Aaron LeBauer, PT, DPT has successfully opened and coached many out-of-network PT clinics over the past decade. Based on his insight, he believes that in-network providers could do SO MUCH MORE with their marketing and conversions if they took the time and energy to master those aspects like their out-of-network counterparts. In this episode, he joins Nathan Shields to share what makes him successful in his cash-based niche that could easily translate to in-network clinics and make their marketing and conversions more effective.
I've got a returning guest, Aaron LeBauer. He’s a physical therapist and a business coach for PTs. Mostly for cash-based PTs, but his focus is to help PTs make more money. He is also a host of another podcast called The CashPT Lunch Hour with Aaron LeBauer. Aaron, thanks for coming on. I appreciate you joining me again.
Nathan, thanks for the invite. It's always great to be here and share the knowledge that I've gained because I don't want to hold on to it. It takes too much space in my head. I got to get it out.
That's why I have successful PT owners like you on, simply to be a resource because you have so much knowledge to share and share from your experience, of course. If people would like to know about your professional story, I first referenced them back to our previous episode with you. We won't rehash that. We'll just do the cliff notes version and say, “Aaron has built a successful cash-based physical therapy clinic.” He is also a successful coach for PTs and has done a lot of hard work for over a decade.
I opened my cash practice in 2009 right when I graduated from Elon’s DVD program and I've been helping other people grow and scale their business since 2013.
The reason I wanted to bring you on and I know you've got plenty to say about it is there's got to be something that in-network PT clinic owners can learn from the out-of-network guys, the cash-based guys, whether it's marketing or how we do things or how we convert or how we talk to physicians or whatever it is. I know you've got a ton of ideas. I’ll let you take the stage here and let us know what could in-network physical therapy owners learn from you guys?Be present in the conversation where people are. Click To Tweet
The number one objection that we have isn't copays too much or, “I don't have enough time.” It's, “Do you take my insurance?” I've had to develop marketing and sales strategies that get people who would otherwise go down the street and pay $20, $50, even $150 for a copay to come and pay us up to $250 an hour or $2,000 for a plan of care and forego their insurance benefits. Without logically explaining, you might save money coming to us and you might not. It's not a logical conversation.
We have to create a whole system of marketing that allows people to do that. The one problem that I see most traditional clinic owners make is not a problem or a mistake that they would recognize. It's that the actual service of physical therapy and the reimbursement from the insurance is the top of the value ladder in the clinic. It's like, “We're going to do all these things and then where we make our money is delivering physical therapy.” The reason I see that as a problem is because insurance is decreasing. That's not the top of the value ladder. A value ladder is where we have one on the left. It's something that costs me less time or little time and the prospect doesn't pay anything.
Maybe there's a free eBook and they give me their name, phone number, and email. The next thing, like in our clinic, would be a total body diagnostic for $35. It’s a twenty-minute visit, which is a sales visit. We have a $2,000 eight-visit plan of care and then after that, we have a wellness warrior program. For us, all of it is cash. My friend, Greg Todd, has a clinic and he's got 2 or 3 locations down in Tampa. They're making tens of thousands of dollars every month on all their wellness programs. It's not just the gym membership.
The number one thing is if we look at physical therapy. Medicare is a better payer now than then it used to be. It's consistent. A few years ago, there were some other companies that would pay better than Medicare. Now we're like, “Medicare's consistent paying $80 or $85 a visit.” What we have to do is look at like, “How can I set up my business so that Medicare or Blue Cross or UnitedHealth or whatever the insurances that I'm willing to still accept is going to be decently profitable? How can that be the reason people come in the door, but we have other programs to keep them?”
In the grocery stores, they put the French toast ingredients upfront in case of emergency or whatnot. It's the reason you come in. What do the grocery stores do is they put their loss leaders in the back of the store, so you have to walk by all the other profitable items. Can insurance be the reason people come into our business, but we have other products and services, whether there's vitamins, supplements, gym programs or health coaching? I wouldn't say massage is profitable. I've employed massage therapists and had been one. Are there other wellness services and programs we can put people through to generate income that's not insurance-based rehab and pain reduction? Does that make sense?
Yeah, because you have to focus on all those things. It sounds like you've got a menu, essentially of what you can provide a patient that's not just physical therapy. They can pick and choose some of the other things that they might come to your clinic for and pay cash for. I don't think a lot of in-network providers consider that or maybe they do, but they don't spend a lot of energy considering it.
Your energy is probably spent on, “How do I maximize my insurance collections?” What if insurance collections were the thing that paid for the advertising and the revenue came from what's next? Whether it's a return to sport program. What is it the insurance isn't going to cover? There's a huge gap between us and getting someone back from a labral tear to competing in CrossFit again. Whether triathletes, runners or cyclists, there's a big gap there. We can create programs and memberships and even group training programs where people are getting a specialist physical therapist, maybe even a doctor to supervise their return performance. They'll pay cash for that. Blue Cross won’t.
Those are programs that people might look into. The thing that’s coming into my mind is how do you get potential patients or customers to get past the, “Do you take my insurance mindset?” What do you do to overcome that or work around it?
I've said to people, “If only people who took insurance market it as hard as we did, you shouldn't have a problem as long as your amount collected is profitable.” People still have a problem. What we have to do on the front-end is built so much value to our patients about the transformation that we can help them make about their goals and touch their wants, needs and desires. By the time we get to the price of the program, they're like, “Dr. LeBauer is going to help me get my life back, so a couple of thousand dollars is nothing.”
We have to build that up versus, “Where are your orders?” We're going to do “the physical therapy” three times a week for six weeks because someone else made the decision. For me, when someone calls us and says, “My doctor gave me a prescription for the physical therapy,” which is what people call it, they're not calling us to help them make a decision and they won't be our patient. I'll probably recommend that come in once, maybe twice a week, not three times. There's no one I see three times a week. Even if it was in-network, that would be a deal-breaker because I wasn't the one that made the decision with them.
Talk to me a little bit about it. You weren't the decision-maker and the doctor referred them over to you. You weren't the decider as to if they should get physical therapy or not.
I haven't made that decision with them. In that role, I'm the technician. It's going to be hard to change the course of care if someone's coming to see me with a prescription for physical therapy. In North Carolina, we've had direct access for many years. I'm lucky that I grew up here and I got into the profession. I was like, “It’s no different.” The big thing is if someone comes to see me because of my marketing in our social media, emails and website, they come in for a visit and they allow us to work with them to create a plan.
They're much more likely to agree to my plan of care than if the only reason they're coming to see me is because they found me online, someone recommended us because we were close or we were the first search result. The reason they're coming isn't because they made the decision with me. They made it with their other provider. Thank God they recommended physical therapy because most orthopedic surgeons don't recommend physical therapy first. They made this decision with someone else, so it's hard for me to change the course of care when they have this piece of paper that says what they need.
I know where you're going. The next step for most in-network providers or owners is then, “What is your marketing message so that you get them in the door? Where have you found success, either in the channels that you're using or in the message that you're putting out there?”
There are three different things that have been the most powerful. One is word of mouth. It’s the easiest for everyone, but it's not just like, “Tell your friends to do X, Y, and Z.” We have to cultivate word of mouth by requesting referrals and reviews and by making it easy for our patients to send others to us. A lot of people have great word of mouth, but they don't cultivate it. There's a way to ask. There's also our website/Google Maps, but people come to our website and it's a website for our patients. It’s not about me or my degrees or the treatment or skills that we have, but it reflects the problems people are experiencing.
Our website does a lot of different things, but it reflects to patients like, “Here are the problems you're probably experiencing.” We've helped these people do X, Y, and Z. “Here's some information you can get to learn about why you have this problem and what you can do about it.” What you can do about it leads you to, “Physical therapy is the thing.” I'm not trying to sell my degree and certifications or even physical therapy. I'm trying to get them to understand that we help people go from frustrated and in pain to doing things that they were told they could never do again like run, lift or squat.
We've all heard patients, “My doctor told me never to lift 35 pounds again.” It's a new mom with a two-year-old and just holding on to the two-year-old daughter that weighs 50 pounds. Instead of marketing physical therapy and like, “We treat ACLs and labral tears and X, Y and Z,” it is talking about, “Here's the type of people we help and here's the result we help you get. Here are some other people like you that have had success.” That drives our marketing message because if a person finds us and they like that, then they apply to work with us and we make a decision, and we go through the eval with them. They're much more likely to pay us in cash, do all their home exercises and get better and tell their friends.Stay fit, healthy, and strong. Click To Tweet
I like the message that you're putting out there. It falls in line with a book that I read called Building a StoryBrand. The whole idea is that people see their lives as a story and they are the hero of that story. What we're promoting as physical therapists is that we will come in and be the hero to your issue. Whereas, that's not what they're looking for. They're looking for a guide.
We’re Obi-Wan and they're Luke Skywalker but we're trying to be Luke Skywalker.
We're coming in saying, “We're going to fix it all for you. We're going to kill it and do great things. This is how we're going to do it because of all these letters behind my name.” Whereas the message should be more along the lines of what you're talking about, “This how we help you this is what happens when we work with people. They go from this to this.” That's what people want to see. They want to see, “Who can be the guide to make me the hero of this story?” That's what sounds like your message is coming across.
How do we speak to patients, not in our words, but through our marketing, our website or social media in ways that it resonates with them? They don't know what physical therapy is. They think it's hot packs, leg lifts and ultrasound or it didn't work, “I tried physical therapy before and it didn't work.” Physical therapy is much more complex and the thing that works or not.
It's become commoditized so much over the years. You wouldn't say that about a dentist that says, “Dentistry doesn't work for me.” You find another dentist.
Or you lose your teeth.
It hasn't worked that way for our profession but we've been lumped together like that. You said there were three things. You focus on the word of mouth and your website, but quickly regarding cultivating word of mouth. You guys are actively promoting your word of mouth referral program in the clinic on a regular basis, I'm assuming? That's something which is a routine.
Here’s how I do that. You come in and we see you and we make a plan, “Mrs. Jones, I'm on a mission to help 100,000 people in Greensboro avoid expensive imaging and unnecessary surgery. If I can help you reach your goals of running a 5K and feeling strong, healthy and confident so you can be a good role model for your daughter, do you think you can help me reach my goals?” She'll say, “Yes.” I’ll say, “Great. When the time comes, I'll let you know how you can do that.”
Visit number 5 or 6 when she's like, “I feel better than I ever have.” That's when you say, “Can we shoot a little video of you saying that or would you mind leaving us a Google review?” That’s one part of it. In all our new patients, they get a specific email series from us and in some of those emails, we're asking them to refer their friends or giving them ways to share about our business or our group and all that stuff.
Here's a link to Google reviews. This is a link that you can send to your friends and family. You are making it easy and simple for them.
Also, something valuable like, “We came out with a brand new book on back pain. If anyone who might benefit it, just send them this link,” versus, “Review us.” I don't want anyone to review us. I want people who feel compelled to review. The email and the initial conversation helps but what it comes down to is, if I can set it up in the beginning, when the time comes and they're happy, then I can ask them. They've already been pre-framed that the consequence of getting better is telling other people.
We talked about word of mouth and website. What's your third channel?
It’s social media.
You hit that hard.
2020 has been a great year to do it. It's not only social media. It's not only Facebook Ads. It's being present in the conversation where people are. Prior to 2020, anytime I can do an in-person workshop but in-person workshops are a lot harder to do now. We can do them online but where are people right now? They’re on social media. They're on their phone. I've got over a million views on our clinic’s YouTube page.
What are you posting on your YouTube page? Is it all how to get better, how to improve your shoulder and back or are there other things also?
There are other things. The most popular ones are I did a Self-Massage for Your Feet video and I did this a couple of years ago, but within the first 30 days, all of a sudden it got 20,000 hits. I was like, “What happened?” A foot fetish community got a hold of it and posted it on one of their forums or websites and got tons of views. This has over 250,000 views. I've got one where I was cutting a chicken and I was like, “Here's some fascia.” I took my phone and my kids in the background and I was like, “This is interesting.” I put it up on YouTube and it has tens of thousands or hundreds of thousands of views. I've got a neck pain relief video.
The videos I put up didn't grow as fast because YouTube back then had fewer people on it. Over time, it's one of those platforms that the sooner you get on it, the sooner you'll get results with it even though it takes time. I do have a video that we put up sometime during the pandemic. It’s already got over 20,000 views. I would have to go look and see which one that was because I do have a ton of different videos. There'll be things that you don't know what is going to hit.
Here's the thing, the people in Greensboro aren't like, “I saw your video on YouTube and I got to come to see you.” What they're seeing is they see us on YouTube, they see us on Google Maps, they see us on Facebook, Instagram, maybe they'll see our Facebook Ad, and they'll get our emails and their friends will talk about us. It's the omnipresence strategy. We become the go-to for people that are hurt or in pain or active in Greensboro and want to feel better, stay fit, healthy and strong. They’re like, “I’ve got to go see Dr. LeBauer. I’ve got to go to LeBauer Physical Therapy.” They look us up, call us and we put them through our system.
I learned long ago that any paid advertising is tough when we say, “It's LeBauer Physical Therapy. You deserve to feel great. Call us.” It's not enough. Any paid advertising we do outside of Facebook Ads is educational. You've seen Dan Kennedy stuff and a lot of people might not know who it is but it's if you look in the newspaper or a magazine and you see what looks like a news article, but it says, “Paid Advertisement,” that's a direct response type of marketing strategy. It's an informative ad. We have to create information, educate people and give them a reason to contact us versus blasting them with our name. That’s some of the things that we're doing. That’s the main thing that we do with social media.
I'm thinking about some of the therapists out there that are treating full-time. I'm thinking, “How much time do you spend on social media work? Do you have someone else doing some of that for you to keep you constantly posting and engaged?”
What's the number one problem that we all have? The number one fear most business owners have when they go from being self-employed or a small business, it’s like, “If I want to grow my business, it means I have to work harder. I'm going to explode.” I don't do our social media for either my coaching business or the clinic. What I do is I'll record a video. Maybe I'll do a Facebook Live video, make a little caption, or I'll do an Instagram Live video and add a caption. I take the video, I download it, I put it in a Dropbox folder, someone on my team gets it and we create a blog post, content and other images out of it. We’ll pull quotes up from it and they'll go and post it. I'll say, “This is awesome.” She's like, “What's exactly what you said.”
Since you brought up Dan Kennedy, isn't he the one that brought out the Who Not How book?
No. I haven't heard of that.
He had Benjamin Hardy write it for him. What you're talking about is finding who can do it for you not how you can do it. All of us have that limited amount of time. We don't have the expertise. Who can you find to do the social media stuff for you? It all is dependent upon you.
That's Dan Sullivan but they're both great. The Dan Sullivan question is a great question. I want to come back to that, but yes, it's who can do this not how do I do it? It's exactly it. Dan Kennedy and Dan Sullivan are two powerhouse people. Dan Kennedy does all the direct response old-school marketing. The Dan Sullivan question, we ask this to our patients. Do you know the Dan Sullivan question?You deserve to feel great. Click To Tweet
I don't. I think I know where you’re going because I know some of my PT owners have asked this question of their team members. I know what you're talking about. I'd love to hear it.
This is a question we use in our sales process. As physical therapists, we have to sell. It's our obligation to sell physical therapy but only when we think people will benefit from it. It's only sleazy if people won't benefit from it. The Dan Sullivan question goes like this. Imagine if we start working together. I teach you everything I know and do everything I can to help you get results. Fast forward a year from now, we're having the same conversation. Looking back over the last year, tell me what's happened in your life personally and professionally for you to feel happy with your progress? It’s not amazing and the best ever, but happy. People start to answer and you basically say, “Tell me more and why is that important to you?”
That's how I find out not that Mrs. Jones wants to get her knee pain resolved because she's afraid of having arthritis, but she wants to be able to run, feel strong and be a good role model for her daughter which is what people are paying for. You can go anywhere and get physical therapy but where can you go to return to running programs so you can feel a good role model for your daughter and that's LeBauer Physical Therapy.
I love that question and it gets to the heart of why the patient is coming to see you in the first place, whether they have a prescription or not. I love how that question can get buy-in for a patient to the point where they're not thinking about what the copay is anymore.
If you asked that question to everyone, no one cared about their $20 to $150 copay. My copay this year to see PTs is $150 or maybe it's $175 in 2021.
At that point, they're thinking, “I'll pay $1,000 to be able to run again.”
Also, be a role model for my children. Sign me up. How many visits is it going to take? Let's get it on.
Being able to move my knee or run isn't enough. It’s, “Why is running important? Why is that thing important?” What's that 3rd, 4th or even 7th level of why. Why is this activity so important? When I was working in a high volume clinic as a student, I didn't have time to ask these questions. Even with an eval, we would do one person at a time. They get an hour eval, but you didn't get to when the questions are asked. I didn't have any time to dive into what was happening beyond that initial assessment.
We all know, after 3 to 5 visits people either get better quickly, get better slowly, or maybe we miss something and need more time. It's tough to not push people through based on a decision we made a few weeks ago when I'm being pressured as an employee or a student to meet productivity levels or to see a certain amount of people when I'm like, “I’ve got to put my hands on you.” That means I can't talk to this other person and find out how does that exercise feels.
That'd be a great provider training program to roleplay and work through that one question and the follow-up questions after that, “Why is that important,” to get buy-in to improve the patient's commitment so there are less fallout and drop-offs. Also, getting their commitment to show up as often as frequently as you're telling them to show up and do their home exercise programs. It’s that patient engagement. Simply going through that one question, that one exercise, could do a lot to improve patient buy-in in any clinic.
What we do is we do that three times with them. People go to our website and there's an application to work with us. You don't have to do it but what 55% of people do is they go through our website from an email, an ad, social media or Google. There’s an, “inquire about availability, talk to a PT and request a free total body diagnostic.” In that, we're asking not this question but other questions. We're pre-framing that we have other services beyond physical therapy. What service are you most interested in? We'll put all five of our services, PT, massage, health coaching, private yoga, performance and etc. in there. Eight to nine percent of people are choosing PT. We got this application and when we call them on the phone, we're asking sometimes the same and sometimes different questions. In our free total body diagnostic, we'll ask this question plus others because we want to find out why is this important to people. If it’s not important enough to them to do anything about it and they can't connect with it, they're not going to say yes.
I need to be able to build value that's worth $10,000 or more. I have to build that because health doesn't have a dollar value. I have to build a vision of like, “There's no way I'm going to get that going down the street or with anyone else.” When we say, “Mr. Jones, my recommendation is you return to running or back to the box. Your total body complete program is $1,998 and we'll help you feel better, faster, stronger so you don't have to worry about damaging your knees and you can be a great role model for your daughter. How's that sound?” They'll be like, “Sign me up.” We do get objections. If I can do it right, we don't get objections. If you're not getting objections, you're not selling. We have to get objections.
We have to remember that purchasing is an emotional process more so than a logical process. You'll pay more for things that are illogical. If you can tie it to the emotional process and where they're going to get better, you'll get a financial commitment in spite of the copays that they have to pay. You and I both know that any mother would gladly pay a $100 copay each visit if that meant their daughter could get back to playing volleyball. They wouldn't pay that for themselves to overcome their shoulder because they can't lift it above her head and they haven't been able to do so for two years. They don't pay that extra. If you can get to the heart of it and get to the emotional part of it and tie that to, “This is going to get you that,” picture of happiness that we're talking about, then the dollar figure can immediately be tied to a value. The value and the dollar amount can be equal and they can buy into that.
The most valuable thing is time. It’s like, “How much longer are you willing to wait for this to go away on its own? How long have you been trying to fix this problem?”
How much longer is it going to go on if you don't fix it now?
“If I can help you do this in the next eight weeks or at least make a 50% difference, would you like to give it a shot? Would you like to work with me?” People are like, “Yeah.” If we can make a 40% change, it’s like, “Yeah.” I would say that because I know I can make a pretty significant change in 3 to 5 visits if I can help someone. If they've been struggling with this for three months or three years and they've gone to five different people, “I know you've been doing this for a long time. Do you want to keep struggling or do you want to give it the best shot? How much time would that be worth to save if we could save you?”
I try not to quantify it because it is an emotional decision. We have to somehow bring in a quantifiable understanding of time lost or gained and not just money lost or gained. The time gained has to be greater than the money spent. If I can get that equation right, it doesn't matter. Going back to your original question, what’s a thing that a traditional in-network clinic owner can do is how do we work on not just the marketing process but the sales process and reposition something beyond rehab and the physical therapy we were doing so that people are coming back to see us month after month? People who've been our customer before were 80% more likely to buy from us again than someone brand new.
From your perspective, why don't you think in-network providers go through these processes? Why don't you think they focus more on sales, the conversion, getting to the heart of it or even the marketing process to be more patient-centric?
It's hard not to make a generalization. Generally, there's not been an objection. If a physician says, “Go get physical therapy,” you go get physical therapy. “My copay is $50.” I've had physicians say, “Aaron, I would send you patients but only if you took their insurance.” I’m like, “You don't even know how much I charge. In some years, it's less than a copay.” I've seen receipts from physical therapy in outpatient settings where people are being charged $600 and $800 a unit or even $1,000 a unit. We can't make a judgment on that. Going back to my original thing is if we focus on sales and what's next for people after therapy, those two things are going to shift but people haven't been doing it because the way it's always done and it's been easy enough.
It's the easiest path. You get your prescription, you come to me, I provide you the service and you move on. What you're challenging the in-network owners to do is to think a little bit more.
Level up your sales and back-end products and services.
Think about what more could you provide. How can you make physical therapy simply another option on the menu of services that you provide with the others being cash-based alternatives that can add some greater revenue and consider your conversion process? Market like you're an out of network provider. You have to sell what people are going to gain by coming to you versus other people that might charge you more or charge less.
Stop competing on physical therapy and start selling results that people want. When we try to sell physical therapy, it's like, “I'll go wherever it's cheapest or wherever is in-network.” If I can sell them the result and something that they want, they can’t get it anywhere.
I love what you're talking about. Is there anything else you want to share?
Based on this, it's something like dry needling. Dry needling is a big thing. People will sell dry needling. Dry needling is not covered by insurance, it's a cash-based service. If you want to get a needle, it's going to be an extra $50. Patients are going to see needling as an a la carte item that if I feel like it works, then I get to go where it's the cheapest. Maybe the guy across town isn't all above the board and they're including needling for free in their treatment. You're charging me an extra $50, I'm going across the street.
I get dry needled and we provide it but we don't sell it. I'm not knocking it. I'm saying the strategy of selling the treatment technique that I've learned or the treatment technique that I provide allows patients or customers to price shop. It’s like, “Here’s what they get at the price shop.” They'll go wherever is cheapest. I have this done to me and I hate it. I'm like, “I guess I missed something in the conversation.”
It would be more of how do we create a bigger picture and a bigger goal that people want? “Mr. Jones, the good news is your insurance covers 50% of this program. Instead of the $3,000 program, your cost is only $1,500. If you'd like to pay in full now, I'll give you a 5% discount.” That includes the therapy that the insurance covers, plus the wellness program or the needling that’s not covered by insurance and the other things that they need.
I love that different perspective and the way you package it up like that.
The good news is your insurance covers 50%, 40% or 10%. The good news is all of our patients have great insurance and we can help you. Whether insurance covers it or not, how about we get started now, get you some results and we'll take care of the insurance piece together.
I love how you package that and if there was some way that you could get a provider team to agree on the different packages that you provide and say, “This cost a blank number of dollars. It’s $2,000 if you're going to come to us without insurance, but because you have blankety-blank insurance, they're going to cover this much of it.” It'd be cool to reword that and consider it.
It's the framing of it. I'm also including multiple services. We can break up the charges on the bill however we want. It's up to us. What we're framing is a bigger result and how we're going to get you there.
I love what we can learn from you. When I say, “We,” the in-network providers can learn from you because that's where I'm coming from. It would challenge many owners if they thought, “What if I didn't rely on insurance?” There are many owners out there that should be dropping some insurances that pay less than what their expenses are. You've seen that.
I've worked with a lot of clients who are like, “I have to drop insurance because I'm losing money no matter what I do.”
They're scared to do it. If you could see the benefits of it, try it. Act like you're out of network and market accordingly, change your message, package it accordingly and provide the value. I don’t think you're going to miss that insurance.
The one ace up your sleeve that you guys have that I don't is you already have the systems in place to bill on behalf of patients in or out of network. I would have to go hire someone new and build new systems or pay someone else money to do it. If you've already got it set up, it makes it a lot easier and it becomes less of a barrier because people will ask you, “Do you take my insurance?” You’re like, “We do.” We're out of network and this is how we're going to do it and we'll file the claim on your behalf or we’ll just file it for you. That's the big barrier that I face every day.
It's easy to find you on The CashPT Lunch Hour. They can find you on the podcast but if they want to reach out to you individually, how do they do that?
Thanks for your time. I appreciate it, Aaron.
Nathan, thanks so much. I appreciate being on your show. You've got a great voice. Keep rocking and rolling.
I've got a face made for it.
Aaron LeBauer PT, DPT is the host of The CashPT Lunch Hour Podcast, the founder of The CashPT Nation Facebook group and as a business coach has helped 1000’s of passionate physical therapists build successful businesses without relying on insurance. He owns LeBauer Physical Therapy in Greensboro, NC, a multi-therapist 100% cash-based physical therapy practice. Aaron's personal mission is to save 100 million people worldwide from unnecessary surgery by inspiring other healthcare providers to start their own businesses and learn how to market directly to patients, not physicians.
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Christina Panetta, PT learned fairly early on in her clinic ownership that she needed to outsource in order to grow and improve. When she needed some time and space after having a baby, she hired a PT and came back to part-time work. When she recognized that she needed more business training, she hired a business consultant. Now, decades later, when she needed some support on social media to drive patients into her clinic, she hired a social media marketing company. Too many times, in order to save money, owners will take it upon themselves or leave it to their staff to work in areas that are not their specialty (business ownership and social marketing are two examples). This inevitably leads to poor outcomes, distractions, wasted energy, and little return on the investment. Moral of the story—hire them on or hire it out.
I have Christina Panetta out of New York who not only brings and shares a great story about her growth from a single room clinic to multiple practices, but I'm excited to share this because Christina recognized fairly early on and as a firm believer in either hiring them on or hiring it out. What I mean by that is either hire on another physical therapist if I need more time and space or hire on a coach or consultant to teach me what I need to look for and do that I don't know how to do or also hire it out. Find the resources, find the vendors to do the things that you're not an expert at, which could be many things. Social media marketing and billing come to mind. All these things that sometimes we try to do and we're not trained to do it. We don't know the ins and outs where we could hire an expert and get it done much more efficiently. Christina is a huge believer in that and her story reflects that because she's hired on and hired out. She has grown significantly and continues to grow and continues to look for other resources to help her grow and she's been successful at doing it.
I've got Christina Panetta, Founder and CEO of Panetta Physical Therapy in New York. I've met Christina through Hands-on Diagnostic Services, which we’re both owners of diagnostic treatment centers. I've always been excited about talking with her because she has plenty of wisdom. She's been around for a while. First of all, thanks for coming on, Christina.
Thank you for having me.
I consider you a great part of my network because every time I've interacted with you a lot, you've had the wisdom to share. I don't know if you remember those instances, but they were important to me. I'm excited to bring you on. Did we meet a few years ago for the first time?
Yes. When we were training, learning how to do EMGs and diagnostic testing.
I always liked our conversations as we were going to lunch and whatnot, but for us in the audience, would you go back and share with us a little bit about your professional story of what got you to where you are? I know you started small, now you're up to four clinics. I want to share what your path was like with the audience.
I wouldn't consider myself a business person. I went to physical therapy school because I wanted to help people clinically. I never thought about having a business. My husband was a business guy. He had his insurance office and I was working for a big medical group. I had at that point one child, I had my son, he was maybe two years old and we joined a gym. This is back in the time where free weights, we were moving into Nautilus, it's the '80s. We wanted to get back in shape. We joined a gym and we were walking around the gym and they were telling us about how they're going to move some walls down and put in a Nautilus center. My husband says to the sales guy, "Did you ever consider having a physical therapist here?" This was before anybody did things like that. He's like, "No, what would you need?" He looks at me and I'm like, "Room for two tables." The next thing you know, that's how I got into the business. I didn't quit my other job. I got 500 square feet maybe, I don't even know if it was that big. We put two tables in there. My father in law made the sign and it said, "Physical Therapy Office: Christina Panetta, PT." I sat down.
I didn't even have a telephone. I use the club's phone number and my marketing when I would get a phone call, they would go, "Christina Panetta, you have a call on line two." I would run out of the office through the club and answer the phone. I legitimately didn't know anything about anything. The first patient was a gym member and he walked in and he was like, "Who are you?" I'm like, "Physical Therapists." He's like, "I’ve got back pain." He was a landscaper. That was my first patient. I remember his name. I even went in on Sunday mornings to treat him. I started small.
What were the first couple of years like? Did you ramp up quite quickly? How soon thereafter did you get out of your full-time job and recognize that maybe you needed your phone and your space?
It was a slow ramp-up. The cool thing was I got to know the doctors in the medical group and the medical group, what would happen is they would have patients. People that were injured at work and in car accidents, which could be treated in or outside of the group. It was a weird situation. Even when I was working there, I was allowed to bill privately anytime anybody was injured at work or in a car accident. They didn't have inside the group all the access. I had access, a pool, and I had access to this new Nautilus equipment and treadmills. I could use anything in the gym. I started two nights and then eventually, I tweaked my hours in the medical group.
I was working three days and then I would work two long days in the health club. The owners of the club, I'm not even exaggerating, my rent was $50. This is the '80s. Therapists were making $10 an hour. My dad was in awe. It's different in the '80s and they were always like, "Are you doing okay?" They love the prestige of having a physical therapist. I was full-time with two nights, then three days a week in the medical group and then two days a week. Eventually, I got pregnant again with my second child. After I had the baby, I switched to two days in the medical group and three days in the main office. Once I was three days full-time with my patients, I bit the bullet and left the medical group.
At that point, you were probably looking for new space. At what point did you finally establish your clinic had set up a lease? I'm sure that was a huge jump for you at the time, but to have your place or jump out of treating full-time and going to your thing.
It was a big jump. I feel like in some ways I was lucky because my main office is still in this health club. What happened was the health club kept expanding. Every time the health club expanded, first of all, they would've given me any amount of space when I first said, "How much do you need?" I was kicking myself because I'm like, "Why did I only say two tables? I need four tables." I eventually did get my phone. In the early '90s, I got a computer. The '80s is pre-computer. I got a dot matrix printer. In the beginning, I had an aide receptionist because I use all their exercise equipment. I always needed an aide in the gym, that was my big plus point. Everybody got to like, "That's got me the whole body concept, come in for your back but I'll treat your whole body." The club liked it because anybody that became a patient often would become a gym member. It was a nice give and take in that period.
It's not uncommon to have a physical therapy combo like that in a gym. One of my good friends, Aaron Williams with OSR in Arizona, worked closely with a gym down there. One of my previous episodes was with Paul Wright. He's in Australia, but the same thing connected with the gym and was able to establish something big with them, especially with that crossover.
It's an easy way because I didn't have to have a big layout of equipment. My most expensive equipment, the same thing, the early '90s. Electric stim units, it was big. We hardly ever use it, but in the '90s you needed electric stim and ultrasound. I remember my electric stim unit cost the same as my Camry, which was my first car. I didn't have to take care of the bathrooms. I kept growing and I was lucky in that the club kept growing. They put a second floor on and I'm like, "I need four tables," and then I was like, "Four tables is not enough. You're not using that conference space. Can I take over that?" I was like, "I need eight tables." As I grew, first, there was me and then Karen Eckardt. She was my first employee. Her father-in-law was one of the owners of the gym. It's convoluted.
Her husband was an insurance agent. Her husband was walking by my office and he was like, "Who are you?" I'm like, "I'm a physical therapist." He's like, "My wife too." I'm like, "I need to meet her." Karen comes and meets me in that summer. I was working. I worked three twelve-hour days and that was my schedule. The other two days, I was a mother. I had two young children. That summer, all I remember is I hired Karen and I said, "This is fantastic. Here are your patients." I was only working three days a week and I gave her the whole schedule and I said, "I'll work on building my schedule in the fall." I took the summer off and enjoyed it. I know it sounds insane, but I was trying to balance being a mother and being an owner of a business.
Many times I come up with people that I interview that eventually become successful or coaching clients that I have, and they keep thinking, "I'm treating full-time. I need to bring on this other provider and build up their schedule." I try to tell them my coaching clients at least or who aren't at that point, "No, you give them your patients and you worry about building up your schedule or scale back so that you can work on your business." Looking at it from a different perspective, how can I financially afford to bring on somebody else and not treat patients myself? What am I going to do to become productive? You found that because you were essentially living a higher purpose and that being a mother and spending time with your family, especially as young as they were and concerned about building up your patient load afterward. For you to give that to Karen was not only insightful, but it's an example of what people could do. If they have the focus of themselves and their business first. When you bring someone on, it’s investment. It might've been a scary situation for you at the time to take on another salary like that. To invest in bringing on a provider that you can scale back and work on the things that you need to work on, whatever that might be.
My husband, his degree was in marketing. Come the fall, he was like, "We’ve got to go out and visit doctors." That was not easy for me. Because he was insurance, I used to help him. They used to call this X dating where you would call people and say, "When does your insurance expire?" I hate it, but I would do it. I'd be like, "Please don't make me do that." When I had to go and visit doctors, I was like, "No way, this is terrifying." He was like, "I don't understand." He couldn't understand that. I was terrified. I did it, I would go out, but I had a lot of awkward experience.
You learn it over time and you're probably pretty good, I'm sure.
I feel comfortable. I had a lot of help along the way. For me, I had people that helped teach me how to go and make a relationship with a physician.
Things seemed relatively smooth. When did you hit a point where you're like, "I'm in trouble?" Did you ever hit a point like that?
What happened was, a lot of my referrals came from the medical group. The doctors wanted their patients to have what I had at the gym. They were referring their patients to me and everything was great until one of them, the leader of the pack, the orthopedic, and then probably hundreds of people have been through the same story. My biggest referral source, way more than 50% of my patients. What does he do? He wants me to open a business with him, but I don’t want to open a business with him. He opens his own PT clinic. The interesting thing is I had an office manager at that time. That was Karen and myself, an office manager and a trainer. Karen and I worked opposite schedules that we could fill up our table, and we only had a certain amount of tables. This is how I got introduced to a survival strategy. The office manager sent us a postcard. It said, "Do you need more patients? Are you afraid of visiting doctors?" I'm like, "Yes." I didn't answer it. I throw them in the garbage. She filled out the postcard and she was like, "We need help." Way back in the '90s, me and the office manager, we fly out to California and then that's when I learned how to make a relationship with positions that I didn't already know. That was either sink or swim. Either I was going to do something to handle the situation or I was going to think.
Was that difficult for you to sacrifice the time, energy, money that it takes to have some consulting through survival?
The first program I did with them, we doubled our business. Karen and I being together to four full-time therapists. It was a big thing because I remember saying that I always had this target that we wanted to do $1 million. Being able to double the business, that was our big target. I have four full-time physical therapists, I could do $1 million, which is pretty much what we did. That was huge. That was where the club added a second floor and we were able to double our space. I could have gone anywhere, but I've been lucky in the club that I got to stay in the same place because they kept expanding as we expanded. That was huge for us.
It took more time going to a weekend course and then coming back and all of a sudden you have four therapists. How much time did that take for you to build up?
We doubled our referrals in one year. It was probably one year that we've doubled the amount of new business coming in. I did a marketing program with them and then the following year, I didn't know how to manage anything then I did a management program. For us, that’s the basis and it put the organization in the company. The first step is you have to be able to go out and then form relationships, find the patient's people are out there suffering. You have to be able to find those people, bring them into your place but then you can't treat everybody yourself. You have to learn how to delegate. I always say my type of management I call it household management. When I was little, I was treating, but I could hear my office manager and front desk receptionist. She was everything. I was treating and I would be like, "No." My management was like family-style. To me, you could get yourself maybe one therapist. If you want to expand out, we're open from 7:00 AM to 9:00 PM and that's two completely different staff. You have to have a management system in place and an organization. That's what Survival Strategies helped me a lot with setting up, having an organization in place, having systems. Everything even that we do has come from what we learned with them.
The way that my business partner and I looked at it as we were going from mom-and-pop to an enterprise. If you envision what a mom-and-pop place looks like, everything is dependent upon mom-and-pop being there and running everything to an enterprise. The idea of what an enterprise looks like means that there's a structure in place, there are policies and procedures about how you do things. You might never see the owners on site. We recognize that it took some investment in capital, energy and time to make that transition. It’s necessary if you want to grow and if you want to avoid burnout for the individual. The one thing I'm confident I can say this about you is that when you did get that consulting you were adamant about implementing it quickly. You didn't come across and be like, "That's a good idea. Maybe I'll do that someday." I'm certain that you came back and you put a plan in place quickly to get this stuff implemented. A lot of us might read a book or hear some good things at a conference and think, "That's great. Someday I'll implement it maybe, maybe not." You were pretty determined about that.
The big thing is that it wasn't a course that I took. The way that Survival Strategies works is a consultant works with you every single week. More than anything, they were guiding me. I would have assignments every week. There are those people that always get the assignment and they do it right away. I'm the opposite. There's the student that they get the assignment and they're like, "I work good off a deadline." I don't do it when I get it, but I never miss a deadline. I need the deadline to fire me. Every week I would say, "I'm going to talk to this person. I am supposed to have visited five physicians and ask them these questions or I'm supposed to have met with four of my staff and written up their job descriptions." I always had somebody. They were cheering me on and motivating me. To me, I needed that. I was motivated but I needed maybe more than anything the person to hold me accountable.
That's the beauty of having a coach or a consultant, especially one that meets with you regularly, whether that's weekly, biweekly, whatever it is. They hold you accountable. They provide deadlines simply by the meeting. You don't want to let that person down. You want to show them that you're capable and competent. That's the beauty of having that because who else would hold you accountable? You're left to your devices and there's not necessarily a deadline. Essentially outside of the household is the head of the business. You don't have any one individual to answer to when you're at your founder/CEO stage. That's the beauty of having a consultant that meets with you regularly, is to hold you accountable, guide you and teach you. What I find is a lot of them are helping you fulfill your goals and what you want to learn and what you want to figure out. Is that what you found as well?
You've expanded out of four clinics. You've got the policies and procedures in place. You're no longer the household business. You've got the structure, you are an enterprise. What are some of the successful actions that you're handling to overcome the problems that you have?
The biggest thing is keeping my eyes open and being willing to change. In the beginning if you want new patients, you had to make more relationships with physicians. I love that because in New York, we have direct access. People can come right to us. Everybody that works for me other than me has a doctorate. They're all doctors of physical therapy. We have social media. Social media to me has been the game-changer. Think of this, who is on Facebook? People like me. Who makes the decisions about healthcare? Women age 40 to 65 years old and they live on Facebook. They make the decisions for themselves, their husbands, their children and their parents.
Just like Survival Strategies, there are companies like Breakthrough PT with Chad Madden. They specialize in helping you reach the people that are looking for help. What I've learned is that people are out there. There are more patients than all the private physical therapists in the world could ever handle. Many people want help. Still, when they go to their doctor, even despite all the educating. Thirty years I'm educating doctors and I have educated a lot of them, but they still don't always prefer them first to physical therapy. They're looking for answers and people aren't trusting. They don't trust people. They're skeptical. They don't trust their doctors. They do their research. We can use social media, we can use Facebook. This has been for me the biggest thing, our newest clinic.
I did the numbers, only 25% of my patients come from a physician. 30% are coming because they were past patients but everybody else are direct people, just public. People are searching for answers. To me, they're the best patients you can have because it isn't the doctor who said, "Get some therapy." They're looking and saying, "I have back pain. I'm an active person. I want to get back to doing what I want to do. I want to get back to doing what I love. I don't want to take medication. I don't want surgery. I don't want injections. I've tried all that." They're doing their research and then they come across our educational videos about knee pain, shoulder pain or back pain and they sign up for our workshop. I'm 100% in control of who do I want to see. I can turn it on, turn it off. The fun thing is I can say, "Let's decide what we want." We want shoulder patients. I can go and I can work with all of my staff and say, "Let's make sure we're all doing the same thing." That's a lot of what I spend my time doing because I don't treat it all. I don't have any patient load. Even Karen, she is still with me.
She doesn't have a patient load. We spend all of our time keeping our systems in, but also looking out there and saying, "What's new?" You do the diagnostic testing. It's like, "We should be doing that." We’re researching what's out there. "Therapists can do EMGs, NCVs and Musculoskeletal ultrasound." Does that fit into the practice? Doesn't it fit in? Does it bring the type of patient in? What I find is when you bring that type of patient in and you have to make sure all the staff is capable of delivering the same outcome that you're promising when you deliver the workshop. Our workshops are all about, you have a pain in an area, most likely the cause of it is somewhere else. It's always that message of, "You have a herniated disc. You're bone-on-bone. Yes, you have a torn meniscus." What's causing it? If you never fix what's causing it even after you get the shoulder decompression, you're still going to wear out the other tendons in your shoulder if you don't fix your ribs.
I love the experience that you share because it shows what you would be doing if you're not treating essentially. That question comes up from physical therapists all the time. “If I'm not treating, how am I being productive? If I'm not treating, what am I doing with my time?” You've established that. You're keeping your structures in place. You're still monitoring all the key stats. You've got your KPIs, you're probably graphing them or at least looking at them week-to-week. If you're not, then Karen is doing it for you, reporting up. You're looking ahead and that's what a true leader should be doing. It’s not heading in the ground or buried in patients, but rather looking up forward and saying, "We've got direct access. How can we take advantage? What is our demographic that we're hitting at?" We're getting into marketing strategies. Knowing what your true demographic is and how to message to them is the first step.
I love how you said, "It's like a spigot." You've got two systems in place where you can turn on the patients, turn off the patients or tweak things enough to say, "We're doing this and this is the message that we need to do. We're going to focus on this body part. We need to train the therapists appropriately." Everyone's using the same narrative, the same vernacular, the same vocabulary, they hear these patients hear the same story to build on that foundation. That's what you should be doing as a leader, developing that over and over again, tweaking the marketing and doing the training. It's great that you shared what you're doing as a leader.
If you know what it is, it's much fun meeting with the therapist. We have thirteen therapists. Every quarter, we meet with every single therapist for 30 minutes. If I do look at their production, I'll usually have a question. I'm always looking for, what's their passion? When you learn things about people, how do I pull that passion out? What do they want? What I see is that most of my therapists other than Karen, myself and Mary Jane, they're all 40 and under.
You guys are 41, 42?
I'm more in that other demographic of the Facebook people where my staff is the Instagram generation. They will balance in their lives. They want the family and they want the profession. They want to have an impact. I'm reading this book called Impact Imperative. They care about the world. They care about people. They want to treat people who want to get better. I talked to them all the time at the workshop, people are suffering. We have the answers, but there's this big disconnect. They don't know it. When you can take a person, we always do success stories, testimonials, complete a plan of care. We take a picture. The patient talks about the before and the after. You take that person that thought they'd never run again or they'd never be able to walk them all with their grandchildren or go to Disney. That's what's great about being a physical therapist. You can help a person that wants to do that passionately.
We spend a lot of time teaching new therapist, how do you pull that out? I spend a lot of time talking to the therapists about who is it that you love to work with? Why do you love to work with that patient? Let's get down to the bottom of it. I'll find out some crazy things like, "This person loves to work with people that are grandparent’s age that can't walk." You would never think of this. He’s a young guy and he's like, "That's my favorite patient." How do you create a story and how do you find those patients? You can get so good at working with that patient. That's what I'm having. I spend my time and I'm having fun. That's helping me have my therapists have more enjoyment and getting more out of work because they think they're having a bigger impact on their community.
It sounds like what you're doing intentionally, you're creating a culture that is focused on purpose and you're getting to the heart of what the therapists want to do and fulfill that purpose that they had in going to physical therapy school and helping them define that. I saw you're reading The Coaching Habit or Change Your Questions, Change Your Life. Which coaching book was it?
It was one of those, The Five Questions.
It was The Coaching Habit. I highlighted that in a show because that was one of my top books. I know you're probably following that agenda a little bit to help them get in becoming a coach. That's what a coach does. What else do you want to do? There are some books that have been influential as you look back.
The last book I read, believe it or not, was Impact Imperative. It was all about having an impact because I do all the work in Haiti. It was looking at, is what you're doing having the impact that you thought it was going to have? It has a lot of research of sometimes what you think could have a good impact and sometimes have a negative impact. That's why it's called Impact Imperative. Making sure that you look forward and you also look backward to say, "This is the impact I was trying to have. What impact did it have and was it all good? Could some of it have been bad?"
With the knowledge that you have and the wisdom that you gained over the years, what would you tell your past self about what you know now?
I would say don't be afraid to challenge yourself. Most of the time, people don't give themselves enough credit to have the confidence to move forward. Give yourself more credit. When I would go to visit a physician, I was the one that was afraid and I felt uncomfortable, but my husband was like, "Christina, every time you come back here, every conversation you're like, the one is good." Some of it is your demons, hold yourself back. The other thing I would say is to get help and reach out. Open your eyes, read all the magazines that we have. There are a lot of people out there that can help you. If I had reached out and worked with Survival Strategies years earlier, what would that have done? I would have been twice big in the hay day of physical therapy. Not that I'm not, I've achieved a lot. I've moved through it, but some people can help us. What I'm finding, go on the other extreme, I'm like, "Who's the expert in diagnostic testing?" That's E-stim. You’d go to HODs. I had issues with getting patients to arrive. "Who's out there?" It's much easier. It pays itself off much faster. If you're having difficulty in an area, look out there and don't be afraid of the changing environment. I look at it and say like, "Social media." Even for me, I have an Instagram account too. I know Facebook because I'm that perfect demographic, but when I want to hire a PT, they're not on Facebook, they're on Instagram. A lot of it is being willing to study up a little bit and research.
I love that you've gotten to that point and that surprised me. It took you several years to get to Survival Strategies from when you started?
It was 1996.
It was about the same thing for me. We got coaches earlier than that, but it took me several years before I was willing to invest in getting some coaching and consulting. Frugal as I am, it's hard for me to part with money. Like you, once that I found the benefits of it and how it not only increased my volume and my profits, my revenue, you name it, all that stuff, it also improves my life. The freedom that I had in my life. Fulfilling a greater purpose and helping me achieve that. There was all that stuff that was helpful that came from having coaches and consultants and I would do the same thing. I would tell my earlier self to get a coach much earlier, get some consultants. The same thing I had this accident.
For me, the big thing is, I am in the second generation in the practice. Transition planning, even Karen and I had talked about that. There's a lot of consolidation going on in the industry. You work hard to create something that I feel is unique in the marketplace. How do you transition? That's I'm exploring not much selling the business but looking at, “How can I offer to my employees to become perhaps owners in a company?” That's the next step, how do I make sure that it lives on? Even for my staff, you have this environment, if you sell out, half of them could lose their jobs and life may not be the same as the way that it is. It's like, "How do you have it live on?" I'm not there every day anymore, so less and less.
Good luck with that but it goes back to you being the leader and looking forward to seeing what's coming down the road. Not for you individually, but also you're noticing what's going on around you and how are we going to survive this? How can we structure it? What do we need to do to survive and do what's best for our team members? You brought up something. Tell us a little bit about what you're doing in Haiti. Do you mind sharing?
Haiti had an earthquake in 2010. Another 300,000 injured and maybe twelve physical therapists that were all trained in the Dominican Republic. For a country, there are ten million people that live in Haiti, the poorest country in the Western hemisphere. It didn't have a good, stable system to start with. You know the story. I had gone there during the earthquake. I brought back a woman and a baby and I have continued to work at Stony Brook University there, maybe after four years, I brought them down there to help establish a PT program at a university. The cool thing, our first students graduated and 22 of them. The two are my scholarship students from rural, I'm talking rural mountain, no electricity, running water. They live in banana huts, they ride mules. I sponsored two kids and they're graduating. Everyone has a passion. My passion is to help that country together to help grow the physical therapy profession in Haiti. They have 50 something physical therapists in the country. They are all young, smart professionals. There was another school. There are two physical therapy schools in Haiti.
You don't have to go to the Dominican Republic and learn to speak Spanish to become a physical therapist. They're at the point of being forming licensure. If they're at those early stages of having physical therapy be a recognized part of a medical program that every hospital would have a physical therapy program. All therapists would be registered by the government. They're trying to set up, they have a legitimate association and they are recognized by The World Confederation for Physical Therapy. They just got that.
That's great and kudos to you for taking on such a massive project like that, but your influence has been felt. Congratulations and thanks for your work with that.
The cool thing is all the physical therapists that I know, people in private practice, they have helped me with that project. Anytime I've reached out and said, "Can you donate money for a laptop or a table?" People are amazing and that they've helped and they've also brought their talents. Many people have come with me to Haiti. That's where you get to see how good people can be.
If people were interested in what you're doing or wanted to donate, do you have ways to take their money or take their time or help?
I haven't asked much for the money but the talent they can email me Christina@Panetta.com. We haven't set up a 501(c) officially yet.
I'm sure there are people out there who are like, "I would love to join a trip sometime or if there's any way I can help out, let me know." I want to make sure that's available and to do that, they need to reach out to you?
I'm sure you've posted some of the pictures on Facebook or Instagram or both?
It’s on Facebook.
You've gone from a point of success and you're making significance in the world, and even in the PT industry in regards to Haiti, at least. You're at the forefront it seems like. Congratulations on that.
I feel like I wake up every day, I go to sleep thinking about, “What can I do?” It drives me. It is my passion. I try to share as much as I can with the therapists in Haiti because they have such a thirst for knowledge and know-how. Being able to share, not just me, but that's where you realize how many cool, great people I know that I can bring those talents together to help in ways that make such a big difference.
Thanks for your efforts there. Is there anything else you want to share with us?
It makes me realize, why I do what I do and how much physical therapy touches many lives. The biggest thing I see is that I don't think any of us know the effect that you have on the person. I came in, I couldn't do this and now I can do it. You don't always fully know. I thought it would be cool to follow-up with people and say, "You've got this person back to anything." It could be walking or running or work or helping their grandchildren in turn. Think about physical therapy in general, you get that active person who's involved in their community back to doing what they love, what do they, in turn, accomplish in the community? That's where I feel like physical therapy has such an impact. I can't think of anything, honestly, that has a bigger impact on not just life, but it's the trickle effect into society. Anything we can do to promote that. If we always keep that in mind, that's why we do what we do because it makes the difference.
Thanks much for sharing your story and your wisdom. I appreciate it.
You're welcome. Thanks for having me. It was fun.
Have a good day.
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Transitioning from a small to a big business owner involves a lot of elements to tackle, including handling a bigger staff and balancing a busier timeframe. Parents who are also business persons can fully relate to this balance struggle. In this episode, Nathan Shields interviews Aisha Wilbur, PT, DPT, owner of Willow Physical Therapy, as she shares her struggles between starting a business and motherhood. She teaches us her success formula – Reach Out + Step Out + Network. If you want to have the same freedom that she has while still having a strong vision for your PT business, listen to what Aisha has to say about how to not be stuck and continue moving forward.
I'm excited to bring on a fellow Alaskan. Aisha Wilbur, out of Fairbanks at Willow Physical Therapy, is joining me because I'm excited about her story. We don't have any specific topic to talk about, but what it led to was recognizing the amazing transition she made within a couple of years out of such a horrible stuck situation to now doubling her business and not treating at all where she can focus on the future and vision of her company. In the meantime, she is affecting a greater number of people than she can do with simply providing hands-on physical therapy. She's got a great story and there's plenty of value within it that I hope you can glean from. If nothing else, it's just a great story and should be an inspiration to all those owners out there who feel like they're stuck. Let's get to the interview.
I’ve got Aisha Wilbur. She is a pelvic physical therapist and practice owner of Willow Physical Therapy in Fairbanks. I'm excited to bring her on because I know a little bit about her story. I heard about her through Jamey Schrier, who has been influential in her growth, but considering how successful she's been, I thought, “I’ve got to have her on.” First of all, thank you for coming on, Aisha. I appreciate it.
Thank you for having me, Nathan.
Tell us a little bit about your story. You're in the far-flung reaches of Alaska, in Fairbanks. I'm in Alaska too, but Fairbanks is even further. Tell us a little bit about what got you where you are now and helped you develop a successful clinic in Fairbanks.
My story begins after I graduated from PT school in 2008. I practiced in Arizona for a year. I moved up to Alaska to be with my then boyfriend, now husband. I joined a practice and my goal was to become the best pelvic physical therapist. I joined a practice and my goal was to bring that patient caseload to the company. That was my task. That was in 2009. In the summer of 2010, the owner of that practice pulls me back into her office and I'm thinking, “I'm not doing a good job. We don't have enough patients.” Scarcity-minded for sure. “I'm going to get fired.” Lo and behold, she's like, “Aisha, I'd like you to take over the practice,” and presents to me numbers and stuff like that. Totally serious. She wanted me to buy her practice and I was like, “What?” I didn't feel ready. I remember thinking in PT school that I wanted to have a practice, but it was so soon. It was barely two years out.
I was new to Fairbanks too. I didn't know the people there as well as everybody else or the culture. It was a great opportunity and I said yes. Fast forward, anyone who's gone to PT school, you don't know the business ins and outs. Do you think you can do it? You have this mindset of, “I can figure it out. I'm smart. I'm a doctor of physical therapy.” You get into it and you're like, “I don't know what my numbers mean. I have all these that come my way. I don't know if they're good or bad. Marketing, whatever I had learned from others and in school,” and just all the other things. I took over the practice in 2010. By 2016, I was in a lot of trouble.
You were going blind for 5 or 6 years.
At first, it was okay because I had all this time. I didn't have any children at that point. I can work a million hours a week. I could treat full-time and manage and handle the business stuff and make it work for the time being. I had my daughter in 2013. I started to realize I can't work 60 hours a week. I got to start cutting back. My money was affected. There were times where I just didn't get paid. I was working a ton and not bringing home much. I got pregnant with my son, my second child, and I knew I was going to be in trouble. I need to figure this out. I have to be able to take time off. I started seeking help. He was born in 2015, so I had started that realization of I need help. I worked with a company for a little bit, but just wasn't a good fit and it didn't work out for me for what I needed at the time.
I had my son and I'm back into treating four weeks after. I brought him to work. I was treating. I was managing, marketing, doing all this stuff. I give myself 30 minutes in the middle of the day to document, to check emails, to answer calls because my staff was calling me while I'm breastfeeding and pumping. I was eating lunch. It was just trying to do way too much in 30 minutes. My laptop's in the sink. I have my food over here and my pumping parts over there. It was just a ridiculous scene. This one particular time, I sat in on a webinar. It was Jamey and his accountant, Craig, and they were giving good tips. I was like, “This is ridiculous. What am I doing here?” I just had this a-ha moment. This can no longer continue.
I did the online program that he had at the time. I started to learn about basic things like my dashboard. What does my money mean? Money in, money out, things like that. I had a call with Jamey and I decided to join his group at the time, The Lighthouse Leadership Group. That was a big deal for me to do that because there was such support there. Everyone was open and kind and just friends. They’re people just like me, private practice owners who are struggling and had resources. It's just a brain to pick. I started to change my business then. Things started to change, but 2018 was a big change. I got pregnant with my third child. At the beginning of the year, I was like, “I'm due September 13th,” or whatever it was. I have this goal and my goal is that I will remove myself from treating altogether 100%. It was a good goal. On top of that, it wasn't going to affect my money. That was the other thing. I could pull myself out, but then I wasn't getting paid as much. I made that very distinctly. I wanted to be able to pull out of treating and still make the same money or more.
That was a year of focus. I focused on what I wanted and I think that's where it began. I had a very clear vision of what I wanted and I wasn't going to let anybody get in my way. I got organized. You begin with the end in mind. I had a very specific deadline, a due date that wasn't going to change that much. You can push it up back a week or whatever, but not really. I have this deadline and then I worked backwards from there. I went through, “If I want to do, how many treatment hours am I working?” I worked backwards from that. I fully removed myself from treatment a month before my due date. I accelerated it a little bit. My biggest struggle was hiring and recruiting. It's still a struggle. What I figured out was I just brought on a traveler. I brought her on a few months before so that I can mentor a little bit, do some training and she could take over my pelvic health caseload, because that was the biggest challenge. I can find maybe an ortho, PT traveler a little bit easier, but those pelvic health pts, those are hard to find.
What was 2019 looking like and what is 2020 looking like for you?
2019 continued, so I'm still not treating. We grew a ton in 2018. I was able to double the practice. The more you remove yourself and you work on your business instead of in it, the more your business succeeds. It's hard to believe that until you do it and you see your numbers and you see your results. I decided, “I'm a business owner now. That's my main role. I cannot delegate that.” I need to give this a go. 2019, I continued that and we doubled our space. We have a 6,200 square foot space right now.
Kudos to you. Going back into your story, first of all, you knew you needed help. There's usually that inflection point in most of the owner’s stories that I interviewed where it just hits you like, “This sucks and I’ve got to do something different.” My challenge to the owners out there who haven't got to that inflection point is don't wait until it sucks before you make a change. There are things you can do and avoid all that heartache. What you did and why I want to say kudos to is number one, you did reach out, but you also recognized that it wasn't a good fit and decided to move on and didn't give up on the consulting path entirely, but rather found someone else. Kudos to you for finding someone and recognizing that maybe someone else to do a better job for me and recognizing that that was your path out. That's just amazing. I think Jamey's program now, is it still Practice Freedom U or something like that?
That's what he's calling the company. The Lighthouse Leadership Group is the group that I am a part of.
All of that together, I'm sure it gave you the business acumen to know your numbers, your stats, your finances, that stuff. It seems like it also changed your mindset.
One of the things I did in 2018 was to eliminate all negative talk, any negativity coming my way. I would find myself being negative to myself, just saying, “You can't do this,” or “Why can't you do this?” or, “You suck, Aisha,” or whatever it was, bringing myself down instead of saying, “You can do this. This is what you want. You're not the first woman to do this. You can do it.” Eliminating any negativity coming my way or from myself or bad news. I stayed away from all of it and trying to stay focused on what I wanted.
The other thing that stood out to me is what you said where you're working on your business and by doing so, you doubled the size of your practice. Because that's something that I come up against again with some of the PT owners that I coach. When you're a physical therapist, if you treat somebody, you get paid for that visit and you immediately know your productivity. When you take on the owner hat and sit in the owner's seat, you don't have that immediate productivity stat in front of you, “I'm not seeing so many patients. I'm rather just working on the business.” That's abstract. What happens is that the energy and time that you put into the business returns multiple times because of the effect that it has on the entire team and making them more efficient, more productive. The opportunity to market more in energy and freedom and culture and all that stuff expands and accelerates because you're able to work on it and put some energy into it.
I love the way you sum that up. It is. As PTs, our schooling teaches us that we're with a patient. That's our productivity. We get paid for that time. That mindset shift is important and I had to go through that. I’m still struggling a little bit with it.
My initial goal with the consulting was that I'd get some business acumen and then I will step aside and implement that stuff so that someday I can come back and treat again. I never made that turnaround.
I thought that way too. I want to have the option to, but now that I have the option to, I haven't done it. I see where I could go a little bit backwards or the company could, if I decided to focus my attention on treating, then that means my focus is away from the business.
You recognize that your effect can be multiplied through so many other people if you're not treating. One of my clients in particular said, “I do my patients a disservice if I am treating because as I'm treating the patient, I can't concentrate on them. I'm worried about the accountability meeting I need to have or the marketing that I need to do next. My attention isn't completely focused on the patient and that's not okay. That's not fair to the patient. It's not fair to the business because the business needs your attention as well.” Sometimes treating is not appropriate because you should be spending time on the business and making it better. That would be better for the patient in the long run.
I agree with that. That would have been hard for me to agree with some years ago, but it's true.
It takes some effort and some thinking to get over that. I know Jamey's coaches help you through that. The mastermind group that you're talking about helps you through that. Just the examples of others, that's one of the reasons why I do the podcast is because here are people that I’ve done it before. They've gone through the same struggles. They've had the same questions. There are resources out there.
Yes, which is why I tried to absorb as much as I can through books or podcasts or whatever. I can hear other people's stories and learn from them.
Initially, what were some of the more successful actions that you found? Maybe things that stood out that like, “As soon as I did that, it opened up a new avenue or path for me.”
I would say organizing my time and my schedule. Chunking my time, like in my story, I was treating, managing, doing all the things on the fly. I fit everything into my day. I started to say, “I'm going to treat from this to this time, and then I'm going to have dedicated admin time where I get to manage and do these things.” My brain wasn't so tired because bouncing around, I'd be treating a patient and then going into the next room or patient session. Somebody would come in and ask me, “We're having this billing problem. Can I just quickly ask you?” Because they needed my time and they didn't have it any other time maybe. They had to find me and break into my treatment session to get that answer that they needed and deserved. I realized I needed to start to focus and organize my time so that I could get results and whatever I was doing.
That's what I find and I had to do the same thing. The company I was working with said two half days a week, at least to begin with. You don't need to take a full day. They tried to ease me into it, dedicate 4 or 5 hours one day and maybe another 3 or 4 hours the next day at least a little bit. Because I think once you get a taste of it and recognize some of the productivity that you're able to generate and do and pay attention to some of these things, then it's easier to open up that full day and then open up into that. Now I'm trying to get my clients to do the same thing. I think once you start recognizing that, that snowballs and you start chunking out more time.
At that same time, you're struggling with, “Am I a PT? Am I an owner?” I think that's part of the struggle as you're trying to hold onto that patient care because you feel good about that. I am good at that. I went to school forever to do that. Breaking away from that is a challenge.
How did your team respond to that? I want to get your experience because I want to share the experience of my clients and my team members as well as I started pulling away more and working on the business. What was your team's response?
It was different depending on the team member. Some realized the benefit right away. They could see that I wasn't scatterbrained all over the place. I was making better decisions. Some didn't like that because I had to start to organize my business and accountability. I hold people accountable for their work and their jobs. I probably had a range of like, “You're doing such a great job. Thank you. You need time to do this. We're not going to bother you.” There was kickback where I'm asking them, “What happened to this? You said we were going to do this. I gave you a deadline and it was never done.”
I'm assuming those people didn't last long.
That's another benefit. As you start organizing and incorporating your purpose, values, structure and accountability, the people that don't align naturally start falling off. As they do so, the other team members are like, “Finally, they're gone.”
You don't see it until after sometimes like, “Why was I blind to that?”
I did have some say, “It took you long enough to finally get rid of that person.” I was like, “I didn't see what you guys are seeing. I'm sorry.”
If I had known, I wouldn't have acted sooner.
The place where you're at, you said recruiting is always hard for you. Fairbanks, Alaska, it's going to be hard, especially with your specialty. What are some other things that you're working on now where you're at that benefit the business the most?
We'll go with recruiting and travel because I think that was another big one for me. That was a huge mind shift change where I was fixated on hiring a permanent person from the PT. What I found was I could pretty easily find travelers. We have ortho here too that we get. People love the sound of Alaska. They want to travel up here. They may not want to live here, but they want to come up here for a little bit and check it out. I can pretty easily find travelers. I didn't want to for a while. I had one bad experience and then I was like, “Forget it. I'm not doing travelers anymore.”
I had to revisit that and make sure that maybe I should try this again. I know a little bit more, I need to screen these travelers a little bit better, ask better questions. That helped to grow the practice. Along the way, a permanent person may show up and that's pretty much what has happened. I can replace some travel positions as a permanent employee. What we found as we keep growing, we keep those travelers. I'm on board and so I have good relationships with a few travel companies that I work with pretty regularly. We always have at least one to two travel positions. Those companies help out a lot.
You take the time and energy to filter some of the travel candidates that come through. Maybe you do a little bit of training with them or you are to a point where you have people training them, which is even better. The energy that you can spend on that or not just take the first travel opportunity that comes to you, you can pick and choose you because you have the space to do that.
We've restructured our hiring process and our interview process so that we're finding out what this person is about before they get on board. It's not just me during the interviews. It's me and some other people sit in the whole step of the way, not just me by myself, which I used to do a lot before. I didn't pick up on everything.
How do you do that? Because another thing that I'm talking about with my coaching clients is so much of it is owner-centric. You have all the answers. You do all the things to make it run. If ever anyone has an issue, they come to you. What were the important steps to remove yourself from that position so that they could be self-sufficient, self-reliant, answer some of the same questions over and over again, train them and hire people without you the focus?
2019 was my big year of SOPs or Standard Operating Procedures, protocols left and right. Just creating them and making sure that everybody knew the steps and it wasn't just me and my head. That was a big deal getting that on paper so that everybody knew and we're still working on that. It's like an ongoing process, but I think that was huge because now questions that I shouldn't answer, maybe questions about the billing or questions about scheduling, those should be coming my way. Now other people can handle that. An office manager or financial director can handle that. That was a big deal for taking more things off of my plate.
Did you find yourself having to tell people to look up the policy and procedure manual even though you could have given them the answer? Did you have some issues like that? Because we had that where we're like, “There's a policy on that. Check that first and if it's not clear, then come to me,” to make sure they get in that habit.
It is directing them to the right person. If the policy is not clear, then that's a great question for the office manager and then she could come to me if it wasn't clear. The whole point was not to have all those questions coming my way so that I can focus on some other things.
I love that you brought up policies and procedures. I assumed you were going in that direction. The other thing that I found important to maintain a culture that Aisha wants to see is purpose, values, mission statement. I'm assuming you've got all that incorporated as well and it's part of the culture.
We tried to incorporate that into the interview process like, “This is what our core values are. This is what we're about.” In our break room, it's all on the wall, our mission statement, our vision, our core values. It’s there and visible to everyone. I'm serious about them. I'm not trying to be nationwide PT practice. I want what we have here to be special and unique and to provide a good service for our community and to anybody who's here on the team.
That's huge because I find as I'm talking to PT owners, I bring that up and sometimes it falls flat. They don't understand the purpose or they don't understand the significance of it. I have to tell them over and over again. It comes down to who you hire and how you fire, how you assess. It even comes down to so many times we get caught up as owners. I don't know if you faced this, but as you're trying to improve productivity, which we know would benefit the patient and the clinic, it turns back on us for those people who aren't aligned to be, “You guys are just pushing numbers and stats.” You want to have that purpose firmly established because then you can say, “No, following those stats helps us fulfill our purpose and our mission statement.” If you don't have that grooved in properly, all the things that you're trying to push, you're trying to become more corporate. You're losing the feel, all that stuff.
This I’ve learned over the years too. Any relationship begins with clear expectations. When that person is interviewed and then I'm brought on board, there are clear objectives like, “This is what your job is. These are your numbers.” Start that way and they shouldn't change much from there unless there was a big insurance shift or something like that, just being clear. If there is a change that the change is clear, why does that need to change? I’ve gotten pushback from things like that too. What am I about? Sometimes you have to revisit that and know that I have to maintain this business. My first goal is to be an owner and to make sure I have a good, strong, stable company so that employees have a good, stable place to come to every day.
Along the way, were there some influential books that you read that helped you that you would recommend?
I'm an avid book listener. That's what I say. There have been lots along the way. The one that comes to mind right now is The E-Myth. I'm listening to it again. I listened to it years ago and it was before realizing some things. Now I'm listening to it again and it is hitting home the fact that my main job is an owner. I'm not a PT turned owner, which I am, I guess. I'm trying to leave that PT mind elsewhere, not bring it into my business so much because it is detrimental to my growth. That's harsh to hear for some, but I’ve found that to be true.
The other one is the emotional intelligence book. I think Emotional Intelligence 2.0. It starts with a test. You test your emotional intelligence, which is something that can change in your life and generally it improves as you get older. Unlike your IQ, that does not change. What you start to learn is those who have higher emotional intelligence are more successful, whatever that means to you. They tend to be more in leadership roles because you can handle how you're feeling. You understand others a little bit better and you can navigate communication better. That one's been huge. I’ve incorporated that into our hiring here if it's a leadership role. If it's someone who's in a management position, we're going to check that out and see how it goes, especially if we don't know them if they're coming new into the company. That's going to be good.
It sounds like you've developed like a leadership path. Do you have leadership trainings? Do you have something set up?
It's not so structured, but that's where I'm going. Because as we grow, I’ve created leadership positions. My job is now to mentor those positions and just trying to figure out what's the best way to do it. I’ve grabbed some things that I’ve learned from my mentor, Jamey, and incorporated it into what we have here so that I can continue to nurture my team.
You eventually have to pull yourself out and as your team expands that you need leadership in place. What we did is there were certain business books that me and my partner both agreed on that were must-reads if you're going to be a leader. They had homework assignments. They had delegated some things, like you're going to lead out on team meetings once in a while or maybe a project here and there and see, are they able to rally the troops? Are they able to get buy-in? How do they interact one-on-one with people? That's a period of time. That's something that I think all businesses, as they grow, need to develop some leadership tracks that they grow. Because ideally, you'd like them to come from within because they've already bought into your values and purpose and you want to keep those people.
You want to provide an opportunity for them. That's one of my things as an owner, I want to provide more opportunities to my employees and growth is one of those things. Moving up is one of those things.
If you were to look back to the early ownership years, maybe before you had kids or within the first two children, what would you tell your younger self?
Probably to read that E-Myth book sooner, the entrepreneurial myth that you fall into. I want to do my own thing, but that doesn't mean you understand what a business needs. It took me a long time to figure that out. If I had come to that realization sooner, it would have just saved me from a lot of heartaches and crying and all that stuff.
Do you want to own a business or do you want to own a job? Because that's two different things.
I used to say that to myself because I had to break out of that thought, “Do I want to own a business or do I want to own my job?” Because that's what it is. That's what you end up facing.
Either way, you're a slave. You're either a slave to someone else or you're a slave to the business. That's not what you went into business ownership for. You want some freedom and some ability to do what you want when you want to do it. That's how you become effective. I can see in your path, and not to be some guy on the mountain or something like that, but you're going from a certain amount of success and you're moving into significance and how you can affect more people and be a better influence in the community. I love to see that transition in owners.
That's what I'm going for. I'm trying to think bigger. Before, it used to be how many patients I can see in a day. That's the amount of lives I can touch. Now it's like, “How many patients can we as a group see in a day and touch and help? There's such a need out there. What can we do as a group?”
Thank you so much for your time. Is there anything else you want to share with owners out there that might be reading? Our audience is independent practice owners, any advice?
Reach out for help. It's okay to ask for help and to not have all the answers. Even right now, I don't have all the answers and I reach out for help. I have a mentor and coach. I have a group of people that I can ask questions to. It's just a journey. Try to think of it like that with no end in mind. Keep going.
If people wanted to check out Willow Physical Therapy and your place, do you have any contact information you can share?
For those people who want to check out Alaska, they have a place to go when they want to work in Fairbanks.
There are lots to do up here. Just a little different, maybe. Fairbanks is a unique place. I'm from New Jersey, so it is odd for a Jersey girl to be out here, but there's just a uniqueness to Fairbanks that I love.
Congratulations on your success. You are a great example to other physical therapy owners. Thank you for your time and wisdom. I wish you the best of luck.
Thank you so much, Nathan. I appreciate you having me.
Aisha Wilbur, PT, DPT was STUCK back in 2016. Stuck in a bathroom during her only break from patient care trying to respond to emails, answer employee phone calls, catch up on patient notes, all while pumping for her newborn. It was in that moment that she knew she couldn't continue to live (or run her business) like this anymore. She finally reached out and got some help from PT Owners Club friend Jamey Schrier and as of 2019 has doubled her business and removed herself completely from patient care. An amazing transition that needs to celebrated among fellow PT owners.
Aisha was dedicated and focused in her efforts, and is now reaping the rewards. But her path is not unique. She followed the success formula - Reach Out (for help) + Step Out (of treating full-time) + Network (with other small business owners). In doing so she has all the freedom she wants along with greater visions for affecting her community in the future.
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If you consider marketing to physicians "Marketing 101" for PT owners, then obviously, marketing directly to consumers (potential patients) would be "Marketing 102." And if Marketing 102 for PT owners were a college course, Matt Slimming, PT would be the professor. Recognizing the changes happening around him - POPTs and hospital network consolidation, referrals from physicians are down 50% over previous years, etc. – Mark realized that he needed to access patients in a different way. Whether it's improving SEO, getting patient reviews, or utilizing social media ads, he found that there is a greater pool of patients available to him when he markets directly to the surrounding community, plus he won't have to rely solely on the doctors to keep his eight clinics steady busy! It may be a new concept for some of us, or maybe some of us have tried it and not seen the results. Listen to what Matt has to say and maybe he can guide you to online marketing strategies that have been proven.
I have Matt Slimming out of the Greater New Orleans area. Matt is uber-successful. You can tell he's a transplant from Australia. He came to America and has established and grown his physical therapy clinic to eight clinics at this time, I believe. He's doing something right. Matt has come up against some of the similar issues that we have as independent clinic owners in obtaining new patients with as many physician-owned physical therapy clinics that pop up, hospital networks that have gained ground in many urban areas. Based on the inspiration of an episode I did with Mike Bills, I'm excited to talk to Matt a little bit more about online marketing and getting your patients not from physician referrals, but focusing on direct to consumer marketing and how he is able to get more patients that way. Matt is going to share with us what has been successful for him in his online marketing and social media marketing approach that has led him to be successful and continue to grow and get new patients in this current environment. Let's get to the interview.
We have Matt Slimming, Founder and Owner of STAR Physical Therapy in the Greater New Orleans area. First of all, I'd like to thank you for coming on.
It's a pleasure, Nathan. Thanks for having me.
Matt, if you don't mind, I've heard great things about you. You've got a great presence within the New Orleans area, eight clinics. Congratulations. Tell us a little bit about what got you to this point where you've been able to grow to where you are.
What's allowed us to move forward was the struggle that many clinics have of suddenly finding themselves competing with an ever-increasing amount of pops and hops and start-up clinics coming from every nook and cranny. It happens to a lot. I was speaking to an owner in North Carolina and experiencing the same thing. Suddenly, they're everywhere. They seem to love to jump into the nice areas that people want to move to. Chances are if you're in a nice area, it's either undergoing a dramatic increase in competition or it's about to. We found ourselves in that situation where we had at that time three clinics and we found that we weren't growing anymore. We were starting to slip backward in one of them.
How long ago was this?
This was about 2010, 2011.
Were you starting to see some of these pops in hospital networks coming in?
Pretty aggressively. Also, our community that we're in, which is on the Northshore of New Orleans, our main clinic early on was designated as the place that New Orleans was growing to. Therefore, all the business owners wanting to get there before the crowd got big. We saw an influx of new businesses, the new PT clinics. We had to work hard at marketing. A couple of years later, it was about 2015, direct access became a reality in Louisiana. In 2011, we started the market aggressively and we started to do a little outside marketing. In 2015, we realized that we now have the freedom to market in a way that attracts the direct access consumer. Since then, we've been studying online marketing. Gradually, our business has shifted over the years to where that's the main focus of our organization is online marketing to gain the audience and the new patients through that media.
It's interesting that you say that because in 2014 or 2015, you got the direct access opportunity in Louisiana. It sounds like you guys jumped up on that quickly. It seems like a lot of physical therapy owners drag their feet when it comes to marketing direct to consumers. What do you attribute that to? Why aren't owners taking more advantage of direct access in their states? All of us have direct access at this point. Some may be better than others but we do. Why aren't physical therapists taking advantage of that?
In some communities, it is a concern that they might ruffle some feathers and that they might offend referral sources. The orthos have been against direct access with good reason that they would perceive that they might lose market share. We understand that. A lot of physicians in a lot of communities hold the belief that we shouldn't have direct access, that we don't have the skills and knowledge for that and the education for that. Because of that awareness, a lot of good PTs with great relationships with physicians didn't want to rock the boat. Why mess with something that's doing okay? That combined with the, "How do you do that in a way that works?" A lot of guys tried a few things, it didn't work for them so they said, "Forget that. We'll keep on rolling."
It's tough to swallow because like you said, there's not only competition coming around every clinic out there but there's also the fact that physician referrals are plummeting. I don't know about your experience, but my experience is if a physician is referring out to physical therapists nowadays, the majority of them are saying, "Here's the prescription." They’re giving it to the patient, "Find a physical therapist that you like." They're all good. We're commoditized in their view. We've always had that subservient attitude. We want to be subservient to the other healthcare providers and not ruffle feathers.
That's a different conversation for a different day about my issues with that but a lot of it goes to how do you do it? Do I now become the local car dealership that posts advertisements for other chiropractors that are doing it? How do we do it effectively? How do we do it in a smart sense that makes us look well but also shows that we are the experts? Maybe there's a part of that too where we haven't necessarily been the gatekeepers in the past. Are we prepared to be the person that sees that for that patient right off the bat because they've typically gone through somebody else first and been screened out?
To answer the second thought, we all deal with initially the idea of, "I have much more responsibility now. I've got to catch those red flags or yellow flags. I've got to make sure I know what I'm doing." There are a lot of PTs, and some PTs in our group, that we had to educate on how to do direct access well. That's the first thing we have to be good. We got to know that we're not going to hurt someone, that we're not going to keep someone from getting the care that they need that might be better for them.
As you're dealing with more direct access care and maybe as you bring on the physical therapist onto your group, especially new grads, is that one of the first things you're doing in your training with them? Are you saying, "If we have direct access now, these are some of the things that you need to sure up?" Are you doing some training in that regard?
We don't have our new PTs do much direct access work initially. It might be months that they're working with us before we allow them in that process. What we find is most PTs have the education to the DPT where they're effective at doing direct access. I didn't know that when I first came to the US. I went back and got my doctorate and that's what allowed me to have that knowledge. Most PTs now, they're coming out with good knowledge. There are more nuances perhaps that we have managing and massaging the direct access than just the clinical stuff.
We can do it. If it's a hurdle or it's a fear, it's a matter of training yourself a little bit more and getting ready for that opportunity so that as you do the marketing direct to consumer, you show yourself well. You become that actual gatekeeper and gain confidence. It's the repetition and the work that breeds confidence. The confidence doesn't come first.
It's a good point, Nathan. There are two groups, those guys who are confident and happy to be putting it out there and then the other guys who are just as great skilled as a PT but don't feel like they are the expert. The reality is that PTs are the experts at musculoskeletal problems from a broad area. We need not be concerned that, "I'm not the smartest PT in my community. There are guys out there who have more initials after their name. I shouldn't be the one doing this." No. You know enough to help people better than most of the physicians in your area, probably would initially is what you can do for them. We always have an obligation on ourselves to be intentional about helping our fellow man and getting the word out there about what we can do.
You guys had three clinics back in 2010. I imagine you might've grown a little bit here and there between then and 2014 and 2015. You've grown to eight clinics. Do you think most of that has come from your direct to consumer marketing?
A part of it, I wouldn't say most of it. Without that direct access marketing, we wouldn't have had the confidence to open other clinics. We know that we can be successful with zero physician referrals. We can still make it work. It's nice to have that behind you to say, "This will still work." We'd be foolish to only rely on that. We're all in communities. We all need only to be good neighbors and we all need to collaborate. One of the nicer things about direct access and being successful in online marketing is that we can now refer to physicians much better. That's a treat when you offer pods in the area looking to chat with you because you sent them a couple of patients last month. That changes dynamics entirely and it's a refreshing place to be able to live.
What are some of the successful actions that you can share with us that you're doing online and developing that patient referral base that is separate from physicians?
A lot of people start and try something. It doesn't pan out well until they say, "It's not for me," which is unfortunate because in every community, there's a way to do it that works. The first thing is we have some real strength as physical therapists. We are the good guys. Patients that leave your clinics will think of you as a friend. If they see you in the supermarket, they're going to give you a high five. They're going to introduce you to their wife. You are the good guy. You didn't bilk them, you didn't even charge them out the kazoo. You're reimbursed poorly as a physical therapist. No one thinks you're tremendously paid. You don't have that burden to deal with. We also can share comprehensively what we do and what we know.
Those two things are a real strength because a lot of other disciplines in healthcare, they’ve got some stuff under their hood. They cannot afford to be comprehensively honest and transparent because there is some weird stuff. I don't want to point at any particular type of doctor but we've got an opioid crisis. That would be an example of some stuff under the hood that might be hurtful. We haven't got that as PTs. With those two things in mind, we can be confident about marketing online. Being transparent about who we are because we're the good guys and what we know because what we know works and it doesn't come with side effects.
That's the base that we work from. We have to couple this educational approach because you can feel free to educate along with a degree of sales knowledge. It certainly isn't good to go out. They're good enough at least to go out there and tell what you know because you may help some people, but the chances are people aren't going to act on what they learned from you through some online medium. They're only going to get the help they need when they see you in the clinic. We have to couple that with some direction, some sales techniques that will bring these people into the clinic and that's in the form of a funnel. If you can imagine a funnel that you've got all these people that join your funnel at the top of the funnel and your goal is to get them through as many of those folks through to be patient as possible or at least of those that need your help.
You only want to help those that need your help. We don't want to be serving people that don't need our services. We have this funnel. You want to attract a broader group at the top of the funnel and you want to keep as many of those coming as a patient as the need to. There's a lot that goes into that funnel. First of all, I will say you don't want to be marketing physical therapy because when you ask someone, "What would you go to a physical therapist for?" you get all kinds of answers and it won't be negative. It won't be back, knee pain, shoulder pain. We've got to be approaching them with, "You've got this problem.” Let's say it's knee pain. You want to have your marketing be focused on how you're going to help that knee pain. From there, you draw them in with some good information.
We have a process that takes those people in through phone calls, texts, emails, and then possibly through some other ads going back to them to educate them a little bit more. Once you identify them, we call that retargeting. You draw these people through the funnel by more and more education until they feel A, that they are educated about what's going on a little bit and about how you can help them. B, they trust you because they've heard from you and they've seen your stuff in numerous channels, but they've also heard from you, your different ways. Now, they're starting to trust you. Once you've achieved that, it's much easier to go that last little step of the puzzle to say, "Come on in to the clinic and I'd loved to meet." There's a long process, but that works.
A couple of things regarding your process. What is the percentage? Is it 10% to 15% of people that need physical therapy or would qualify for physical therapy get it? Maybe it's even less, like 5%. When you're considering marketing to the consumer or the community, physical therapists are fighting for 5% from these physicians. We’re all fighting over 5%. If we could open up our minds and get a greater perspective that there's 95% more out there that need our services and what they don't have is that they don't know us. They don't know what we do. They don't know how we could help them. They can't like us because they haven't met us. If someone's going to buy, they're going to have to know, like and trust you.
What you're talking about then is developing this pattern so that you can show them who we are, what we do, like the message that you're sharing. They have to like it or they'll turn you off and they have to trust you that, "This does work." This guy does know what he's doing and I can put my knee and the faith that they're going to help me with my knee in their hands. There are a lot of thoughts to go that are going around in my head as you're talking because this is the direction we needed to go more towards. That is direct to consumer marketing. Take advantage of the direct access and how we go about doing that is education. Don't start with physical therapy because if you say, "Blankety-blank physical therapist is the best rehabilitator in the Greater New Orleans area," it's not going to get you anywhere.
I read a book called Building a StoryBrand by Donald Miller. People don't want to hear how you are the hero. They want to be the hero of their own story. You are otherwise the guide. You're the Obi-Wan Kenobi to the Luke Skywalker, they're the Luke Skywalker. They're looking for their Obi-Wan. If you can set yourself up as the Obi-Wan to fight the evil and get the bad guy, then they can become the hero of their own story. It goes back to a lot of what I hear from marketers is that they don't want to necessarily hear about how you're going to heal their knee pain. They want to know how you're going to get them back to golf or tennis or things that they want to do, a lifestyle.
It's often said that people don't make decisions based on information. They make them based on feelings. That's how most of us make most of our decisions. That's the case with me. We analyze everything, but in reality, we would be paralyzed if we analyze everything to the point of decision. We all do things on emotion. Nathan, it's important to be fit for them to feel comfortable and to like you. Thinking that you will be a good guide where they can say, "Show me the way," what a relief that is for people.
What are some of the successful actions you're doing online to create this funnel of available patients and to maintain them? Are you on social media? Is it email campaigns? Are you using some postcards? What are you doing?
We're doing work on Facebook and Google and email campaigns. Those are our main ways that we're reaching people now. Our website captures a lot. If you do all this stuff well, it's great for your SEO because it directs people back to your website. I'm a great student of Facebook and I utilize it for work fantastically I feel, but I am not a great partaker of Facebook. I'm not one that can sit there and look at whatever I was thinking now about the same thing or something. My wife tells me that every single lady that she knows is on Facebook. Thankfully, our wives, the ladies, the ones who make decisions about our healthcare, those are the folks that you want to hit. Those are the folks that make good decisions based on their emotions. They've got great instincts. If you can connect in the Facebook world, ladies and seniors are probably prevalent on Facebook, a bit more than younger fellows. It's a great opportunity for us that there's a great group to connect with.
You have to consider it. You and I probably do the same thing. If someone's going to send you a referral to a place, what's the first thing you're going to do? You're going to google them. You're going to see what their website looks like. See the picture. Who's treating me? Do I like that staff member? What does their website look like? Is it easy to navigate? What is your clinic? What does the inside of your clinical look like? If you're considering that person, my wife and I are the same way. If we're considering any vendor that we might want to use, throw it up on some community page on Facebook and say, “Who's a good physical therapist out there? Who's a good doctor for blankety-blank?” You'll get 4 or 5 replies. My wife does photography and she gets business because she's in a group or in different small business groups in the community. When someone on Facebook says, “Who do you guys recommend for some portrait photos?" my wife will come up. The same thing can be said for physical therapy. You're on physical therapy, I'm sure as your clinics, are you doing some Facebook ads as well?
We do a lot of Facebook ads. What connects with people changes all the time. What's working now won't be working very well in several months. With Facebook, there are a couple of keys. The first thing is you want to measure and track every single ad that you put out there. There's a lot of great information that Facebook provides for us. From as little as cost per action you want whether that's a lead or a click-through to how many people viewed it. You can look at likes, all those things. There's so much data that Facebook provides. Whatever ad that you do, you can check and analyze then measure how successful it is.
What we see now is that surprisingly, picture ads are still effective if they're done well. They've got to connect with the individual. What will connect in one community is different from other communities. The key is to be measuring. We'll throw out 6 or 7 ads for one particular opportunity. Let's say we have a funnel that we've put together a shorter resource online and we're trying to direct people to the shorter resource. We know that when they get into this shorter resource, there will be opportunities for them to connect with us through message and through email. They can set up an appointment with that shorter resource. We use seven different ads perhaps for it that will direct people to that shorter resource. There might be 2 or 3 picture ads. There might be a slideshow testimonial. There will definitely be a couple of video ads in there. We make video ads of different types.
The key is to measure every week we feel what's working and what's not. You stop the ads that aren't doing as well until you end up with the best 3, 4, whatever that are killing it for that. It changes over time. It used to be that the talking head ad would do well where it’s me sitting up there on Facebook saying, "Does this problem hurt? Let me talk to you about this problem." It used to work great. People either get tired of seeing the same face or it might be that they're tired of that type of ad. We've evolved into doing video ads that are more creative to them. There are a lot of great ways that you can get a good video that you can create and turn into a compelling ten-second message. It tells the story they need to understand in order to take action and click. That's the first thing. You've got to try different things and every community is different and it changes over time. Measure and get rid of what doesn’t work and keep on finding what's working better and better.
At your size, do you have someone that's creating that content? Do you have a team in place? Do you have physical therapists that are creating some of that content for you on a regular basis? How does that work?
That is my job, Nathan. The creative is me. I'm a frustrated marketing guy. I went into PT by default or something, but I love it. I find that fascinating science is creating an interesting creative. You've got to have that. You've got to have something that jumps out at people. That's my responsibility. We have other people in other paths that we follow too.
I'm not that creative guy. All that for me is like nails on a chalkboard. The important thing to take away is to find that person or get a team around. It might be this past episode that I interviewed Mike Bills. His physical therapists are responsible for creating one blog post a quarter or one article a month or something like that. It doesn't have to be a lot and maybe one video every quarter. They're developing this library of articles and videos that they can repost if necessary along the way so that content creation isn't all dependent upon one person. If it was depended upon me, it wouldn't happen and it wouldn't happen well. For someone like you, and there are plenty of owners out there that are the creative type and it's an outlet and fun and exciting, that's a great way to go but for the guy who might be a little bit overwhelmed, you've got to find, "Is there someone on my team that can do that?" Are there resources out there now? Do you use some other resources out there to help you out?
I can get video from different sources. There are websites where you can find a short video. The tricky thing is you can't type knee pain and there wasn't a video for knee pain. You've got to think outside the box. For example, we had a knee pain funnel and we want always to catch their attention. We've found this great video of different people dancing. This video phrase through had a couple of seconds of five different types of people, old people, young people, hip hop, all crazy stuff. The message was, "If your knee can't do this then you need to do X," which was the next step in our funnel. You've got to think outside the box and find a video that works and uses music that connects with the audience that would match that video.
Are most of your campaigns then diagnosis-based or body part-based?
I would say body part-based, not diagnosis-based.
Do you find more certain body parts attract more patients than others? I would assume that your back or neck pain patients or those ads might bring you more patients than others.
It's surprising, back can do okay. What we find is that there are many people treating backs in our communities. There are chiropractors, goodness knows how many guys would like to inject backs whether they be surgeons or guys that usually are surgeons. There are many disciplines that are trying to get onto backs. That's the toughest space to compete in. It's worth doing but shoulders do great. Knees do great. Surprisingly, we've always had a positive return on ad spend but we would think they'd be right up there with backs, but not as much.
Are you also doing Google reviews, Yelp or anything like that? One of my previous episodes was with Roy Rivera and he doesn't do any physician marketing. The one thing he stresses is that with every discharged patient, he sits them down and says, "Did you like your therapy? Did you meet your goals? Will you write a Google review for us?" He gives them the link card and then follows up a few days later with an email that says, “Here's the link to Google. Would you please rate us and write a review?" Do you do something like that as well to improve your reviews online?
We started a couple of years ago where we said, "Let's take this seriously." We did an intensive 60-day campaign to get a bunch of Google reviews done. It was a face-to-face process where we were intentional about doing it. It's not something we wanted to keep up because for us, it didn't quite gel for our PTs long-term. The way I feel about our PTs is these guys work hard and they are good at one of the most important jobs in the world. I want to be great at that. Enjoy yourself. I don't want to load them up with an ongoing Google responsibility. We use bot ware and there are a few of these companies out there now where patients are sent emails asking them to do reviews. That's an automated fashion and that works well. We may only get one review a week per clinic or something, but that's all you need. I'm not an SEO master, but it does seem that as long as you're getting consistent reviews, it doesn't need to be a bunch. Get a bunch to start with because you don't want to see that there are 30 people or something that like you. As long as you're continuously updating that, that's what matters.
If you can get some ongoing consistent up-to-date ones, you don't want to see a review that's from a few years ago. You want to see something that's happened in the last month. That can always be positive. It sounds like you're also cultivating some of your past patients via email. Is that right?
As part of our online process, we do an email campaign to all our past patients we have emails for every month. It's not a one-off email. It's normally in a funnel mindset. It might be saying, "This is the first exercise we usually give for shoulder pain. This might help you if you have shoulder pain." You want to see okay. You don't want to be harassing people with emails that don't apply to them. You only want to re-email people that opened that email. For those people that opened that email, then you can send the follow-up email. It might be an article or it might be a web resource that you've developed or something else. Maybe after the next email, you give them a chance to opt-in for a free consultation or an operation. It's funnel-wise.
Are you using something like Infusionsoft to do that for you or another program to help you do that so it's automated?
That works for you. Is that something that you're on top of? Do you have someone that manages those campaigns?
I'm on top of that. I enjoy the content. Building that content and I'm deferring a lot of the responses to other people to manage. I don't need to go through and I don't go through and respond to every email. They go to other people that can respond. I will send emails from our other PTs. All our clinic directors, I'll send an email to their past patient list from them so that when they read that patient response, it's going to that clinic director who can then answer questions and so on.
Anything else you want to share with us about some of your successful online marketing strategies?
A key is to think outside the box. Workshops have been great over the years and they've been effective and they remain effective. What we all should be striving for is if you've done workshops, you know who generally goes to those workshops. It's folks over 55. You might get a few younger folks in there, but generally it's the over 50, 55 group which is great. We want to serve them and they're our bread and butter. For most of us, most PTs reading, if someone offered them a workshop on any topic, they would probably never go out. Who has time? Nathan, you might have a couple of kids.
We've got a couple. I'm a little busy.
If someone were to say, "Nathan, why don't you come to sit down for an hour and listen to something about investing?" you have to say, "Will you give me the first $100 to invest?" You're not going to go. How do we reach people that wouldn't go to our workshop? Think outside the box. Think about what would get their attention. One thing we did that was effective was we created a full risk assessment page online. You could go to this page and you could answer some questions and it would give you a lot of great information. There’s video work on there too that tells people how bad their fall risk is. We had ads on Facebook and Google the directed people to, "If you want to find out your fall risk, here it is."
The great thing about that is that the CDC and Medicare are behind us. They desperately want us to stop people from falling down and breaking their hips. You can feel good about that educational program where people are learning, "I'm at risk for this. I didn't realize that many people fall every year and when you break your hip, it’s that much chance that you won't make it for another year." It's striking for people. That's been effective for us in educating the community. Those folks that need it, they're coming to the clinic to get their balance right again. They don't have time to come in there and sit around an hour for a workshop one evening, but they do have time to go through some emails, some texts, some phone calls, and then they're like, "I need you guys. Let's do some therapy."
It's a good exercise to go through before you start any of these campaigns is to think about who's your target audience. What do they need to hear? What are they thinking? What are some of their fears? What do they want to do? How is this inhibiting themself? If you have a good idea of what that avatar looks like, then it helps you write the content that's directed to them and it's going to get their attention.
It's certainly helped to have true patients for a few years. It'd be tough for someone doing this. We know those marketing groups out there that aren't in this therapy space but they're trying to sell you stuff. If they don't know patients at this intimate level that we know them, it’s hard for those guys to know what they want to hear.
If people wanted to pick your brain and maybe see what you're doing on your end, is there any way they can get in contact with you? Would you share your information?
I'd love to chat with folks. What we all need as PT owners are lots of other great PT owners being successful. That's what we need most because if that happens, then people know they need to seek out good physical therapy as opposed to the other specialists. I'd love to answer questions and help and guide people for sure. I love doing that. My email is probably the best. It's Matt@StarPTClinics.com.
Are you willing to help people on this journey towards online marketing?
Absolutely, Nathan. I chatted with one lady in North Carolina and gave her some direction of where she could go. I enjoy doing that. We're going to be working with a small group of PT owners and taking on some of their online marketing responsibilities for them and building out some campaigns. The other thing is not only is the content time-consuming to develop but managing the funnel. Responding to the replies, the emails, the text, the phone calls can be pretty involved. Most PTs haven't got time for that. We'd like to handle that for them as well.
That could be huge. It could be a good resource because if you're not a content creator and you don't want to do it, you don't have the time to develop the funnels. Most importantly, follow through on the metrics and see what's working, what's not working in any particular area. You’ve got enough stuff on your plate already as a PT owner and I'm assuming my audience would love to have someone help them with that.
I'd love to. It's a blast. We enjoy it. If we can help, that's a win.
Thank you so much for your time, Matt. I appreciate it.
You're welcome, Nathan. It's been a pleasure. It was nice chatting with you.
Matt has had extensive training and specializes in treating the spine, lower extremity and vestibular rehabilitation. He is certified in the Fishbain DOT-RFC Functional Capacity Battery, Golf Fitness, and Essentials of Musculoskeletal Imaging.
He completed Barefoot Running, Surgical conditions for the athlete, Tennis Rehab, Running Rehab, BEST Exercise Program for Osteoporosis Prevention, Rehabilitation for the Postsurgical Orthopedic Patient, Modules 1 and 2, Physical Therapies in Sport and Exercise, Modules 1, 2 and 3, Muscle Energy Techniques, Evaluation Manual Correction and Treatment of the Sacroiliac Joint, and Direct Access Medical Screening.
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Going through the interview or hiring process is much like courtship. When you are really smitten by the right person, you can become a nervous wreck and bumble the job offer process. Brian Weidner of Career Tree Network is back on the podcast to share even more wisdom on successfully recruiting and hiring your next PT. He shares some successful actions that you can take to increase your odds of getting a "Yes!" when you put an offer out there. You've moved the ball this far down the field, be sure you get it across the goal line!
I've got Brian Weidner from Career Tree Network back in the show in order to talk about that last step in the hiring process, the offering of the job letter. Sometimes that can be a nerve-wracking experience to send it out, not knowing exactly if they'll accept it or not. You're putting yourself out there and you want to seal the deal and sometimes we can lose people if we don't handle that correctly. We want to talk about that last step in the process and how to successfully offer and present a job offer to an applicant that we're excited to bring on. If you have read the past episode with Brian, we talked about recruiting physical therapists and some tactics you can use to successfully recruit more physical therapists on your team, but we niche down a little bit more on this interview. Let's get to it and see what we can do to make that last part of the recruiting and hiring process as successful one.
I've got Brian Weidner of Career Tree Network on with me. Brian was a past guest. If you want to know little bit about his story and where he came from, I recommend you look back. We talked about some tips and tools as to recruiting physical therapists and what he does at Career Tree Network to help physical therapy owners and staff their companies with physical therapists. He reached out to me because he's recognizing that there are some holes in our abilities to actually get candidates to accept our offers. We want to talk a little bit about best practices in terms of extending job offers and getting those people that we want, those physical therapists that we want to join our teams. First of all, thanks for joining me, Brian. I appreciate it.
Thank you so much for having me. It's great to be back. I appreciate the service that you provide here.
This is something that you've been noticing with the people that you're working with. What are some of the things you're recognizing? Maybe there are some tips you can give us on how to get that person that we want, that physical therapist that we think aligns with us and taking them through the application process, whatever that is. There's still that nervousness that maybe they won't say yes when I present them the ring on one knee. You’re going into this marriage and not sure what they're going to do. You worry about numbers. You worry about if they're going to accept it or not and how the negotiation processes go. What are some of the things we can do to make sure that goes to our advantage?
I like that example of a courtship process. You are building a relationship with this candidate and especially at a smaller practice, if they are hired onto your team, you're going to potentially see them more often than you'd see your own spouse or family. In a lot of ways, the people that you work with are your relationship, or at least they're part of your interactions with other people for sure. We've all had that time when we extended a job offer and then that candidate that we thought we liked and we wanted to hire, they would not accept our offer and they would go and work for one of our competitors. Losing that good candidate is very painful. It's also sometimes preventable in terms of the process that we're using. In general, we're at a point here where PTs are in very short supply. Whether we like it or not, they hold the control and they're driving the relationship often. That's because they have so many different options not only within private practice, but also in the other practice settings. When a PT is looking for positions, they're often interviewing at multiple organizations and it's important that in on their side that they find the best fit. Through those multiple interviews, they're also receiving multiple job offers. This is a topic that offers process, if you're doing it in a way, you can increase your response rate and you can actually get more candidates to accept that offer.
It does actually go back to like the relationship. What's needed is important. Candidates often lose interest quickly if they don't hear anything back. If you're able to extend that job offer quickly, that's the most important factor. We had one client who had a candidate who they liked, but the candidate was interviewing multiple places and they had multiple interviews scheduled down the road. Our client was waiting to potentially extend the job offer until that candidate had finished all of their interviews. In other words, the candidate was the best person for the job. The intention was to extend the offer, but they wanted to almost wait until they got permission from the candidate to extend that offer.
Like the candidate is going to say, “Now I'm open for offers.”
That's the first piece of advice that I would give is that you don't need to wait until the candidate is ready to receive the offer if you know that the candidate is a good person for the job. If they can do the job well based on your evaluation, go ahead and extend the offer.
We talked about this last time and how speed is so important. I don't know why we want to slow things down. Maybe that's a procrastination technique or maybe there's a fear that we're trying to avoid but think about it from the candidate’s point of view. If they think, “That interview process went well with that particular PT owner, I wonder what they think about me. I wonder if they're going to extend something to me,” and then I don't hear from them for a week. Going back to the courtship idea, usually if you want to go out with somebody, you want to let them know rather quickly and not wait a week and see if they come around to still wanting to go out with you. You want to jump on and as soon as you can. You don't want to let them linger out there waiting if you're actually interested and you're excited about that person. It's okay to show that excitement and extend the offer and say, “I was impressed with you. I'd love to bring you on to our company. Here's our offer. Hopefully you can talk more.”
Showing them the emotions and doing that heart to heart type scenario with the candidate is great. You never know, the PT might accept your offer and cancel the other pending interviews. There's no benefit to waiting. The only downside risk on that, which a person might ask is, “We can't have the job offer open forever. How do we make sure that the candidate gets back to us quickly?” The piece of advice with that would be to have an expiration date on your job offer. You could say something like, “We see you as a great candidate for our opening. We'd love to get this wrapped up as soon as possible. When do you think can you get back to me on the offer?”
Is it too much to say, “This is our offer for the next week?” If you know that they're going to do some interviews over the next two weeks, should you jump the gun and say, “We need to know within the next week,” even though you know that they're going to be interviewing for a little bit longer?
That depends. You might phrase it as, “I know you have a few extra interviews scheduled. Is there anything else that we could do now to enable you to accept our offer at this point?” Maybe there is something else, like a specialty area or a certification they were looking for or something simple that you could go ahead and do and that the candidate might cancel their other interviews. It's more of a case by case basis where you want to be respectful of the person doing their due diligence and making sure that they're exploring all the options on the table. At the same time, if you're open with the person and like, “We want this to work out. What can we do to make it happen?” that's a good approach. You never know what the candidate might say. It might be something we all fear, like if they're going to ask for a sign on bonus or they're going to ask for a corporate jet or a briefcase full of diamonds or something. We don't know what they're going to ask. They might ask for Friday afternoon off at 4:00 PM and you're like, “Let's do that.”
I like what you said about things that you can add because there are some things that maybe as smaller practices that we can add to the pot, if you will, if you're trying to woo a candidate that maybe other larger entities can't provide. That is maybe the ability to pursue a particular niche or treat a certain demographic of patients. Maybe provide time off to work at certain places within the community that you could leverage to then increase the patient volume on their schedule, something like that. Those are things that we can leverage as small practice owners, and you talked about this before we started the interview. It's important for us to play to those strengths, especially going up against larger chain practices or corporate settings that might be offering other things, even larger salaries. Maybe we have to stick within our realm and offer other things that maybe those companies can't provide.
A lot of our private practice clients are quite concerned on the salary side. How am I supposed to compete with the larger hospital systems? They have deeper pockets, they have higher reimbursements, better benefits, things like that. Playing to your strengths is the best approach. Private practices offer a great mentorship opportunity where you can play into that card. We want to be the best physical therapists in this community, and we will work with you and mentor you and you will exponentially grow in your skills here. That's one angle, that professional development piece. Another card would be flexibility as well. Like our company here at Career Tree, we're quite small but we offer a great flexibility. If you want time off any day, any time, go ahead, take it off. That's perfectly fine. A larger company would have policies and hoops to jump through and that is annoying for folks. That’s one other thing on the strength side. Some of the smaller clients that we have, they don't offer like health insurance, for example.
My recommendation on that would be to have a stipend earmarked on the paycheck that has a wellness stipend that can be used for a wellness benefit or health insurance where your employee might be able to purchase health insurance on their own via the exchange. If you don't offer health insurance, I feel like in order to compete apples for apples, you should still do la certain amount of money earmarked for that wellness stipend so that the employee can compare. “They're not offering me health insurance, but they do have this wellness stipend.” It helps equate the two offers. Some clients will say, “We don't offer health insurance, but we try and pay our people a premium rate.” That's fine but that money should be separated out in that separate bucket so that the candidate can see it clearly as a benefit to them.
They recognize the full value of their compensation. Maybe I can get your two cents on this since you're talking about benefits and that can be a huge issue whether or not someone joins you. I've sat in a presentation by the guys from Paychex. They provide payroll but they also provide HR support and they can help you with all your onboarding and your contracts that are reviewed by lawyers. You can also enroll in what they provide health insurance-wise. Because they have a large network of small business owners, their premiums can be lesser. Have you had any experience with a company like ADP or something like that where they provide benefits? I wonder if you've seen anything from your angle.
I know some of our clients are enrolled in similar programs where it's more of like a group plan. My personal preference and maybe from employing people here and maybe from a candidate perspective would be it's a lot cleaner to offer a candidate that money earmarked for the wellness benefit and then they can do whatever they want with it. If they get insurance through their spouse or maybe they're younger and they're still on their parents' plan. Because when you do those interesting health benefits, I don't want to name names, but there are some that they're not that great where the candidate would say, “The health insurance that you're offering me is very low quality versus what the larger hospitals are offering me.” Rather than comparing health insurance plans, it's better to give them money and then they can use that money for whatever they want.
I wasn't planning on going into this too much. If we didn't offer full health benefits, we would also offer what is called Teladoc benefits. We got ours through redirect health and that gives you 24/7 access for a phone call to any physician at any time. You talk to them about your issues and they can also prescribe medications and send the prescription directly to the pharmacy for you to pick up and offer $100 or $150 or something like that per employee per month. You can provide those types of benefits and I believe it falls underneath the Obamacare guidelines if you're greater than 50 full-time employees. It’s something also that's out there that you can utilize and not have to buy a full-blown healthcare plan for each employee that could cost you $500 a person. It’s good to recognize that there's a telehealth option out there. I actually love it because then I don't have to make an appointment with my doctor and take my kids in and all that stuff. I can call them anytime day or night and Facetime me if they need to see, I don't know, a rash or a cut. Nonetheless, we're getting a little bit off topic. Sorry about that. I like what you're talking about as far as working with that person and making sure speed is a part of the process. Would you ever recommend someone have an offer ready to give to the candidate in person?
Yes. That's a great option to do it when they're on site at the interview. If you have the interview scheduled and the candidate is coming in, you can have the offer ready to go and give it to them at the end of the interview day while they're there. That impresses a candidate that this practice is interested in me. You're covering the speed basis. They might accept it on the spot based on their positive experience from the interview and the job shadow. The only other piece of advice with that is some organizations will do reference checks or background checks and the fear would be, “If I extend the offer, how am I supposed to do reference checks and background checks?” You can have the offer contingent upon successful completion of the reference checks and background checks. We're extending you this job offer. It is contingent upon your licensure in the state that's contingent on your graduation from PT school. It’s contingent upon whatever else you need, but you're still offering them that position or giving them all the details at that point.
More than likely, extending them an offer in person isn't at the first interview unless you've done a ton of maybe conference calls, video conference calls or multiple calls on the phone. I'm glad you said after their onsite job interview because maybe you want them to work within your facility amongst the other providers and patients for a couple of hours so you get a feel for how they work in the environment and how and what the other people think of them. I could see where this might be completely appropriate after you've had a couple of those types of phases that they've been through in the interview process.
We do recommend doing the onsite interview in one day because it's very difficult to get the PT back and do a second day and oftentimes a candidate will drop out of the process if you say, “I want you to take another half day off of work and come in again next week.” That's not feasible for some candidates where if they're already there, I would say, “Let's do the job shadow,” or do whatever you need to do on the day when the candidate is visiting. You might not fully be interested in a certain candidate, but they can still do the job shadow. You might as well have them do everything on the same day. That way they don't have to try and come back. You don’t have to schedule it.
On the delay side, there will be less delays between the steps because every time that there is a delay, that candidate is considering other employment opportunities. Those delays are very important to minimize in terms of the sending the job offer in person. If that's not possible, the next best option would be doing it over the phone. I would not recommend sending it as a blind email. “Thanks for your time. We'd like to extend you the offer,” because you want to be there either in person or on the phone when the person first learns that they're going to be receiving that offer. Because then you can answer their questions and you can clear some things up right away and maybe get the process through to closure.
A lot of our clients would email the job offer, “We decided to offer the position to the candidate. We didn't call them or bring them back in person. We let them know via email that we were going to offer it to them.” That causes some delays because did the candidate receive your email? Did they open it? Did the attachment work? The candidate can wait and they can reply back at their convenience. Also, candidates are more likely to negotiate. They're more likely to feel empowered to negotiate job offers via email or text message, which could wind up costing a lot more in terms of wages and benefits if you negotiate via email because the candidate is more empowered to ask for things.
I can understand that. If I recall our process, we usually call and say, “We want to offer you this position. Look for an email from us.” You're saying you take it a little bit further and say, “We'd like to offer you the position.” Would you get into the details during the course of that call or would it be sufficient to say, “We're going to send you an offer. If you look in your email right now, it's there.” How quickly do you want that to happen, so we minimize that time distance between the interaction?
I would say the best practice is to extend the offer via the phone and actually go into the details, go into the most important details. “We enjoyed meeting you. I'm calling to offer you our position here. We're excited for the opportunity to work together. For a start date, we're flexible on that based on your preferences. For the hourly rate, we were looking at XX per hour. The benefits would include three weeks of PTO. How does that sound?” and go from there. You can say, “I'm going to follow up with the offer letter via email. It sounds like you need a couple of days to look at it. That's great. let me know as soon as you can because we'd love to work out with you.” Trying to get those questions answered as well right away is important because a candidate might not feel comfortable or might delay the process if there's emails going back and forth on questions and stuff.
If you can knock it out during the course of a phone conversation, then that could save you days of emails.
We’ve seen a lot of candidates that accept the offer right there on the phone. They don't negotiate. They accept. On the negotiation side, I may have talked about this last time, but a lot of newer grads are uncomfortable negotiating. They basically take what offer is given, which is from a business perspective, that's a good thing in some ways. Because PTs are in such high demand, they're not going to necessarily go back and negotiate with you. They're going to accept whatever else is out there that's better fit for their needs. We always recommend to aim high with the offer process rather than trying to low ball and say, “We're open to negotiate. Let's offer what the wages to as much as you can on the initial offer and leave it from there.” We can't risk the candidate not wanting to play ball and do any fancy negotiations. Because then we're going to maybe miss out on that person.
You imagine what you might gain in offering a lower salary. You could potentially lose out on them finding out that they could have gotten $5,000 more if they went over here and that being an issue down the road. What does that cost you to replace that person? If you low-balled and they're more than likely going to get a higher offer somewhere else, you might as well add onto your offer in the first place and thus avoid the possibility of losing that person, especially if they're aligned with you and you see a future with them in your company.
The wage from the employee perspective needs to be competitive. You can certainly play to your strengths like we talked about before, adding in some fun benefits that a larger company might not be able to offer.
That's part of the interview process. I talked about it a little bit with Kim Rondina. You want to find out where they want to go on the future, what do they want to do with their PT? If they're looking at particular things that they want to do specifically, that's maybe also during the course of that job offer where you highlight, “This is what we can do for you. We can provide mentorship via this channel. We can provide continuing education specific to this specialty that you're wanting to do. We can provide some bonuses that can be tied to student loan repayments.” That sounds like a big thing nowadays because every student’s coming out with hundreds of thousands of dollars in debt. As you not only explained the benefits, you also might want to take advantage of taking the time to explain the value add that you provide as a small business owner compared to other facilities they might go to.
Just one other point that I had on the offers and related to the business owner side is when you're extending the offer, try and remove the emotion from it. We don't know what's going to happen in the future in terms of will that PT stick around? Will they leave and go and work for somewhere else? There's a lot of fear and emotion around that job offer process and that often leads to the hesitation. Should I offer this candidate position? A larger organization, they're able to oftentimes move quickly because they don't have that emotional side. We often see it as well in terms of maybe holding out. We've had a few clients that we've had a lot of people interested in their position, but they're holding out for a rock star unicorn person coming forward. Not every candidate is going to be the next award-winning physical therapist. Not to say that you shouldn't hire a quality person, but if you have a job that's open, you need to evaluate candidates. Can this person do the job? Will they do it well to a certain extent? Will they meet the needs of what we have? That emotional piece sometimes comes into play.
The best way to get around that is to have other input within the hiring process so it's not you as the owner making the decision. You have your administrator or you have other PTs on your staff that are helping you like a panel discussion where the quality of the hire would increase if you have more data points and more people giving their perspective. You remove yourself a little bit. You obviously still make the final decision as the owner but to have more data points. It helps to remove that emotion in the process.
Maybe stepping back and saying, “What I need is a staff physical therapist.” If that person can perform that job and maybe you don't see a higher trajectory for them and you don't project them to be leaders, then maybe that's okay. Not everyone has to be leadership quality. I surprisingly had therapists who I didn't think would do much leadership-wise become clinic directors and killed it. Because not everyone has the personality where they're going to come out and shine and show a ton of charisma and be flamboyant and confident and know exactly what they want to do and how they're going to do it. “This is how I'm going to rule a team.” Not everyone's like that. If you're simply looking to add PTs on staff, you don't have to have the unicorn out there. Maybe you can suffice with a very solid rock star. Maybe not even a rock star. A very solid person who simply aligns with your values and that's okay too. Those people can have places within your company.
As your clinic grows and you're looking to add additional people, there's a business need to have additional staff. That business need, if you need to hire someone at a certain point in time, there's only a certain group of candidates that are potentially interested to join you at that time. When you're recruiting for a position and a given window of time, you're seeing the interest in candidates at this moment who can join your team, fill your position, help with your utilization and etc.
Is it only in that given period of time?
Down the road. If you wait six months, you'll have a different pool of candidates at that point. We need to be more business minded with the hiring process.
That goes back to what was successful for my business partner, Will Humphreys, and I especially as he was doing the recruiting, is that we're always recruiting. We're not going to limit our scope to this period of time. We're always taking candidates. We always have an ad out. We're always open to take resumes for physical therapists. That way, when someone does come along that is the unicorn, it's not only when we have a position available, but it's at any time we're open for that person to come into our clinic.
Not having that networking mentality and being willing to talk to candidates even when you're not actively looking. Are you still willing to you have a PT contact you? Are you still willing to talk to that candidate and maybe help them get connected with another practice area or to save their resume for your future hiring? Maybe they want to come in. Maybe they're a newer grad and they want to come in and do a job shadow. Would you be open to support that student or that recent grad and have them come in and network with you?
That puts you at least in a position of power where we actually had people on the bench waiting to get into our company. People who would tell us, “When you have an opening and a position in your company, I'd like to be considered please.” That puts you in a position of power so that when someone does leave, and inevitably someone does do so with short notice, we have a pool of candidates that we could pull from that had already been vetted. That changes the dynamic and it puts you in a different position altogether to find the next great person to join your company.
Some candidates are not in extreme hurry. We have a situation right now with a client where they do have a candidate waiting to go in basically. The candidate is continuing their current employment, and everything is fine. Once the situation opens and the clinic becomes available, it's intended that they're going to join the team. You never know what's going to happen. At least have a few people on the sidelines. It's great.
It makes a big difference. Thanks for your insight on that. We talked last time a little bit about recruiting the PT. I don't remember us taking it all the way through to how do you get them to accept that offer. These are some important tools and tips to make sure you carry that ball all the way across the goal line.
It's important. Obviously, we know once you have that candidate, you've interviewed them, you see them as being great and how do we seal the deal and actually get it going. Especially when you have larger organizations with more sophisticated HR and recruitment procedures, the PT is going to have multiple job offers as well. Getting out there and getting there first would be ideal.
Thanks for your time again. If people wanted to get in touch with you, Brian, how would they do that especially if they're looking to get some help for hiring PTs?
We still have our website, CareerTreeNetwork.com. We also added HireAPhysicalTherapist.com as our second website, which is more employer-focused. There are blog posts with strategies, information about our service as well. People can actually book a call to chat with me right on the HireAPhysicalTherapist.com website. I'd be happy to talk. I know I'm not a salesman per se, so I'm happy to chat about this for free. Feel free to book a call and we can chat if anybody’s interested.
Thanks again for your time. I appreciate you coming for a second go around.
Thanks a lot. It's a lot of fun.
Brian Weidner is the President of Career Tree Network, a recruitment advertising firm based in Milwaukee, Wisconsin that helps Physical Therapists connect with career opportunities.
Since 2007, Brian has helped thousands of Physical Therapists achieve their career goals within a new position.
Outside of the office, you might find Brian playing princesses with his daughters, watching heist movies or eating sushi.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Kevin 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.
I'm excited to bring John Woolf, a physical therapist out of Tucson, Arizona. He has a ton of experience. He is the Owner of ProActive Physical Therapy in Tucson, Arizona. He is also the Founder and Owner of Patient Success Systems where he provides coaching and consulting to physical therapy groups. He is also the host of a podcast called Master Clinician Storyteller. He’s a fellow podcaster. He is an athletic trainer as well. He studied physical therapy at Northern Arizona University and soon completed a Master's Degree in Biomechanics and Motor Control at the University of Arizona. He was the Head Athletic Trainer and Director of Sports Medicine for the University of Arizona in the ‘90s before entering private practice at ProActive Physical Therapy in Tucson.
In collaboration with the faculty at Texas Tech University, he also runs the International Academy of Orthopedic Medicine in the United States. You might have seen their continued education courses, IAOM-US. With this group, he's developed a course that explores the neuroscience and general impact of patient-provider relationships and their clinical outcomes. He teaches this course to providers and health systems in the United States, and this is what we're going to get into in this episode. He explores topics with clients through coaching and consulting through Patient Success Systems, his company, and that provides healthcare providers and organizations, systems and specific training to improve outcomes through patient-provider relationship training, changing their language and focusing on relationship-centered care. On top of all this, he's currently completing a Ph.D. in Performance Psychology. He also is on the clinical faculty at A.T. Still University for their Orthopedic Physical Therapy Residency Program. He has lectured on the faculty at the University of Arizona's Surgical and Nonsurgical Sports Medicine Fellowship Program in the Department of Orthopedic Surgery and Family Medicine.
John has a lot of great credentials. However, we're focused on the relationships between patient and provider and not just patient-provider, but also as owner to employee leader to direct report. We're focusing on building relationships. You'll hear from my story during the course of the interview, I noticed early on that a lot of patients don't really care how much you know about the technical aspects of physical therapy. Some do, and some are looking for that. Maybe a specific treatment protocol, but a majority of patients that come across our desks, that come to our clinics are more focused on us helping them see a greater vision and getting to a goal that they have for themselves. If we're not in touch with that and aligning our goals with their goals, then it's going to be hard for them to complete that plan of care and be successful in physical therapy. That can lead to losses in reputation, money, and credibility on down the line. It's important to focus on the relationships that we build with our patients. This extends to what we also do as owners with our employees. Let's talk a little bit with John about what we can do to improve the relationships that we have with our patients and coworkers.
I have John Woolf with ProActive Physical Therapy in Tucson. I’m excited to talk about his focus and what he's doing as a business coach and consultant with some of his training that he's doing for his Ph.D. program. John, thanks for coming on with me.
Nathan, it’s great to be here. I love your stuff.
Let's get started by telling everybody a little bit about your story. What got you into physical therapy or more so into physical therapy ownership and what led you to where you are now?
Like a lot of PTs, I had an injury in high school. I was playing football and I had a great encounter with somebody who was present to me at a time when I needed someone to help. It left a lasting impact. I went from one career choice as a senior in high school, which I had a pretty clear idea that I was going to go to the Air Force Academy and play football there. The next thing you know, I knew for sure I wanted to be a physical therapist. It got clear to me. I went to college knowing that that's what I wanted to do. I went to NAU. You and I share the same alma mater. After PT school, I came back to Tucson because I wanted to go to graduate school. I'm an academic at heart. I wanted to understand how the motor system works. I got a Master's Degree in Biomechanics Motor Control and I studied with a premier motor control specialist.
Interestingly at the same time, I ended up working at the University of Arizona in the Department of Athletics as a rehab coordinator and eventually as a director of medical services. I took over as Head Athletic Trainer and took care of D-1 athletes for a total of about nine years. Then realizing that state employment was going to be a one-way path, not necessarily bad but at the same time, I knew that I was interested in growing beyond that. I stepped out of the State Employment Plan and into private practice with a guy I went to school with. We got ProActive Physical Therapy up and running and grew to up nine clinics.
When did you step out? What year was that?
It's about 2001.
You grew rather quickly to get to the point where you are at nine clinics.
It was a lot of enthusiasm and a lot of learning.
Along the way, did your partner or you have some business experience that helped you to grow that quickly or grow that big?
No, and I think for a lot of us, the business experiences that we have are the business experiences that we create in our minds. Many business owners have a vision for what they want to create. They may even have a certain acumen for putting things together and developing relationships. Business owners have a certain gift that inspires them to get out there and take some risk. That's one of the biggest gifts. What happens though is often business owners fail to realize what they don't know. What it becomes is a long journey of discovery, learning what works and what doesn't work. I have a very long list of absolute mistakes that have taught me a whole bunch of things along the way. If I can say if there’s any super cool thing about getting older, is that you know that you made a lot of mistakes and that you learn from those mistakes.
That’s tuition for that experience.
I'm mindful of that now when I'm going, “Is there any way I can help somebody avoid some of the mistakes?” It's almost like I had to make the mistakes in order to learn them because I’m stubborn headed that way. The stubborn headedness is the same chutzpah that gets people into the game of doing things.
What are some of the things you might have learned early on that you can look back and say if you were to counsel or coach someone who's in their first year of ownership? Is there something that sticks out or an experience that you have that you would recommend or share with someone like that?
The most important thing is some clarity at some point about where you want to go. If you're out there and you’re one and you've got some things going and you're working very hard because everyone in your one is working very hard. It's about developing some visioning process about where in your heart of hearts want to take this thing. If it is truly to grow it to three, four, six, eight or twelve clinic system, that's important to have a sense of. If it’s like, “Things are good. I just want to get two or three or more therapists over a period of time,” that's good too. There’s no right or wrong answer. It's about this idea of having clarity. I say that because I spent a lot of time flailing. When I say flailing, it's like I'm busy. I’m working hard and doing a lot of stuff but I really don't know if I know where I'm going. What that means is if you don't have some clarity or a target or a destination, it's difficult to know in which direction to row the boat. I spent a fair amount of time splashing around and spinning my boat around in circles. Often frustrated because I didn't know the very next important thing to do.
It speaks to vision. As you're talking, some of it speaks to purpose. If I'm going to grow this to four, six, eight, twelve clinics or if I'm going to stay single practice, why? What's the greater end? For what goal am I trying to do this? That's what it tells me.
That is a process. I use that word a lot. It's a process of cracking open your own brain to figure out what's important about this to me. When anybody gets clear and what's important about this, it totally realigns the motivation structure. It creates a lot of clarity about what the next step should be in order to get there. We'll borrow from that start with the why concept. It's important not for the popular psychology that we've come to appreciate but the actual psychology research. It lends itself to the importance of having meaning in any endeavor. This is no small endeavor.
You're studying about a lot of that when it comes to performance and motivation and whatnot?
I am. Let's say you had a midlife crisis. Back to our story, I get to recall earlier on in my journey when I was going, “What's important about this to me?” I had a great deal of realization that healthcare is jacked. It's broken in a lot of different ways. We're experiencing it at a real technical level of trying to figure out how to get paid. That's the super important part. Even beyond that, I kept going, “What's missing in this whole equation of serving a mission around healthcare?” What I came to conclusion is I just wanted to change it. Let's say you wake up in the morning with that as your mission. What are you going to do with that besides having a cup of coffee and contemplate? The lunacy of even thinking that that's important. That’s what I do every morning, I figure this out.
If that's what's important to me, I had to step back and go, “How am I going to do that?” I needed to understand what exactly creates a good and healthy outcome in any part of healthcare. Let's say you are in here in the United States and in a modern delivery system of what we have come to learn as ill-care or if you're in another part of the country. What if that creates an outcome? I took my academic geekiness, or I should say my desire to truly understand something. I studied like most of us have studied the orthopedic side of things, Orthopedic Manual Therapy, and differential diagnosis. I feel over the past 30 years, I've developed a pretty good handle on how the musculoskeletal system works and the nervous system around that. I’ve got to tell you with an outcome, that's only a percentage of the attribution factor.
A lot of what an outcome can be attributed to is how one's belief system aligns to it. It truly, as much as we've heard it, is a biopsychosocial model that works, which means you've got to go biopsychosocial or psychosocial. This cool motor system that we're walking around on, I call it a robotic system, is governed by a pretty fancy computer system. I embarked on a Ph.D. program in Performance Psychology to do a deep dive into the research about what really happens to get people motivated in order to take care of their own health. What motivates a physical therapist to inspire patients in a way that gets him performing? What inspires a business owner and how can they create a way of thinking about things that lead to the processes that help them to grow their business?
The things that you teach, coach or consult when it comes to inspiring the provider with their patient or the owner with employees or peer-to-peer relationships to inspire other people. Is it the same pattern that you use, whether it's you talking to a patient, you talking to a co-worker or you talking to an employee?
Yes. What was important to me is to get deeper into the foundations of human motivation and the impact of language and identity. The impact of relationship on motivation. I believe, and I think the research is going to bear this out that there are specific formulas that are universal. That which we use with patients can also be used with our employees, colleagues, and with our spouses. It goes on. This is why I went to CSM and I made a presentation to the private practice section on why patient-centered care is a myth. I'm on this topic, although the concept of patient-centered care is cool because it swings us away from this idea that it's all about the expert or the provider. We have to engage the patient. I get that part, however, have you ever been in a one-sided relationship? A relationship where you were constantly focusing on the other person. What would that feel like?
It's cool to focus on the other person, serve them and see them progress and grow. In some situations, that can be cool.
What can happen over time though?
Overtime, it wears.
That's what I’m talking about. It wears on you. It starts to get the burnout factor climbing. One of the things that we're suffering from in healthcare overall is this constant top-down pressure. For performance, of course, we have to do that but it's compassion fatigue. It's the ability to show up every day with your best stuff. If it's all about the other person, it's not a formula that succeeds. I'm shifting the conversation from a patient-centered model of care to a relationship-centered model of care. It's not about what happens to the patient and it can't be all about what happens to me as a provider. It has to be about what happens between the patient and the provider.
How do you do that? How do you switch from focusing on the patient to focusing on the relationship? Focusing on the patient seems very easy. I can get some objective measures as to how well their knee is doing. The focus on the relationship would seem a little bit more ambiguous and subjective.
The way to do that is to start with the patient. When I teach this in a two-day course, the foundational element is to try to understand exactly where the patient is. What is it about the patient’s world right now that needs somebody like me, listening and how to ask the questions to extract that information in a thorough fashion? How to engage with them? When I have their map of understanding, I then get a chance to help them get to where they want to go.
It's a lot of where in a regular evaluation you're going to use a goniometer to measure range of motion. You're talking a lot about the questions regarding the person and how this issue is affecting their lives. Maybe what some of the issues are around them, their environment at home and in their personal lives and whatnot?
The more meaning about it, the better. The more meaning means that I get to have a better understanding of what this person needs from me. It is going to be different from one person to the next. The trap we fall into as business owners is the same formula for everybody. Sometimes it works, sometimes it doesn't.
This is what I'm gathering and thinking of in my head. It takes a lot of questions. It takes a lot of focus on trying to understand where they’re at, in order to see how you can affect to them and make sure you're on the same page when it comes to what they want. Whether that’s a patient or whether that's an employee, spouse or child or whatever. It's first seeking to understand before being understood.
That's not brand new. The answer is yes. The struggle for many people, business owners included is, “How do you do that well?” I've come to learn this and teaching this for years is that you have to have the right mindset for it. You have to understand the value of it and why it's important to do it? Ultimately you have to have the skills to do it. In healthcare generally, although we're taught how to ask questions about clinical relevant sub-things, rarely are we taught to ask the right questions in a manner that extracts what's important to somebody else. That is a skill. What I've been trying to help people understand is that is a skill that is equally as important as the hands-on skills that you're trained in or the exercise skills. When you can communicate well with a patient, you get clinical information that is going to greatly impact your outcomes. That's only the first step.
How do you teach that skill to ask powerful questions?
I have done it in two ways. One, I've taken the neuroscience of why this is important and how this actually works in the brain so that colleagues who are physical therapists would start to go, “I get this.” What I want to make sure that people understand is that I’m not a psychologist. I'm not trying to turn physical therapist into psychologists. What we're trying to do is we’re trying to give them skills so that they're psychologically informed to understand that there's a person behind that need. How we deal with that person specifically is going to create the outcome. The first part is the basic science of it. It’s not unlike learning how to manipulate a shoulder. You have to understand the parts of the shoulder before you climb in there and start yanking on it. That's how we do it. We teach people the basics of that. From there, we teach very specific skills not unlike in a laboratory where you're going to grab the shoulder. Learning what it feels to see how the shoulder moves, use your hands to sense the tissue quality, degrees of motion and the translation. We do the exact same thing about teaching people what it feels to connect with others at this level. They get to go, “That's interesting.”
Are there any exercises you could share with us as a teaser of what you provide that you might recommend to develop more of that skill set?
I've got a pretty interesting example that I use in the course. We'll do one of the exact exercises I do in the course. If your audience has a quiet space to give it a try, it will be pretty cool. This is a skill set called Problem and Solution Language. Oftentimes, medicine is focused on the problem. What's the very first thing that we ask a patient when they come into the clinic?
“What's wrong with you?”
The other one is, “What's the level of your pain?” Where's our focus?
Pain and the problem.
Step back for a second, close your eyes and listen to the following questions. I want you to think of an issue or problem that you're currently facing. Don't answer the questions. I want you to pay attention what your internal brain does. When is your problem the worst? How has your problem limited you in other aspects of your life? What will happen if this problem is not successfully resolved? What is the worst thing that will happen if you don't resolve this problem? Did you get that?
I want you to compare that with this. Feel what this feels like in your internal state. How will you know you have resolved this problem? How will you know you were on the right way to resolving this problem? What would be the first sign? What else is likely to improve as a result of solving this problem? What will it be like to look back at how this had been a problem? You listened to two sets of questions essentially around the same thing but what did it feel like in the first set of questions?
I don't want to say fear but there was more negativity. There was more dour. I've felt foreboding.
What you're doing is you're thinking about, “What kind of an atmosphere is foreboding? What neurological state are we bringing our patients sometimes into as a result of the questions that we use? Is it optimizing physiology?” How we talk to patients impacts a patient's physiology and the questions we use and how we ask the questions matters. If we think about this as a specific skill, we get a chance to impact how we inspire or detract from somebody’s self-talk, their emotional state or their mental mindset. We get to presuppose that there's something good going to happen rather than a dire endless sense of dread.
Some imminent problem is coming, waiting for the other foot to drop.
What we're doing with these skills is we're trying to help therapists understand that how they talk to patients is a skill. By learning these skills, your outcomes are going to be better because the patient is going to be more likely to follow through with their treatment plan.
Do you see the same effect on employees, people that you’re working with and the questions that you asked them?
Yes. As a leader, there's a real important identity that comes with being a business owner. If you're being a business owner with more than yourself in the business, then at some point you're a leader. Leaders have the ability to inspire behaviors or to demotivate people through the way they communicate. These skills not only are useful for the therapist with regards to their patients, but it is also useful with our ability to communicate and inspire others to reach whatever goals that we set before them.
You have a set of questions. Are these some of the example questions that you’ll give clinicians to share with their patients?
That's exactly it. Let's say a patient comes back on a second visit. I hear some of our colleagues asking, “What's your level of pain now?” What's the first thing you have to think about? Pain. Another way another way you can ask a question is, “What improvements have you noticed since our last visit?” Guess where their brain has to go when you asked that question?
What's better in my life?
They have to go there and it's pretty useful. It's sometimes a better place to start. To take those other questions and put them in more general clinical terms, what will you be doing? This is some language you can use. What will you be doing or how will you be thinking, feeling and speaking when you have moved past this point? What will be different or better when you're healthy again? Think about that question. What will be different or better when you're healthier again? Part of the skill set is pausing and watching the patient search for that information. Determining the degree to which they're capable of actually seeing it. I've got to tell you more often than not your patients will pause, and they'll go like this, “I don't think I can see it. I don't think I can see myself getting that much better.” If your patient can't see themselves getting better, what are the chances that if not addressed that's going to hinder your ability to get them better?
If they can't have the vision themselves even though you have a vision for them, if they're not seeing it, they are going to stop themselves from getting there.
Who's going to have to carry the burden of the vision? You are.
You’re working all alone on someone who's not willing to work with you.
What happens to that patient is they don't get there. They “failed” physical therapy. They don't complete a plan of care or they have a stray of cancellations and no-shows. Sometimes we're working at the wrong end and we don't even know it. It would be the same formula for a business owner who's trying to get a certain level of performance out of an employee for example. If there's not clarity on where we're going in this vision, it's going to be very difficult to get the expected behaviors. These are the skills we’re completely for the most part missing in healthcare. I can also say that some people do this well. Nathan, tell me, “Have you ever been in the clinic?” This is an interesting framework that I've noticed. You see a group of clinicians and some have all of the certificates, certifications in manual therapy and their skills are extraordinary. They've learned all the technical aspects of it. Their outcomes are okay in a lot of stuff but then maybe there's another clinician who hasn't taken all those courses and classes. They knew some of the clinical skills that you go, “I don't know if that adds up to me,” but yet their outcomes are extraordinary. Their patients love them, and their cancellation and no-show rates are low. The reviews from their patients are great, but are they doing the top-level evidence-based clinical skills? I was so frustrated by this I said, “What's missing with this person?”
I learned that early on. I got a sense with physical therapy especially because we see our patients so often, we develop a relationship with them that it's almost more about the personality at times. As I hire, I look for those soft skills. Those things that you can't learn, not the hard skills of our technicality in the profession but the soft skills, the personality skills. One of my first hires, a clinic director eventually ended up becoming my business partner, Will Humphreys. I knew he was going to be successful. I didn't even know how much education he had but I knew he would be successful. He was so personable and that bore out over time. Even he said within the first few years as he was running his practice, he would bring on other clinicians who had a ton of experience and patients would get better with them. The patients would end up on his schedule all of the sudden. He'd asked them straight up, “Why are you coming to see me?” They'd say, “I was getting better with that other guy, but I like working with you.” Not only was he very positive about everything that he was doing and very personable, but he did a lot of this. He could see a vision for people, help them and engage with them so that they could see a vision for themselves and recognize that, “My life is better if I work with this guy. I feel better about myself.” That led to improved outcomes.
What I'm doing then is giving people who do this. If you ask Will, “What are you doing?” He might go, “I don't know. I'm being me.” For example, if Will takes a course he goes, “That's what I'm doing.” He gets a language for what he's doing. He gets to label the innate qualities that he already has using. The colleagues who are not as innately gifted with this, you get a chance then to teach them because now you have a language for it. It's not like people aren't all capable as Will. It's like some people are probably capable. They just don't know how. Anytime you take a concept that's relatively abstract like patient engagement, which I still think is a fairly abstract concept and break it open and put some language to it then you get a chance to teach it. If you can teach it and measure it, you get a chance to improve it. That's Business 101. You can't manage what you can't measure.
What's measured improves. I like the language that you put in that. This is solution-based language and not a problem-based language for clinicians.
That’s an example. We take people through a series of these specific skills that have to do with communication, not just the language that you use, but state management, your own state management. The importance of rapport. What exactly is rapport?
Do you get under accountability and language behind that?
What do you do with someone who's not doing their home exercises? What's the secret formula so that you don't get all pissed off with the patient which is everybody’s first and then they have a bad experience. It's not like you chastised them and like you're a bad person because you're doing it. I'll bet you a fair percentage of therapists probably leak it out nonverbally, a certain level of disappointment like, “I'm showing up here but where are you at? How come you're not doing your part of the relationship?” That's why I'm trying to focus this conversation on an idea of a relationship. We have to understand the patient has needs, desires, and goals so do the provider. You have expectations. You understand what the problems are. You have specific goals that you have to accomplish. What do you do with a patient who's chronically ten minutes late? That's going to eat into my day in a pretty significant way. I've seen too many colleagues go, “I don't want to see them.” That's one option which means you lose the visit. The other is I'll see them and then I'm going to try to take awesome care of them. Give them the full thing but then I'm going to get behind and then the rest of my patient day is going to suffer. There's a real constructive way to deal with that patient in a manner that respects and honor what you need in a relationship, while at the same time honoring and respecting what they're bringing to the relationship.
I like how you bring that up. They have goals for themselves and you might even have goals for them, but you are in the background have your own goals that are related to their care that aren't necessarily specific to them. Some are objective measures that you're being measured by. You're working together to achieve different goals, but you've got to understand both sides of it as the provider or as the leader.
This is why I say that if you do it with a relationship-centered approach, you have what the research is calling out, is this idea of a therapeutic alliance. It's a good word and it's got great evidence behind it. It speaks to what's happening. A therapeutic alliance by definition is an agreement on goals, tasks, and unconditional positive regard for the patient. Can you do that? Can you get a complete agreement on the goals and complete agreement on the tasks required to accomplish the goals? Can you do that all in the context of unconditional positive regard? This is where the training comes in. If you do this, you're going to get optimal outcomes. Patients are going to be happy. The physiology is going to be optimized. They're going to be motivated. Their chances of sticking with a treatment plan are going to be at their highest.
They're likely to show up for visits and complete a plan of care so that, “Physical therapy succeeded,” because you’re able to give them the right dose. All too often, if that alliance fails. Let's say we're not clear on the goals. What if your goals as the therapist are different than the goals of the patient? It happens all the time. Let's say you have goals for the task to accomplish the goals, you have one thing in mind and they have a different thing in mind. That's not going to work. We spent a lot of time developing real clarity upfront with real concise communication platform. This isn't rocket science. It is information that once you get it you go, “Of course, that makes sense.” Once you get some of the language skills then it gets super easy after that.
To come down to it, what comes to mind is my interview with Heidi Jannenga of WebPT. They did their state of rehab reports and they found that the average clinic lost $150,000 a year simply because patients did not complete their plan of care. It can be a money factor. You could literally lose hundreds of thousands of dollars on average because you are not aligning with your patients successfully.
You're not doing the most fundamental part of why a patient comes to see you, which is a healthcare relationship. If you don't get the relationship right, the best manipulation exercise in the world isn't going to get you any further. You've got to do the relationship right. That's number one. When you do that, everything that you do after that is going to make a better difference. Everything succeeds after that. That's how we need to change healthcare is make this a very practical approach. This isn't mythical. It's not some ethereal psychological techniques. It is regular simple communication skills and enough knowledge to know how to apply them properly.
Are you giving more of these continuing education in this in the near future?
That is correct. I'm putting together the schedule. Some of it's already in place, some of it is yet to be determined. More often, I end up working with a clinic or a clinic system that's interested in putting this information in the hands of all of its clinicians. I will go out to a group and give a one or two-day course on this content and then help them build some of the processes necessary to pull this off.
If someone's interested in either taking your course or reaching out to you to bring you into their clinics, how would they do that?
The best place would be to go to PatientSuccessSystems.com. That's probably the best place to reach out.
They can get ahold of you through that website and they can also see when you're offering these courses?
Are you going to be speaking anytime soon?
I don't have anything scheduled. I went up to the market challenge up in Denver and did a great one-day gig with their fundraising event. We took a lot of students and some of the therapists in the community and did a great training program where they got an idea of exactly how to put this in play. It's funny about new grads. Even new grads who we already sense are struggling with communication at some level because of the technology and other concerns that we have. This is important for those new grads to get because it's going to take years to get their clinical skills dialed in. If we can work on relationship ship skills right off the bat, then anything that they do with the patient skill-wise and their technical skill-wise is going to have a better outcome.
They can be successful right away even with their limited skill set. That’s huge. Just thinking about that, it would be wonderful training for any new grads to be sent to or to have some experience in.
The skills aren't about the relationship, it's also knowing that you have to have a certain amount of integrity in the relationship. Not that you have to do more. It's like, “How do you know when you're starting to feel the burnout or if you're starting to feel resentment towards the patients?” You are starting to feel anything. If you don't tend to that stuff regularly, it will lead to burnout. Burnout leads to crappy care and not just attrition. Attrition from your clinic team but it leads to care that’s substandard. It's less than engaging which is going to impact how people leave a review on your Google page. The degree to which they are willing to leave a review at all. All of these things can be measured and managed, but the take-home message is relationship and engagement. Relationship-centered care rather than patient-centered care and engagement.
Thank you for your time. I really appreciate it, John.
Nathan, it’s my pleasure.
I encourage everyone to go and check the website. Even from the little that they could implement from what you shared, there's much more that could be hugely valuable.
It's a process of learning and had I known this years ago, I probably would have saved myself a whole lot of headache and I probably wouldn't be able to grow the practice even faster.
Thank you for your time. Have a good one.
John Woolf is a physical therapist and athletic trainer. He studied physical therapy at Northern Arizona University and soon after completed a Masters degree in biomechanics and motor control at the University of Arizona. He was the Head Athletic Trainer and Director of Sports Medicine for the University of Arizona in the 90’s and then entered private practice at ProActive Physical Therapy in Tucson, AZ where he was the CEO of a 9-clinic organization.
In collaboration with a faculty based at Texas Tech University, he runs the International Academy of Orthopedic Medicine - US, a continuing education company that teaches physical therapists, and medical providers in the US, Europe and in South America.
With this group, he developed a course that explores the neuroscience and the general impact of the patient-provider relationship in the clinical outcome. He teaches this course to providers and health systems in the US.
He explores these topics with clients through coaching and consulting company, Patient Success Systems, that provides health care providers and organizations with systems and specific training to improve outcomes through patient-provider relationship training, change the language and relationship-centered care. He is currently completing a Ph.D. in performance psychology.
He has lectured as clinical faculty at the University of Arizona’s Surgical and Non-surgical Sports Medicine Fellowship Programs in the Department of Orthopedic Surgery and Family Medicine. He lectures for the University of Arizona’s Integrative Medicine Program and is on the clinical faculty in the AT STill University Orthopedic Physical Therapy Residency program.
He is proudly married to Chris and has two children, Natalie 22 who lives in LA and Timber 20 who is a freshman and Northern Arizona University.
Our guest is Christopher Music who's a financial prosperity coach. Financially speaking, this may be the most important podcast that I've done to date. Christopher joins me having twenty plus years of experience in the financial planning profession and is a best-selling author and financial expert. He's been seen on NBC, CBS, ABC, and Fox affiliates around the country on The Brian Tracy Show. He's also been noted in Forbes Magazine, Newsweek, and various healthcare industry publications. Christopher has over 100 physical therapy owner clients in his practice and has focused his efforts on the private practice owner, whether that's in physical therapy, veterinary medicine or dentistry.
A lot of the tenants that we speak about are true regardless of what industry that you're in. You're going to find some immediate, near, and long-term financial success by following it through with those tenants. I can’t underscore the importance of it. He’s got some great information both in the podcast and also on his website which is www.PChristopherMusic.com. He has free information, free downloads and has plenty to share but hopefully what you take from this is at least one or two things that you can immediately implement into your practice ownership so that you can make it a financial asset in your life and create the stability and financial freedom that you’re looking for.
Thanks for joining me, Christopher. I appreciate you joining the podcast. As someone who's not a physical therapist, I love bringing you on because you work with over a hundred physical therapists across the country. Do you mind sharing with the audience a little bit about yourself professionally and your work with physical therapists in general?
Thanks for having me on the show. I've been a financial advisor now for 26 years. I started in Columbus, Ohio. I built a practice and I sold it for twice the average market value in 2002 and moved to Florida. I became a business consultant working in a lot of different professional practices and different small businesses. When the great recession came along, I realized that people were getting killed financially because they had no real technology on how to attain and maintain wealth. It's a very multifaceted subject. I went to work and created a science of financial planning called the Econologics. While I was building that, a lot of my friends who are also business consultants had different professions that they consulted, like chiropractors, dentists and veterinarians and one of them consulted physical therapists. I went to them and said, “Why don't you refer me to a couple of clients?” They did and they were in bad shape. I said, “No, I want the good ones too.” “Why don’t you create a seminar where we can educate these PTs on how to build and protect their wealth and we'll get the financial plan as part of that package?” We developed relationships and we have 120 PTs that we serve all over the country from Hawaii to Maine. We help them build and protect their wealth in a very scientific and very predictable way.
Having such a varied amount of experience with so many physical therapy owners across the nation, what are some of the common themes or common issues that you see amongst the physical therapy owners that come to you financially speaking? Is there a common issue that they're dealing with in general?
There were a couple. The first one is the mindset. You have a PT who is interested in physical therapy, not business ownership for being a professional investor. The problem is when you get involved in private practice, you now have two other functions that you need to be as good as or better than you are being a PT. The first one is being an executive. You need to know how to create a group of people, how to manage them, how to hire, how to train people, how to manage your finances, sales and marketing, public relations and so on. I have an MBA and that was worthless. You have to learn from someone who had the blueprint. You find the top 10% of successful PTs in your industry and find out what they're doing and do what they do.
Follow the same blueprint that they created because they’ve won that through blood, sweat, tears, money and sacrifice. That's where you're going to learn that. You're not going to learn that from any school or anything like that. That’s the first thing. The second thing is how to be a professional investor. When you have a private practice, you own an asset, a business and you have to treat it like a business. Just like Warren Buffet were to invest in your business, you need to be investing in your business. You need to know how to get the rates of return, how to run profitably, and how to build that thing to sell. One of the biggest errors that PT owners have is they don't build the business given the idea that someone else is going to own that thing someday. They just want a place to practice so they can be the captain of their own ship and practice PT the right way, which is their way and I dig that.
They've got great motives for getting it started. They're excited about doing things their own way. No one's going to tell me what to do. I'm going to be my own person. I'm going to see my own patients. I'm going to build this great thing and make a huge difference in my community. They're looking for success and they're looking for significance but many times, they don't go into it recognizing that they have now essentially taken off the physical therapy hat and put on the business owner hat and without even knowing it.
They don’t know the games they are playing. If you want to be a staff PT at a hospital, that's one thing. If you know how to manage your business, understand that you'll start getting results when you realize that you're not building that business for yourself. Those are two different mindsets that have to be involved in this game called private practice.
I love what you said about building it to sell. I don't think a lot of people have that in their mind that it is going to be sold. You're not going to own it forever. It's going to change hands at some time. The way to maximize that is to have it set up financially, structurally, legally, so that it is a smooth transition. The more you can make it a sound structure like that, the more profitable it's going to be, even if you don't sell.
If you're building it to be the most profitable owner-independent business, owner-independent means it runs without you, which is what you want, then why would you ever sell it? That’s the question people get to us, “Why would I ever sell it?” Someone will come with a big old check one day and say, “I'll take this thing off your hands” and you will have to decide sooner or later. If you understand retirement planning at all and the changes of viewpoint as you get older in life, you'll come to a point where you're like, “I'm done.” You’re going to be done. That's going to happen in one way or another and either you're going to have a seven-figure asset to show for it or not.
You want to set it up so that it is running well and that takes a lot of effort that physical therapists aren't trained to do. I'm sure you've seen that. We’re trained to treat patients, we're not trained to run businesses.
One of the biggest crimes is to graduate students from any level of schooling with not one lick of financial or real economic training, business management training and sales skills. Those are universal fundamental things we need to know just to survive in a money economy.
That's one of the reasons I've set up this podcast is to share with other physical therapy owners that they didn't get that education and we recognize that. In order to overcome that, we need to invest in consultants, coaches and professionals like you who can give us that education essentially.
My personal blueprint that I created cost me at least $1 million out of the pocket of money that I lost to find it. Not to mention the thousands and thousands of hours of trial and tribulation to come up with it. Any consultant worth their salt is going to have done that. You have a choice. This is simple economics. You can either go through the same learning curve and pay the same fee of time and money to learn it yourself or you can buy the blueprint from someone else. Who cares if it's six figures? If you can make seven figures of the six-figure fee, what do you care? That’s far better off than trying to go through the pain of learning it yourself.
You’ve got to recognize that your education is an investment. I love your idea that mindset is huge and where we need to start this. What are some of the other steps you take with physical therapists to get down that road? Any other common issues that you see that physical therapy owners aren't addressing?
Probably the biggest issue is staffing. Financial planning, which is my area, is a function of post-income earning. Your income planning comes first. How are you going to make money? Financial planning is how you’re going to spend money and how you’re going to spend it on future income and value and how you’re going to protect yourself. That's the area of financial planning. Income planning is a different function, although under the broad umbrella of financial planning. Income planning is marketing. How are you going to get new patients? The number one thing PTs always want to know is how do I get new patients? That could be the answer to everything. No, it's going to be the answer to this week's income. The big question then is how do you hire people to handle these functions to be ethical, to be productive, to work as a team, to be able to be trained and coached? Your job as a business owner is how you’re going to either do it yourself or put someone in place that has the capacity and the capability of doing all of that. I am not good at that. I'm not good at hiring and training people, but I have people who are.
You’ve got to find the people that will do it. That says something. It’s very simple but you've got to recognize how well you do as a business owner. You're a physical therapist but as a business owner, what are your strengths and your weaknesses? If your strength is marketing and it's not in training, then you need to find someone who's going to train or vice versa. If you're great at training and building an executive team but you hate getting out and knocking doors and making the calls and doing social media, then you need to hire somebody to do that.
This function has to be done. There's no way you cannot do them, but there is a big decision whether you want to do it or you want to get someone else to do it. Here's the truth and this is where people fail a lot, especially in the financial area. You cannot delegate the responsibility for that as an owner. You have to be able to know what that person is doing enough to oversee them, to make sure they're doing their job. You can't just turn it over to someone and then let me know how it goes, which some people do. There's no reason ever for a professional practice to be financially in trouble. The only reason it does happen is that practice owners misspend their money. They spend it on things that don't create future value like marketing, like the staff and like business systems. They spend it on cars, big houses, and this lifestyle rather than building a business and/or they turned the accounting over to someone else and they don't understand how to read a balance sheet and money disappears, doesn't get collected, and then you end up having all kinds of trouble there too.
How do you recommend the owners engage with their CPAs? How often do you recommend that they meet with them? How engage should they be?
The first criteria is what is your CPA doing for you? CPAs do a lot of different things. Some of them do bookkeeping and you need to get with your bookkeeper every month. A bookkeeper is the one who keeps the books, your profit and loss statement and all your transactions. As an owner, you have to see that profit and loss statement every single month. You have to know what the numbers mean. If you don't know, you go take a course on how to read a balance sheet. Probably you can go watch a YouTube video and learn.
Even looking at it and recognize where your trends are, when the expenses may be a little bit higher than normal compared to the previous month or previous year and a lot of those things.
That’s strategy. That's management. That's financial management. An accountant is not going to do financial management, nor will your bookkeeper. A bookkeeper is going to keep your books and you want to make sure that they're accurate and that you can read them and plan with them. Your accountant is going to get the data from the bookkeeper. They may do the same function or whatever and they're going to keep your books and they're going to make sure that everything is accounted for. It accounts for things, where's all the money. Taxes are different things. Taxes are simply the reporting of what the books say to assess an income tax. Your accountant simply just prepares the return. 97% of accountants just prepare the return. Only 3% will do some planning to reduce taxes. I hear it all the time, “My accountant doesn't help me save taxes.” Did you ask him if that's his job? 97% of surveys say, “No, it's not my job,” so we wonder. As far as managing the books and all that stuff, every month at the worst case, you’ve got to keep your finger on the pulse of your finances or you’re going to be broke. This is the truth.
You have to know the language as well. You've got to know what your cashflow is. You've got to know what your net profit, gross and your margins are and all those kinds of things that we weren't taught.
That is a very important point. If I were to be thrown in a physical therapy office and you guys start throwing around the Latin terms and the anatomy terms and methods and all these other things, I'm not going to have any idea what you're talking about. I’m going to probably get pretty mad at you eventually because I'm being excluded from the conversation because I don't understand. That's what financial people do to nonfinancial people every day, “I don’t understand finances.” You understand finance just fine. You just don't understand the words that define certain concepts. What I'm going to suggest you do more than anything is if you come across an accounting term or a financial term that you don't understand, get a dictionary, Google it immediately and get a definition for that term. Money is an intangible thing. It's strictly concepts. If you don't understand the concepts, you're not going to get control over your money. It's that simple.
Are there some things that you're doing with your physical therapy owners that you would recommend everybody do in general? We talked about mindset and considering your practice as a business, as a retirement asset, is there a general thing that you highly or strongly recommend that physical therapists do in their clinics right off the bat?
You have to understand that your practice works for you. You don't work for it. The practice is owned by the household, the owner. That practice needs to be made to produce and needs to be made to throw off income to the owner. The only way you do that is by a little bit of force. It's not going to happen by a wish or be nice or I'm going to manage it all then hopefully something comes out the bottom and I get to spend that. The way it works is that you need to be pulling money out of your business to pay you as the owner right up front. Practice owners being altruistic don't understand what value they bring to the table. The practice would not exist without your license.
There would be no business without your expertise, your intellectual property, your creditworthiness, your capital, just to name a couple things. Not to mention operating as a director and as a consultant to your own business and so on. What's that worth economically? Let's say it's worth 10% of practice gross. In the licensing world, if I were to license like a franchise from somebody or to license a system, I'm going to pay about 25% of my profit to pay the licensing fee. Let me translate to a percentage of gross income, but let's say it's 10% of gross income. As an owner, you have the first right of that first 10% of the revenue that comes in a year to be paid to you.
Every dollar that comes in, the first $0.10 is yours. Then you can pay everybody else: the tax man, the rent, your employees, the marketing and everything else. Until you do this, you will never have any money because you're paying everybody else first rather than you as the owner. That's what we call an inversion. The exact opposite of the way something should be. Inversions are terrible because they get the exact opposite result than what you're going for. An example of an inversion is, “Is the government run by the people or does the government run the people?” That’s an inversion because the government is running the people. It's the same thing with your practice, it can get that results. The first thing I'll tell a PT clinic to do is take 10% of their practice gross income off the top and put it into a bank account that they will never touch ever again.
As they freak out and have loss of bodily functions and cold sweats and all these things, then there’s, “But why?” The only way you're ever going to have any money out of your practice is if you pay yourself as the owner first. You're the most valuable person there. There is no altruistic, ethical thing in place in the world to pay everybody else than yourself. There's no benefit in sacrifice. Let's say $1 million practice, that's $100,000. “You want me to take $8,300 a month and pay myself before I pay anybody else? You are out of your mind.” Everyone always tells me, “Christopher, you don't understand.” I do understand. You're already spending 110% of what you make. I know you don't have it and the reason why you don't have it is that you haven't put it there. Here's the beautiful thing about private practice. Anybody who is going to say, “Yes, I'm successful in private practice,” is going to do one thing. That is to cover their bills.
If you're making $50,000 a month and you're spending $49,000 a month, “I am a rockstar practice owner. I am killing it. I am covering my bills.” Everybody's doing high fives and life is good and so on and so forth. Then if you're not covering your bills, “Probably I’ll cut back. We got to work harder or we got to get everything going. We only made $48,000 this month and I spent $49,000.” That is like the bare minimum of covering your bills, but that's another discussion. If we say, “I can't possibly take $8,000 a month or whatever it is, 10% of my practice gross and clear it away.” Yes, you can. All you need to do is make that an expense of your business.
If you put that extra 10% in there as an expense of your business, then what's going to happen to the income of that business? It's got to go up to cover the bills. The amount of income you make right now in your practice is what you have determined is going to be enough to cover your bills. We’re not even assessing what the bills are yet. There's probably a lot of waste in there, but you’ve got to make enough money to cover those bills, “I had another 10%. Who cares?” Within three months, six months of the way outside, you can be making enough money to cover those bills. That's the miracle of that 10% because the gross income of your practice will go up. The beautiful part about it is it's not going out in taxes. It's not going out in waste. It’s going to pay for the practice owners’ retirement, which would never occur any other way except for the $300 a month put into the IRA because your mutual fund salesman sees this to be a good idea.
I don't think we see that there is money to be had within our company and if we put ourselves first, other things will work out.
That's the most beautiful way of saying that.
It goes back to a decision filter that I learned a number of years ago. You put the business first, the owner comes second and then the employee comes third. If you follow that decision filter that you run the business for the benefit of the owner and then pay your employees and cover your bills, if every decision is made that way, then things tend to run smoothly.
The owner, sooner or later, is going to experience a time where patient visits are going to dry up. Either because of a lack of marketing, a market crash, your main supplier of your patients might disappear like a military base or something. If you have enough money accumulated in assets that are in the household out of the business, then you can turn on that and make a loan to the business to make it survive if you lose a lot of patient visits for a period of time. You have enough money to bail it out as opposed to groveling to a bank, which is not going to lend you money when you're in trouble anyway. Have it close the doors and things like that.
I wish I had taken your advice fifteen years ago. That way I'd be much further ahead. I hope people are trying to figure out ways that it can work. Not just saying, “That's good advice and maybe I can implement it and bring it up with my wife,” or something like that but take it to heart and say, “Let me look at my P&Ls. How can I do this? Let's do it.” Set up that bank account, talk to your bookkeeper and your CPA, and say, “This is what I'm doing going forward.” Control what you can and make the effort to make it work.
We work with mid-career professionals. Our youngest one is probably 32 and our oldest is probably 65. The first thing people say is, “I can't afford a financial planner at this time.” That's not true because we have a 36-year-old right now who came to us about five years ago. He's got about five years and he can retire. He just decided to do it. He couldn't afford it because no one ever can, but he did it. He followed our advice and he's building a multimillion-dollar practice that he's building to sell for more millions of dollars. He's doing it for that purpose all on the way saving his 10%.
The truth of the matters is this. You haven’t got enough money to do a financial plan because you're blowing it all in taxes right now. There are three tax strategies that we can get anybody to implement that would pay for a solid financial plan that you are already blowing every year. It all comes down to where you spend your money and if you get control over the wastes. Taxes are waste, interest is a waste, over-paying your investment fees is a waste, which most people do. Reclaim all that and put it towards your financial future and your efficiency, then nothing can stop you. It creates a synergistic effect, an exponential effect as you move along.
Is there anything else that you might want to share with the audience or maybe even how they can get in touch with you?
You can go to my website, Econologics.com. We wrote a book for physical therapists called The Financial Success Guide for Private Practice Physical Therapist. You can get it on Amazon. We might have a free download of it. There's some information in there about how to get more profit out of your practice and how to introduce that 10% rule and a few other things that are going to help you as a PT practice owner to start to gain efficiency. It's efficiency. I know it's a boring word, but get that money started going towards things that create a lot more value than being wasted.
It's more than just efficiency. Two of my things about starting the podcast and what I was looking to do with my physical therapy clinic was to create stability and freedom. When you create that financial efficiency and take control of your clinic, then you start to see both of those things. The clinic doesn't run you, you run the clinic and then you start obtaining some stability and freedom in your life.
A private practice millionaire model is the practitioner, the executive and the owner. I see PTs go to physical therapy conferences. They tend to go to all the new technical stuff because it's so exciting and all the business consultants and the financial people are looking at each other. The big truth is that you are not going to make more money by being a better practitioner. That's the big lie because being an awesome practitioner is not what is economically viable. What’s economically viable is marketing. It’s managing people to go from a staff of three to a staff of 30 so you can deliver whatever quality of technical delivery you have to more and more people for more and more money. The public doesn't know or care if you're a 10% better PT than the guy down the street.
If you want to do it for purely academic purposes and a feeling of self-accomplishment, that's wonderful and that's great. You've already made your investment in being a PT. You went to school, you’ve got your license and your degree and you're doing a continuing ed. From now on, your investment needs to be an understanding of economic laws. If you understand basic economic laws and you use them, you'll be wealthy. If you violate them, you’re going to get killed. You can look at your financial situation right now and you can see a snapshot of how much economic law you actually know. If you're wealthy, you know more than if you're broke.
One of the things that we did was we created a questionnaire online that I'm going to invite everybody to take. It's called the Financial Prosperity Index. Go to FinancialProsperityIndex.com and take the test. It's a questionnaire that gives us a snapshot of basically how many economic and financial laws are you applying. It'll do a snapshot of nine different areas of your financial life and give us a relative strength or weakness in these nine areas. What we’ll do then is we'll do what we call our financial power strategy session. We'll sit down with you over the phone or assume a meeting or whatever and analyze where you're at and basically give you some strategy on how you can immediately improve your score.
The truth of the matter is you're going to be financially successful or not, depending on how you manage your financial risks and there are 89 of them. Until you know and understand how to handle those 89 risks, going through life is going to subject you to losses because of those risks that aren't predicted. We help you do that. That analysis gives us a quick snapshot of what those risks are. We can see what's going to happen if we don't take any action.
Thanks again so much for being on the podcast with us, Christopher. Any other information you want to share with us, maybe your websites or any ways to contact you?
Go to Econologics.com. Econologics is the name of our system. It's a scientifically validated approach to personal financial planning. It's predictable and consistent and our Financial Prosperity Index is what gives us the start of how we can apply that to a particular system. Back in 2010, I created what I call the Private Practice Millionaire Academy. It’s a three-day retreat event where we teach basically a master's level personal financial education, a one-year master's level education. We do it in three days in fourth grade English for you.
Knowledge is power and applied knowledge is unstoppable. One of the things that we do is we have a lot of content. We have a lot of very simple concepts and you can apply them. We've had hundreds of professionals go to it over the years. We do it three times a year here in Clearwater Beach, Florida. We have them in March, July and November of each year. I like to invite you all to come to that. That will change your life and it will fill in the financial education that you never got and should have.
Thanks for the offers. I'll be looking into it myself. Thank you for taking the time in sharing your wisdom.
Thanks, I appreciate the opportunity and I hope you get some value out of some of the comments. If you want to reach out to me, please do so. My phone number is 727-588-1540.
Thank you so much, Chris.
In every message he delivers you'll find that he takes an innovative and simple approach to the complexities and challenges of modern financial and economic matters for an individual and his family. He deeply believes in the power of simplicity and basic truths to create better conditions for people of all races, creeds and faiths. Christopher has achieved his goal of delivering his message in an easy-to-understand method, stripping away the difficulties of complicated and illogical solutions to our financial prosperity that pervade today’s financial media.