time that’s going to take eight or five visits. We'll figure it out if you are super diligent with your home exercise program.”
Number two, we've always gone off of maybe the prescription from the physician or referral from the physician to create our plan of care. The physician arrives two times a week for three weeks while we stay two times a week for three weeks and call it good and say, “Six visits is what we need,” versus using expertise and our knowledge. We're able to help with predictions on this too. This is what's exciting about our analytics program and reporting components within WebPT. We now have learning on, “With these comorbidities, you can expect more of this outcome and it will take eight visits.” You can have a more accurate prediction, based on data predictability of how many visits it might take so you have a more educated conversation with the patient. It’s a shot in the dark and we just maybe see the prescription so maybe we knew all along that it wouldn't take ten visits. It would only take eight, but you said ten just to make sure it covers because you don't want to have to go back and get another referral.
The tough thing is number one, we don't learn how to have those conversations in physical therapy school. If you've got a great CI, then maybe they helped you along that path, but it's valuable upon the owners to make sure that they're doing sales training. We've got to initially show them the value that we can provide. Number two, it’s worth it financially for you and your health to fulfill this plan of care. We've got to be empathetic as to the financial burden that it causes. We also have to recognize that if we're not able to complete our plan of care, we cannot guarantee their health. That turns into the patient that walks away and says, “I tried physical therapy and it didn't work for me.”
If we are able to have that conversation in the first place, then there's a cascade of events that it goes into play. It ends up being not good not only for that patient because they're going to have issues down the road if they don't finish up their plan of care. Number two, it's going to look bad on our clinic and on our profession. There's a whole cascade of issues. The training for a physical therapist to have that conversation at the very beginning, at that very initial exam is invaluable. It can benefit us financially. It benefits the patient, our profession, clinic and our reputations.
There are many things that can help with that. I get excited about it sometimes because I remember listening to a podcast by a Paul Gough and one of his first episodes talked about it. Paul’s in London or England and there's a nationalized healthcare, but he doesn't participate in that install cash-based. He's busier than he ever needs to be because he’s really focused. He trains on that initial conversation and so it's imperative. I want to make the point that owners need to recognize what their therapists are saying in that first conversation to get buy-in. What are they doing to educate? What are they doing to work together with the patient? What does that conversation consist of so they complete their plan of cares?If you don't have a website that truly reflects what you do in your practice, you’re missing out. Click To Tweet
When I was a director and I had therapists, it was hard to have some of those conversations unless you sat in with the patient visit and you understood what was happening because you didn't have any objective data to go on. Now, you do have more opportunities for objective data. For example, with our outcomes platform, you're able to see therapist’s utilization for specific diagnoses and what outcome they're getting. If you have people who are outliers and are getting the same outcomes, but it's taking them fifteen visits versus on average while every other therapist is taking ten or if you have dropout rates for a specific therapist where their cancellation and no-show rate is significantly higher than anyone else in your practice, there's very clear education that can be done with that particular therapist.
Having those guys close to you and in a dashboard form, you can run your business through software like, “That’s what a lot of other people do in every other industry, why aren’t we doing it in healthcare?” At the end of the day, what we're trying to accomplish with WebPT is to have that tangible objective data where you can have a very pointed conversation based on objective data-driven decision-making versus just subjective like, “I’ve got a patient complaint, is this true?” We had to do it that way in the past because we didn't have access to this data, but now you do. It's important as owners to take advantage of that.
I noticed in your report that the compliance to plan of care was worse in the bigger organizations. Those PT clinics that average between $1 million and $5 million in gross revenues had some of the best averages, but those who were in the bigger organizations had the worst compliance.
There are a lot of complaints sometimes about the cool “corporate healthcare” and how it's turn and burn situation and all they want is revenue. I don't believe that because I know that every clinic is different and it's about the people in the organizations. Just like any organization or company, you have a culture and if that's your culture, then you're not going to get the best outcomes. It is interesting that there were significantly greater dropout rates as the clinics got larger. It's also a function of numbers too. You have a lot more patients running through these larger businesses, so those numbers may drop a little bit more.
I’ll make a point so that owners, specifically those who focus on growth, recognize that that can slip away. There's a crack in the ship there that could be a loss of finance, revenue and reputation. It’s important to note the $1 million to $5 million gross revenue mark. As you get bigger and as you take on more clinics, you can start losing sight of that initial contact with each patient. That training is probably something you want to nail down and clean up with all of your therapists.
It's imperative for those executives in those organizations to understand how important it is for those completions of care. When it comes to their outcomes, there's this cascade that happens. You have this unique opportunity to do some education on the forefront. That could create a lot of dividends as we showed with the amount of dollars based on the number of visits that you're losing.
One of the other things that you said that was important to you was the discrepancies with the gender pay gap. Talk to me a little bit about that and some of the factors that might play into that.
We had more than half of our respondents and we asked them about their salary ranges, most of them fell within the range of $50,000 to $90,000. The average PT right now is getting paid about $70,000. If you look at the census data, it all correlated well. Males were more heavily represented in the $70,000 and over salary segments whereas females were much more heavily represented in the lower than $70,000 range. The biggest piece that I wanted people to take away from this is the expectations from the get-go. We’re not unique and the whole salary gap conversation. We will definitely do more in our next survey because there are lots of people that work part-time. It's not just women that work part-time, but there are lots of people that work part-time.
To make sure that we have some of the nuances behind the lower paying wage information is going to be important in the future. Even for that first job, what the expectation was for male therapist versus a female therapist was significantly less for females than it was for males, going into their first job or even going to any job. Coming into it, there's already a gap, which was frustrating to me because, “Why does that exist? Why does a female therapist think that she's less valuable than a male therapist?” You can pile on top of the gap that in general, females tend to negotiate less when it comes to salary grade.Most people don't know what they're spending on marketing. Click To Tweet
All of those things come back to education right from the get-go in PT school and talking about how important it is in some of these negotiation tactics, but also realistic conversations. What we also hear is the reality of what an average PT will make coming out of school versus what they've been told sometimes academically does not necessarily match up. Knowing regionally what the average pay is because that regionally changes as well. It all comes down to knowing the business of PT. Knowing how reimbursement rates, payment rates, all of that has to affect how much you're able to get paid, “If I don't get reimbursed, if I don't get paid for my services, I can't pay you what you want to get paid. You’ve got to have money coming in to have money going out.” We’re also remising this in PT education on the business side of physical therapy of how the whole process works from the time you treat to the CPT code that you bill for, to the judication of your claim to coming back in. It’s knowing how much it costs to run a business and the liability insurance.
All of those nuances are important for people to understand. You ran a business for a long time, you understand P&Ls but you don’t even know how to read a P&L. It is basic business knowledge. That’s why we did our second event, which is Ascend Conference that WebPT puts on. It's an annual conference and it is specifically focused on business and how to run a business. We run two tracks, we run a small business and new owner track and then we also run an enterprise track of those that have been in business a long time running with much larger practices. There are two tracks running simultaneously and some amazing speakers who will come in. We're all together as a group, but we have had a tremendous response over the years. This particular year, it’s coming up on September 27th to 29th. It is WebPT’s 10th year anniversary. If you are in Phoenix, Arizona, feel free to go to AscendEvent.com or search WebPT Ascend and get your tickets because they’re going fast.
I'm impressed that you're doing it because I don't think there is enough of that out there in our industry that is separate from the APTA. I have nothing against the APTA, they're working hard. It's imperative that some of the more grassroots events take place so that we can get together and network. Also step out and see what's happening outside of our bubble.
If anyone wants to buy a ticket, you’re going to have a PT code and it’s PT Owners Club. If you put that in, you’ll get a discount on your ticket.
I invite everyone to go there as well. Take the time. From my experience, taking a week or a day coming away from patient care and attending some of these events can be hard to do, but it's imperative. Honestly, if you're a business owner, you've got to wear your business owner hat first and know what's going on in the industry. You've got to know what best practices are and it's out there for you. You've got masters and experts in PT business that will share the secrets. They'll show the blueprints and you'll come in contact with other therapists who are going through the same issues. Some of them have overcome what you're going through or you've overcome what they're going through and you can share.
We love taking extra time to provide for networking. After every session, there's an elongated period of time where you can digest and talk about it amongst other people. We have found that one of the most valuable parts of our conference is to make sure there is ample time for that networking and sharing of ideas from what you learned and how you're going to implement that immediately when you get back to your practices. We also do have some folks from outside of the industry coming in and sharing. With us continuing to tell ourselves what we're doing right, not doing right, sometimes it’s important to get ideas outside of our own industry and the best practices that have worked elsewhere that we have found like, “This can be applied to PT.” It’s going to be a great time.Having a therapist be the alternative to pain medications is an opportunity that we need to be seizing. Click To Tweet
Thanks for sharing that information. I'm sure there are not a lot of students that are reading this, you alluded to this at the mounting student debt issue. If there is a student out there in the audience, what's your advice to overcome that debt and schooling issue?
I would say press on, know the reality of what it is to be in the PT industry, and know why you got into it from the beginning. Most of it was to help people. We're on the cusp of blowing out much more of that 90%, especially if we're able to attack this with the grave issue and be a strong part of that as another provider that can help those folks. There's a lot of evolution that's going to happen hopefully over the next few years that opens the opportunity for more PT. This isn't just a conversation for students. This is a big conversation that needs to be had from owners because they're the ones that are hiring these new grads.
The cost of what they're coming into or the debt that they're coming into your business with is high. The burnout of having to not only work a 40-plus hour work week that you're going to ask them to do, but most of them will probably also be working on weekends and everything else. It's not anything different than I did when I came out of PT school. I also worked for DM on the weekends to help finance my pre-med out as well. It's a much larger amount of debt they're coming out with. They have over $70,000 in debt that they're coming out with graduation and more than a third are coming out with more than $100,000 in debt. That's not including any debt that they accumulated through undergrad.
That can be a big stressor. As owners, we need to be cognizant of that.
Having a frank conversation with academia to understand the reality of our business and our industry to hopefully disrupting the education process of how we continue to attract the best people into our profession. What was disheartening to me was when we put out this blog about student debt, the conversation was around how therapists are discouraging people from coming into the profession because of how hard it is. You're limiting the best of the best that you want in our profession, and you're saying, “I'm not sure if you want to think about PT, it's been hard. This is what you’re only going to make.” Rather than the benefits and all the pride you have in who you are, it's the starting to become a more negative conversation.Regardless of what tools you're using, it's imperative that patient experience is seamless but also shows value. Click To Tweet
We heard from students too who are saying, “I love being a therapist, but after a couple of years of knowing how long it's going to take me to get out of debt, I'm going to go to some other industry that I can use my expertise in. I can't keep doing this.” It was disheartening too because now we're losing some potentially best people out of our business into another practices and industry into another industry. That's not sustainable. If we’re going to continue to push our outcomes and value, we have to have the best in our industry that want to be here for the right reasons. We have to start some frank conversations about how we can disrupt our thinking about education. John Tiles with EIM, their group is doing a lot of amazing things with the two-year program versus the three-year program. There are a lot of opportunities. It always takes the pain and pushes back to make change happen. We're on the cusp of having more pointed conversations and making some changes here quickly.
We need more PTs with the number of people turning 65 every day here for the next 25, 30 years. 10,000 people a day are turning 65. The demand for physical therapy's not going away. It's only going to increase.
It's still one of the top ten jobs that people always say that people want. When your pay is not commensurate with your debt that you're coming out with, if you can make an annual salary of $70,000 and you come out with $100,000 debt that has a 5% interest rate on it, if you’re paying a minimum it’s going to take you 45 years to pay that back. It doesn't sound appealing to a lot of people.
What is your vision? What are some of the exciting stuff coming up that you see in the PT industry or WebPT itself?
Despite all of that negative stuff, my faith in the industry is unwavering. The future is bright where there are so many people that are needing our services and our expertise. It’s about how we reach them and how we get our profession more well-known in the mainstream as the go-to for any kind of musculoskeletal injury. Also to work collaboratively with others that are getting those patients to understand what our expertise is, how we work together in a referral sharing way to make sure that we have access to them, but also that we can share. It's not just only our expertise that's going to help them.A lot of people are now much more available to take patients in without referrals from physicians. Click To Tweet
For the WebPT side, there are many exciting things but right now we're working a lot with making our whole platform much more integrated. Efficiency is the word on all of our developers and product managers. A mindset of no longer having the oxymoron of EMR documentation efficiency happening, we want that to truly be a thing. We have some innovative changes we're doing to our documentation portion, the heart of our platform to make that a lot more streamlined for therapist student to get through their documentation portion. We're also looking at integrating more of the billing process to get those claims out as clean as possible and get that payment back into the clinics as fast as possible. Just enabling and empowering our therapists to run their businesses better.
Thanks again for taking the time and sharing your information and perspective from the report. Your personal perspective is extremely valuable. If people want to know what's going on with Heidi Jannenga or WebPT or how to get on webinars that you're posting, how can people get in touch with you?
If you go to WebPT.com and click on our blog posts, you can get those sent to you on a regular basis. I am on social media, my Twitter handle is @HeidiJannenga, so feel free to reach out that way. I'm on LinkedIn as well. There are lots of different places you can get in touch with us.
Thanks for your time, Heidi. I appreciate it.
You're welcome. Congratulations on this awesome venture into the podcast and with all your businesses. Thank you.
Thank you very much.
Heidi serves on the boards of numerous organizations, including the Arizona Science Center, Support My Club, the Physical Therapy Political Action Committee (PT-PAC), the Institute for Private Practice Physical Therapy, Conscious Capitalism AZ Chapter, and the Arizona Community Foundation. She also dedicates time to mentorship within WebPT (through her women’s empowerment group PropelHer) and in the broader community (through her work with physical therapy students and local entrepreneurs).