PTO 154 | Steps To Success


Everyone wants their business to succeed, but what does it take to run a successful physical therapy clinic? In this episode, we find out the key steps to success for PT clinic owners. Nathan Shields takes a look at eight key steps that you need to take for your clinic to succeed. He analyzes each key step and tells you what you need to know and do. Tune in and learn the secrets to a successful PT clinic here.


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8 Key Steps to Success as a PT Clinic Owner

I want to talk about the Eight Steps to Success as a Physical Therapy Owners Club member. Some of you may be thinking, “I’m not a member. I didn’t join anything.” Let’s say you are a member because you are an audience of the show and/or a Facebook Group Member and you are passively engaged in the club so you are a club member.

I want to take this time to talk to you about what that pathway looks like for success as a Physical Therapy Owners Club member. In essence, what are the eight steps to becoming a successful physical therapy clinic owner? They are one in the same thing. The whole purpose behind the Physical Therapy Owners Club is to help you as an owner generate more profits and freedom in your business.

PTO 154 | Steps To Success
Profit First: Transform Your Business from a Cash-Eating Monster to a Money-Making Machine

I want to take some time to talk about what those steps are. Some of you definitely are further along in the process. I would love to talk these out with you and see where you are and how far you have gotten. Also, look back and say, “What things do I need to do to shore up my ownership in my clinic?” Bear with me. There are a number of things that we could be talking about. I'm looking at things from a larger perspective as to what it takes to become a successful PT owner.

Let's talk about the first step. The first step that I have to encounter with most of my coaching clients is obtaining an ownership mindset. What I mean by that is many physical therapists, I included, opened up a clinic thinking, “I’m a physical therapist that now owns a clinic.” Taking on an ownership mindset flips that script and helps you recognize that, “I am a business owner that happens to own a physical therapy clinic.” I am also a physical therapist. However, what comes first if you want to be successful in your business is to recognize that you are an owner of a business, the business requires you to think that way and what is in the best interest of the business at any and all times.

As a successful business owner, your job is to give the business quality time. If we were to talk about love languages and if your business had a love language. That love language would be quality time. You must take the time that the business needs for it to run successfully. If you are treating 50 hours a week and trying to fit in business/administrative tasks in-between visits and on the weekends, inevitably, you are either going to burn out. Number two, your employees are going to get frustrated. Three, you are going to have limited growth. You might obtain some measure of financial, security or goals but you are not going to have a lot of freedom to go along with it.

If you want to take the first step towards successful business/PT clinic ownership, that is to obtain an ownership mindset and recognize that your business comes first. What do I do? How do I become a business owner? That's the second step. A lot of your training has been in physical therapy or working towards a physical therapist for twenty-plus years of your life throughout your education so you can become a physical therapist. Now I'm telling you, don't be a physical therapist anymore, essentially. What do you do to get that business training? That begins with listening to me and others. Also, reading books related to business ownership.

If your business had a love language, that love language would be quality time. Click To Tweet

I’m going to toot my own horn and say we’ve got a ton of great resources over the past years at the Physical Therapy Owners Club show. Tons of great interviews from successful physical therapists and industry leaders that can teach you different aspects of successful business and administrative actions that you can take to improve your business. That’s one, but I’m not the only one out there to help physical therapists. There are others.

Paul Gough is one that I have appreciated many times. I know Devin DeBoer has one for cash-based businesses. Check them out. Listen to them. Gain what you can from them and use those as resources. It also goes toward the idea is to read more. Read the books that we have recommended here in the past that many times. Read E-Myth Revisited, Think and Grow Rich, Profit First, Traction, and Who Not How, is a great one that I read. These are all books that are number one important to read. Number two, it’s important to implement.

PTO 154 | Steps To Success
Who Not How: The Formula to Achieve Bigger Goals Through Accelerating Teamwork

Many people have read all the books, done all the things but haven't taken the time to implement them. Thus, they haven't progressed in their ownership path. Take the time to read the book once, twice, maybe three times, come back and implement, and take the time to implement those recommendations in those books and those shows. How do you do that if you are treating full-time? That's the third step. You've got to cut back on your treatment time.

You’ve got to take the time to implement the strategies that are recommended. If you are not taking any time now to do administrative tasks, it's got to start with at least half-day a week. I recommend two half days per week to start with. During that time, you will implement these strategies. You will plan appropriately, hold people accountable, develop policy and procedures, which we will talk about later on. These are the things that you do with your administrative time. Even though you haven't had any business training, you can start doing some of these things.

Taking the time to implement business practices and improve your business will take you a long way. I didn't see a lot of gains in my business until I stepped out of treating a significant amount of time so that I could work on my business, not just in my business. That's the third step. Take the time to step away from treating and putting the time to work on your business.

The fourth step, leverage your network. What do I mean by that? Number one, you have to be a part of a network. That could be the Facebook group of the Physical Therapy Owners Club. That could be a peer-to-peer network from the private practice section of the APTA where you meet with other physical therapy owners that could be joining entrepreneurs' organizations, which is a small business network that Will and I joined, and had a ton of success with when we recognized that we needed more training in business. This is another group.

You could even join local Rotarians or Lions Club. These are networks that you can use to interact with other business owners and share some of your concerns, issues, ask questions, if you will, especially on the Facebook group. We had a lot of great questions on there from private practice owners. That's where you can leverage your network, ask questions and get advice.

Many times, as an owner, you can feel like you are alone on an island dealing with things that no one else has dealt with. That's not the case. Even people in other industries are dealing with similar issues. You must recognize and lean on their experience to overcome the obstacles you are dealing with. That's the fourth step.

Training is invaluable and helps you generate physical therapists that are both value-aligned and part of the clinic's culture. Click To Tweet

The fifth step, hire a coach or get a consultant. Whatever you need to have someone to guide you, hold you accountable or give you feedback and support on a routine basis. It might be somewhat self-serving of me to do that because I am a coach for PT Owners at this time but I can tell you that I'm not here in this place. I have not gained the success that I have without the help of coaches, mentors and consultants in the past, who have helped me. In fact, even now, as I'm coaching others, I have a coach of my own because I know their value.

I have spent hundreds of thousands of dollars on coaches in the past and it has gotten me to the point where I am. I wouldn't trade a single dollar for any of that experience that I have had, the training that I’ve got and the wisdom that I learned. I find that a majority of owners out there, I would say 96% to 99% if I had to put a number to it of successful owners out there have had some coaching or consulting in the past to get them to the level that they are successful. Hire a coach or a consultant.

The sixth step, develop policy and procedure. This is how we do, blank. This is how we collect copays, maintain a higher arrival rate, treat patients, treat shoulders, order supplies and clean. That policy and procedure manual that you develop on how we do things is something that lives beyond you and allows others to do those things the way you would do them if you did them and do that at a successful level without your physical presence. That’s the magic of policy and procedures. It gets you to a point when instituted, followed and utilized to a point where you don’t have to be there. That gives you freedom.

Traction: Get a Grip on Your Business

If you have read to any of my reality show with Avi Zinn in the past. I followed him for the past couple of years in his ownership journey from a young owner. His success thus far to the point where he hardly steps into the clinic more than once or twice per week is all due to the fact that he spent a significant amount of time establishing policy and procedure for his therapist, front desk, managers to follow.

As they follow that, his involvement is less and less necessary because they stick to the policy and procedure manual, and rely less on Avi to be the answer man for everything. Developing policy and procedures for the front desk, training and onboardings, recruitment, treatment, you name it. Policies and procedures for all those things take time but when you do them, it starts to organize the chaos and give you the freedom that you need to be the visionary for your clinics.

The seventh step, find your next physical therapist. You have stepped out of treatment. You have done all these things to organize and progress your clinic. You need to find a physical therapist to take over some of those patients and come on full-time. Most importantly, hire physical therapists and train them appropriately. Train them how you would treat patients.

They don't have to use the same techniques. I shouldn't say that many times, they do prefer you have certain techniques or training if you are going to treat certain patient populations. Train them on how you greet patients, how we keep patients all the way through their full plan of care, how we discharge patients, how we ask patients for referrals a family and friends, how to interact with the front desk, how to schedule patients and how to do their EMR. All of that training is invaluable and helps you generate physical therapists that are both value-aligned and part of the clinic's culture.

PTO 154 | Steps To Success
Think and Grow Rich

Not only hiring the physical therapists but training them accordingly. The eighth step, work on building up that business more. In most of your situations, if you can get to 4 to 5 physical therapists running full time, you are in a magical profitability state and a place of freedom. As you grow from 1 to 2, you are increasing in size, essentially, 100%. 2 to 3, you are growing at 50%. 3 to 4, that's a 25% increase.

The pain is less as you add more physical therapists. On top of that, whereas you get to the 4th and 5th physical therapists, your fixed expenses, rent utilities and EMR systems stay about the same outside of salaries. Once you get past that third physical therapist, the revenue generated by the 4th and 5th therapists goes straight to the bottom line outside of their salaries because all other fixed expenses are fixed.

Getting to that place where you can get to 4, maybe 5 physical therapists will require some effort. That's where you need the time to spend on marketing strategies to the four buckets, physicians, community, past patients and current patients. Have a marketing strategy for each bucket to generate the new patients necessary for 4 or 5 physical therapists.

Also, what you need to do to generate a culture that breeds a patient-friendly environment, keeps the patients engaged and keeps the physical therapists engaged will require a lot of work. You can't be treating patients full-time if you are going to do that. As you get to the 4 and 5 physical therapists, make that your goal because the profitability is great.

Considering you have done all of this. Maybe you have reached all these steps, you are well on your way or you are at the 7th and 8th steps. What do you do after that? Essentially, it comes down to duplicating what works and eliminating what doesn't. When it comes to policy procedure and personnel, you’ve got to duplicate what works and eliminate that, and those that don't, then you can start looking at expansion either in terms of square footage or another location. Again, duplicate what works in that first clinic, take that marketing strategy, take the therapists and the personnel that are aligned with you, take the policy and procedures that work, cut and paste into the next clinic and you do that over again.

PTO 154 | Steps To Success
The E-Myth Revisited: Why Most Small Businesses Don't Work and What to Do About It

That's what you see a lot of successful multi-clinic or large clinic owners do. Duplicate what works and eliminate what doesn't. I could have spent a lot of time in these eight steps talking about the importance of establishing purpose and values, KPIs or stats, reviewing stats and establishing battle plans based on those stats. We spend a lot of time on necessary meetings.

To get to this point, I wanted to give you an overall picture of what those eight steps look like because along the way, you are going to have to address those things anyways. Purpose and values being foundational aspects. Statistics are necessary to know when to grow next. Those are the things that a coach can teach you and you can learn from your networks and books. Inevitably, you have to establish those things along the way but they are super important.

I want to look at from a global perspective, a higher-level perspective as to what it takes to become a successful PT Owner/Physical Therapy Owners Club member. Remember, you are already one because you are an audience. You are well on your way because you are an audience and taking advantage of the resources that are out there for you.

I recommend you follow this path to success. If you are along the path already, keep moving and know what your next step is. My goal for each of you that are reading is to obtain the freedom and the profits that you want from your clinic so that you can fulfill your personal purpose and goals for yourself and your family. I hope you do so by following this path to PT clinic ownership. Have a great day.

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PTO 93 | Growth Accelerator


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.


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Growth Accelerator: Hire Them On Or Hire It Out With Christina Panetta, PT

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?

PTO 93 | Growth Accelerator
Growth Accelerator: You can't treat everybody yourself, so you have to learn how to delegate.


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.

Success comes from finding experts and surrounding yourself with people that lead you in the right direction. Click To Tweet

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.

PTO 93 | Growth Accelerator
Growth Accelerator: The best patients you can have are people searching for answers.


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.

Keep your eyes open. Be willing to change. Click To Tweet

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. 

PTO 93 | Growth Accelerator
Growth Accelerator: You have to make sure all the staff is capable of delivering the same outcome that you're promising when you deliver the workshop.


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?

Don't be afraid to challenge yourself. Click To Tweet

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.

PTO 93 | Growth Accelerator
Impact Imperative: Innovation, Entrepreneurship, and Investing to Transform the Future

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 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?

Reach out to me. Even if you go through my Panetta PT website, there are links and find me on Facebook.

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?

Most of the time, people don't give themselves enough credit to have the confidence to move forward. Click To Tweet

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. 

Important Links:

About Christina Panetta

PTO 93 | Growth AcceleratorChristina graduated from Stony Brook University with a Bachelor’s of Science in Physical Therapy in 1985. When it comes to helping those in critical circumstances, Christina wastes very little time – in fact, just after graduating from Stony Brook, Christina began working at the Brunswick Rehabilitation Center. During her tour at the Rehabilitation Center, Christina worked closely with patients that were recovering from extreme physical injuries; these injuries include patients with spinal cord injuries, traumatic brain injuries, amputees and burn victims. Christina eventually went on to open her own Physical Therapy clinic, and never strayed from her calling to help those in need.
In 2005, after Hurricane Katrina left many parishes throughout Louisiana and Mississippi in ruins, Christina immediately took action working with local Law Enforcement to provide medical care and aid. Hurricane Katrina, as devastating as it was, is only the beginning of Christina Panetta’s dedication and unyielding commitment to others.
After the 2011 earthquake in Haiti, Christina felt compelled to help those that were injured, and went to assist distraught families at the state hospital in Port Au Prince. One of Christina’s most fulfilling acts of aide to humanity was when she successfully cared for and brought home to the U.S. a young woman who had sustained a double amputation due to the earthquake and her eleven-month old baby who was suffering from malnutrition.
During the course of the next three years, Christina continued to provide medical care and aide to the people of Haiti. Recognizing the overwhelming need for Physical Therapists in this region, Christina turned to her Alma-Ata, Stony Brook University. She went to Richard Johnson, PT, EdD, Chairperson, Department of Physical Therapy and through his strong leadership and the stellar reputation of Stony Brook University a successful collaboration between Christina, Stony Brook University and UNIFA ensued. On October 6, 2014 the first University Program in Physical Therapy opened in Haiti.
Christina lives in Oakdale, NY with her husband Richard Panetta; Mana and Wolf continue to reside in the Panetta household. Wolf is 10 years old.

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PTO 25 | Marketing Secrets


Ian Johnsen, PT, MSPT has been a success in his small private practice in the Seattle area and, like me, decided to launch a podcast and introduce more private practice owners to the resources and success stories that are out there. So I decided to have a conversation with him to learn a little bit more about him and what he's doing to be so successful. He was kind enough to share a couple of his marketing secrets, which any practice could benefit from right away! He also shares some of the resources that are guiding him along the way to success. Funny thing, there are a number of resources that are the same ones we use and espouse here at PTOClub! Have you used the same ones?


Listen to the podcast here:

Marketing Secrets And Business Success In Small Practice with Ian Johnsen

PTO 25 | Marketing Secrets
Practice Perfect

On this episode, I get the opportunity to interview a fellow podcaster, Ian Johnsen who hosts a podcast called Practice Perfect. He interviews healthcare professionals, especially healthcare or private practice owners along the same lines as what I'm doing. I took the opportunity to sit down and talk with him. This is more of a conversation that is rather free-flowing with Ian. We talked a little bit about his podcast and what got him into that. We also talked about some of the struggles and success that he’s seen as a small physical therapy practice owner. We also talked about some of the books that have been influential for him as a practice owner. We also talked about a couple of secrets that he's used with the marketing techniques that have been beneficial for him in getting patients that are higher reimbursing. Also, focusing his marketing efforts and thus improving his efficiency and productivity in this marketing efforts. We talked about some of the secrets that he's used in his practice. Hopefully, you can take a little bit from what Ian has learned and also relate and maybe implement some of the things that we talked about into your own professional experience.


What made you decide to do it?

Frustration, more than anything. The whole issue with not being educated on running a business. That was it for me. This was something I wanted to put out for everybody that's in the same boat that I am so that they can get educated along the way. It's a big give back in the selfish side. I get to meet cool people and build connections.

I want to know a little bit about your story, where you're coming from and what you're doing now. Also a little bit about what you learned from the podcast and whatnot. What got you started into PT and where are you at now?

I grew up in Washington up in Everett. My dad was a mailman. I lived with him and my stepmom once he remarried. He was a nighttime bartender. Money was a bit tight up in the north end. I watched my dad go to work every single day and grind it out at 5:00 AM and make it back home at 5:00 PM and crash on the couch after making the kids dinner. He put the time to help the family survive. At fourteen years old, I'm thinking, "I don't want that life at all." I went after the idea of finding something that would hopefully pay well. In my mind, that was medicine. I was heavy into playing soccer and running cross-country and that stuff. I wanted something in sports and medicine combined. I went that route. I went to the military because I didn't have college money. I jumped to the military. I got the four years in. I started taking a couple of classes while in the military and then I used that college fund once I got out.

I discovered that sports medicine for me wasn't a thing that I could wrap around. It didn't exist in where I was searching for. Once I got it, it meant that I would be a doctor and then have more schooling on top of that, probably become a surgeon and distributing medications. It wasn't what I wanted to do. I want to heal people naturally. This was the field for me and it was a step-by-step process from there. I went to a two-year college. I went to Shoreline Community College. I got my Associate's in Science. I hopped up to the four-year school, which is called Western Washington here. It was a lovely school with a nice Exercise Science Program, lots of kinesiologies, biomechanics and all that good stuff. In there, I found Kathy Knutzen who was my counselor and program director. She suggested moving on towards either chiropractic or PT school. We made the format of the classes to be such that I could do that. When I found my school, which was Regis University out in Colorado. I went there and I fell in love with their program. I highly recommend everybody go out to that one.

PTO 25 | Marketing Secrets
Think & Grow Rich

Your story is not all that different from mine. I grew up in a middle-class neighborhood but money was tight or at least from my dad's point of view. He always complained about, "We don't have money for that.” That was a common refrain. I had uncles that were in healthcare. I saw, "This guy has some financial stability and my cousins have things that they want and can play with and they have the freedom to do that." I started moving towards healthcare as well and I then came across Physical Therapy Owners as I was doing my undergrad. These guys had decent homes and they provided for their families. They didn't have to take the MCAT and they didn't have to go through all the schooling that an MD did. I was like, "That's for me."

As I volunteered, I had an adrenaline rush after adrenaline rush every time I volunteered at these private practices. I knew this is for me and I was developing relationships with some of the people that I would meet once or twice a week, however often I volunteered. I thought, "There's no way in the medical field that you can develop a personal relationship like that and get them better in a rather quick manner and not have to do all the medical schooling and MCAT testing. I thought that was for me and that's how I got into it. It all stemmed from the same thing, looking for some stability in my life and then things worked from there.

The PT practice is not always super easy. In 2006, I was in some form of the practice. This was back when I was getting my feet wet. I went from the hospital. I stayed in a hospital setting for a year and I got some good mentorship from the folks that were there skill-wise. There was a group of PTs, probably eight of them. I learned a lot of cool things there. Then I transferred out to the private practice realm and found a guy that was doing what I thought I wanted, which was to have a small clinic with himself being the primary owner-operator. I learned as much as I possibly could from that guy financially and from the billing side. The good and the bad because there is always some bad in there too.

When you write down the fears that you have and what those worst case scenarios could look like, it dissipates. Click To Tweet

Then you decided to strike out on your own and since that time, have you found resources or have reached out to consultants or coaches to help you along?

There are always going to be mentors and coaches in the process. I don't think you can get through this without that. It's part of why the podcast exists at this point so that we can mentor people along the way. I'm not an expert yet. I'm still struggling and when I grow, everybody else can hear it and they can grow with it too hopefully.

One of the reasons why I started the podcast is I didn't see it back in the day. I opened up my clinic in 2002. At that time, I wasn't seeing the resources or they didn't seem readily available whereas they seemingly do so now. I've interviewed a number of them and talked to a few people and have had some of my own coaches since that time. I wish I had gone back and I would tell myself nowadays to get some coaching because like you said, we don't do this stuff. We are physical therapists who happen to own a business. Getting some of that insight from somebody can always help along the way. Have you followed any particular books or theories or coaches along your path?

PTO 25 | Marketing Secrets
The E Myth Revisited

One of the guys that's been with me for quite some time now, his name is Michael O'Neal. He's a podcaster. He does Solopreneur Hour, a one-on-one coaching for solos. He's done a good job initially at pushing me forward and helping me with marketing ideas and marketing strategies. I'm playing with the focus of where I want my best clients to come from, finding who that best client is and building your avatar. Digital marketing is definitely a piece of it. Mentoring me through the podcast portion too to get that going is good. Other business mentors also. I learned a lot about how to build a practice in terms of where do new patients come from and acquiring those guys and then building the systems around the business. It partially comes from people teaching me, but then partially from some of the books that Mike O'Neal had recommended. I always had six books and I can never remember all of them. One of my favorites is still simply working towards systematizing everything in your business. That book was called The E-Myth Revisited. It's a super easy read. A nice audio book and I read that first and then I read Rich Dad Poor Dad. Get both of those books. Get Think and Grow Rich to get your mindset framed. Then you can start to develop. I love The 4-Hour Workweek. That thing was genius and funny. It could be out-of-date a little bit, but it got my mental juices flowing on other things I could put in place besides doing day-to-day practice.

I did an episode of The Best Business Books that are most often referenced between me and my guests and it’s a lot of those same ones except The 4-Hour Workweek and I should have mentioned that one. For sure, The E-Myth, Rich Dad Poor Dad, Think and Grow Rich, Good to Great by Jim Collins and Verne Harnish's two books, Mastering the Rockefeller Habits and Scaling Up. A lot of it between all of those books is to get clear on what your mission, vision or purpose is and shift your mindset to making this a business and not a job and systematize. To get everything in your head down on paper so that it ends up being a business that can run without you, right?

Exactly and be sure that you're following your passion. If you're not passionate about what you're doing, you're in big trouble.

What are you doing now in your clinic? What's your size? What are some of your goals? Where are you at?

PTO 25 | Marketing Secrets
Profit First: A Simple System to Transform Your Business from a Cash-Eating Monster to a Money-Making Machine

Prior to that, I want to give you one more book to check out. I'm digging into Profit First. The cool thing about this is that it's basic but powerful in terms of helping you organize your accounts properly. Instead of running everything out of one account, you parse it into five accounts. You have an income account, you’ve got a tax account, you've got the owner's income account and the profit account. He's big on making sure you take profit every single time or a couple times a month when the deposits all show up.

We talked about that a little bit and it blew my mind on an episode that I did with a guy named Christopher Music. He's a financial advisor for a lot of private practitioners. One of his first rules is set aside 10% at least every month. Simply just set it aside. The 10% goes to you as the owner every month and he said you make your business work off the rest. Once you do that and get used to it, you find ways to pay bills or increase gross revenues if you have to. If it does not turn out at least that much, then it's not worth it.

This is similar. It's all these separate accounts we talked about and then you set an overall big-time goal of what those percentages should look like. Then you start in smaller versions of that and just start setting aside all those monies and all the different accounts that you've set. You don't have to worry about your taxes.

I’ll have to check it out.

PTO 25 | Marketing Secrets
Scaling Up

Definitely do that and I hope everybody does because it's changing things rapidly for my group. In terms of what I'm up to and what the clinic's doing, the size of the clinic and all that, I'm still not that big. I’ve got a second PT with me and she's part-time. I could probably handle her full-time. I'm busting my butt internally at the same time. I'm doing a full load. I'm there from 7:00 to 5:00 typically. I've been getting out around 3:00 or 4:00 to get the kids off to dance classes and do podcasts and different things that I want to work on. I've got about three equivalent full-time aides. We work in batches or in small groups. Each PT typically has one to two aides working with them. We spin it a little differently. We don't even have a receptionist, which I'm about to change. It’s getting a little bit challenging at times as we get busier. What I wanted was not to have Marge sitting on the front desk, playing with her thumbs and not being effective. I'm learning that I can make that person accountable and use them in a much better way than what I've seen used in different clinics.

That front desk person and that can be the boon or the bane to clinic, they are so huge. They're not practitioners but they are the first and the last person that everyone sees coming into your clinic. If they're not doing well, then you guys will suffer. If they are good, they are good and they end up being better than you sometimes getting people into the door. It's a huge role in the clinics and it's a huge hire. They've got to be aligned with you and they've got to have energy and they've got to be part salesman to make sure they come in three times a week. They've got to be courageous to collect the copays and the deductibles and all that stuff and be anxious to make calls. It's a certain personality set.

They have to be so personable. They've got to have interpersonal skills locked out and you've got to identify that magical person, almost like at Disneyland person right off the bat.

PTO 25 | Marketing Secrets
Rich Dad Poor Dad

That can be a tough hire. You want to make sure their value aligns but they can be huge. To have someone like that that's making the calls and scheduling patients and stuff, if you can get that off of your plate, then that's a huge bonus for you as well. It improves your productivity. Was it really hard for you to bring on that second physical therapist? Was that a difficult jump?

I was scared out of my mind. You're talking dollars at that point. You're looking at a big cost jump right out of my pocket. When you hire them on, you're already trucking it, whatever your max amount of client load is. I'm going to bring you on and you get half of that and then my potential goes down. You have to have it ready to go that you can crank up the volume of clients as you bring that person in and have the staff and all the support to handle that. If you don't get that right, it's tough.

That's where you have to find the right physical therapist that's value-aligned and treats patients at least similarly. Maybe they could be compatible with your treatment skills. Someone that has a similar mindset at least. Now, you're actually managing somebody. That's a different story.

I found the perfect candidate. This woman was an aide that worked for my old boss and she went to PT school. As she's going through PT school, she's looking for a place to intern. We interviewed her first. Then she comes on and she has a lot of the same skillset that I have. A lot of the same theory, it's a beautiful balance. We work well together and get patients better quickly.

It's a necessary step. I'm sure you felt the push and pull. It sucks to take that money out of your pocket, but at the same time you know that if you're going to grow and really become an owner, that you need to bring on other people in and systematize that process.

Once you have that person and they're rolling and they're doing their job and they're doing all the notes that sometimes you don't get completed in time, you become more profitable because of that. Because of the fact that you can get behind the scenes and work the processes harder and make sure the front desk is doing what they need and then things ramp up.

That's a huge step for any practice. Me personally, I recognize the same thing. After hiring that first person and getting them on board, then it becomes a lot easier to bring on other people because you're not feeling the financial pinch as much. Your revenues are increasing. You've been through the fire and it will work out somehow. You're not going to go bankrupt after all and lose your house. You're going to make it. It's also a necessary step to push you into working on your business instead of in your business.

I'm going to step back to those financial scares and not getting your mortgage payment paid this month and in all the big scary things that happen. They'll work out. They do. You have to figure out how to make them work out and not be scared.

I listened to Tim Ferriss’ podcast where he talks about managing fears like that and he was talking to another business owner who would sit down when they have those anxious moments about making significant changes in their businesses. To consider the real, maybe even the imagined worst possible scenarios that could happen and then work your way backwards like, “Worst possible scenario is a go bankrupt and lose the clinic, then what?” “I'll find another job. There's always a demand for physical therapists.” “Would that be all that horrible?” It would be a blow to the pride, but financially we could still make it. There are some ways that you can work your way out of that. Did you do anything like that as you dealt with your anxieties regarding bringing people on?

That was part of that The 4-Hour Workweek book too. I went through that entire exercise. This is what is out there and this is what could happen if I screw it all up and if it does get all screwed up, fine. This is where we live for the moment. Then we reorganized and then push again. You write down those fears that you have and what those worst-case scenarios could look like. It dissipates. It's an interesting exercise.

PTO 25 | Marketing Secrets
Mastering the Rockefeller Habits

Instead of letting your imagination run amok, you can confront the fears head on and come to terms with it right then instead of brewing on it for days, weeks, months at a time and say, “We're going to do this. It's the best decision I'm making for my business and it's the best decision that I can make with the information that I have at this time. I'm going to move forward with it knowing that there is a possibility that things could go wrong, but I can handle whatever goes wrong. This is how I will handle it and then move forward. How long has that physical therapist been with you?

I believe she is going on the second year right now. It's coming on two pretty quickly.

Is there quite a bit of competition where you're at for physical therapy clinics and for physical therapists?

Yes, it's a pretty affluent city. Bellevue, Washington is home to Microsoft and you've got Expedia. There are a lot of good paying clients that will come through the door, but there are a lot of clinics too. We've got ATI Physical Therapy that bought up nineteen clinics. There's a group called RET, which is up to 23 clinics strong. There are plenty of big boys out here. There are not a lot of one-off shops for PTs anymore. I don't know a ton of them. I can count on one hand how many they probably are. There are probably more hiding out there. I feel like there's quite a bit of competition but there are niches for everybody as well.

What have you done to separate yourself or have you done anything in particular?

One of my favorite niches is to get in with chiropractors for what I call the finishing touches of treatment. That's a strategy that might work for others and that means not looking at them as enemies but looking at them as colleagues that need some help in trying to wrap up cases. I go in and I have a lunch meeting with somebody we specifically talk about that, “I don't want to steal your client. You can have them as a forever patient, but I do want to make sure that as you manipulate and will identify people that are weak. I know that you don't have the time to totally strengthen them unless you've got somebody in house doing therapy and exercise. Let me have him for four weeks. I will set them up on a home program and then you can get that case closed and get paid. We’ll finalized and make it stronger.” Those types of words are helpful for getting some confidence in what I do so they can understand it. I'm not trying to steal from them. I'm trying to help him out. On the flip side of that, I get some high-paying clients. Like the Tim Ferriss’ 80/20 rule, if I can get in and get my best paying clients first, then that takes the financial stress off the company.

You've seen a lot of success from that. That's a niche that I haven't heard of much.

PTO 25 | Marketing Secrets
The 4-Hour Workweek

That ebbs and flows so you really have to stay on top of it like anything. Those relationships fall apart at times if you don't stay on them. It is an effective thing and that could help small private practice groups quite a bit. If I can get somebody in a motor vehicle for six visits straight, the visit is $220 a pop, then why am I going to concentrate on lower-cost clients coming from a doctor that's hard to get into and talk to when I can easily make a lunch appointment with a chiropractor?

Do you find yourself referring back to them?

A lot of them want that, but when you go in and let them know upfront how it typically works, there isn't a lot of that that happens. If they can use it as an adjunct and not expect that and if I can queue them up for that, it's okay. There have been a couple in that meeting that are starting to ask me and I say, “If you've got a massage therapist on staff, if you've got something I can refer into, then I will send you my clients that I think need a bigger adjustment.” In Washington State, it's interesting. We’ve got the right to manipulations in the State. In order to be able to do them, you have to have some advanced training on top of the PT classes we've already had. I believe almost internship with somebody that's a manipulator. You might go with the chiropractor to get that certification. I could be a little bit wrong on some of that. I haven't researched because I didn't care to. I've been taking the approach that I'm not well-versed in doing manipulations anymore. I was great out of school. I don’t do them so I can send them to them and I'm okay with that if I find the right chiro.

A lot of people could use that because I'm the same way. I don't necessarily view chiropractors as competition, but we could work in conjunction with each other quite a bit on a lot of these patients. Tell me a little bit about Mike O'Neal. Is he a physical therapist or is he a simply a coach that you used?

He's a podcaster. He hosts a podcast that's called the Solopreneur Hour. He's got some great tech info in there for everybody. It's some good courses that he's developed and good strategies too. He does help solopreneurs. The guys that are going out on their own trying to start things up. I found him because I was listening to podcasts. One of them that I listen to is Entrepreneur on Fire. That’s John Lee Dumas’. The first time I heard that thing, I'm like, “There are people out there like me. This is great.”

Entrepreneur on Fire is what lit me up to podcasts as well.

It's done that for a lot of people. A lot of people went out and copied it. I love the way you're doing it here. The real conversations. That's how I play it too.

Like the 80/20 rule, if you can get in and get your best-paying clients first, then that takes the financial stress off the company. Click To Tweet

You talked with Michael O'Neal that you established an avatar. Can you talk a little bit about that and what your avatar is for your clientele? The first time I heard about an avatar for my clinic or for my business was through Paul Gough’s Podcast. He talked about his avatar and his ideal client. He mentioned he detailed it all out about who he wanted to see and how he's been successful. Tell me a little bit about your take on avatars and what yours is.

In meeting with Michael, it was developing a fitness program that I'd come up with called LEVO Fitness and it's somewhat in stasis right now. We were really trying to focus in on who would be the best client for that. You go through everything. You're going through your demographics, even the gender. You're looking at his avatar. Her name was Mary. She's 50 years old. She stays at home. She has kids there. Their house has $200,000 in income. It was very similar in what you're trying to accomplish with this and then your messaging just becomes to that person. Inevitably, you're going to get a whole bunch of surrounding people that will pay attention and come in. It may not always be Mary at 50. It's going to be a Susan who's 25 that really liked the exercise program, whomever.

For the PT clinic, it's a little bit interesting because who are we marketing to? I can set an Avatar for a woman at that age group, but that's not where the majority of my patients come from yet. All are cash based in England. We have to directly market to those people in the community and we can do that, but it isn't very effective yet. ClickFunnels can help with that and Facebook and Instagram and all that kind of stuff. We're getting there but right now we're still really reliant on a referral, and that referral will either come from a patient or you’re getting it from a physician. Who is the best referring source is what we have to look at.

That's huge especially when you're considering your message, you want to go directly to that avatar. You want to go directly to that person so that you can get through to them. Ideally, it's the person that’s handling the finances and in-charge of where these referrals go and whether that's the doctor or whether that's the mother or the father of the household at a certain age. Someone who makes the decisions.

In the case as you're asking me about my avatar, I would say that it's a physician or chiropractor and there are two avatars. There's that chiropractor I talked about that needs those finishing touches to those cases and then there's the physician that has a lot of low-back patients or pelvic alignment patients. If I could find those particular people and show them my results, then I can start taking those referrals. It really becomes a message of what I can do for their clients and how quickly I can get them better. I'll never go to a doctor and be like, “I'm so good at doing this and so good at doing that.” I'm not going to give them my skillset and my resume and beg them for an appointment. I'm going to show them results from the words of the patients. Those testimonials and bring them in and show them if we need to and try to convince them to try us out and just give them results and given great communication.

There's a physical therapist owner here in my town who I work closely with. He decided to narrow down his marketing to physicians quite a bit. Most of the physical therapy owners, they're going to market to every physician that's out there. Anybody with a pulse that could refer a patient, we're going to market to them. He decided, “Forget it. The orthopedic surgeons are too finicky and a lot of them are taking physical therapy in house. I'm going to focus my marketing efforts on the family practitioners and the internal medicine guys in my area and talk to them about what's important to them.” He says by doing so, by actually scaling back on his marketing and focusing a little bit more, he's exceeded his revenues this year by at least 20% to 30% and you wouldn't expect that.

Maybe after you've been in it for a while, you would. It makes complete sense. I stopped marketing to orthopedic surgeons. They have their own staff and I'm not interested in that anymore. Family physicians and internal guys, definitely. To niche down, take it a step further and create a relationship with five of them. These physicians and nurse practitioners and everybody, they're seeing a caseload of 30,000 people a year. You need to survive as a PT independently five visits and five new evals a week and then you learn how to keep in front of those clients through the years and all of a sudden, you have repeat customers over the years.

Tell me a little bit about your podcast. That's how I came across you. I was intrigued by a fellow physical therapy podcaster. Tell me what your focus is on at Practice Perfect.

It's very similar to what you're doing in the PT realm but I had a bigger, wider scope looking at practitioners as a whole. Definitely, I'm going to be a little bit more PT-biased but I'm interviewing medical people from all the spectrums. I'm getting doctors. I've interviewed naturopaths, acupuncturist, some marketing people and some financial folks. Anybody that can help us push our businesses forward and grow in a much smarter way. That's the main thing with that and we went over why it exists.

Relationships fall apart at times if you don't stay on top of them. Click To Tweet

Anybody that can utilize the people that we bring to them or the ideas that we bring to them via podcasts, for me, it's simply to provide that resource. There are other practitioners, private practice owners that have gone through some of the same things that were going through or have gone through. You can learn from them. You don't have to figure it all out by yourself, whether they’re programs offered by PPS through the APTA or consultants and coaches that I interview or books like you mentioned. There are ways to get the information that you need to be successful business owners.

I've talked to so many different practitioners already and almost every time I talked to somebody, we've got another idea from another resource. That person might be an acupuncturist and they've had this amazing experience where they're selling these supplements out of their clinic. They realized that they can't take time away from their day to fill these things and put them here and get clinic interruptions. Then they have to walk away from their patient and set these things up and all of a sudden, they’ve decided to open an online store. There are all these cool ideas flowing from different practitioners. I'm even thinking me telling you guys about directing your focus towards some chiropractors for a little bit to see if you get a $220 visit instead of an $85 per hour visit. Those are real value for us when we have these discussions and what we’re looking for is even one little tip that makes you light a fire and make a difference for people. It's like doing PT. You made somebody better. I made that arm better. That shoulders moving 90 degrees in every direction. The same thing for these practices. If we get the practices up in any way and see measurable improvement and somebody writes me a message via email that says, “I implemented that and it worked.”

If you hear something positive coming from a listener, nothing beats that. It's like getting a patient better. How can people listen to your podcast or if they wanted to reach out to you, how do they do that?

Just head over to iTunes, Google Play and Stitcher Radio. It’s where we're at. If you don't have that on your phone, download it now and do a search for Practice Perfect. I'm on Instagram as @PracticePerfect. Facebook is @PracticeCast. I'm starting Facebook groups as well and trying to get listeners involved in those groups so that we can have conversations within those things too. If you're interested in that, you can email me at I'm open to any kind of questions you may have. Those are all the ways to get to me quickly.

Systematizing your processes is the difference between owning a job and owning a business. Click To Tweet

Thanks for sitting down with me. It was great to hear about your story and we're on the same page as to what we're trying to do to help other private practice owners. I don't think there can be enough of us out there to guide and steer and be resources for people, especially in the PT world. I don't think there's been enough focus on the business aspect of the physical therapy profession personally. People like you help out in that regard.

We're going to help out a lot. This is something that's been missing and hopefully people take notes and see that it's a necessity. Maybe we can actually get some change to happen within some of our schooling systems.

More needs to be done from the schooling standpoint. I know more can be done from the APTA standpoint. There's a lot of room for growth and that's cool to see. There's a very bright future for us as we continue to focus on the importance independently on physical therapists.

I've got the main podcast which is like that and I dropped a few episodes and I'm doing this thing called the Daily Drive now. I hit record on my phone in the car, on the drive home from a day in the clinic. You get to hear some of the real time struggles that are happening in the clinic to me. It's a nice little extra piece for people to listen to you. I've got ranging from financial crisis to somebody's not showing up on time and how to deal with that person, reviews and all the nitty-gritty of what's going on in the daily life of a practice owner.

That sounds cool because I've always thought that a sitcom based on a physical therapy practice would go pretty well because we see some pretty crazy stories out there. I'll definitely take a listen to that. I'll check it out. Thanks for your time. I appreciate it.

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About Ian Johnsen

PTO 25 | Marketing SecretsFrom Ian's Practice Perfect podcast iTunes page, it says:
"How much Business Education did you get in your Degree Program? Struggling to make it to the next level? Just starting or trying to expand your business? Build your "Perfect Practice" in a fraction of the time. I didn't start to find success until I started listening to business shows like Entrepreneur on Fire and the SoloHour. I cried the first time I realized there were others going through the same struggles. This show exists because I wanted to hear from people in similar industries that are CRUSHING it, to learn from them and to build a better future."
Listen to the podcast and Ian will give you rundown of what he's all about.

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PTO 01 | Physical Therapy Clinic

Physical therapy (PT) clinic owners are masters at creating stability and freedom for clients, but not for themselves. Sure, there's financial stability - but when it comes to personal freedom, not much. In the pilot episode of the Physical Therapy Owners Club podcast. Nathan Shields shares advice for PT clinic owners on how to achieve true business stability and freedom.

Nathan owns a PT clinic in Chandler, Arizona, and decided to open a satellite clinic after his patient list grew from 3 to 7 to 11 per week. He enjoys the social aspects of physical therapy itself, along with its immediate improvements for patients. But there was something missing: a business network tailored specifically for PT clinic owners. More often than not, PT owners saw each other as competitors. Now with the Physical Therapy Owners Club, Nathan hopes to galvanize his fellow PT owners into joining a discussion for stability and freedom. So sit back, relax. The Club is now open!

Listen to the podcast here:

The Club Is Open: Introduction To The Physical Therapy Owners Club

Welcome to the Physical Therapy Owners’ Club podcast. I am Nathan Shields. This is the introductory episode where I want to talk to you a little bit about why I'm doing this, how I got to where I am, and the purpose behind the podcast itself and what brought me to do it. What I'm really trying to talk to and create is a podcast that helps individual PT clinic owners grow as well as build a network. Become more successful, figure out how to do things better, and be a resource that you can use to improve your clinic and especially improve your professional and personal lives in the meantime. It all comes from the belief that I have that physical therapy clinic owners are masters at creating stability and freedom for their patients, yet they rarely experience that themselves. The first steps to creating that stability and freedom in their lives starts with simply reaching out.

My personal story starts as a child growing up in a middle-class neighborhood, a loving family. We had some financial instability and my father didn't have a lot of freedom to do the things that he wanted to do personally and with our family. As a young child, I recognized I wanted more stability in my life. I also wanted the freedom to do the things that I wanted to do. As I looked around me, the other men around me in my life, my uncles in particular, were men that were in the healthcare field. They were doctors, dentists, and surgeons. I look to them and thought, "I'm going to go into the healthcare space."

PTO 01 | Physical Therapy Clinic
Physical Therapy Clinic: Physical therapy clinic owners are masters at creating stability and freedom for their patients yet rarely experience that themselves.

As I made that my general plan, I got into college and came across a couple of physical therapy clinic owners and thought, "Here are some guys who had some stability in their life. They had some freedom. They were known in the community for what they did." I took advantage of the opportunity of volunteering at their clinics and thought, "This is the profession for me." I love the social aspect of the physical therapy treatments that were provided. I loved seeing the immediate improvements that they were able to create in patients, positive feedback that was given, and the entire atmosphere around the physical therapy clinic. I thought, "This is a great meld. I can do something that I enjoy and also obtain the stability and freedom that these PT clinic owners had."

Fast forward, I went through physical therapy school and treated for a few years. After doing so, I decided, with the encouragement of my amazing wife, Whitney, to pursue my dream and open up my first physical therapy clinic in Chandler, Arizona. I started off relatively modestly. I saw three, seven, eleven, fifteen patients a week and gradually grew and grew and enjoyed a measure of success to the point where I eventually opened up another clinic, a satellite clinic in another location. I recognized that as I was growing in numbers of clinics and numbers of visits in my practice, I was creating more and more stability and freedom for the patients that we were affecting, yet in my personal life and in my professional life, I was creating less and less the ability and freedom for myself and my business.

What I mean by that is I had some financial stability, things were going well, yet from a business standpoint, I wasn't stable. I was the lone source for all the answers and I didn't have the business acumen needed to run a business of that size. Personally, I wasn't enjoying much freedom. I would go days without seeing my children or do the things that I wanted to do. The business was solely dependent upon me so I had to put in a lot of hours to make it work. That's not uncommon for entrepreneurs. However, that's not why I got into physical therapy clinic ownership. I assumed everything would be great simply by opening up the clinic and business would grow and improve from there.

I decided I had to reach out and get some support and find some resources that could help me become a better business owner and ultimately lead to that freedom that I was looking for as well. I reached out to my CPA and figured out, "What was my cashflow? What were my gross revenues and my net profit margins? How do I read a P&L? With the help of my business partner, Will Humphreys, he introduced me to Entrepreneurs' Organization which put me in contact with other small business owners where we shared and solved each other’s business problems and recognizing that I wasn't alone. I also started reading business books to gain greater business acumen, Good to Great by Jim Collins or The E-Myth Revisited by Michael Gerber.

Between the professionals, the network and the books that I was reading, I started obtaining some business knowledge especially by implementing those practices, gaining some more business stability. Yet I still wasn't quite there when it came to the amount of freedom that I was looking for a in my life. I was still putting in a lot of hours per week. That wasn't why I got into clinic ownership in the first place. I recognized, in order to grow, in order to lead and actually run the business, I had to get out of the way. I recognize that if I was going to affect more people and provide some more stability and have some freedom to make the clinic grow and improve, I had to stop treating and work on the business and not in the business.

Click To Tweet

That was a hard decision because that's not what I got into physical therapy for in the first place. Yet I recognized that's what the business needed and that I could affect more people by doing so. By stepping out of the clinic and stepping out of treating full time, I continued to recognize more stability in the business itself and started to gain some semblance of personal freedom to enjoy with my family. In the meantime, I also developed a network of PT clinic owners through the organizations that I was part of. These were people who had experienced some of the same issues that I was dealing with and they had already overcome those issues. I was able to gain off of their knowledge and expertise and find solutions to the issues and problems that I was having at the time. I recognized as I reached out, as I stepped out, and as I networked, I then started to experience the stability and freedom that I was looking for in the first place.

It took me some time but over the course of a number of years, I went from being the single practitioner in his own clinic to now co-owning four clinics with my partner Will Humphreys, with multiple practitioners, and affecting more people than I ever could have imagined by just treating patients one on one. Now, thanks to the support of Will, my business partner, and my family and I have moved to Alaska to go off on an adventure and start another new business and decided to actually start this podcast. It's been in the dream stages of mine for a number of months, but I've finally been able to put it together. I'm excited to bring it to the world, especially those physical therapy clinic owners who are looking for support, who are hoping to get a little bit of guidance and advice from people who have been through a lot of the issues that they're experiencing themselves. What I recognized as I look back on it and as I look at the current landscape, there seems to be a lack of business-specific networks for physical therapy owners where they come together and focus on the issues unique to physical therapy, not necessarily in physical therapy treatment, that can be handled by other podcasts and other networks, but specific to physical therapy business ownership.

As owners, we frequently see ourselves as competitors and not necessarily associates who have a lot to learn from each other. We haven't galvanized to create a network where we can affect positive change. The whole purpose behind the podcast is to expand my network, create this club, the Physical Therapy Owners’ Club, where we can learn from other successful physical therapy business owners, even business leaders and other entrepreneurs, and ultimately work to elevate ourselves and our profession. In order to do that, I'm going to interview at least one successful physical therapy business owner per week and ask them to share their insights and experience to help others learn and grow, to help you learn, grow, and succeed in your business venture.

PTO 01 | Physical Therapy Clinic
Physical Therapy Clinic: As owners, we frequently see ourselves as competitors and not necessarily associates who have a lot to learn from each other.

My call to action for you at this time is wherever you are on your path to or on or in physical therapy clinic ownership, I want you to look for ways in which you can reach out, step out, and network in order to gain stability and freedom for your business and for yourself. As we do that together, we can affect our clinics, ourselves, and our profession for good. Together we can succeed in doing more.

This is the beginning of the PT Owners’ Club. I look forward to meeting with you every week, sharing the experiences of others and helping you learn, grow and succeed as physical therapy owners. Subscribe to the podcast and I'll meet with you here every week. I invite you to join and hope to see you soon.

This is the beginning of the PT Owner's Club podcast. I invite you to join so together we can succeed, grow and change independent physical therapy ownership for good.

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