It's been two years since the start of the Physical Therapy Owners Club! Hard to believe the podcast has been around over two years and 100 plus episodes. The PTO Club has generated some great content for and from PT's across the globe and is a dream come true. In this episode, Nathan Shields and Will Humphreys, Nathan's business partner, spend some time reflecting on the beginnings of their ownership journey and some of the faults, triumphs, and relationships along the way. Follow along in this special conversation, reminding you of how your journey may not be that lonely after all.
I've got a frequent flyer guest. One of my good friends, Will Humphreys, is in the house. Will, thanks for coming on.
Thank you. I appreciate it. I love being in the house.
Thanks for joining me. I had you on before and we're still surviving through the pandemic. PT owners are starting to ramp up a little bit. Some places might still be closed. I don't know if they're getting the 50%, 60%, 70% range in productivity and whatnot. Last time we talked about what people can do while things are shut down or slowed significantly. We're going to talk about a number of different things. We're going to go back in history a little bit. First of, what have you been doing since we last spoke?
It's interesting because as I went to Europe for six months with my family. I came back to Empower Physical Therapy, our company that we love and cherish. Gratefully, they were at a point where things were going pretty well. I started having some ideas of how I could better serve the industry. They've been incredibly supportive over there helping me go out and do other things. What I've done in the last few months are a couple of things I'm excited about. One of them is like a dream. Something I've been wanting to do for many years and I'm actually doing it. One of them is that I started an insurance billing company. It's called In The Black.
You were getting things going at that point.
It's been crazy because I came back with a different proposition than what's out there for billing companies. There are a couple of good companies out there that I love that are PT-owned, but none of them address all of the different influences that impact our profits and finances. We're a full RCM business, which means that we don't just do billing and collecting. We also do insurance verification. We do provider credentialing. I also provide training to front office and back office as part of that. There's no additional fee to that. It's been fun because we look at all the items, including P&Ls and what shape of company. When I was a PT, I used to think that an outsourced PT comp billing company was the worst way to go.
We had some bad experiences. You know how they do it wrong.
The biggest thing is when I did end up having what you and I created, it was your hire that led to this in-house solution that was massive. It was unreal and ultimately, it was the biggest reason why when we came together and merged, our company did so well. I wanted to share that message because I believe profitability unlocks possibility. You and I didn't know how freedom felt until we were able to get the profits to help generate that. When I did that, that's when we looked at Alaska and that's when we looked at all these things. In The Black, the website is coming out. We stopped taking new customers for the next two months because we had such high demand when we've opened. We're satisfying our first twenty locations. They're loving it, which makes me happy. We try and keep close relationships, which is different. It's been going great. We will be taking new customers for any potential audience in a few months.
For those who are reading, your website should be around August 1, 2020. You'll be taking more customers at that point. I don't want to disparage outsource billing, but because of our experiences, you know what people should truly experience from their billing company, whether it is in-house or outsourced. I talk with my coaching clients all the time about the statistics they need to be looking for and the reports they should be receiving from their biller because many of them are like, “I don't even know how to judge if they're good.” That's where we were many times until our biller showed us proper reports and statistics, we didn't know if they were good either. As we got that experience, we started seeing how billing should be managed. Coming from that point of view, you can provide a service that lacks out there in the PT industry.
I appreciate that and I do want to acknowledge, there are a couple of companies that are doing it well. I'm a big fan of MEG. I love those guys. I think they're great. Bob's company, billing solutions. There's another company that's fantastic. We were all offering a little something different, but we're all PT-owned. That's the thing is that as PT-owned billing companies, we offer so much more of that relatable advice, experience, and knowledge. That’s been going great and the thing I’m super excited about as well is I have launched a YouTube channel. You know better than anyone how I need attention. I don't know if my parents didn't pay attention to me growing up, but something feels whole when I'm filming a video.
The cool thing is your YouTube channel isn't specific to PT owners but also PT students, which is cool because there's no one out there speaking to PT students. It is pretty interesting that you would take that tag. You share some awesome input and have some great content for PT owners as well. I love the stuff that you're doing right now in regard to C-players and how to find them and handle them. That's great.
It means a lot to me. You were such an inspiration to even do it with this show. It's one thing to have the time and desire to want to put yourself out there in that way, especially when you've been through hell and back 4 or 5 times. You want to share those experiences with your colleagues and ultimately like you, this show, my YouTube channel is a love letter to my industry. It's given me everything that I have. I'm still this incredibly passionate PT who thinks there's no better job in the world. Everything that you and I invested in with coaches and clients and all these things that we've done over the years. I'm getting that information on Tuesdays. At this point, it might shift but Tuesday is centered towards leaders and owners, Thursdays is for students and new grads. It's things like, how do you stand out in job interviews? How do you find a job in the COVID environment? The seven mistakes in most interviews for PT owners is all talking about all the stuff that we've been through and learn from. It's been a lot of fun. We've had a lot of initial success out of the gate. That's a perfect way to say that guys like you paved the way. When you launched your show, there was a handful of shows.
When I first started, there were maybe 2 or 3 that stood out. The reason I wanted to do the show was simply because there was no one speaking to the business aspect. I liked Paul Gough's stuff. He focuses a little bit more on marketing and he has some great insight. His first two episodes, I was like, “This is amazing.” I know there were a couple of them out there. The PT Insiders, but a lot of them were either about marketing or about patient care. I was like, “I want more help as a leader, as an owner.” You and I had developed this amazing network of PT owners and I'm like, “We’ve got so much information out of just picking their brains.” We'd go to these conferences and you might learn something from a presenter here and there, but it was the in-between sessions and the dinners where you sit down with successful PT owners like Coury and Buehler in California or John and Chad out in San Antonio or Blaine up in Montana. I was like, “Why can't there be a platform for those guys to share those successful actions?” I thought this show is a great way to do that and it's been so cool. We were on our 100th-plus episode as of this one.I'm proud of the content that Physical Therapy Owners Club has generated over the past two years and hope it's a resource for many PT owners going forward. – Nathan Shields Click To Tweet
You're stealing the wind out of myself. I want to announce to the world that this is your second-year anniversary and you've broken 100 shows. It’s amazing. It's another thing to even stay with it for two years. I love that you mentioned some of those. It’s a big thing I want to acknowledge and I hope all the audiences at home or in their car are grateful for guys like you who are standing out, who are building upon the efforts of others to find additional ways to create value. No one is doing it the way that you're doing it and definitely with this kind of consistency, that builds trust. I love how you mentioned the heroes of our networks before and you mentioned some of them by name. When you said those names, I felt chills. I remember what it was as freshmen in high school and there were the seniors. It was like, “These guys are so cool.” Who else would you say are some of your PT heroes?
Who's not a fan of Vinod? He was one of my first episodes. Here's a guy who's got a killer business in New York City but lives full-time in Florida. Who doesn't want to live that dream? I knew Blaine was super successful in Montana, but then I went to Whitefish, Montana, I was like, “This is a cool place and this is where I would love to live.” Blaine was amazing. Those guys are great. I love hanging out with them, and then Bill out in Detroit with HQPT. He's unassuming and then he tells you he's got 15, 16, 18 clinics. He's just walking around in shorts and a tee-shirt.
I’m sure he has a six-pack. He's got zero body fat and if I ever get to the point where I can see my abs, you will not be talking to me with my shirt on.
I loved these guys and they're so willing to talk to you. We were nervous talking to these guys and we feel like the underlings, but they're totally open. They're like, “This is what we do and this is what we'll share and they do presentations,” and you're like, “You guys are killing it. I wish I could be like you.” I still feel that way. They still have so much to offer and that's why I think I'll continue with the show. There have been a number of times over the last few years where I turned to my wife. I'm like, “I need to pay for more production of my episodes.” I don't do all the editing and whatnot myself. “I have to pay some more upfront. Should I do it? I don't know. Maybe it's run its course.” Every so often, I'd get this jolt and I had an amazing interview with somebody that I think is full of awesome content and I'm like, “The PT world needs to hear more of this.” I guess I'll keep going.
I want to challenge everyone reading to comment if you're able to get on iTunes and give some love because what you've done for the industry has been massive. It’s great because we met these guys through a group called Measurable Solutions, which still exists and still has amazing powerful PTs, Mike Bills. The main thing that they presented besides wonderful information was each other and that's what you're doing. You're connecting our industry. As a guy or girl is reading, they're feeling like they're a part of something so much bigger than themselves, which is why we got into this whole career in the first place. Not a single PT I've met in all of the years of talking to PTs has ever had a boring story. Even when they think it's boring, there's this huge emotional draw. As a two-year anniversary highlight, I'd like to ask a few questions about things I don't even know. You mentioned that you did it because you felt like you wanted to create more value. Emotionally, what was some of the first experiences you had? What were some of the challenges? What were some of the initial wins that you had?
With the show or with PT ownership specifically?
The show, let's go into that. I'm sure your audiences would love to hear about some of those experiences in the company as well.
I remember my first episode and I was interviewing Sean Miller, our good friend and partner. I knew he had a great story and so I wanted to share his story. I remember walking through my house an hour beforehand and nervous telling my wife, “forty-five more minutes and I’ve got to do my interview.” I’ve got to sit down and just shoot the bull with Sean. He's still one of the most listened to episode. It was awesome and I came away with that energized more than anything else I'd done before. Physical therapy is very fulfilling. I rarely came away from a treatment session where I was like, “That was amazing. That was fun.” Even if I did that, there was some crappy patient right after that would spoil my day. I'm sure you experienced that. By the end of the day, you'd seen enough patients that you're drained mentally. After doing my interviews, that carries over to my coaching stuff. After doing my coaching client stuff, I can sit on the phone with owners for an hour and a half, two hours and be like, “That was cool.” My wife tells me all the time when I came out of the interviews or I come out of my coaching client calls, I'm like, “What's up? What's happening? The sky is blue and the birds are chirping. Did you guys notice?”
It's cool because number one, I'm curious. I want to know what's making people tick. Number two, I can come out of those interviews and be like, “There was some cool content out there that if the people out there listened and pulled away 1 or 2 things that could help their business.” Number three, helping people simply feel connected so that they're not alone. That's where I felt so much when I started my clinic. You probably as well since you're out in the boonies of Florence. You feel like you're on an island. You're on your own. Who else knows that I'm even out here besides my “competition” within a few miles of me. It wasn't until I started networking and getting consulting that I recognized I'm not alone. There's a whole bunch of people that have already been there, done that and they're willing to help. That's what I wanted to provide owners. There are people out there and you can reach out to them. Almost every episode, they share their contact information. You can reach out to them. It’s hardly anyone takes them up on it, but they can. They can pick these people's brains and they're open. It's so funny to have Dimi on and he'll share his personal cell number. It’s cool and I love sharing with people. It gets me energized.
It’s neat to see you in this space. I've known you for a long time now. It's been many years. I met you in 2003 at Fat Camp. You were my sponsor. Do you remember where we met?
If I'm not mistaken, I met you at church in the hallway or something like that.
I remember meeting Whitny before meeting you. I remember she came out to me and said, “You need to work for my husband.”
She came home and said, “I found the guy that needs to work for you. I found our next PT.”
We are here because of Whitny Shields. Shout-out to the amazing mother of seven, your wife. She moves to Alaska to start electrodiagnostic company. She's an unsung hero. Tell me, what was it like for you when you were thinking about those early years? Do you have any memories? This is where I'm trying to serve your audience is trying to get them to understand a little bit more about you and what I know, and maybe what I don't know about your background. Can you think of any experiences that you had that were pivotal to your growth? You've mentioned Measurable Solutions and that wonderful network of people, which we'd be remiss if we didn't highlight Beth and Lisa out at Magnolia, Louisiana. Some of the most powerful leaders of all time. Do you have any other moments like that that you think of as pivotal in terms of, “When that happened, things changed?”
Taking the first step was huge. I still have to attribute that to Whitny because I was working full-time for a physician PT clinic for about a year and a half. I remember after work one time, I was like, “I was looking at this area in that area to maybe open up a clinic someday.” I saw a for lease sign of a new construction built down in South Chandler. I gave Whitny the phone number and she was going to call him the next morning when I went to work. She's like, “The rates there are amazing. It's a brand-new build. We've got to open up a clinic.” I was like, “We do? Is this happening?” She was like “Yeah, put in your two-week notice. Let's go.” You know me and change, we don't jive. That's why I married my wife. She's like, “Change is great.” I’m like, “Change sucks.” Finally, we opened that up. The referring physicians down there were gracious and helpful, especially Dr. Paul Evan reached out to me out of the blue and that was great.
All that was pivotal, but you had to learn so much. Back then, I was doing the billing myself. I didn't even know how to do that. I was doing the credentialing myself. I was marketing by myself. I didn't have any support staff. Occasionally, I'd ask my mom to come in and help, be attack or something like that. That was all crazy but outside of the initial beginnings. That was in 2002, pivotal parts were like you and I opening up the Maricopa clinic. That was a huge change and we thought it was going to be a lot easier than it was.
If I look back on it and I'm going to ask the question to you, what I would have done differently. What I would tell myself as a young owner, knowing what I know now, is to get some coaching or consulting in day one. Hire the people to do the work and trust the experienced and professional people to do their jobs. It will get you so much further so much faster. If I could have seen that. I didn't even know that was an option on the table. I'm running by the seat of our pants and doing what we can and saving money here and there. I thought that's what you're supposed to do, instead of investing in the company to help it grow. That's what I would have done differently and it's when I started making those investments that things significantly changed. Unfortunately, it took me close to a decade or more before we did that.
I remember the day we signed up with Measurable Solutions. We went up there for a two-day course that I paid for because I was desperate for help. I paid for 1,000 courses. Last minute, I'm like, “Do you want to come to Seattle with me?” It’s good for two people. You and I hadn't merged our companies yet. There was some separation in our business model, even though we shared Maricopa. When we went up there, it was mind-blowing. We met Steve Rodriguez who is now family to us. I don't even know how many years it was. At the end of it, they're like, “Here's how you get to freedom and here's how much it costs.” Your jaw draws open. You say you don't handle change but you were the one who was like, “I think we need to do this.”
At that point, I distinctly remember we have to do something different. I don't know what it was. It could have been like a webinar packaged for $500 and this was significantly more than that. I would have done anything to make a difference. I wasn't experiencing a life that I wanted to continue living. I told people all the time that, “I loved treating patients, but I hated the business aspect of it. If I have to continue at this pace for another ten years, I'm going to be done. I'm going to be checked out. I don't know what else I'm going to do, but I'll find a different career.” I think that happens a lot with PTs. That's a topic for another discussion. What's funny is since I got the consulting and coaching and networked with entrepreneur’s organization, I don't get the joy out of treating patients as much anymore. I love treating more patients through other people and creating a bigger impact within the community or even within my small clinic to affect the community, to make it a better experience for not just the patients, but also the team members and grow and improve that way. Now I get so much more fulfillment out of being a leader and an owner and giving back.
I don't think that's everyone's journey. The reason that was true is because you were meant to do what you're doing now. The problem with a lot of us in our industry as owners is that we get into that mindset of like, "I did this to treat and that becomes an excuse to not learn what we don't understand about business. Both of our cases, I had a pivotal moment in my life. When it occurred to me, I was driving home in the dark at the end of a horrible day. My beeper's going off because my charts weigh as much as a human being in the seat next to me. I am so burned and it occurs to me in that moment of clarity that it doesn't matter how much I know about patients and patient care and making that process go well. It would never make up for what I didn't understand about business. That's why coaches are so valuable.
I think you are meant to suffer that way because now you're supporting this mastermind, which I got a chance to be with those guys. It's like seeing all those wonderful people in our old group at our earlier stage. These powerful men who were committed to doing something better. Once they get free of the demands of what they don't know in the business end, you can always opt and choose to go back and treat electively, but not because the business requires them. That’s the difference. In your case, you got free and it was like, “I want to share this message with the world.”
What would you tell yourself as a younger owner?
I can't reiterate enough what you said about finding a coach as quickly as seemingly possible. When I came back from Europe and I'm consulting. I'm still working with Empower, but they were like, “Go ahead and have some space to do some other things.” As soon as I heard there was space, I hired a coach as quickly as I could get my hands on. My beautiful patient wife, she saw how much I put down on that. She was like, “I get it.” That's what it is. Freedom comes at a cost and it comes at a price. We probably paid multiples of our PT degree to ultimately achieve financial freedom.
It was hundreds of thousands of dollars.
That was over years but it was a small investment into what ended up creating impact, income and freedom.
My wife is the same way. I might go a few months without a coach and find one that that's aligned for my purpose and what I'm doing now. I'll tell her, “It’s many thousands of dollars,” and she's like, “Okay,” whereas that wasn't the case a decade ago. What she's recognized in me, and I know your wife’s recognized that in you, is that you having a coach improves you as a business owner and leader, but also improves you as an individual and a father. When you're talking about creating freedom and living the life you want to live, a lot of that is not necessarily about you. It's about your relationships with your significant others, your partners, your children, your friends, and whatnot. When you can improve your business to the point where it gives you the freedom, the space, the energy to share with other people, that's when your life changes.Profitability unlocks possibility. Click To Tweet
What do you think are some of the things that showed up in your personal life that are a result of you having owned a business? How are you different as a father and a husband because you had the courage to go out and start a company?
I have a better take on what it takes to lead and that leadership is not limited to the business and professional aspects. There's some leadership as a father that are necessary to lead a family and so that's important. What's helped me a lot, and maybe you can speak to this as well, is the ability to have those one-on-one conversations with my wife and children. Come at a place of objectivity out of curiosity, from a point of understanding and not from a place of judgment and learning more about myself as I go through these experiences. It makes me better as a leader. Some of those things that are related to that also include, what's my purpose? What's my individual purpose? I talked about purposes for your family here on the episode or purposes for your clinic here on the episode, but what's your individual purpose? What's your purpose for your family? What are some of the goals, just like you have goals for your company? Do you have some goals for your individual self as well?
Relating so much of that, we'd like to think that’s professional life and this is personal life, but how do you draw the line? People say, “Don't bring your personal life into the workplace.” How do you do that? Because it happens and there's no way you can flip the switch and go home and all the stresses that you felt at work, aren't going to somehow affect how you're treating your family at home. When my wife recognizes that I'm not up at 4:00 AM and coming home at 8:00 PM or 9:00 PM because I'm seeing patients and doing charts and running the business, but rather have more freedom in my schedule and more time for them. I can go on vacation without getting emergency calls every other day, wherever we're at. She's like, “Whatever coach or consultant you need, go ahead.” We'll spend a few thousand dollars to make your life a little less hairy and have our kids have a picture of you as a father.
This isn't just for physical therapists. I think PT owners probably experienced this in large amounts at least early on, but how often do we give the leftovers to the people at home after a long day at work? The hardest hitting thought is for how many years I would come home with a moderately successful clinic that was me dependent. I’m holding onto that from a place of insecurity because who am I when I'm not that? Coming home and faking it through, playing with my kids and stuff. The generations of owners now are hopefully not where I was in that regard but when you talked about that, that resonated with me is how there is no separation between these different environments. We are who we are. We are better or more successful in our environments because we're sacrificing something of ourselves at the other. My favorite analogy when you described is the idea that we're all juggling different balls in life.
There's a ball called work and a ball called church and a ball called home and family, and they're all made of different materials. The only one that's made out of glass is family. Work is as important as it is. It's a bigger ball that we're juggling but it's made out of rubber. It will drop and as painful as it's been to hear my journey but listening to you talk about those moments. What I sense is that overall, understanding of what matters most and when you learn from dropping the ball here, it's so that you don't have to drop the ball of the family, which is the most important one. Thanks for sharing. That's powerful to hear how that shaped you as a person. Do you have any memories of fun time? I don't want to paint this picture that ownership sucks. What were some of the best times professionally that you have. What are some of those moments?
A lot of it was surrounded around the patients. Sometimes you get a certain patient mix and you look forward to those afternoons because you’re all kicking it and chilling and once, I got a TV in the office. I was watching the Olympics or the Major League Baseball playoffs or something would come up on TV that would spark a conversation. Those days were awesome. Getting your first checks from insurance companies back in the day, I was like, “They paid me to do some work that I'm not even sure I know how to do well.” Worrying that they're going to figure you out someday and the auditor's going to come and say, “You're not a good therapist. Give us our money back.” Making something successful like that. We had some awesome fun company parties with people.
Acknowledgment to Stacy Sullivan. She was with me for a long time. It was sad to see her pass, but my memory still revolves around her coming in every day. She’s like, “Good morning sunshine.” My wife said that to me the other day in the morning and I was like, “That's what Stacy used to say.” It’s individual people and individual experiences that I remember more that gives me happy memories about it. It's something prideful to go back and say, “Here's something that started back in 2002 and it's been an amazing journey and changed a number of people's lives. Not only the people that I've treated, but people that I've worked with and team members that we've had through the years.” It's been a cool experience to look back on that. I can't say all that without saying, “Some of the business trips that we had were some of the coolest times ever.”
That's what comes to mind when I was thinking about this interview. We have times and some of the ones that you and I have are epic.
That was probably worth the price of admission for all the money that we spent on the consulting was to simply go to some of the conferences whether to Florida or Seattle. I feel like I know Seattle with the back of my hand.
I calculated it. We spent six weeks back-to-back there after two years.
It's Seattle all the time with the place. We go to Montana or New York City and all these cool places together. We kick it. It was so much fun. Those experiences in that time were what makes it a lot of fun to look back and say, “That was super cool.” To have the opportunity then to share those experiences with my family and now to take some of my kids to New York City or tell them, "Someday I'm going to take you to Whitefish and you're going to experience how amazing Whitefish is,” or “I’ll take my wife to Clearwater once in a while for a seminar and see the amazing white sand beaches.” That stuff was super cool.
It’s that investment is what forced us to open up to what it could look like if we weren't committed full-time to treating and running the aspects of our business that we weren't meant to. I remember multiple times, you and I would make the comment. Who'd have ever thought when we started this tiny little clinic in Florence, Arizona, that we'd be in New York on 9/11 at ground zero, or we would be in Florida on the white sand beaches, or we'd be in Seattle at the Farmer's Market or the Pike Place there? All the different things that we did. Ultimately, we were able to take some trips. We bring our spouses and, in those things, they weren't the reason why. They were these little perks that occurred to help counter some of those dark times. I feel like every difficult time at least that I experienced in that journey being with you came with comfort. It was a conversation I needed to have that I didn't know how to have.
It was usually a relationship that was out of alignment and I didn't know how to address it. I feel what you're saying around that. I want to quickly highlight for the audience that you are an amazing technician. Your skillset of physical therapy is one of the best that I've ever come across. I'm not complimenting that. Nathan and I were looking at setting up this business in Alaska and you were able to grasp the electrodiagnostic understanding, which is a totally different belt. It's not a different tool in the belt. It’s a totally different belt. You pass that exam, which is a whole other board-plus some. To prove a point, I passed a kidney stone, thanks to you. A real short story. My urologist has told me since it's the biggest kidney stone he's ever seen pass from the kidney through the ureter. It was an 8x8 kidney stone and I didn't know I had a kidney stone. I thought I hurt my back and Nathan and I would be in our business meetings and he'd be treating me. I know for a fact, that's what did it. You manipulate that kidney stone out of me.
I milked that kidney stone through your ureter.
It was an intimate moment. Your skillset is phenomenal. When I hear you talk and you're like, “I don't know what I was doing,” I want to make sure people knew that you were a master at your craft.
I had this vision initially set up that I was going to open up my own clinic, but because of the work I had done in Casa Grande, you guys don't have to know the geography of Arizona, but I was working in Casa Grande. I started a clinic in Chandler. I always knew that I wanted to open up a clinic in Florence. That was at the back of my head always and I don't know why I was thinking, "I’ve got to go to Florence.” I opened up a clinic in Florence, bought the equipment, and found the space. I didn't have a single provider in hand. We met you and Whitny is like, “This guy’s got to work for us.” I'm like, “Who's going to want to work in Florence?” You remember the space that we worked in. I showed you the equipment that I had in my garage. I was like, “I'm taking this down to Florence on Tuesday. Do you want to come with me?” Somehow we set up a way to get down to Florence. I was nervous that you were going to see Florence, Arizona and be like, “Why am I working here?” It was the complete opposite. You have to share with us your experience.
It was fun because you've got more years ahead of me than I do and so in terms of experience in PT. It didn't matter that you were only two years of piano lessons ahead of me. To me, you were a grand piano master. We're driving out there and it's 45 minutes from our house and it's getting close to an hour or whatever. We pull into this tiny little town and all you see on the outskirts are jails and prisons. I think the actual number is eighteen. They have eighteen different facilities ranging from high security, maximum, whatever and you pulled me up at this building that was probably 100 years old. It was 600 or 800 square-feet total. It was musky and infested with lizards.
I remember we had termite tunnels hanging from the ceiling.
I'll never forget, you walked me around and there's a big safe, because it used to be a bank back in the ‘40s or ‘50s. We got to the car and you're like, “What do you think? Do you want to work for me?” I'm like, “We haven't talked money.” You showed me this decrypted building but I was like, “I'm optimistic.” Growing up in El Paso, Texas, it gave me this point of reference of community feel. It felt like when it ended up becoming this unbelievable experience being out with some of the most kindhearted family-oriented human beings I've ever known. They were still, to this day, the one population that I believe for more than any other is the people in Florence. They are as kind and generous as they are and anything else, but it doesn't look like that when you're driving through it. When you're driving through it, you're like, “What was that?” I remember thinking like, “He's new at this, I think.”
“He doesn't know what he's doing.” You're dead on.
You're great to work with. You're always easy going you. The reason we were able to succeed all these years was because we laughed at things. Our relationship would have caught in a different direction if we didn't have so much in common over stand-up comedy. He introduced me to Dane Cook when he was okay to listen to. I’m like, “Who is this guy?” He introduced me to Arrested Development. That was a big thing. Tell everybody what the name of our company is that we created. The one LLC. There are two actually. The Hermano Holdings and we have banana stand. That’s one business that failed.
There's always money in the banana stand and Hermano still exists.
I want to highlight some statistics that I wish I'd done right out of the gate. For two years in, you're over 100 episodes in. You are at 35,000 listens that blows my mind. As you look forward for the show, your coaching and your masterminds, what do you see for yourself?
It's hard for me to see that. I'm not necessarily visionary in that regard. My vision is limited a little bit forward so I can see some steps and moving that direction. If I like it, then I'll continue going down that path. The mastermind has been cool and fulfilling. We've had one meeting, but I love these guys and it's exciting to see the banter and the collaboration between them. The coaching, I’ll continue to do that. I enjoy that. Sometime, maybe it will run its course, but I'm enjoying it a lot right now. The show, I'll continue doing it. Sometimes, it's hard to find guests. I come back to guys who I know are solid like you. I interviewed Eric Miller. I'll have some featured guests every so often that are the same dudes, but they do great stuff, and have a ton to share. I'll keep doing the show because I find it fulfilling. At the end of the day, if I did stop, I'd be comfortable with it because we've put some awesome content out there and it's out there in perpetuity. My kids, grandkids, great grandkids can always hear my voice. I think that's cool and I'm able to share some of the things that I believe were successful, not just about business ownership but about life. Where does this all go? I don't know. We're loving Alaska right now and enjoying it. I look forward to doing more and serving more, and helping PT owners out there. That's where my head is now.
I have something I'd like to ask for you to do as a final thing if you're cool with it. It's a little bit different. If it aligns for you, do it. If you want to wrap it up, that would be great. It all comes back to family, that glass ball. You mentioned at the very beginning of this episode that’s the real reason why we're doing all this as we help patients and as we have the courage to fail over and over again as business owners. It ultimately shapes us as leaders in our home to help us make an impact where it matters most with those little children who are growing up. What would you like to say knowing that 100 years from now, your great grandkids are listening to this? What would you like to tell them about what matters to Nathan Shields?
That's where I tend to get spiritual. I believe in God, Jesus Christ is my savior. A lot of it has to do with faith. I go throughout the day constantly thinking and in my mind praying, maybe not on my knees, but I’m praying like, “What do I do next?” I’ve got a list of to-do things here. What's the highest priority. Am I missing something? I'm going to start at the thing that's easiest for me that I think is the highest priority. Inevitably a thought comes to my mind, “You need to consider your wife.” I hadn't thought about that. When the kid is having some issues. What do I need to say to him? It's either an inspiration to like, "Go talk to him now," or “He's going to be okay. Spend a little bit more time with him this week.” That's where I have to be grateful for the influence of our kind Heavenly Father to give me those inspirations to lead my family. That's where I can look back many times where I see His hand in my life that I'd be remiss to not be grateful that that's there.Creating freedom to live the life you want to live is not necessarily about you. It's about your relationships with other people. Click To Tweet
I've spoken to you about it when we've talked about business decisions that simply either I feel good about it or I don't based on the prayers that I've had and the answers that I feel I've received. My wife and I talked about it all the time, “How great is this? How cool is this?” This isn't a conversation that we have now that we've reached the pinnacle type of conversation. It's been like that throughout our lives. “How cool is it that we witnessed this happen over the past 6 to 12 months? What would have happened if we hadn't been inspired to do that? How well did that turn out for us?” We're talking about things that you otherwise maybe don't pray about. I had an inspiration to sell our house in Chandler and it was not at buyer's market or a seller's market. I talked to my wife about it. She felt good about it and got the house ready in seven days. We put it on the market and got a full price offer in 24 hours. It’s not in a sellers’ market. The realtor was like, “This doesn't happen right now in this market.”
That's a witness to me that number one, He exists and number two, that His hands works in mysterious ways. A lot of it's about faith. A lot of it is Whitny, my wife, the huge support that she is. I think a lot of owners are like that. There's somebody in their life, whether it's a spouse, a parent, family friend or a mentor of some kind that they have to lean on and that helps a ton. You have that someone who's in your corner no matter what. Giving you the push and the inspiration to live outside of your box and make you a little uncomfortable and force you to sacrifice things and things that you otherwise wouldn't sacrifice. A lot of it goes to Whitny and maintaining that relationship and it's those relationships. You would agree with me. The relationships that we've developed over this time are powerful, emotional, fulfilling, bringing not just happiness, but joy.
The people that we've been able to work together with. My relationship with you is super powerful, loving, caring and supportive. You're my biggest cheerleader outside of my wife and family. Even down to Stacy Sullivan, Michelle, Erica and Katie. These people and these relationships that we have with people are so fulfilling and amazing. Even the people who came in and out of our lives, past employees that no longer work for us or whatnot. I still love and I enjoy them and it's those relationships. I think about patients. The physical therapy profession is such a cool experience that affect many people's lives positively and develop relationships in short amounts of time.
It’s a cool opportunity. You get that with your patients. You get the same thing with your team members, especially your leadership team who buys into your vision and has faith in you. You're like, “Why do you have faith in me?” I remember asking Stacy that all the time, “Why do you still work for me? I know you hate what I do.” They have faith and they captured a vision that was probably granted than our own, which is weird. I then develop relationship with you and then we talked about our network, those relationships. If those guys reach out to me, like Vinod texted me, I felt a teenage fangirl. It’s like, “Vinod texted me. Mom, Vinod wants to talk.” That kind of stuff and to meet Dimi and Shaun Kirk, and the benefits of the show.
I've had opportunity to talk to Heidi Jannenga and some of the huge leaders in our industry that have been around for years and years. Randy Roesch and, Greg Todd, and Jerry Henderson from Clinicient and all these cool people that I never would have been able to meet before. I've had an opportunity to develop some awesome relationships, but it all comes back to I feel like I'm living right. I've got my ethics in order. I rely on my Heavenly Father and Savior Jesus Christ to guide me on a daily basis and try to do what's right and it's that simple. That's what I hope my kids would remember. I hope my kids remember that it's not that hard. Your life's going to suck at times. We went through the experiences, but we came away with wisdom and knowledge, an ability to empathize with other people who go through the same thing and say, “You have bent there? Do you want to know what you can do about it?”
Help them in that regard and not just PT owners but with our kids, with our spouses, you can have the same empathy when you go through crap like that. We're not at a point yet where our kids are married. Heaven forbid our kids get married and now have to deal with spouses of their own. They're going to be like, “I had that argument ten times over with my wife.” There we go. They then have kids of their own. They're like, “Dad, what are we going to do?” It's because we went through some of those crappy trials along the way that helped us learn and gain wisdom and humility. That's some of the stuff that I'll always be grateful for. It has been a cool experience in that regard.
Thanks for that answer. On behalf of everyone reading, thank you for being who you are, for creating the show. I love and adore you. It's a treat to be in your life and I'm grateful for the example you said. Not just in the show, but who you were beforehand and your continual application to be a better human is inspiring. I wish people in the audience could know you the way that I do and ultimately, they get teary a little bit. Thank goodness for the PT Owners Podcast.
Thanks for joining me. It was great to sit and shoot the ball with you and reminisce. I was nervous about how this would go because I've always been the one to highlight the guest and I rarely liked to take the spotlight. I didn't know how that was going to go. It's been awesome to think about it.
It’s my favorite show so far for me.
That's cool because you're the one that wants attention. What you didn't say is how do people get in touch with you. When you're ready to take on more clients because you guys are killing it, how do people get in touch with you?
What we'll do for anybody who's interested is if you're not sure about your existing billing solution in the last couple of months, one of the reasons we've been successful is I don't have to grow this thing. I want it to be a major influence in the industry, but I don't have to grow this billing company out of a need to. What we ultimately care about is making sure you get what you need. I've told people that they should stay with their in-house solution. I've told multiple people that. I told other people that they should outsource, but I'm not their solution. I'm not everything to everyone, but who I can serve, I can go deep with. Who I'm serving are people who want to grow. I want people who are anywhere between 1 and 5 locations. I'll consider bigger companies but if you are between 1 and 5 locations and you have a desire to be free of your company, that's who I want to serve. My email is Will@TheProfitablePT.com and my billing company is called In The Black. We have a separate email for that, but I'm going to keep it simple for people. It's the same as my YouTube brand. You can call me. I don't know if I should give my cell out because I'm worried for the people that I will spend too much time on the phone with them. The email is fine.
Imagine this is after August 1, 2020. What's your website going to be?
My website is going to be InTheBlackBilling.com. We're super excited. We do have a vision of taking on another ten clients. We’re going deep with them and helping them blow their minds. It's such a fun industry to get into it because there's nothing sexy about it. We're bringing the sexy back in a way it's never been. I'm doing normal things you do in other businesses like appreciation and keep relationships strong. I love it. It's so much fun. I still feel like I'm treating is what it feels like. That's how you get ahold of me.
I don't know where this comes from in us because I've done the same thing with coaching clients. I've had people call me and be like, “I don't know if I'm the best fit for you,” or I said, “I don't want you to sign up with me unless you talk to two other people.” I've done that a few times and I'm trying not to say that because we're charitable human beings, but what I'm talking about and the way you presented is that's a true consultant and someone who recognizes the needs of the person that's calling and not necessarily your need to acquire another client. If people who are coming to get a consultation with you, maybe they're going to come away with a couple of nuggets. I do the same thing when people call me about coaching clients, whether they come with me or not, I try to give them a couple of words of wisdom and I share my experience. It’s the same thing for you. You're going to say, “You might want to look at changing your EMR or stay with your current EMR or stay with your current in-house billing person,” but add a couple of statistics or reports that would make them more efficient and hold them more accountable. That's what a true consultant would do.
What we offer is a free profitability breakthrough audit and I've done this a number of times where people will give me their data. We sign an NDA. I completely show them where there's money. There hasn't been a single time. I've done twenty of these at this point. I've never found less than $10,000 sitting in absolute profit in their business right now that we can’t go and get.
That's bottom line in their pockets if they simply made a call or two.
When I show them that, they don't move forward with us because they only needed some tweaking with their existing solution. What you said, I've heard it said differently and I love this, which is, "We can help everyone but we can serve only a select few.” Who we serve, instead of going a mile wide, we're going to go a mile deep. It's a little selfish for us to be helpful for everyone because that's the only way we can find those who we can go deep with. That's where you and I have learned from people like the coaches you've mentioned. They go so deep. You think of them as family, like a father. You can’t separate that. I'm so excited because I know that's what's happening on your end with your clients. I'm grateful that you're doing it. I see you being a master coach in this industry. You already are, but this is your first group. I’m putting it out there in terms of intention that Nathan Shields will have that name of a major influence in the coaching world of our industry.
As long as it gets me out the door and on the leg by 2:00 PM, that's fine. Thanks for your time. Much love. It's always great talking to you.
Thanks again for having me.
Will Humphreys, the Profitable PT, is the CLO and co-founder of In The Black Billing compnay and has been a PT for 20 years. He owned a multi-locational outpatient practice for 12 years before starting his new venture with Katie Archibald. He is a father of 4 boys, married for 20 years, and a part-time comedian. He is passionate about physical therapy, entrepreneurship, and the freedom that is created through profitability.
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Not a lot of PT clinic owners are focused on what it takes to create a business that is less dependent upon them as owners. Oftentimes, systems and training, coaching, mentoring, or other accountability methods in order to keep PT clinics in check can be overlooked in the midst of the daily hustle and bustle. Here to share his expertise is Sturdy McKee. Sturdy has built a strong, thriving out-of-network PT business in San Francisco that is not completely dependent on him. There was a time that he couldn't conceptualize that, but it's what some PT owners dream of. Even if that's not you, Sturdy has great advice on how to make your business less dependent on you, the owner. His professional growth and the systems he's implemented have allowed him the time to coach other PTs and business owners. In fact, if you check out his website, www.sturdymckee.com, you'll see that he shares some great advice - "Hiring A-players", "New Awesome Intake Form", "The 3 Magic Questions", etc. These resources can help you on your path to making your business less dependent on you.
Our guest is Sturdy McKee. Sturdy has been a physical therapist for over 22 years. He is the original owner, co-founder and current CEO of San Francisco Sport & Spine Physical Therapy, which has two locations in the San Francisco area. He comes to us because he has a lot of experience with business coaching and advising for physical therapy clinics. You can find him at SturdyMckee.com. We talked about a number of things during the course of the interview. We focused on what it takes to create a business that is less dependent upon us as owners. We went through a few things, but we mainly hit upon systems, training, coaching, mentoring, or other accountability methods in order to keep us in check also meetings and what it takes to hold other people, namely the people within our organizations accountable.
Sturdy has gained a lot of wealth and knowledge through his work with entrepreneur’s organization, which he has been a member of for ten years. You'll notice that he on his own, has reached out, stepped out and networked in order to gain this information and help him improve his own practice. He lists a number of books, a number of thought leaders and small business leaders that are out there that he utilized and implemented it into his practice. I hope you can take a little bit of his information, his experience, and even some of the resources that he used and find a way to implement those same things into your practice.
Our guest is Sturdy McKee from SturdyMckee.com. He is a consultant and business coach for physical therapy practice owners and other business owners as well.
Not all of my clients are in the rehab space. I do some work with EO Accelerator as well. Some of the participants in that program are in accounting, data analytics for businesses, dog walking business and baby food business. It runs the gamut.
Tell us a little bit about your story. What got you into physical therapy ownership and led you to where you're at?
I got into physical therapy after having started studying political science and international relations with an emphasis on communist nations. I studied the Soviet Union, Cuba, China and those things. Then, I went to China and lived there for a year. That was my primary reason. I was there learning Mandarin, but in doing that I realized that I didn't want to work for the State Department of the US Government especially in that area of specialty. It'd be very restrictive on where I could go, what I could do, whom I could even interact with and all that stuff.
I came back to the states. I had like so many of us had gotten injured at one point. There was a lot of downtime in the '80s in China. That’s a lot of time to think. I've thought about this PT thing that I've experienced when I was back in Atlanta. When I came back I stopped in California and stayed with my grandparents for a little bit and house sat for an aunt and uncle. I went and got a job as a PT aide. I had several jobs as well. My friends used to make fun of me because I only had three jobs, but they were all in PT.
There was a medical clinic at Stanford where I was an aide to the PTs, OTs and outpatient. I was working at Stanford in the wound care with the PT and that was every other weekend. That exposure and then working in a private practice in Los Altos with a PT and Tom Sutton, I got to do essentially everything but treat patients. By doing the front desk, reception, billing, and everything else, I got exposure to the business. Throughout that whole process, I was taking pre-reqs and going back to school and finishing up a total different path. I have a PE degree from San Francisco State and it took me eight years to get through undergrad that path.
With that experience that you had running the front desk and all the different jobs, did you envision yourself owning a clinic at some point or another?
Yes. Looking back, I always had this entrepreneurial bent. I was in denial and refusing in a lot of ways growing up for all reasons. In any event, I ended up coming back to when I went to PT school, I thought I would open a clinic someday. That ended up happening a lot quicker than I thought it was going to be. When I came out of school, I went to work at St. Mary's here in San Francisco at an inpatient neuro rehab. I did that for a while and then went to work outpatient at Kaiser down on the Peninsula then I worked at UCSF. That was about a three-year whole stint there between those three.Learning to delegate and learning to follow through and learning to do that efficiently is another critical skill. Click To Tweet
UC at that time had merged with Stanford Medical Center, which knowing all the things I know now about business and culture and the rest of it, it was never going to work. I don't know why they thought that was a good idea. In the de-merger, because they got divorced a couple years later, that all came apart. In that process, some consultants told UC that their outpatient rehab is a cost center and they need to get rid of it. More than two thirds of the outpatient staffs were laid off over the time. I was the last per diem therapist laid off there. I worked for over a year there but I was per diem, but I was fulltime with all these hospital gigs.
When that happened, I went out looking for other jobs and the job market was a bit different than it is. I was disenchanted with some of the opportunities and the things that were out there I came home and rethought it over Then, I bought a massage table and opened up in the basement of a gym in the Castro because a good friend who was a trainer there. That’s how I started. A couple of years later, I teamed up with San Francisco Sport and Spine out of the location and then started hiring employees.
You bootstrapped it to begin with.
Yes, the total definition. A massage table, a cell phone, a PalmPilot back then and I did everything. I did my own scheduling, I did my own billing. I did all of it and it was crazy. You learn a lot from that, but what we realized in opening a third location and hiring employees was that we didn't have any training or background in management. We struggled through that first couple of year’s process.
You opened in 2001.
We incorporated and formed San Francisco Sport and Spine in 2001. What precipitated that was an opportunity to open a location in the Marina District in San Francisco that was separate from but adjacent to the 24-Hour Fitness and keeping on that same theme. It was a separate office, essential upstairs. It was above their studio. The landlord wouldn't want to rent it to anybody else because he had gotten some noise complaints before. All their studio stuff was happening in the evenings and it didn't bother us anyway when we were there.
Through that sublease, we got full access to the gym. That was another great business lesson that we got away from at one point that you come back to is having access and things like that to keep your overhead low can make a lot of financial sense and have the resource. Somebody else is maintaining the treadmill. If we wanted to use any of that stuff, we walk next door. It was convenient. I know there are a lot of people out there with those similar setups and it is a symbiotic relationship.
In incorporating in 2001 you said you got to your third location. How many years did it take to get to that third location or to that point where you recognized and said, “We need some management help?”
The third location was the precipitating event in organizing and partnering up. There were two of us running between three locations and seeing patients. That was when we were hiring people and our first employee lasted a day. Dwayne and I are creating a hiring course now because we've done it wrong so many times. Finally, we've gotten to a point where we have a wonderful team and a great team of people. We're very selective about who comes on. Sometimes that hurts us in the near term financial situation. We got more patients than we have therapists. That's frustrating.
I'm super proud of the people that work with us. It is a great team. A lot of people use those terms. One of my things is I want the team to be happy about coming to work each day. They want to be excited. Everybody says that, but I want them to be excited about who they're working with. If they're not a fit, if there's this tension all the time, what I've seen is that can happen a lot more when you're hiring whoever has a license and is available. There's been a lot of diversity, but not in a positive way. You're not controlling for the behaviors, the values, the vision of things that contribute to cohesion and teamwork.
When you're not aligned essentially and your visions aren't the same, there's going to be a lot of dissension. There's going to be a lot of tension. You're moving in different directions and that's going to create different bandwidths within the company. It can stifle your growth and progress. When that starts to happen, it almost becomes a poison throughout the rest of the clinic to the point where it can affect other employees if you don't have the right ones in place.
I have a process to look at that and analyze it. I have people realize where there are people who lie and why these conflicts are happening and that entire thing too. The irony of all this is if you select people for similar values around the business, in patient care, people for their level of performance and alignment with the vision, you end up with a very diverse group of people who have very different perspectives and viewpoints, but they're all working toward a common goal. That ends up being a dynamic team. There's been a lot of business research out there too about the more diverse your team is, the more diverse their perspectives, the more profitable and the better teams execute. That's very true, but there's got to be that alignment factor on the behaviors, values, and the vision part.
You went through that hard time where you recognized you needed some management experience or some help of some kind. What was your first step to reach out or step out to get you to the point where you have frankly a ton of stability through your two practices? You have the freedom that you want to be a business consultant as well as still being the CEO of your company. What steps did you take to get to that point and what would you then recommend to others?
I'd recommend they get help and to do it faster.
That's one of the things I'm noticing as I'm interviewing these other successful owners is they say to a tee, they wish they had gotten help sooner.
We did reach out relatively early. We did try to access resources. We're going back seventeen years. There weren't a whole lot of great resources within the profession. A lot of great clinical courses and clinical stuff, but on the business side, we tried a number of different things with other PTs and what have you it didn't click. We weren't making changes and nothing was transforming. It was probably about two years where our wives were frustrated, we were working longer hours and making less money than I have at the hospital and all this other stuff. I came across this course and my first step was Simpleology. It was a business course outside of PT and their applications to life. I've since met Mark and we're friends. I told him when we met for the first time that it was six weeks after doing that course that we were profitable.
Not wildly profitable and successful but it was like suddenly we've gone from hand to mouth, everything was a stressor to "Here we are. We can breathe for a moment." That success with that one thing made me start looking around and going, "If that can make an impact, what else is out there?" I started pursuing and learning, taking advantage of more resources, and engaging a coach. I did the E-Myth Mastery Impact Program with the E-myth. They've changed it up a bit, but they had a coaching program that was very structured, which particularly for me at that time was like imposing structure on my tangential mind was incredibly useful.
From there, that helped us start that whole process of creating systems and having what I call now and borrow from Jack Daly, a playbook for the business. When I reached out to the E-myth and went through that, what I wanted was an operation manual. I wanted our systems and processes to be in place at the end of the fourteen months. The first conversation with my coach Peter back then was he disabused me of that goal and belief that we would get there. He's like, "You're not going to have it finished. Not in fourteen months. It's not realistic."
Is this the playbook that you're talking about?
On the operations like everything systematized and what have you. It’s like, "It's not going to happen in fourteen months. It's unrealistic." We're not reinventing the wheel, but we're creating all this stuff. There weren't like plug and play resources or at least none that I've found at that time. I think of Catch-22 every time I say this or think of it is you're going to have a running start on your operations manual and you're going to have a system to create systems. I was like, “A system to create systems." Ironically, their system for creating systems is super thorough and super in depth. I tend to try to simplify things and take the important pieces and back it out a little bit and make it a bit more palatable, at least the way I do things.
We had ways to identify problems with process versus problems with people. We look at the process. How do you analyze that? What you do about it? How do you create that? If there was one thing lacking in that program that I really worked hard to do now is include the team in creation of these processes and things. With them, it was very much about, "This is the process you need to create, these are the things." I did all the work. Good or bad, it's like you're taking this thing to your team and say, "We're going to do it this way." Of course week in week out there like another, "No, not more stuff, not more new this or change or what have you." Engaging them in those pieces and processes is not only better as far as adoption, it works better because the group has better ideas.
There's some magic behind that when they create the processes and procedures. In my experience, you can't let anybody create the process and procedure. You find the rockstar in their position and you invite them and say, "You do an amazing job. Can you write down what you do?"
That's been interesting too because some people can't. They get stuck there even though they're good at it. If you're asking them to do it and they're not doing it, sit down with them and you write it down. They can get stuck, a little too self-conscious, concerned and whatever versus if you sit down with them and watch them you're like, "Here’s your intake process. Here are the steps you went through." Then, if you want to revamp it or improve upon it of what you, one big key is turn it around from the patient or customer perspective then look at it and say how does it serve them best? That's one of my pet peeves, collecting all the demographic information before you offer them an appointment. I hate that because you have people calling you for help who are literally in pain and are anxious.Whatever it is you want to do, whatever your goal is, own it. Click To Tweet
When they called the hospital last time, they spent fifteen minutes on the phone and then found out the first appointment was in three months. There's all this stuff going on in their head, whereas if you take that process and think, "What would make it better for them? I got their name and phone number, I'll give them an appointment." We all freak out about it and like, "I got to notice that." Yes, you do. If I tell them, “I've got an opening Tuesday at 2:00. Does that work?” Yes. “I’ll put you in the system. I need your date of birth. Why are you coming to see us?" You're doing all that and you satisfy that anxiety. You have them write it down and get this check off list. That's going to make it easier to train the next person and the next person and to scale it when you open in another location.
What we're talking about how to get you out of being the center of the business, creating some freedom. Not only creating some stability in your practice by number one, setting up the systems in the Playbook like what you're talking about but really gaining some freedom is when those people own those processes and procedures. The training then becomes so simple because they have to follow what's been successful in the past. They don't have to create a new process. There's a checklist or there are outlines as to what they're supposed to do. How you train from there can be in a number of different ways. We find role-playing to be one of the best, but simply work down the checklist, train it into them and start with what has been successful and move it down the line so that you don't have to create the wheel over and over again.
There are two things there. Sometimes we need to be exposed to this same idea over and over before it clicks, before it's the right context for us or what have you. That happened to me with Scaling Up. I was reading and I think for the fourth time before this clicked for me. You were just saying, you don't have to reinvent it, you don’t have to recreate it. You don’t have to figure it out all over again. One of the things in that it says in there is routine will set you free. His whole point and he goes on to explain it and I guess I never read it or listened or it just didn't sink in before, but once you've made this decision that this is how we do this thing, it's decided and you're done and you do it and you do it repeatedly and you can then move on and go to the next step.
If you think you can improve upon it, this is the other half of like Jack Daly thing with the playbook. His whole thing is that most sports teams are run better than most businesses because they do two things. One of them is they have a playbook and the people he worked with, he works primarily with executives and sales and stuff. When they say I want you to help us improve our sales process because he's truly a master at that, he asks them for their playbook. The thing about that is he says only about two out of 100 businesses can hand him their playbook. If you think about your sales process, if you've got all these people doing it in different ways to your point earlier, go figure out what the rock stars are doing and write it down and there's your playbook.
The second piece of what he does is they practice. He literally had an organization of 2,600 salespeople that he built where they all practiced two hours a week. They took the playbook, they identified all the objections and each week they go through one objection with three people. It could be a manager, it could be three salespeople, but one was the prospect, one was the salesperson, and one observed. They rotated and they role-played. They did exactly what you're saying. They role played for fifteen minutes and they rotate after fifteen minutes and then they got to talk about it. No interfering or feedback during the practice. You've got to practice and then you share your observations, you share what you learned. His whole point was if he had a team of salespeople that we're doing that twice a week, every week, what do you think happened to them versus the competition?
They're consistently improving.
Who was the better and who's going to win? The team that practices or the team that shows up and as hasn’t practiced. We end up practicing on our patients or the next person who calls. Your role play thing, that's hugely impactful. You can do that during the meetings. You can do it during group meetings so you can do it over coffee after work or whatever. We practice this stuff in school and then we go out and we don't ever practice again. We get it more information, we take courses and then we'd go and try it on actual people. That's an ongoing practice, refinement and improvement of skills. It might be a little something to consider.
You said you noticed after creating some structure in your life with the Simpleology, I'm assuming you saw some immediate benefits as you started incorporating the systems that you were learning or creating with the help of the E-myth people. How long did that take you then or would you say that you're still working on your Playbook or how long did you say it took you that you felt comfortable with to give you some stability and freedom in your practice?
If you think about Burger King, McDonald's or some giant franchise, they're not using the same exact playbook they were last year or fifteen years ago. I don't think it's ever done. You get to a point where it's good enough for where you are, but then you're thinking also is it going to hold up when we go to the next level? That's another thing. If you look in the scaling up, there are some predictable levels and then areas that he calls the valleys of death. Greg Crabtree in Simple Numbers talks about this too where you need these reserves, you need these numbers, need the money, you need the plan to get through the desert, which happens in between. You were talking about reaching out earlier, that's huge because of PTs in particular, but entrepreneurs in general that’s out there in this parallel play toddler mentality. We're all doing things all the time while thinking about it. If we can collaborate and talk to each other, you can learn and make much more progress that way by forming an accountability group. Working with a coach or having an accountability buddy that you talk to. They talk to each other every day, five minutes, but they stay on track with their priorities. What are you going to do?
In doing this, instead of being out there on your own and thinking this is new and unique and you're doing something that's never been done before, it's simply not true. I want to give credit to people who I have learned some of these ideas from. Rand Stagen came out and talked to the EO Group here in San Francisco. I loved what he did because he put a picture of his daughter up on the screen. It was a picture of her when she was like a year and a half and he was like, "She's sixteen now, but I want you guys to look at her because to us she was unique, special, and precious and yet eminently predictable.” We can all relate to this story. We took these courses as therapists, you know when they're going to walk, when they're going to crawl, when they're going to say stuff, when they're going to be able to eat solid food. You know these developmental stages.
They're eminently predictable like your business. We haven't had the business teach course with the developmental stages. We walk into it and see this new thing happening and it's like, "It's a miracle. It's falling apart." Somebody who knows it and has been there or studied or looked at was like, "That's perfectly predictable.” As a quick aside like the stuff you do in a solo practice isn't going to support you when you were with five people. The system has been processed. You're having a place at five aren't going to work at ten, at 20 to 25, at 50, 100, 200, 500, 1,000. These are very predictable stages of employee growth and interaction where the requirements for communication, the requirements for consistency go to another level. What usually happens is we grow past what's working and then scramble to fix it. As opposed to like the Boy Scout motto, Be Prepared. Pack your supplies. Build a reserve to get you through the badlands.
What do you tell maybe the solo practitioner out there who is running ragged and we're telling them, "You need to create systems. You need to reach out. You need to do these things. You need to get a coach." They're barely getting their head above water. They might even be thinking, "Where do I find the time to do that stuff? How do you recommend they start the process to create the systems and to get with a coach and to eventually start stepping out of practicing so they can lead their business?
I'm a pretty firm believer that everybody needs a coach. You can take breaks and that stuff too. We do tend to be out there by ourselves. If it's not that professional relationship, having an accountability group, having people you can go to, having a peer group, which is what the whole thing's about. Having something that you can rely on and go to is huge, it's critical. Part of that is the personal growth and things I've learned. I'm not a big believer that what worked for me needs to work for everybody. That's not the way I give advice or help people. It's like your patients. You figure out what's going on with them and then you tailor it to them. Having that support, that resource in some way, shape or form tends to work better.Choose your path, but knowing where you're trying to get to and what you're going to do can make everything much easier. Click To Tweet
For that person who's truly solo and scrambling and trying to get everything done, number one, there are so many resources available to you. You can get a virtual assistant overseas for $3 or $6 an hour and then you don't even have any of the employee liability stuff. You start giving things to other people to do. That's actually a big issue with this population. It can be with entrepreneurs in general, but particularly with professionals. Even if there are people who are more mature and older and they’re like, "No, I've learned to collaborate and work together." That's true probably.
Think about the people you’ve hired though, thinking about the young, the new grad, straight out of school. They've been in school for twenty years now, like two decades and they're 24, 25 years old. They've literally been in school kindergarten through doctorate degree of twenty years. In school, what do they call collaboration? If you collaborate on an exam, what happens? That's not called collaboration. They've got twenty years of programming to be right and do it by myself. Then we put them out in this playing field and it's completely different the minute you graduate.
Those aren’t the keys to success.
They'll actually hurt you, inhibit you and hold you back. It's a huge shift in the way people think about it. This is why I'm a big fan of working with and talking with people who played team sports. I mean team sports we had to pass the ball. People get upset about that distinction. The point is even if you've dropped the ball, if you relying upon other people and you've had to do that before, you at least have some framework or context to think about and talk about this. Where you can, then start to translate, "My clinical practice is not school. My clinical practice is more like my soccer team, or more like my basketball or even a cheer leading team or whatever where there isn't a ball."
It’s something around, "I had to work together with other people and we did better when we helped each other," as opposed to being graded on a bell curve. It’s not a competition in that sense. I’m talking even outside of our four walls. If you ask a therapist, who's your competition, they’ll list other PT practices nearby. We only have 5% market penetration. We're not each other's competition. The market is twenty times the size of what we're currently serving, if we could work together to get that out there. I look at things like auto row. Where some people are going to want Hyundai’s and some people are going to want Porsches. That's fine. What if we could all put it there and get people like nowhere to go and know what to do. What if we have a musculoskeletal row where there’s some differences in specialties, visit length and service level, but they get to pick and there are a ton more people out there. Think of it this way. If we even saw a 50% could you deal with or work with ten times more people than you do?
The pond that we work in is so small. It's amazing if we could break through that mindset to recognize the bigger picture that's out and the possibilities.
That's circles right back to that allowing and helping and enabling other people to do stuff. That's true of your business. I talked to business owners that are like, "I have to do this, I have to do that. I'm the only one who can do this." I'm sitting here talking with you. I've got great people running a PT practice that delivers great care and they do a wonderful job. They rely on me for a couple of job functions, I'm selective about what I do and the relevance and importance to the business. Why am I the one who needs to do it? If somebody else can do it, often better then pass the ball. Let them do it. That's a huge shift in mindset.
There are guys out there who are solo business owners, single providers and that are what they want to be and that's okay. They can still benefit from creating systems and processes that can benefit from utilizing somebody to hold them accountable, to make sure that they stay in place or even a sounding board when they have an unruly employee. There's going to be human resource issues.
In every business, by the way.
There's so much more you can do. Your significance in the community is so much greater because you have set systems and processes in place. You've hired the right people. You've created a team and you have the freedom to do what you want to do. It's a stable well-ran facility and if something breaks down, I'm very certain that you have the people to fix it and you might not even know about it. That's the stability and freedom that I think every entrepreneur dreams of.
I used to think so. It certainly was what I thought of. There's a risk in all this. We do tend to project. If it's something I believe in particularly and this is that danger in the hiring process too. If we develop rapport and I like you and you're smiling and all, then my default position is that we're more alike than different. There's no basis in reality for that whatsoever. It's like the real estate adage, you trust but verify. We believe what you're telling me, but we're going to find out. We're going to make sure, we're going to test it a little bit and we're going to see. To that point specifically, there are people who are happy doing what they're doing that way.
There are people who dream of something different. Where the stress and the conflict comes in, I think is when they say they want to do this over here with the freedom and not having it be so reliant but won't give things up. That's again, part of our conditioning and awareness is it the word breaking through that learning to delegate and learning to follow through and learning to do that efficiently is another critical skill. I don't know if we've all done this, but I certainly made this mistake of, "You've got to give stuff up. You've got to delegate." Then doing that but not having a good process to ensure to get it done. We get burned by that a couple times where I did delegate and it all went haywire and I can't do that again. It's like, "I'm never going to do that again."
There are other people doing it successfully. That's the thing I look at. Even back, early days of the practice with a few employees and working our butts off I would see there's this one guy who stands out to me. We went down and visited our billing company in Bakersfield. Things weren't going super well. On the way down to Ontario or something to some conference we stopped in Bakersfield. We met not the guy we knew what the billing company who was running it, but the owner.
The owner pulls up in his Range Rover and he takes us to lunch. He's got the billing company and he's got another company and they're organizing a semipro soccer team. They'd gotten the uniforms and he was doing something else. I'm sitting here going, "How in the world could you do this? By the way, you look so chill and have the time to go out to lunch with us.” I don't even know, like I didn't even know how to talk about it at that point. He isn't doing the billing and he's not working in that other business. He's not running the soccer team. I didn't even have the right vocabulary to ask him what was up. How’s he doing it at the time, but I look at people like that and I was like, "I got to figure that out."
Back to your point for the very same reasons, if I have the time, then I can choose what to do with it. If that is to treat patients or teach classes or create content and stuff that I'm passionate about, then cool, go do it. If it's to ride your bike, hike, take trips or go to the kids' practices, you can make more choices around that stuff. You've got to be very clear about what needs to get done in the business. Enable other people to do the things that they love to do and are good at, which is another thing. There are these discussions. Here's a little tidbit for somebody who's struggling with this delegation thing and not quite sure if they want to do it.
There are all these different tests out there that people talk about them being personality tests or communication styles or whatever. They lump them all together and in my experience, they're all very different. They're very different objectives and reasons and stuff. The StrengthsFinder 2.0 by Gallup is a interesting, very inexpensive test. It's not a personality test per se. It’s identifying along the spectrum of 34 different strengths, what your top five are. The cool thing about that is if let's say we did this at one point with twenty people. We did everybody's tests and then we map them on a spreadsheet that they give you, you just plug in. Then you can see where everybody's strengths are and they're like four main categories and then there are these specific things underneath them.
You can reference or use that and look at things that you hate to do or that you dread doing. There's likely, particularly a team that size, somebody who loves to do that. It's like whether it's their job description or not, you could be like, "Nathan, I see that you're good at visual arts and design stuff. I've got this flyer, would you like to do this? Would you mind?" It's not only would they not mind if that's their number one or number two strength or something like, "Yes". By the time they've looked at it, they already have ideas. It's the way their brain works, it's what they do. They're like, "You can do this, this and this." I'm sitting there going like, "Seriously? That was amazing. I can't do that." That would have taken me all kinds of emotional energy and time and effort and learning and Googling and figuring things out.
I still would have done a crappy job versus in five minutes they're like, "We'll do this.” That's one of the reasons I love doing what I do is one of my top strengths is strategic. When you tell me about a problem, I've already got five solutions by the time you're done talking. One of them is probably bad and something you never want to do. Five is not comprehensive there probably 75 different things or whatever, but immediately what happens in my head, I'm already trying to solve it. That was cool as a therapist too because you're presenting and I'm halfway there.
Learning what other people's strengths are and then, working around those different things and figuring out. If you're going to start delegating, delegate the things that you absolutely can't stand to do or that you keep finding yourself putting off. That you don't do very well at all and you're not happy with the work product. Find somebody on your team and if you don't have on your team there is Fiverr, there are assistants, there are other people or your friends. You have people in your network very likely who can and will and will think very little of it because it's what they like to do anyway. You just got to find the right fit.
Getting started, I did not like marketing at all and I did not want to take the time to go see doctors’ offices. When I finally delegated that to somebody, my life was so much easier. After doing that I learned along the way that it was important than to use statistics and have follow up meetings and whatnot. That was where I wanted to go with you next. You're at the CEO level in your own company, but to get to that point, what is your meeting rhythm where you're at and how often do you hold people accountable? Do you have meetings with one-on-one people that you work with? How do you work at it so that people stay, continue to use the processes that were already set forth and are making sure that the statistics aren't going in continual decline?If a meeting doesn't have an objective, step back and ask why you're having it, what's the purpose of it? Click To Tweet
I feel like we planted this question. The reason I'm saying this is I did a presentation. I have a new favorite talk and I did it for a group at EO in San Francisco. There's a picture on my Facebook page of the group. There were eight or nine people and they are different business owners. It's called Two Things. The first part is, "I taught the course. I don't know why I have to teach a second course because I taught you all this stuff in the first course." It was about raising their profit, number one. We've figured out a way to increase their profit. For those people we were able to figure out $4.1 million in profit. It was awesome. We did that. That was totally cool. Then the thing was you can't run back to your office and tell everybody this is what we're going to do because number one, they'll look at your cross side like here's another tangent, another thing, another whatever.
The second part was exactly what you asked about. How do you make that happen continually and consistently? That is through meetings. The thing I've found is both in personal experience working at other companies as well as doing my stuff and then working with clients is meetings have to have two things. The first one is an objective. There has to have objectives, there has to be a desired outcome. There has to be something you're going to accomplish or achieve. What I say is if a meeting doesn't have objectives, that are not a meeting that's called talking. That's happy hour, but not a meeting.
If a meeting doesn't have an objective, step back and ask why you're having it, what's the purpose of it? If you can't come up with one, then why are you having a meeting? It's a waste of time. Number one is the objective. Number two is the agenda to fulfill the objective. The agenda is the system to get there. Like reinforcing the culture, values, behaviors and stuff in the company is one of your objectives, then telling the core value story early in the meeting and having whoever's reporting to you or if you're reporting to somebody that person share a core value story about somebody else in the company, what the value was, who they were, and what they did to exemplify it.
Then the next question is, have you told them yet? If one of your objectives in the meeting is to make sure that your staff is recognized and you're reinforcing behaviors and culture and stuff that you want, if you've now set up a process where peers are recognizing each other for the great things they're doing on a consistent, regular basis, that's going to help underpin your culture. You create a process around this stuff, and makes sure it happens every week. Then there are other agenda items. What you were saying, how do you get results? How do they making sure they stay on track and do things? That's where the metrics come in but again there are so many little pitfalls here and I know them because I totally stepped in them. I've seen others before and after and the rest of it. If you focus solely on the metrics with many of your employees, the copay collection rate, it needs to be at 95% and it's at 89%, fix it. A lot of times they will get stuck and not necessarily know how to close that gap.
It is important for you as an owner manager to know that there's a gap, but like a lab test or a blood test or something, they’ll tell you where to look next but they won't tell you what's wrong necessarily. Your job is then to go diagnose that. Use your clinical skills, you go to that same thought process and you look what's my differential? I've got these five different possibilities that I'm aware of. There might be others, but I'm going to try to disprove each of these. I need to do that through asking questions and show me.
Show me is one of my favorite things now because what happened is a great question too, but they can tell you where they're like, "Whatever." "Can you show me?" I pull up the copay collection report and I can ask what happened with this patient who hasn't paid the last seven times? What's going on? How do we clean it up? How do we make sure they know what's expected. That they're okay with it, that you're doing it consistently. On my website, I've got these, but they're three magic questions. What happened? When you see that, "What happened?" and stop talking by the way.
In the meetings we tend to do so much of this. We're teaching. We come by it honestly because if you doing your clinical practice, somebody comes in with an Achilles rupture, do they know what to do? Do they have any context that so we teach them about that because we need to impart information so that they can then have this framework so they know what to do next. That's different from your employees and your staff. Hopefully they already know what to do or at least the vast majority of it. Unless they're brand new, they ought to know their job. They know how to collect copays.
What happened and let them tell you. "What are you going to do over the next week to make that happen the right way or cleaning it up or whatever? Then what help and support do you need for me?" Those are your three magic questions. You can get used to and practice those and be quiet because if you're silent and you wait, people will fill the silence. Your job is to not feel it first. If you ask a question, wait for the answer. I've seen it over and over, I ask a question and I'll start talking again because you're not talking. Get comfortable with uncomfortable silences.
If we cut to those three questions right off the bat, it would save a lot of time and effort and conversation altogether.
I've watched people go in and I've been guilty of it. If you walk in and you start telling them what's wrong and what they need to do? How does that work? Do they feel appreciated and valued and like they want to go forth and work harder? If you're asking what happened and they explained it to you, "What can you do next week to deal with that?" They come up with a solution. What help do you need from me? "No, I think I'm good. I can go do it." Are they likely to do it? Then it's there, you document. On your meeting agenda, you keep your action items there. What is going to get done by whom and when.
Then you revisit that next week and you tell them, "We're talking and anything you're asking me, can you go visit these three doctors or I’d come up with we need to go out and do more marketing. What are you going to do?" I come up with, "We're going to do a Facebook push, do an email. I'm going to go visit three doctors' offices. When will you have those done?" Your job is just to write that stuff down and then say, "We're going to check on this next week or whenever the due date is." You're comfortable with making sure all those get done before then. That works in a coaching relationship that works if I'm paying you for advice. I'm still accountable. It doesn't matter. I gave you my word. I told you I was going to do this by this date. For most people, that's a reasonably compelling reason to get stuff done.
Is there anything else Sturdy that comes to mind that you want to share with the audience before we sign off?
I was talking with somebody and the thing that was so interesting and he was explaining this to me and I was like hearing myself again, was being clear and honest with yourself about where you want to go. You brought up the idea that there are people out there solo and happy, and there's nothing wrong with that. You're absolutely right. There isn't. If you're thinking you want to do something else, but you really don't, then whatever it is you want to do, whatever your goal is, own it. Write it down, commit to it. Get comfortable with that too, and then pursue it.
If it really is to grow your business or scale, great, but commit to it. If it isn't that, if that's something you heard that sounded cool or whatever, then you don't have to go do that. Choose your path, but knowing where you're trying to get to and what you're going to do can make everything much easier. Then know that there's a process for all this stuff. For that one, if you know where you want to be in five years, then you write down some three-year goals that maybe that way. You write down some one-year goals or milestones for the three or your quarterly goals. This quarter you need to build to get you to the one year.
You need to know your path and I think that goes back to knowing what your purpose is and why you're doing what you're doing, and being certain about that so that you can move forward with some certainty.
Thanks again, Sturdy for taking the time and showing me your thoughts about really stepping out and becoming less centered in your business and essentially making the business less dependent upon you as the owner. If people wanted to reach out to you for further advice, insight and get in touch with you or whatnot, how would they get in contact with you, Sturdy?
The easiest way is through SturdyMckee.com website, my contact page. That's my personal email and it's also my personal cellphone. It's super easy for people to reach me through that and they can text or call or however it's best for them.
Thank for your time. I really appreciate it.
Thank you so much. You, too.
Sturdy is a business coach, entrepreneur and business owner who also happens to be a physical therapist and private practice owner. His “Why” is to help people succeed. He has a special place in his heart for physical therapist entrepreneurs and private practice owners.
As a business coach and instructor, Sturdy brings the practical knowledge of owning, operating and growing businesses, combined with extensive training and learning, to clients who want to improve their business operations and achieve their personal and business goals.
Sturdy created and taught “Clinicient University”, a 2 day business crash course for Clinicient client owners and operations executives. Attendees of this 2-day course realized an average increase in revenue of 8.9% in the first 3 months following attending with the top of the range at 22%.
Sturdy has served as an EO Accelerator Mentor, helping business owners define their vision, mission and values, as well as achieve their business goals.
Sturdy finds immense satisfaction in coaching and working with business owners and executives to help them achieve their business and personal goals.
Vinod is one of my favorite PT friends - he's determined, focused, and gets what he wants, which shows in his ability to live in Florida while actively owning his PT practices in New York. He's the epitome of what we strive for and tout in the Physical Therapy Owners Club. Success? Check. Stability? Check. Freedom? Double check. Having an uncle who is a vascular surgeon that did very well for himself in having his own practice and having the skill set on a physical therapy technique that he felt could create a big impact pushed Vinod Somareddy to exceed himself and be successful as a private practice owner. After listening to the episode, you'll see what I'm talking about. He ramped up his clinic quickly with the guidance of Measurable Solutions (now Fortis Business Solutions) and learned along the way how to organize his company, hire the right people, and manage by statistics to ensure his company is reaching its goals. Check out his path and what he's learned along the way by joining the club today.
I’ve got a special guest, Vinod Somareddy. Vinod is someone that I’ve always looked up to and thought that if I ever did this podcast, he was one person in particular that I needed to interview. Vinod owns a successful growing thriving practices in New York, yet for the past number of years has lived in Florida. He owns, manages and directs clinic from a major distance from Florida, the clinics exist in New York. I think it’s a dream that a lot of physical therapy clinic owners either have or never even considered because they probably didn’t think it was possible. Vinod does it and does it really well. I think you’re going to appreciate the insight of Vinod. He’ll open up your mind regarding possibilities. I want you to pay close attention where he talks about statistics and as they relate to time. A really powerful insight that I think might come across as obvious but is really helpful if we really understood and implemented that. Vinod even told me that that’s something that he’s leaned on and understood the last few months or just recently. You can speed up your learning process and learn from Vinod after taking so much of his insight and wisdom.
He also makes reference to measurable solutions during the course of the interview. Measurable solutions no longer exist and I believe it’s now for this business solutions. Nonetheless, that was a major force in his growth and was the consultant that help really grow his practice and structure his practice going forward. You’re going to gain a lot of great insight and wisdom from Vinod. I hope you enjoy it.
Thanks for taking some time to be with me, Vinod. You've got a great story that I want to share with my audience, especially considering the lifestyle that you're living as a physical therapy on this time. Could you go back a little bit and just bring us up to speed on your story? What got you into physical therapy in the first place and specifically physical therapy ownership?
Thanks for having me on this podcast, Nathan. I appreciate it. The main thing for me is when I got into physical therapy, I was looking at getting into medicine while I was in high school. Our high school had a great sports medicine program, kinesiology program, which is different for many public high schools to have that program. I got interested in the subject of the human anatomy. I played sports and they got me an opportunity to volunteer in a physical therapy office during one of the courses, which was an internship. It was about a 30-hour internship.
I got to choose between chiropractor, physical therapy, or a medical office. I went to all three of them and the physical therapy office was the one that I enjoyed the most. Interaction with the patients was great. It was alive. It was an action-packed environment. People were always doing things and patients that were getting rehab were happy. They felt like they were being moved in a direction of health and well-being. From the 30 hours I was there, I saw some people come in with crutches and leave walking or have a lot of pain and tell these great stories; I enjoyed that appreciation and gratification.
I worked hard to get into PT school. I was basically a C+ student in high school and I started off my first year and a half in college at about a 2.4 GPA, which is basically a C+ student at that time. I had to work hard for the last two and a half years to get myself into a better condition grade-wise, and I did. I did well. It gave me confidence that I can do something which was needed. I needed that to subsequently become a private practice owner, a physical therapy business owner. I went to physical therapy school. When I came out of school, I started working at a facility and got great experience. I thought it was wonderful, but I always had the passion and dream to have my own practice.
That's one of the things that I enjoyed, that volunteer experience that I saw. It was a HealthSouth-owned clinic, but the way they operate is the one director there ran it like it was his own, and it was great. I felt like running it and treating patients and being involved with that space, commanding the whole space at that time, was an awesome experience. I always had this idea of wanting to be in private practice. I felt that I could have an impact in my area. I thought that the physical therapy in the area was good. It was a growing area in New York. I thought that I could have a good impact in what I was doing as a physical therapist. As a private practice owner, I have some good ideas. I thought that my idea is to put in place and to create a good company.
Were you always drawn to business ownership of some kind or other, or did you feel like, “I could do this better if I just did it myself? I've got some ideas that I want to put out there into the world.”
My family didn’t have a business background at all. I do have one particular uncle of mine who is a vascular surgeon that did very well for himself in having his own practice. That was something that was encouraged for me to do in getting into the space. Then there was also the skill set that I had. I studied a physical therapy technique very early on after I graduated. I felt that technique itself could create a big impact. There's a combination of both, to be honest, that I felt like you're putting something new into this space but also felt like if I was going to exceed myself and be successful, I probably would have to do it under those terms as a private practice owner.
Can I ask what the technique was?
It was Jones Counterstrain.
You eventually decided to strike out on your own. How many years out of out of school were you?
I was out of school about a year and a half.
That's pretty quick out of school, it seems.
I definitely grew up a lot slower than I should have. If I could have grown up a little faster, I probably would have made a lot less mistakes that I did make.
Tell me a little bit about that. You decided to get into practice on your own, strike out, hang out your own shingle, so to say. How long did you work in that space on your own? Did you see some immediate success? Was it slow going was or did you ramp up pretty quickly? Tell me about the general experience.
I had the fortune of ramping up fairly quickly because I had gone prior to Medical Solutions and did the new patient course there. Basically, that helped get me going early on. I also have utilized some of the different relationships that I had established with my father who's a nurse in the area for 30 years. He knew a lot of different physicians in the area, so I got to meet them with a good amount of goodwill because he had taken care of a lot of their patients. It was a good ability to generally state that I'm a physical therapist and I'm sure they communicated that. I didn't get many referrals from a lot of those guys, but there were definitely connections I made from those guys that got me referrals. I could say that that was definitely a big part of it to get me going.
What would you say are some of your most successful marketing actions just getting started to get those new patients in the door?
When we did the new patient course, a lot of that was some direct mailing that we did. That created a good base. It established a base for us as far as being open and being there. At that time, we didn't have as much as a game that we have now, the internet and social media and so forth. It was a little bit more face to face; a lot of face-to-face meetings when patients came. When they called, they were in the office as soon as possible. We’ve got them in quick. We delivered. I gave them great sessions, great treatments and got them better. I made sure that when they went back to the doctor, they were happy with what I did. I didn't pump them up and tell him to say these different things.
I was the real deal. I just got them to understand what they're going through. I gave the credibility that we were a company or I was a practitioner that knew what they needed. I could validate physical therapy as a service for those patients. I ended up getting a lot of referrals from different people like the ENT, the pulmonologists and internal medicine doctors. They could see the benefit of physical therapy not only because I could sell it well, but I did give them the benefit of getting well through what I was doing with them. The patients will go back and say, "I'm walking better. I have less pain," and the doctors are a bit like, "I didn't expect to hear that but it's great that you're feeling better." That was a good part of it.
You ramped up fairly quickly and the direct mailers were helpful in gaining some new patients. That's a great problem to have. Were there other challenges that came up that maybe you didn't foresee? What was the biggest challenge for you, if you recall?
Every problem came up, that's for sure. One of the biggest challenges for me was being a forward-thinker at that time. We started to establish some of the marketing that we did, but then we were behind in other areas. For example, our billing, our documentation and our compliance were so behind because I didn't have the creativity. I'd have the time to think about how to establish those things going forward and that all caught up to us at some point. Every one of those factors caught up to us at some point, either we weren't getting paid or we had a small audit and the audit came back where it wasn't favorable.
We were like, "Why are we getting audited? What’s happening here?" It wasn't a big deal. It was just a couple of charts and it was a one-time thing. When you're doing something and you think you're doing well and you're not looking at every area and then somebody is asking questions in the area and you don't know about it or you're not prepared for it, it shocks you a little bit. I didn't know very much about a hiring and HR rules. Every one of these areas came up eventually to hit us in the face to some degree. We advanced through those hurdles and we improved and we are where we are today. It was tough during those times. It definitely took some hair off my hairline.
We could go down so many roads as you bring those issues up, but the overarching question is at the time, were you treating full time and then having to deal with these issues on the side? If you weren't treating full time, how did you pull yourself out of treating full time so that you could be the forward-thinker that you're talking about so you can address the issues that came up like that?
Going back to Medical Solutions, they gave a clear indicator to me that I need to move out of being a clinician to being a forward-thinker. I didn't initially start treating a lot of patients. I was getting anywhere between 75 to 100 patients a week. It’s up to 140 some weeks because I didn't have a therapist. I was there Saturday, Sunday. I was there until 11:00 PM many nights. The patient would be there with me until 10 PM. It's New York. They're awesome people that can hang. I was usually in the office at 6:30, the first patient at 7:00. About 7:00, the coffee’s through. I was done around 10:30 most days. The best day was Saturday because I could get out at 4:00 instead of getting out at 11:00.
It was hard. I definitely built that up. I hired and we went through a number of different people because we didn't know how to hire so well. At some point, I hired enough good people that I was able to cut back my hours four days a week, including Saturdays and Tuesdays and Thursdays. It'd be like an admin day. Those admin days were tough because you're recouping from your long Monday, Wednesday, Friday and Saturday. I was still working the long shift on Monday, Wednesday and Friday. We had patients coming in and we were working it. The best part about that is that I learned a lot and I didn't go in it light. I wanted it as hardcore as possible. I learned a lot through the process.
One thing I know about you is that you're focused and determined and that you're going to push through those issues. Was it hard for you though? I can imagine for some physical therapists, at least in my experience personally and some of the therapists I talked to you, was it hard for you to step away from treating or was that an end goal for you all the time?
I don't know if it was end goal to step away completely from treating. It definitely wasn't. It wasn't that hard, to be honest, at the time because I was seeing so many patients in such a short period of time for a good two years that I realized that if I didn't get away from this that I could do nothing else. I didn't do anything. I didn't have any kids. We had a small little apartment about 500 square feet. We had a small apartment near the office and that's all I did. I ate, I slept, I came to the office and drank coffee. My wife was at the office too. Our lives became enmeshed with this and I figured that at some point we have to have children, at some point we’ve got to do something. I’ve got to go to the gym. It became the only option basically for me.
From what you're saying, it sounds like you took a step by step approach. You gradually worked yourself out of treating six days a week to three days a week and including some admin time. Eventually, you started backing off the treatment time little by little. With the issues that you came up against, you needed that admin time to address those things. What was your most successful action and during that time to address those issues and overcome them to the point where you could step away and address them and that it’d be handled for the long-term and not just overcoming that particular situation that you were up against?
The most successful action was having my wife there. She's my wife, but she’s also a great administrator. She knew how to administer some of the vital components of the business like the billing. Development of that area takes time. You don't know that area well. There aren't robust consultants that can come into your clinic and say, "After your EMR or your billing method in New York in this geographic location, these are the codes for Medicare. These are the plans to get the credential with. These are the regulations and this is the way you're going to bill.”
That part of it is very difficult and we wanted to keep the billing in house. We knew that if we gave it off initially that we would never learn it. We would never be in charge of the income line to our business, the bloodline of our business. The most important thing that we did was we learned through trial and error to have that. I could focus on treatment, I could focus on the marketing and she could focus on that part of it. Initially, the most successful action was hiring. It continued to be a successful action, hiring high-level administrators to take on sub-components of those areas. They are refined and good at doing it.
I imagine her being an administrator. Finding good people, was there any secret sauce to that? I know you went through a lot of trial and error, but did you land on something that hit for you to find good people?
Having somebody do the interviews, that wasn't me; my wife did it. We have somebody else do it afterwards. It gives a different perspective to the prospective employee, and it gives you a different perspective from the individual interviewing the person. It's a simple thing of having another individual conduct the interview and getting a perspective from a two-way communication. As far as the secret sauce goes in regards to hiring people, it's cliché but finding the things that marry the two people together and not marrying them up for a short enough time that it makes no sense.
For example, if somebody is going to go back to school, then great. If they’re going to go back to school for three years, it makes sense. If it's one year, it doesn't make as much sense to invest in time with them. Let’s say, you are hiring a physical therapist. The therapist comes in and they just want to do something differently than what you could offer. The natural flow of that definitely is important. You have to be able to ask the right questions. You've got to be prepared. That's part of what I look back that I could have done differently. When we did do it well, it showed well as being prepared for the interview. When you go in there, you know what you want and you can ask the key questions.
Nathan, I'm sure you've done it yourself. You’re trying to do a patient or you're doing a meeting, and then the interviewee comes in and you want to meet them. You sit down in the chair, you look at their resume quick and then you're in your discussion. That's not being prepared. Being prepared is looking at who the person is, getting the information about their phone screen, looking at all of the components, preparing your questions based on it, and being thoughtful for the person's time when they come in and getting your answers. That was some of the best hires we've done was the ability for us to seek out and gather as much information. If you want to call it intel because it is a sales component. At the end of the day, it's either you want to buy it or not, or they want to buy you or not. You have to get as much intel as possible.
I noticed from my experience as well, once you recognize what you were looking for better and knew what questions to ask, once you were a little bit more solid and had a good foundation of what employee worked well within your group and then match that up against the intel that you received regarding that person, then you could ask the right questions. Then maybe not being afraid to ask more detailed questions like, "You're going back to school.” Some people might lay off that question at the interview process but you need to dig it a little bit deeper like, “When are you going back to school and what's it for? Is that in line with my company?”
One thing that we get a little bit softer about is invading people's privacy. You’ve got to follow the HR rules and you’ve got to make sure that you're doing it professionally, but you have to be able to gather information to make good decisions, not just for yourself but for them as well because their time is valuable. Sometimes they come in and they just don't fit and you know it. When they do come in and they do fit, then it becomes a different game because now you have to make sure that they are going to be part of your group and part of your culture for a period of time. That's a business we're in. We're in a business of people. We don't sell things on the internet as a main source of our income or our business. We're dealing with people. It is a worthwhile investment.
If you want to provide us a little bit of social proof, and if you're willing to share maybe some of your stats and how well your company is doing and how well it's grown over the last few years. After sharing a little bit of that social proof, can you give us some insight in what allows you to then own from the distance that you're at?
When we engaged with Medical Solutions and then we continue to use all of their work, it gave us an opportunity to look at how do we scale this business? How do we make this organizational chart into more of an actual functioning organizational chart? That has always been one of the tenets of our process to put in good people on those seats on that chart. That started to lead us to proper hiring and proper positioning. We've done 5,000 four years in a row, so we've had good growth in the last three to four years.
When we first started in 2004, we were a startup scratch practice and we've grown to over 1,500 patient visits a week. Many of those are done in our home setting. We have two clinics that are fairly robust in size. We haven't done the smaller clinic model as much. We have pretty good-sized clinics. We employ between 75 and 80 staff at this point. During the course of developing all of that, we went through the organic development phases of how to create that model. We hired very early on a CEO and that position has continued to grow and develop. When you have somebody who's there, a CEO or high-level executive, they will have to grow from a practice that's doing 500 visits a week, for example, to 1,000. That's going to be a different book.
Part of the challenge and what we've done and what I continue to do as a leader of an organization is make sure that I’m forward thinking enough. That way we can grow and scale through what we have in as far as processes go without having to add on potentially an investor or potentially make some different lateral moves. We've tried to do it organically and grow it. From a stat perspective, those are basically our numbers. We haven't even hit the stride with some of the things we've done. Some of the home health stuff is fairly new. We haven't done any occupational therapy yet. It's been about four and a half years we've been doing that out of the fifteen years we've been in business. It's grown tremendously for us in our geographic area.
There are a lot of reasons for that being in the Denton, New York area. We haven’t done occupational therapy. We haven't done speech therapy. We haven't ventured into those areas, but once we do that's going to help our growth quite a bit. At this point, our model hasn't been multiple partners; I've been the sole owner of it. I'm not adverse to bringing in high quality equity shareholders into the company that are current staff, and so forth. We want to make sure they're developed and they're substantial so they could bring a lot of value.
One thing that caught my attention was that you brought up a CEO. I know from just knowing your story that you brought him up from within, and that was earlier on. Did you say around the 500 visits per week mark that you brought up that CEO and started training him and developing him and whatnot, is that right?
It was around 350 to 400 visits that we did that. I want to add one point, Nathan, calling him the CEO at the time was a very noble thing to do. It was a pretty large jump for what the company needed. Most CEOs in companies of that size are going to be the owners. We made a move to reflect on what you said, to help develop a great person and help them, through the course of development, become a better CEO and challenge him to be better over the growth period of time which is the name of the game, and we've done that. That's been a nice thing that worked out for us. Just to comment on it for any of your audience, it could be somebody that could be an administrative person that may not be CEO. They might be a vice president of operations or something like that. Your point is we did take somebody internally and stepped him up into a higher level. They now have the responsibility and the accountability to be somebody. They could see the vision that I put forth, which is not always an easy thing for people to see. A lot of credit to Alex for doing that and it’s been that way.
I don't think that's a typical story. At that stage where you're maybe 300 to 400 visits a week that you take somebody and move them that high in the organization, there had to be something within him that you recognized. Because knowing Alex, I believe he was just one of your techs.
He had come in as a receptionist into the company. There are two parts of the story. One is that ever since I've been little, I was always the kid that wanted to eat the bigger piece of the cake or thought I could hit the ball further than anybody else even though I’m half their age. Some of it was delusional, but I also think it’s an attribute in my personality to go after something and be in that mindset. I saw that Alex had that too. He had some of those components in him which is a risky proposition for him. I wouldn't say it's risky. It's just a challenging proposition for him to take on a responsibility that big and grow. He's got to see that at 2,000 visits or 5,000 a week that his role is going to be very different from 300 or 400 visits a week. The fact that he was able to look at the goal and see that, it gave me an inclination. I was kicking the horse. I’ve been kicking the horse since I was two years old trying to push. So far there haven't been that many scratches on my body, but I definitely have some.
At this time, how have you set up your company so that you could manage from a distance? What allows you to do that? I would imagine, for most owners, that's not even on their radar to own from the distance that you're at. What allows you to do that outside of Alex himself? Alex is an integral part, but what leads to that success?
I'll break it down. Philosophically, I always felt that in order for a business owner to have every bit of the knowledge and information about his business, he should be able to run it from a distance. If you're pretty confident, you could find things at a distance that are right, wrong, however you want to look at it, and be able to engage into that area and make it better. Philosophically, I thought that was very vital for us to do even if I was in New York and not going in every day. I felt that I needed to do that philosophically. The only philosophical point of view people get is that you could just do whatever you want to do, and it's not like you have to go to work.
At the age of 42 and what we have in front of us, we can do a lot more. It's a philosophical point of view. What I did well for the company is before I left, I made sure that some of the key vital things were in place, namely in the marketing area, finding a service like our home care service, which I didn't know at the time was going to be as successful, but finding something that I knew that if I left had good wheels to run without me pushing the back of the car all day long. A lot of owners have that problem. It is a very viable issue if you're not set up in a way where your clinics, if you have multiple clinics, are geographically set up well where there is good marketing team or there's good influence in the area. There needs to be a bit more of that driver. We were able to do well with that. Our marketing person is fantastic. She's my sister-in-law on top of it, but we have a very unique relationship because she treats me very much and she gives me a lot of accountability as the owner, as a boss. She’s done a fantastic job.
A big part of me was looking at the thing too and saying, "If I could move and run it from a distance, how is it going to be? What vital things need to be in place?" One of them is having somebody like a CEO who is able to be there and make decisions that are survival decisions for the organization, and then having key components in place where you drop new patients or you're going to drop a new staff member. I've always gone to the simple philosophy in our business. If you look at it, all we did is we’ve got a patient come in the door, then we hired somebody to treat them and then we sent them on their way. Then we did it again. We hired to be with us as the owners and then we hired others. It's marketing, HR, marketing, HR, marketing, HR. If you could keep it that simple and look at it from that point, then you could build the organization behind those pillars.
You have these two pillars at the top on each end of it laterally, and then below it that looks like a triangle flipped upside down, you have your organization. People put a lot of emphasis on organization, people put a lot of emphasis on hiring good people, but the simplicity is when a patient walks in the door after you've done the marketing, the people that received them which is the HR component of it sets the pace. I felt we had that good with. Alex. We had a good play there. That helped us to do that and for me to make that move.
I like the simplicity of it, how you break it down like that. If you have your marketing dialed in and then are also able to manage the operations side of it, that's pretty much it. Billing's a large component and you figured that out. Some people might recommend you offload it. It's better in-house and that's what you do as well, but to each their own. Nonetheless, if you can maintain those numbers and keep the patients happy, that's a lot of it. Just getting them in the door and keeping them happy and treating them right, that's basically what we do, right?
Yeah, for sure. To comment to what you're saying, I am very involved in those two areas. I'm very involved in all the areas, to be honest. Sometimes you have to be involved with development, growth, looking at options and looking at different things. I got interested in both HR and marketing. You know me and we've talked about these things along the way. The reason for it is because that's what we are as an organization. Most physical therapy companies are companies that are able to bring people in who most likely don't know they need physical therapy at least to the degree that they think. That's almost an irrefutable argument because even most physicians don't even know what we can do. Then of course there's the subject of hiring good people to help those people that are coming in with those problems. It's a whole team of people. I got interested in that subject.
To go back to what allows you to run from a distance, it’s something that a lot of business owners could take even if they didn't run their organizations from a distance, and that is what would it take for me? What do I need to know? What keys statistics do I need to know on a daily basis in order for me to understand the overall health of my company? If the company is poor, then what substances do I need to know and look into to make sure that that area is going right? I like your mindset.
What I'm saying is if you're physically running from distance, but before you moved, correct me if I'm wrong, you looked at things and just said, "What do I need to know in order to do make this move?" A lot of other physical therapy clinic owners, even if they didn't move, could benefit from the same exercise. What do I need to know and how do I hold people accountable to those statistics to make sure everything's going well without me being physically present? If they did that exercise, they’ll see a great benefit or a much more simplicity to what they're actually doing.
People don't understand the subject of metrics and stats. The subject of metrics and stats boils down to time. If you take ten new patients and you bring them in in a week, it's still ten new patients or the stat. If there are ten new patients in the last four minutes, it’s a completely different stat. We have our morning meetings and we go over with a production team. It's all the directors in our company, our CEO, our lead marketing person. We have those calls in the morning. It's now, now, now on the staff. It's not, "It looks good for this week. What more can we get?” What we're trying to do is we try to create efficiency within the organization. The only way to create efficiency is through minimizing the subject of time. The only way to measure that is statistics through the utilization of time as a measurement of those statistics.
I find people will get fairly reasonable. When I say reasonable, they'll become like almost lackadaisical about metrics and say, "We had fifteen new patients last week. Fantastic,” but how fast is your verification people getting it through to get them scheduled? You're telling me that your therapists are still seeing 50 patients a week. That doesn't make sense. You start to look at the metrics. To comment on your metric point, you have to be very aware of all the metrics in your company. You have to look at it from a point of view of how much it affects it on a time basis.
That's incredibly valuable because not only can the employees become a little bit lackadaisical, but if you're the leader and you're simply accepting the stat and saying, “That's great,” then they'll follow at your pace. It's never too much as an owner to expect more out of your employees. If there's one fault that we've consistently fall into as owners is that we are accepting of what they're doing but not pushing for more and expecting more out of our teams. That lends to what you're talking about. We did that. How can we do that more efficiently? How can we be more productive in the shorter amount of time? It's valuable as owners that we consider that aspect of time.
It also leads us down the road of dealing with and continuing to employ people that may not be the right fit for the company. They may not be ultimately the individual that’s going to take you and your area to the level you want to go, so you ended up sacrificing your own goals.
One question I like to ask all of my owners is what advice would you give your younger self as you're just starting off your practice back in your younger days or even before you opened up? What advice would you give yourself? What golden nugget of information?
The best advice I can give myself going back is to become a better study in a good way of understanding people and human behavior. There are a lot of different studies out there and a lot of wrong things out there that don't help people understand people. Just understanding the rules of HR, understanding how to do things properly and look at situations that come up with staff and how to hire good people, how to find the attributes in people, that's more of what I would have done better. Learning and focusing in early on would have led to potentially more knowledge, not that things could've been different.
It all leads up to your journey and how you course your life and your business in turn, but that area for sure is a great place to become knowledgeable. Our company, we've used the Hubbard Management System throughout and that's been a very workable science for us as far as the system goes and in methodology. We're happy with that. Learning a bit more about that earlier on probably would have saved me a lot of money and a lot of upset, but otherwise I'm pretty happy I went through that journey though. I needed to do that myself as a person too.
Hiring good people is a bane of most ownership, finding the right people. A lot of times you think, “I need a body, and if I could just throw a warm body at this then it should be able to work out well.” You learn pretty quickly and through the school of hard knocks that it doesn't work out that way. One last thing, what's your endgame? One thing that's different about your practice is that some of your therapists go out and treat inside the home and it's outpatient home therapy, but what are your goals going forward?
A very important goal for me in this lifetime of doing what I'm doing is I want to build a great company. We have a lot of things going for ourselves to do that. It’s a very high-dense area. We have 5 million people that are just in three counties that our two practices border. I'd like to see us continue to grow and get up toward 5,000 to 6,000 a week, to practice with good solid C-level employees that are there who could run the company and you can look at it and say we are doing a large enough impact on the community as far as treating patients and delivering care.
It's notable not necessarily for myself but it's just more notable to say that we're having a pretty big impact in the community with what we do. That could be from a level of the people in our community. Now with social media and the reach we can have, there are many other ways of doing that. For patients, from hands-to- body care or treatment, that would be a good number for us to do every week. It would help a lot of people to a couple of hundred new patients a week. That would make me feel we're having a substantial impact. That's the goal from a metrics perspective. That's a goal that we've always been shooting for. We're not that far away. We're a quarter of the way there.
I'm sure you're going to make it too. You've got the systems in place and you've got some incredible people on your staff. It's just a matter of time. That time component is something that you're always pushing, so I'm sure you'll get there sooner rather than later.
Thanks. I appreciate that.
Thanks for your time, Vinod. It was great talking to you. I appreciate your insight and experience that you shared. There are many aspects from this interview that will be helpful to the audience.
Thanks for your time and thanks for interviewing me.
For over 30 years, Dr. Vinod Somareddy’s father, a nurse at Long Island Jewish Medical Center, treated patients on the Pulmonary floor. He developed a reputation for his knowledge, perseverance and compassion for his patients. Physicians recognized his hard work and developed a high level of trust and confidence in him, and he was eventually nicknamed “Reddy” by everyone he worked with.
Dr. Vinod Somareddy, the family’s eldest child, became a Doctor of Physical Therapy. In 2003, after searching for a practice location, he decided to honor his father’s lifelong dedication to patient care by naming his Physical Therapy practice Reddy-Care Physical Therapy. Founded on guiding principles of quality care and patient management, his team of professionals have fostered a patient-centered culture committed to improving the lives of every patient they touch. Their success stems from hiring the right therapists – those who have demonstrated academic and clinical excellence, and those who have demonstrated their ability in servicing patients’ needs promptly and thoroughly.
Vinod’s belief in organizational expansion and growth has lead to prioritizing patient outcomes, care, and the use of staff development as a means of effective management. Aside from being an active participant among educational programs, Vinod is an active member of the American Physical Therapy Association (APTA). Improvement, promotion and contribution to the profession of physical therapy are essential for its progress and goals, and Vinod knows that these tenets are essential to achieving the organizations’ future goals. Vinod enjoys lecturing on these matters, along with clinical topics to tie in the importance of technical skill and administrative responsibility.
In his spare time, Vinod enjoys playing and watching baseball, traveling, exercising, broadening his musical horizons, and studying.
Shaun Kirk, PT has been consulting physical therapy owners for longer than he's been a physical therapist. This episode is a must-listen and my interview with Shaun Kirk is one that should be downloaded and replayed by every PT clinic owner and reviewed on a regular basis. Shaun shares from his experience of walking into over 140 clinics across the country to consult them, and having over 2000 PT owners walk through his doors to get trained. He knows his stuff and how to make a PT clinic successful. Shaun says that every PT owner should ask these two vital questions, which is what is your purpose, and what are the six areas every PT owner needs to address in their clinic? He says diligently working on your purpose and one to two of the key areas he notes will immediately pay dividends, but being successful and efficient in all six areas is going to guarantee success with your physical therapy practice.
My guest is Shaun Kirk. Shaun has been a consultant of ours for the last few years and has been consulting physical therapy owners and business owners for over twenty years. He's been consulting physical therapy owners for longer than he's been a physical therapist. Nevertheless, he's got a ton of wisdom and insight into what it takes to be a successful physical therapy practice. Because of his insight, support, training and consulting, there has been a number of clinics on the nation that have been extremely successful because of the things that he's taught them.
I want you to dig into a couple of portions of the interview that happened about midway through or so where we talk about purpose. It’s an extremely important topic to discuss, and make sure that you frankly have one. The second part is his six areas of a physical therapy practice that need to be addressed. Working on just one of those and making sure it's running smoothly and successfully with the right people in place will immediately improve your statistics. Being successful and efficient in all six areas is going to guarantee success with your physical therapy practice. If you address those areas, I can guarantee you success.
This is an episode where you're going to want to come back to over and over again because he lays down some great wisdom and insight that is true for any outpatient physical therapy practice. Take the time to figure out those six areas in your own practice and see how you can work on the one that needs the most work first and go from there, shore it up and move onto the next one. This is going to be a valuable episode for you and I hope you get as much out of it as I did.
Shaun, thanks for joining me and being part of the podcast, especially since it's a brand-new podcast. Thanks for testing the waters and jumping in with me. I appreciate it.
No problem. Glad to be here.
If you don't mind, you've got a great backstory that involves not only PT clinic ownership, but business ownership and a significant amount of consulting. I know you in your experience from the past, but will you share with the audience your professional path? What got you into PT and what path you've been on over the past 20 or 30 years?
From the very beginning of college, I knew I wanted to go into private practice. I've had an itch towards orthopedics from the very beginning. I liked the fast results of it and I felt I was good at it. Honestly, when I came out of school, I had mittens on my hands and I couldn't feel anything. The truth is I thought I was a legend. Maybe that ego got me somewhere, but I went into private practice two years out of school. I was running an orthopedic study group a year and a half out of college for Southwestern Ohio for the APTA. It was like, “Why shouldn't I be teaching other physical therapists how to treat patients? I'm only a year and a half out of school. That's no problem. I'm seasoned.”
I started out with that and I like being in front of a group. I wanted to be a comedian in school. I was a class clown in high school and all that. I just love standing in front of a group of people. Whether they're listening or not was really irrelevant. I just stand in front of them and talk good. I ran this study group for Southwestern Ohio and I enjoyed it. I ran an outpatient facility for a hospital and they put me on television, radio and print. I think it's all me, but it was just the marketing arm of the hospital. We beat the marketing projections five times in our first year. It was just a crazy good thing.
I met with the senior management and they said they wanted to see a 20% growth rate for the following year and I said, "I don't know if it's possible. We have therapists with offices in closets. We can't possibly add any more staff." They said, "We don't want to add any more staff." I went back to the clinic and saw this therapist and said, "Can you see 20% more patients?" She says, "Are you kidding? It's 8:30. I'm doing my notes." She said, "What are you going to do?" I said, "I'm going to go into private practice." She goes, "Do you want a partner?" I went, "What?"
That was my plan. I didn't have any more plans than that because I felt I should go on private practice. She says, "My husband is an accountant. If you don’t set up your company correctly, the IRS will shut you down." I said, "Really?" She said, "What do you know about QuickBooks?" I went, "What's that?" Anyway, we went into practice together and it was doomed from the beginning so we ended up splitting. I went around and pounded on doors just like everybody else did, trying to get referrals and got met with some occasionally unpleasant experiences.
I met my wife in PT school so we're both PTs. I was trying to figure out what to do with my practice, how to turn this thing around. I remember sitting in the kitchen and I said, "I think it I'm going to get my DPT." She instantly starts crying. She's instantly bawling and she says, "How many letters do you think you had to have after your name to have the practice of your dreams?" I went "Eleven, maybe?" The alphabet soup after my name, that will work and I'll be successful.
My wife walked away and honestly, I left dumbfounded because I thought I was doing the right thing. I'm going to go get my DPT, that would make me a better therapist and then I would be successful. Not to diss anyone who's done that or is coming out of programs with that, but at that time, that wasn't the drive years ago. I ended up having this practice and I decided to go out on my own. I realized right away it wasn't my clinical skills that was the problem; it was how to run a business that was a problem.
I don't think you're alone in that. What part of owning the business was such a headache for you at that time that made you think, "I need to go get my DPT?" In my experience, and you might have a different experience, if you're talking to a lot of new PTs that are coming out, they're so focused on, "I want to get my certification in this and I want to get better at that and then I want to do better at this and improve all my skills so much." If they're focused on owning a clinic, that's not the kind of education that you need. In your case, what led you to the point where, "I need to do something different?"
What led me to that was being broke. That's a pretty good motivation. I had a practice that had me. I had a receptionist who read magazines, my mother-in-law worked for free doing billing, and I was as broke as I could be. I realized I was a pretty good therapist but I had no clue how to build my business. Not everybody wants to be a private practitioner and there's nothing wrong with those that who don't, but those do and are failing, it's not hard for them to figure out that it's not the next con-ed course for shoulders and knees that's going to turn their business around.
Eventually, they'll realize there's a know-how that's missing on how to build a relationship. Sometimes the doctors will say, "If you open up a clinic, I'll send you a ton of patients." If they didn't qualify that definition of a ton, because they send ten 200-pound men which equals one ton, you don't get any more business than that. Then you're wondering and scratching your head, "How do I get this year and how do I build my business?" I fell into that trap and I had doctors saying, "I love you. You're amazing. I'll send you business." It just didn't happen. I knew that that skill was something that was lacking.
What was your next steps and what did you do at that point?
For me, it was an unusual situation. I was reading every self-help book that I could possibly get my hands on. I was trying to find the holy grail of solutions. It's something that was easy to do and very effective because inherently, I'm a bit lazy. I like the idea of figuring it out with the least amount of moving parts.
I got a phone call one day and I answered the phone. This guy invited me to a workshop on practice management and I thought, "What the heck?" I didn't even know what that word means? I went with my wife and we loved what we heard. There were 40 different businesses there. There were chiropractors and dentists and CPAs and physical therapists. It all made sense. I was electrified with excitement. When the seminar ended, there was a guy who walked up to us who was the same guy who gave me my name tag. He reached out his hand and he shook my hand. He says, "Mr. and Mrs. Kirk, I wish you nothing but success," and he starts walking at us so we start backing up.
The next thing you know, we're out in the hallway of the hotel. He walked back into the room and we were the only ones out in the hallway. We were absolutely the biggest losers in the room. I wasn't writing a paycheck, my mother-in-law worked for free, my receptionist read magazines. I was a loser in every way, shape and form. I wasn't qualified. I couldn't write a check for their program. I was whiny and bitchy about like, "It's all me." It's like, "It's all them." I was to blame with my lack of success.
My wife then starts walking to the car and I grabbed her arm, I go, "What are you doing?" She goes, "I'm going to go to the car." I said, "I want to talk to these guys." She goes, "Do you know that we're the only ones in the hallway? Everybody else is inside talking to salespeople and we're in the hallway." I told her, “I'm going back in.” I walked up to the guy who gave me my name tag and I said, "Is it possible that somebody can help me?" He says, "With what?" I go, "With my practice. I'm dying." He said, "Could you step back out into the hallway?" We were in the hallway like expectant parents walking back and forth pacing for the opportunity. A guy comes out twenty minutes later and he says, "Do you think you could come back tomorrow at 10:00?" I go, "Sure, I’ve got nothing going on."
I came back the next day and I sat down with this guy who I thought was a sales guy or a consultant and basically found out ten years later that everyone said, "Are you kidding? He's the biggest loser in the room. You need to broom him. We don't have time to talk to him." He said, "I don't have the heart." They go, "Then you sign him up." He sat down with me and he says, "Are you good at what you do?" "Yes." He goes, "Are you good on your business?" I said, "No." He then puts this program out in front of me that looked like Monopoly money. It was crazy expensive. I said, "You're not paying attention to the part where I said I'm not writing your paycheck." The guy says, "I'm sorry, but this is our program." My wife says, "Maybe mom and dad can help us out?" I said, "Your mom has worked for me for a year for free. I can't ask your mom and dad for money." She goes, "I can."
Sometimes you run across people in your lives that profoundly change your life in a positive way. For me and for my wife, it's been our in-laws, my mother-in-law particularly. She believed in me when no one else would. She knew that I was way more capable than what I was doing every day. She trusted that I would do well and I would be a good investment. She paid for the program. I built up my practice, I paid her back her back pay. I bought her a car, I paid her back training. I sent them to Alaska of all places on a cruise, and I actually paid to have them come back. It's a gift that kept on giving and really realizing I’ve got my affinity towards practice management with the same affinity I had treating bumps and back conditions. Everything just took off from there.
I love that you represented your mother-in-law that way because there are people out there that are rooting for us even though we feel like the biggest losers. They might not be saying it, but it's there in their hearts and it's just not out there. It’s good that you represented her in that way.
Sometimes people believe in you long before you believe in yourself. For me, I've been a consultant and have been in and out of about 145 or more practices over the years and definitely been to your place before. For me personally, in many situations, I believe in the client long before the client believes in themselves. That what's allowed me to have relationships like I have with you guys and with other clients over the years, it’s that we're friends. It's because I see greatness and I refuse to see anything other than that.
You might've felt like this back in the day when you had your clinic, and I felt it at times when I had my clinic, but sometimes as a physical therapy owner, you feel alone. I question the networks that are out there for physical therapists because they don't seem to be readily accessible or readily visible and supportive to the independent practitioner. What we tend to do and the guys that I interview and talk to is that they end up finally reaching out. Instead of reaching out somewhere in the beginning to learn what we didn't learn in physical therapy school regarding business management or any kind of business acumen whatsoever, we end up going through the school of hard knocks and getting some bumps and bruises along the way before we finally decide it's time to reach out.
One of my goals with the podcast is to help people understand that it's time to reach out well before you hit that point. Reach out, step out, whatever you’ve got to do, network if you need to, to get the support that you need. There are people out there that are doing it and are being successful and they're willing to help. At times, you need to make an investment in your education to learn how to run a business if you're going to be a clinic owner at some point. Go on a little bit about what happened from there. You had a successful practice for a number of years. What happened then along your professional path?
For me, I had my practice and it was growing and I was enjoying it. I wanted to be a comedian. That was my passion. I told jokes all through high school and I was a matchmaker in high school and I just love people. It wasn't Bob Smith's back condition that excited me; it was Bob Smith. It was the people that I loved. It was how many back-pain patients do you need to see before you go, “I think I’ve got this figured out.” I started to enjoy relationships and mentoring people and bringing them along.
As I started to learn more and more about practice management, I got to where I was working about eighteen hours a week. Two hours a day, I was treating patients. The other eight hours, I was running the practice the rest of the time. I was sneaking out in the afternoon and going and visiting my patients who own businesses and help them grow their business. I have a patient who's got a dry-cleaning business. I go, "How do you get clothes clean without getting wet?" He goes, "It's quite a process."
I was like, "Can I come over and help you with it?" He goes, "Do you want to see how I work my shoulder?" “No, I like to see if I can help you expand it.” I started sneaking out with patients. Every time one of my therapists was treating a guy who owned a business, I would latch onto him, "Tell me how did you get into this?" I got really intrigued. Then I started working with dentists, podiatrists and travel agencies. I started noticing that I was coming home excited about going into a guy's business and helping him with his business.
I was at this crossroads where I was looking at opening up to other clinics because that's what you're supposed to do. If you’ve got one that runs well, go and do more. I was looking at it and I had a lease on a 10,000-square foot place and another 5,000-square foot place. Another guy that I worked with, I said, "I don't know why but I'm not happy about this." He goes, "Why?" I said, "I don't know. For some reason, it doesn't feel right." He goes, "Let's take a look at it from a point of view of purpose. The purpose is something you've been doing your whole life." Physical therapy fulfills a purpose. He goes, "What is that thing you've been doing your whole life?" I thought about it for a minute and I said, "Help people."
He goes, "Great. Good. Does physical therapy help you with that?" I said, "Yes." "Any other purposes?" I said, "I like to help people so that they can help someone else." He goes, "Good, how'd you do that?" "I taught continuing ed." "Good, any other purposes?" I thought for a moment and I said, "I like to improve conditions in people's lives." He said, "Does physical therapy help you with that?" I said, "Yes, I get people back to work or sport or activity of daily living. It does fulfill that purpose." "That's good, but yet you're wondering whether this is what you want to do. What do you want to do?"
"I like the mystery and the investigation of trying to figure out another guy's business problems." He goes, "Does it help people?" I said, "Yes, especially guys who are in helping professions. I can help people in businesses in helping professions and they can help more people." "Does it help someone so they can help someone else?" I said, "Yes, I can help a business owner, he or she becomes more successful, they help their staff, their staff comes up and they do better." "Does this improve conditions in people's lives?" "Yes. If a business does better, they're more successful and more profitable, they'll be able to take care of their personnel." Then I went, "I should be a consultant." I came home that night, I said to my wife, "I'm going to sell my practice." She goes, "Okay." "I'm going to start a consulting business." She goes, "I saw that coming." I sold the HealthSouth and started up a consulting business and never looked back. I've been doing that for over twenty years.
I love how you talked about purpose and I hope that people hone in on that because once they find their purpose and what aligns for them, then other things tend to fall into place. Decisions become a lot easier, right?
Absolutely, they do. When you know your reason why, purpose is the reason why. I talk to practice owners all the time, untold numbers. I’ll say, "What do you think is your driving purpose? What do you think you really want to accomplish?" They'll say, "I want to have five clinics." The obvious question is, “Why do you want five clinics?” “I like the number five. It’s a good number.” The purpose is the reason why. Why you want five versus one? When you ask that question and the guy goes, "I'm really impressed with what we do. We have a model that gets results with patients and I want to bring it across my city," that guy has got a chance.
The guy who goes, "I don't know, I like five. I think five is a good number. Don't you?" or something like that, it's like, "Forget it. You aren’t going to achieve it. Let it go. You're not going to be a ballerina. It's not going to work out for you." Purpose is the reason why. Those of you that are in private practice and you're looking at how things are going or what you'd like to achieve and you want to achieve something, you better have a very powerful reason why you want it or you'll never achieve it. If you say, "I want to open two clinics," you better know why. If you say you want to add interactive metronome, whatever that is, in your practice, or whatever, you better have a why.
It's one thing to say, “I want five,” and for many people it might be like, "I want to have greater numbers. I want to see growth. I like the net revenues that I'm getting now. If you'd multiply that by five, then I've reached a financial goal of some kind or another," that still doesn't answer the why. What are you going to do with the money because there's no guarantee that's going to be there? Are you going to push through the hardships that it takes to get to that point? You better have a stronger purpose than some financial goal or a number goal or something like that if you want to take the effort to do that.
In terms of my company, I've had 2,600 private practices come through our doors over the years. It's interesting, you'll have a program of how you handle and practice, it's very similar almost practice to practice. The ones that do really well and the ones that do okay is just separated by drive, command and purpose. Some people are dumb as a box of rocks and find every way to do it wrong. Those guys exist, but in general, the people who want to make something happen and whether to do or not is driven by how badly they want it. Are you willing to overcome some barriers to make that happen? If it was easy, everyone would do it. It's hard work.
You better have a strong purpose because when those trials come up and they're going to come up, you’ve got to have a reason why you're going to push through or those things will falter for sure. You're consulting now and doing a lot of training. Would you say that's one of the consistent issues that you come across in the number of clinics that you've been to or are there other things? Are there marketing programs out of whack or their financial is poor or are they not able to hold people accountable or they’re not hiring the right people? Can you nail it down to purpose or are there other aspects that you see consistently as an issue?
Purpose will give you the fire in your belly and the reason why. That's all good, but it doesn't necessarily make you competent. It gives you the reason. It's the fuel behind what you're doing. You can actually have the machine all tuned up, but it has no fuel in the engine. At least, if you have fuel in the engine, you’ve got a chance to go somewhere. No matter what practice, large or small, I always look at just six things. If you can do those six things really well, you're an amazing practitioner. If you do not, then you're not. Those six things are effective marketing that brings about new patients. You’ve got to have that.
I always think it's private practice. People who start private practice is very synonymous to getting married. What I mean by that is when two people love each other and decided they are going to get married, it's like, "Where are we getting married? Who's going to be the celebrant for our wedding? Where are we going on our honeymoon? Are we going to get an apartment?" Then you get married and you look at each other and you go, “Now what do I do for the next 50 years?” Sometimes starting a private practice, what happens is like, “Where are we going to put this practice? What's our color scheme? What's the name? Are we going to do extruded letters out front or just a big sticker on the window? What kind of equipment do we get?” All of a sudden, your doors open up and it's like crickets in the clinic. There are no patients. We dress up for the event but we don't plan for the duration of the event. Sometimes people go into private practice without confronting the estimation of effort that it takes to be successful.
These six things, one is external marketing. How do we get new patients in the door? The second thing I look at is schedule for control. If you have weakness at your front desk, you're losing buckets of money. If you've got a receptionist that doesn't have a 92 or above arrival rate, then you need a new receptionist. You look at two things. Of all the things a receptionist does, there are two things you can write a check for. Those two things are high percentage of patients that keep an appointment and collecting all the money that's due at the front desk. If they can do those two things but they can't put a chart together to save their life, you should keep that person. You have to look at the front desk and schedule book control because reception is to receive. They are there to bringing people in, they're about filling the book, they are about looking for people who are missing in action and drawing them back in because they're passionate about the delivery of the service to better people's lives.
If you overburden your receptionist, which is too much crap, watch your stats crash. It's going to crash. Some people try to save money and they just keep dumping it on the receptionist. Eventually, you're not saving money because all of a sudden, the phone rings and they’re pissed off because they answered the phone, “That's your job. That's one thing you're supposed to do.” The phone just keeps ringing. You should be happy about that. Scheduled for control is number two.
Number three is case management. How are we managing our cases? People go, “What do you even mean by that?” This is the discharge, the frequency that you see a patient. There's a study done that showed 2.3 patient visits per patient per week had better outcomes than more than that or less than that. When you see a patient, 1.5 five times per week, your scheduling in general is less than two because you’ve got cancellations. If you schedule two times a week and you have a 10% cancellation, you're going to be at 1.8 times per week. Being above 2.0 to 2.3 is important.
You can get therapists who go soft and a patient got high out of pocket or something like that. They go, "Let's just see one day a week and then maybe someday you'll never get better." When that patient doesn't get better, they don't go, “The therapist is taking it easy on me.” They go, “Therapy didn't work.” Physical therapy is the problem, so they go up and see a crystal hugger or a massage therapist or acupuncturist or rub two pennies together and they'll hope to get better. It's because we didn't do our job and we didn't get that patient overcome the barriers to get the service that they need to get better.
One thing I've always felt very strong about in case management, as you know, I'm a pretty good sales guy. I’ve become a very good sales guy and purpose has driven that. If you had a therapist who believes in what they're doing, and I'm not talking about anybody who's just a PT practice owner, I'm talking about a PT who believes strongly in what they're doing, who believes that they do change lives and improve conditions in people's lives. They need to be able to get that viewpoint into the minds of all of their patients that those patients have to do their part that's necessary to get better. That is coming at a certain frequency and a little visit. Do your home program. If you’ve got a therapist who wimps out because of costs, you're doing a disservice to every one of your patients.
It's not just your patients, you're doing a disservice to the profession. It's not overblown but you're starting the beginnings of a reputation, at least in that person's mind, and they're going to spread it to everyone else that they know that, “Physical therapy doesn't or didn't work for me,” because the therapist wasn't capable of finding their purpose and what's best for the patient and getting over their issue that the patient might have a high copay or a high deductible and work around that or help them over that issue.
You've been in practice for a number of years. I was in practice for a number of years. If you look at your patient load of patients that you've seen in the past and have had therapy elsewhere, they never say anything about the therapist was all about money. They say, “It didn't help me.” That's what they always say. If they complain about PT and they've been elsewhere, they say it didn't help. They didn't say, “They’re $20 more than you.” They never say that. They always say they didn't get help. We get all wimped out about fees and yet all the patient wants to do is get better.
As a profession, in the general sense we are pretty ethical on how we manage our patients. Sometimes I think were unethical and this is what I think. Let's say you have a great insurance plan and I assessed your condition. I think you should come in three times a week for the first two weeks, two times a week for the next couple of weeks to say. That's what I believe in my heart of hearts that that's what you need. All of a sudden, I find out you’ve got a crappy insurance plan with a high out-of-pocket expense. I go, “Why don't we just see two times a week for the first two weeks, then one time a week for the next two weeks?”
Which one’s unethical, the first one or the second one? If you think a person needs to be three and two, then suddenly you change it to two and one, which one's an unethical? Are you over-treating in the first category or are you under-treating in the second? If it's ethical, it's just the right thing to do. Instead of just looking at you are allowed to have your pain for a long time because of the high out-of-pocket. Why make a judgment for the patient? They got their cable TV, they got their cars. You can work this thing out. You’ve got to toughen up. PTs who are spineless in this area have a practice that suffers 100% of the time.
External marketing, schedule of control, case management. The next thing I look at is internal marketing. There’s a gold mine in internal marketing. It’s one thing. If you have patients that come back and you haven’t seen him in years and they go, "Do you remember Jimmy? He got into Stanford." You’re like, "That’s awesome. Who's Jimmy?" Physical therapists are like the hairdressers of healthcare. Generally speaking, if you think of hairdressers, people tell their hairdresser everything. Honestly, how many times have you had a patient say, “I've never told anyone this.” You want to go, "You're batting a thousand. You're doing really good. Just open that door up right now. You might regret it. Don’t close that door." I can't tell you the number of patients who told me things. I can't even get this picture out of my mind.
We care for them and they know what we do, and so they hang on every word. They come back a year or so later and they do pick up where they left off. They know about your kids. They know about your family. You’re one of the most important people in their lives. Why the heck can't we ask for referral? I was always pretty hardcore in this. I would be like, “Nathan, it looks like Friday's your last day but I'm not going to be able to let you go. I was calm and like, “We haven't replaced yourself yet.” You chuckle, I chuckle. “Do you know anyone that needs our help?” I cornered people.
Old people are fantastic referral sources. They're the most intelligent people in the healthcare world because they know. Their little black book has a lot of MDs in it. They definitely know good care from bad care, caring individuals from just next. Those older people, to be able to tell them they have a job, and their job is to find people who need our help instead of letting them suffer until somebody directs them to us. If you're confident enough of what you deliver, the results that you get, and that you are about helping as many people as possible, you will not be spineless in this area. If you are, you'll just lay them on the table. Internal marketing is number four and it's very key.
The fifth thing I look at is billing and collections. Are we coding properly? Are we collecting copays and deductibles? Simple things, but they do make a difference. That's the money side of the machine. That's the end product of doing a job well done, the billing and collections and the management of that, to follow up on accounts. The sixth thing is a very simple thing. Do you have the right people and do you have them on the right seats of the bus? If I walked into your office and there was no receptionist, I would think that was odd because there should be receptionist here. In 2,600 practices that crossed our doors, less than 5% of these practices had a staff member who had a full-time job driving in new patients. Someone should be in the practice who isn't there. The typical practice owners are like, “I wish I had more patients.” What are you doing?
Most of them spend less than five hours a week doing anything actively to drive business in the door. They go, “I don't understand why I'm not busy.” I’m like, “Probably because you're not doing anything to get busy?” That might be that. One of the things that I recognized early on with my practice is that I needed to figure out how to get business in the door and being able to do it in a way that was easy and have that right. I wanted to figure out something that didn't require a lot of technical savvy that could have some basic foundation that if followed would make a difference. I started doing that with my practice.
If I was going to walk into anybody's practice, I go, “I'm going to walk in and I want to do something to better the practice.” The very first thing I would do is I would be all over the front desk. Do we have the right people in the right seats on that bus? What is our cancellation rate? I like to invert that and call it arrival rate because when the number goes up that is a good thing. Arrival rate is better than our rising cancellation rate. I would be all over that. That's always my primary target. Truthfully in business, it's easy money. As you know by working with us, that's always the first thing we jump on, schedule book control. It's easy and it's very easy to quantify, but if you've got a weak front desk, you’re probably weak on your collections and weak on a lot of other areas. That’s always the first thing I jump on.
I'm assuming you see this, it's very common. You're able to rattle off the top six things that you go into because you've been through a number of practices. There's typically a hole in, what would you say, one or two or more of those six areas?
Sometimes you can find that case management isn't that far off. Sometimes you can find that their billing and collections practices are pretty solid, they're on top of their compliance points and stuff. You'll find where they are weak is external and internal marketing and schedule book control. The thing about the internal marketing is I haven't found too many people that see the value of that. If you looked at your stats and anybody else, usually about 50% of your patient load are patients who've been there before. What are we doing to get that? We provide excellent care.
That's not a marketing campaign, that's your job. What if we actually did a little bit of a boost? What if we offered free screens? What if we did something like, “Nathan, I'm going to be letting you go, but I want you to know that all of our follow ups are free. If your knee or your shoulder is bothering you again, I want you to feel free to give us a call and we'll take a quick look at it. If we need to see you, we’ll start seeing you. If we don't need to see you, we’ll recommend a couple of solutions. As a matter of fact, you’re such a pleasure to work with. If you have any friends or family members that have any problems, just let them call and drop your name. We’ll be happy to take a look at them for free.”
That cost you nothing other than really crafting the communication with sincerity. The first time a patient comes to PT, pay careful attention when you take in your initial eval. You listened to their story. It's like, “I hurt my back and hobbled around for a while. Then I went to my family doctor. I went on some pills. I came back two weeks later and went on some other pills. Then they sent me to an orthopedist who then did an X-ray, and then they said I go to therapy.” It's a month and a half before they walk in your door. Once they've walked in your door, they realize, “I don't need a month and a half, I'll just call Nathan.”
They call you, “What do I do?” Depending on your state, they can walk right in the door. Hopefully if you're in one of the states that have direct access and all, you should make sure every patient understands that because what you've done is you shortened the runway from the decision that I need care to getting care. There are so many things in the internal marketing world that doesn't necessarily show up right away, but if you keep doing it, you have people coming back calling you for advice, sending their friends, those types of things.
It goes back to your purpose. One of our successful actions in our clinics in Arizona is to push the internal marketing because there are many people who love what we do and are on our bandwagon when it comes to physical therapy. We'd get return clients for years and years. It's hard to get the providers over the feeling that they're being salespeople and reminding them what their ultimate purpose is. All your training is about helping people get better. If you're not actively promoting the fact that you can get people better and you can rehabilitate better than anybody else in the healthcare profession, then you're doing yourself a disservice and you're not following up with the purpose that you set out to do in the first place.
It's tough and I was excited to hear you get on your soapbox because I could get up there as well a little bit. There's a gold mine there. It's much easier now with email campaigns that can be automated. You just get those email addresses. Social media can work to an extent, but there are many opportunities to touch those past patients, the opportunity to do direct mailers to them and to follow up with them. That list grows while your referral list of MDs stays pretty stagnant and static. You can always follow up with current technology to access that goldmine of pot of patients.
It's a misunderstanding of sales. Sales is something where people see it as a bad thing. I hear it all the time, “I don't like to sell.” It's like, “Really? Do you like to get patients better?” “Yeah.” “Do you have to get them to do their exercise program?” “Yeah.” “Are you closing on that?” If the patient's not compliant and you're saying, “You’ve got to show up or I can't get you better,” are you not closing them for that service? I was at a workshop and this one guy said this thing and I've been using it for last twenty years. It's something I stole from him. He said sales comes from an old English word sellan, which means to give, to offer or lend a hand. Years ago I would say, “I’ll help you with a barn and you're going to pay me back with a deer.”
The odd thing is you're carrying this deer on your shoulders for days trying to find me and it starts to smell bad. We figured there needs to be some other way of handling, and so as currency, gold and silver came along as a standard. The dollar’s backed by gold and dollar’s backed by silver. Now it's just dollars back by other pieces of paper. We assign a value to that. True sales is a helpful option and bad sales or any odd feeling about sales is when it's not helpful. If you believe that that patient needs that care and you're doing it from “I'm helping that individual,” then getting in their face and being straight with them is right and it's ethical. We see it so many times and you go, "It's awfully expensive." I totally understand. It's not a problem. It's like you did a disservice to the patient. It means you will not take any money because you're not going to get the patient better.
If you look at sales and help, they do fit. We’re looking at a computer screen and in that computer it's like somebody sold this computer to us. Somebody sold it to me. Does it help me? Yes, it sure does. Is it good and handy? Yes, it does. What if I walk into a place and I want to buy a computer and I go, “How much is it?” He goes, “That's $2,000.” I go, “It’s so expensive. I could only pay $100.” “We don't have a computer for you.” Sales is that. PTs who can't sell and go into private practice are broke PTs. That's who they are. If you are an executive, you are a salesman. If you're doing anything, you're selling ideas. You're getting your staff to take that hill that takes sales. If you suck at sales, you suck at private practice.
I'm pretty passionate about this profession. What I love about physical therapy, these individuals who take on this profession have taken it on for noble reasons. They want to help people. They want to change lives. They want to better people. There are a lot of things you can go to college for and you can learn, but there's nothing better than taking on a profession that helps people and that is what we do. For me, I've always loved the fact that I help people who help people. I'll never be doing anything other than that.
It's obvious that you've got so much experience in seeing how things have gone right and how things have gone wrong and how you can correct those wrong things. Also, it's so succinct. You nailed it down to the six different areas to assess. Your passion shows through in that and that's awesome. Many physical therapists are the same way. Some of them have the experience and have had some success and some haven't. That's why people like you exist because your passion is there to spread the wisdom, share the wealth.
Sometimes you have to have someone kick your butt until you can kick other people's butts. I remember, for me I had a receptionist that read magazines. She was very good at it and she could read three at one time. It's a skill. It’s not very popular but that was what she was able to do. I remember doing this training and my consultant gave me this program, a little step by step list of actions that I agreed and she agreed that I should do and it would better my practice. Step one was to have a staff meeting, go over the basics of what I had learned, get everybody on board. I was to talk to my receptionist; her name was Terry. I was to talk with Terry and let her know she needs to fly straighter or she's out of there.
Then I had step three. I had a phone call about ten days later and I get her on the phone and she's like, "How's it going?" “It’s going great.” We’re small talking for a second. She goes, "Did you get that program I gave you?" I knew she was going to talk to me about it because I didn't do step two. She was like, “Step one, did you have your staff meeting?” I go, "It was amazing. We laughed, we cried. We held hands and sing Kumbaya. It was such a bonding moment." I keep on talking and she said, “Good. Number two, did you talk with Terry and let her know she needs to fly straighter or she's out of here?” I said, "I was so busy. I have so much going on. I honestly didn't have time to do anything." She says, "That's totally fine. How much time did you black out for me?" I said, "An hour." She goes, “Great.
We've only been on the phone for about ten minutes, so how about I hang up right now and you go ahead and talk to her. Bye." All of a sudden, it felt like I got punched in the chest. I'm pitying and I'm sweating and I'm like, "I have talked to her." My consultant is Israeli and she spent two years in compulsory military. She said she's going to kick my butt, I felt like it would happen. I was very much afraid of her more than I was afraid of my receptionist. What I did was I walked up to Terry, our receptionist and I said, "I need to talk to you." I sat her down. I said, " I'm going to have to tell you, if I catch you read magazines during work hours, I'm going to let you go.” Her jaw gapes and she goes, “Ah.” I said, “Did you hear me?" She said, "Aha." I said, "Good. Number two, if you fail to acknowledge a patient when the patient comes in the door, I’m going to let you walk out the door. Got that?” She's like, “Got it, I'm good.”
I went through eight things cool as a cucumber, then she says, "Should I be looking for another job?" I said, "Yes, I don't think you're going to make it through the week." She goes, "Could I leave now?" I go, "Sure." She gives me her key and she walked out the door. I turn around and there's my mother-in-law with a double high five. Then my PTA gives me the chest butt. I go to the phone, I call my consultant. I said "I did it." She goes, "You did it." She said, “Good. Number three.” I looked at the next step of the program and I never looked back. Any good consultant serves as a cheerleader and a coach at the same time. They validate the client who does well, “Well done, that took some courage,” and they're there to put a boot in your butt if necessary. They get you to overcome those things. It all gets easier after you do it. Thank you, Nathan, for inviting me into this. This is awesome.
It was great. You have so much experience to share. If someone didn't get something out of this then we can't help those people. If we had stopped at purpose alone, that would have been a lot for probably half the audience. Not that I know, but so many people are flying without a purpose. Your six areas to focus on in the clinic is invaluable stuff. If someone works on just one of those aspects, then things are going to change. It's not the end all be all, because holding people accountable is something you have to do as leader. Leading a team is another thing. Systematization of maybe meetings and protocols and statistics and reporting are all other things that have to be dealt with. If you just get down to some of these basic principles then you can progress and change in your business.
I've seen a lot of practices, particularly small practices, they get overwhelmed with so many things. You're right, just give me or find me one that the guy can do that's within his capability and resources available, one where he can quantifiably see the difference. Sometimes it's just like the front desk and getting a little bit better control of that. When they get that, they would feel a sense of pride, “I took that from that to that. Look at what it did to my numbers. What's next?” You overwhelm any guy. “You’re capable. You can do it.” It’s like having a baby. It’s like, “Come on, crawling’s good.” We can't be pole vaulting by year two, right?
No, step by step. Shaun, thanks for providing so much information. If people wanted to connect with you or get in touch with you and see what you're doing and where you're at, how can they contact you?
The easiest way would just be to use LinkedIn. We can connect that way. Just reach out to me on LinkedIn and if you have questions, I'll be happy to help you out.
If people have questions they want to shoot off to Shaun, they can also email me, Nathan@PTOClub.com. Maybe at later episode or something, we can bring you back to answer some individual questions that some of the audience might have. Would you be open to that?
I'm totally open to that.
Thank you, Shaun. I appreciate your time.
Alliance Physical Therapy Partners is supported by a very successful private equity group. Our strategy is to partner with private practice physical therapists by making a sizable investment in their practice and help them to build their brand.
We do not change the company name, owners or corporate entity. If you are curious, I would suggest that I connect you to our Director of Business Development who can assist you.
My role with Alliance Physical Therapy Partners as the VP Operations, is to work directly with our partners to assist them in expanding their practices, identifying other practices in their area that could be "tucked-into" their practice in order to build their brand. In short - help our partners reach their goals, create growth in their practice while creating a best in class experience for all their patients.
Sean Miller believes that we all have the ability to essentially win in life, if we just understand the abilities and processes to be able to win in life. He says that there are successful formulas and things that we can do to be able to win. Growing up as a kid, Sean liked to take things apart to understand how they work. As he got older, he got into sports which drew his natural inclination on understanding how the body works, which started his journey into physical therapy and helped him develop physical therapy processes to get people better faster.
I've got Sean Miller of Kinect Physical Therapy in Arizona. Sean owns five clinics in the metropolitan Phoenix area. A couple of reasons why I wanted to bring Sean on to the podcast is number one, he's been a great success. Sean typifies the model of the PT clinic owner that a lot of us want to become or might even already be there. Nonetheless, he's an example of what it means to be a PT clinic owner and grow and become stable and have the freedom that he wants to do. Number two, I also thought it'd be interesting to have him on because one of Sean's five clinics is close to one of my clinics, within a few miles of each other. I would say until about the last two or three years, we saw each other as competition. We didn't have much of a relationship at all. After me and my partner, Will Humphreys, have gotten to know Sean, we developed a great respect for him to the point where I don't feel like we have a lot of competition between each other because there is quite a bit of work out there honestly. After we've gotten over that hump and developed a relationship, I don't see it that way. Do you feel the same, Sean?
I definitely feel exactly the same way. Just like you, I used to think every guy around me was my competition and now I look at it completely differently.
Sean and I were in the same workshop, The Campfire Effect with Chris Smith. After being with him and working with him a couple of days, I gained an even greater amount of respect for him. After hearing his story and getting to know him a little bit deeper, I thought this guy would be perfect to have on my podcast. I'm excited to have him as one of my first guests. Sean, why don't you take a couple of minutes and share your background and share your story a little bit? Tell us where you come from, what got you into physical therapy, why you're a clinic owner, that type of stuff.
Thanks, Nathan. I appreciate you having me on and I appreciate the accolades you've given me in the beginning. Sometimes the hardest thing as an owner is no one always appreciates everything you go through. To hear someone talk about me the way you did at the beginning, I was like, "That's pretty cool. That guy's pretty awesome. Wait, he's talking about me." I appreciate it. Thank you.
You deserve it.
I believe that we all have the ability to essentially win in life if we just understand the abilities and processes to be able to win in life. I believe that there are successful formulas and things that we can do to be able to do that. It's something I've always known growing up as a kid but didn't realize until more recently in my life. Just a background and you know this, Nathan, from my story that I taught at The Campfire Effect. When I was growing up as a kid, I was that kid that constantly was taking things apart to figure out how it worked. My mom would buy me a new bicycle and I wouldn't go ride the new bike. I would actually take it apart and then put it back together again so I knew how it worked. I've just always been curious in that aspect of it, but what that ended up doing is as I got older, I was into being an athlete. I love sports and I realized that was the same thing. You can win in sports if you have the right systems and processes or if you understand how it works essentially.
Can I ask you what sports you did?
Football was my biggest thing. I was pretty good in football. I played in high school and played one year in college. After that, I realized I wasn't as big as I should have been or could have been. As I got into sports, that drew my own natural inclination on just understanding the human body and my own understanding of how the human body work. I couldn't take that apart. It's a surgeon's duty. As a kid in high school and stuff, it was always fascinating to me. I had a couple of buddies that got hurt playing sports and they needed me to take them to their physical therapy appointments. I started going with them to their physical therapy appointments and I thought, "This is really cool. These guys know how the body works and how to put it back together again essentially and get you back on the football field or a sports field, whatever it may be in life." That's what drew me to physical therapy initially. It was going that route.
I went to college in Brigham Young University for my undergrad. I went on to Texas Women's University in Dallas. I'm a proud Lady Pioneer graduate. My patients still give me a hard time for that one, but I'm a proud Lady pioneer. It was a great school. They do a good job there. When I got out of it, after that then I got into PT and just started the same thing, like how does the body work? As I got into PT, it was the same mindset of, "There has to be a successful way to treat a patient, to get them back to where they want to be." That same thing when I was a kid figuring how the bike work, it was the same thing for me. It just came natural for me to develop processes to get people better faster. That was my journey into physical therapy and how I ended up in the physical therapy aspect of stuff.
How long were you a physical therapist before you decided to jump into ownership or partnership, in your case?
When I got out of school I had a goal that I wanted to own my own clinic within five years. I felt like I needed to become a good therapist first and then give myself five years. I did it in three and a half, four years basically though. That's when I started being my own clinic owner.
You initially went into a partnership, is that right?
Yeah, I was approached by another physical therapist. He had a clinic and he was like, "Why don't you come join with me and when we can open up clinics and do our own thing?" I thought that sounded great. Going into business always sounds great, but it was so unknown and actually quite scary at first. I felt comfortable knowing I was joining somebody who had already been doing it.
Joining something that was a little established so you didn't have to start from the ground floor, develop all the systems and processes, and getting it on a partnership level. It can be a good situation for some people. What happened from there?
He and I joined forces. The guy had a lot of confidence which I fed off of, which helped build my confidence. Joining together, we went from one office and ended up opening six offices within a two-year time span across the Phoenix area essentially.
What did you think about that? Was that a pretty hectic time or did you feel like you guys were prepared for that?
What I know now, I'd say definitely we weren't prepared. I've always been a doer, like, "Let's just go do it," so that's what we did. It was fun and exciting. We took off super-fast. It seemed like every time we've opened a business, another opportunity would come our direction. Things just kept happening for us and we're like, "This is awesome," and just kept opening type of thing. It was exciting times in the beginning for sure.
You said in the beginning. You took us down the path. I know your story but keep it going.
After a few years, probably about three years of doing it, what I soon realized is that I was working 60 plus hours a week. We were having a hard time making payroll sometimes. There were times our power got turned off and in some of our clinics our phones got turned off. It was only a couple of hours or half a day or something like that, but it was just pure chaos because we were just running open clinics and this will work out. When I started realizing, I was like, "We're doing something wrong." It started to get where it was more of a drag and I wasn't enjoying what I was doing. I'm thinking, "Why do people own their own business? This is turning into misery." I realized I've gotten away from who I was and that I was just doing. I wasn't stopping and analyzing what are the things that make a real business work and how do I make it work? I felt like I need to figure out what that is. At that time, I decided I was going to break off from my current business partner and go out on my own and figure it out essentially.
What was the tipping point? Was there a certain event or a certain time where you made the realization that, "This isn't right, this isn't working. I need to change things?" What was your tipping point?
A few things. One was the fact that we would have a hard time making payroll. The other one was every year I'd get a bill from my accountant saying I owed the government money. I'm like, "How do I owe you money when I didn't even have any money?"
That's a little bit of a wakeup call. You need to be prepared for Uncle Sam.
I was like, "I can't believe just how businesses run. We’ve got to change something here." That's how it started off.
At that point, did you approach your partner and say, "We need to do things different," or did you just feel like, "We need to part ways?"
I approached first trying to do things different. I felt his hesitancy and not wanting to shift as much. I could be wrong. Maybe I'm reading that wrong now but I just felt like that was the time for me to make a move as well and go off on my own.
Maybe you don't recall, but do you remember sitting and stewing about that for a couple of weeks before you approached him to take some of the clinics off his hands, or is that something you guys talked about a lot? What was that time frame?
I stewed about it for probably a good eight months to ten months before I finally got the guts up. It took me a while. I don't like to disappoint people. It's one of my weaknesses and strengths on the same breadth. I sometimes will hang on to things longer than I should. It was an uncomfortable conversation. I look back at it now, you learn through the struggles and trials. That was definitely a huge learning time for me for sure.
If you were to go back and do it again, it wouldn't have taken eight to ten months, I assume.
No, it definitely wouldn't have taken eight to ten months.
You would have acted on that really quick, I'm sure. Hindsight 20/20 is nice to have. You became an independent clinic owner, didn't have a partner, didn't need to filter anything through him and whatnot. What was one or two of your biggest challenges since that time?
Once I separated off, I ended up taking two of the original six offices that we had together. One of them I got because my brother was the clinic director at that clinic. That was almost a default. Right away, I was getting organized, getting a new name, but I realized that I needed help. Most PT clinic owners will tell you that the thing they think they need more than anything is, "I need more new patients." I was then at the same boat, "I need more new patients." I remember getting a flyer in the mail from a consulting company. At the time, they were called Measurable Solutions. They've changed to Fortis Business Solutions now, which you and I have worked with. I got the thing in the mail and their postcard was, "We'll show you how to help you get new patients." I thought, "That's what I want." That started me on my course and my trek of a consulting with people.
Your first step was to get some consulting coaching. I'm sure that essentially set you on your path to where you are now, would you say so?
For sure. It was huge. I definitely recommend if you're trying to open a business in PT and you've never done it and you don't have any business background, you need help. They offered that which was awesome. What I soon found out was it wasn't patients that I needed, but I needed systems, I needed processes, I needed to know how to run a business. That's basically what they actually taught me.
It's just something that we didn't get in PT School, right?
No one does.
We learn how to be good physical therapists, but that doesn't mean we can run a business. Having that consultant, that coach, some system no matter what it is, to give us some guidance on how to establish the organization of the company. You used a consultant, you used a coach that honestly developed one of your networks, I'm assuming. Did you join any other networks at all besides the Measurable Solutions group?
I didn't join any other group at that time. I do find I'm constantly reading. I've been doing this for a long time. I'm constantly reading business books and I'm always trying to learn from people who have been there before me. That's been the huge part.
Any books in particular that were inspiring to you or really helpful in gaining some business acumen?
In the beginning, the few books that were really key to me was the first book I ever read called Think and Grow Rich by Napoleon Hill. That book was instrumental in helping me gain the confidence and just go with it. In that book they have you write down your biggest dreams, like how much money do you want? Be real specific in writing a number. I remember doing this back when I was in my 30s, like 30, 31 years old. I wrote down how much money I wanted to have by the time I was 45. I wanted to have the ability to retire if I wanted to, not that I want to retire, but I wanted the ability to by the time I was 45, just to have that freedom. Financial freedom and personal freedom are the two things I wanted. The craziest thing is I turned 45 this year and I'm right on the eve of all of that actually happening for me, which is just awesome. I'm a big believer of the book.
You better be if it makes your wildest dreams come true. It's like a Disney movie.
It is. Anyone who hasn't read it, go read that book and follow what it says. It's pretty awesome. It works.
It's got some timeless truths in it and that's why it's been around for so long. You also mentioned another one that was important to me as well. That was The E-Myth Revisited, Michael Gerber. He lays out simply the importance of what you talked about in creating systems and creating processes. Of course, that's not just the issue of a physical therapy clinic owner. That's the issue with any small business.
I would agree. That book is massive in my opinion as well.
A small book with massive influence if you apply its principles, right?
Yeah. If you're going to open a business, if all you do is you read E-Myth and follow that, you're going to have some pretty good success in my opinion. You're still going to have your trials and difficulties, but that book will help immensely.
Maybe you can speak to your own experience, but what was helpful in getting you out of treating full time and working on the business? I don't think a lot of us get into PT clinic ownership thinking that we're not going to treat full time anymore because we typically love what we do. For me and I'm assuming for you, a lot of your business hinges on you not treating full time. What was helpful in helping you make that step and stepping out?
You definitely need someone working on your business if you want it to grow. That was one thing that Measurable Solutions helped me see and understand. It was really hard to step away from doing that. I kept thinking if I step away from treating, the clinic's going to crash because patients want to come see Sean.
It's like you've got the big Superman suit underneath your business suit.
Now I have more business than I've ever done and I don't treat a single hour at all. I've been treated for almost three years now. You got to get it out of your head that you're the reason why the clinic is successful. It's really not. It's part of the reason why for sure but getting out of that mindset and shifting to a completely "I'm going to work on the business" mindset was probably the hardest part for me to get out. One concept I've learned, which I believe in is doing things on a gradient, which means when you start doing something, don't just stop treating and go fully working on business. Start with just like five hours a week that you don't treat and you just work on your business. As you start doing that, pretty soon you start seeing your business do better and better, and then pretty soon you find you need more time. I went from five hours to twenty hours. I did that for about a six-month period. Then I realized I got to get someone in here treating patients for me so I can work on the business more.
You recognize that it's a little bit counter-intuitive that I can treat more people if I'm not treating. I can affect more people for good if I'm not the one doing all the treatment all the time. What you really need to be is the captain of the ship looking forward at the vista ahead and guiding the ship. People are coming to you asking all the questions and making you the source of all the answers, which can be an issue in and of itself, but you need to get out of treating in order to work on the business.
You bring up a good point there. One thing that drove me to get out more was I have a belief in how I treat patients and that I spend the time with them. Unfortunately, sometimes as therapists we get stuck working for companies where they want you to see as many people as possible and we can't spend the time with our patients the way we'd like to. A big piece for me was I didn't want my business to be that way. I want it to be known for we spend time with their patients, quality time and we get them better. What I soon realized is what you're bringing up there, and that was I can only see so many patients in a week, but if I can expand and grow my business, then I can get ten, fifteen, twenty therapists treating the way I like to treat as far as high-quality care, I'm now helping way more people than I could by myself. That was definitely a big motivator to get out and to create this thing on a bigger picture than what I could do on my own.
It's a matter of going from success to significance. You'd gained a measure of success and now you're moving on to creating more significance in the world. You're a perfect example of that.
It's important that people have a purpose when they do this stuff too. If you're just doing it to make money, you're in trouble. You have to have a purpose. Our big purpose is to help as many people as we can and providing that level of care. That drives our decisions in what we do, and that's been a huge part as well.
That shows up in your story. Your initial purpose was to grow as fast as you could with your partner and get six clinics in two years. Would you attest that maybe your purpose wasn't on target?
100% agree. I was just out doing. I didn't have a purpose, I didn't have a plan. We were just opening clinics and putting people in them.
You were taking advantage of great opportunities, but I'm sure now you would attack that differently.
I totally would. Somebody was saying, it was in the conference you and I ran, they were saying, "Life is never short of opportunities," and that's so true. There are opportunities everywhere. It's more important for you to establish yourself based upon what you believe and your purpose, and then the opportunities will be there.
You can align those opportunities with what works for you. Not every opportunity it needs to be addressed. If you do address them all, then you're going to spread yourself too thin. It's important to filter those out by determining, "What is my purpose? What's truth for me that I'm going to stick to? What's my filter going to be when these opportunities present themselves?" I'm going to ask you just a couple of housecleaning items that I'm sure a lot of other clinic owners want to know, and that is what EMR are you using at this time?
We use Clinicient, a software based out of Portland. They're one of the bigger ones. The main reason I use them is two things, flexibility and creating our own documentation-type platforms or templates. More importantly, one thing I learned more than anything is the importance as an owner to track statistics and data. Clinicient is by far the best one that has given me almost too much information sometimes. They have a lot of good information in there to run your business off of.
You use their billing. You don't do your billing in-house?
I outsourced to them about a year and a half, two years ago because without money coming in consistently can ruin you. The nice thing about when I outsource to them, I felt like they're are bigger company, they've got money behind them, they're not going to let my billing fall apart. They've done a phenomenal job. They've done a really good job. We're collecting about 98% to 99% of what we bill, which is pretty good.
We use Clinicient as well but we do our own in-house billing. Each one has their pros and cons. You just decide what's best for you.
I agree. You guys have done a phenomenal job from what I know. That's awesome.
Katie is the bomb. It's all about Katie.
That goes back to a huge successful point in business. To me it's two things. You have to establish the right systems and processes which is what E-Myth teaches you. The next thing is you have to have the right people, which Good to Great the book, Jim Collins talks about having the right people on the bus and in the right seats. If there's any advice I give anybody, that is I tend to take too long to let people go and bring good people in. The thing I learned too was when I first started all this process, I would say, "My staff, they're all eights, nines and tens on a zero to ten scale." Then I started learning how to hire people. What I realized pretty soon as I was hiring people who were better than who I had and people that used to be an eight or a nine in my book all of a sudden looked like fives and sixes because I had people who were tens. Pretty soon, you begin realizing, "I need to get better people and the right people and so much better."
They need to start top grading. I know exactly what you're talking about. That's where we've hit a home run with our bill. Katie, not only is she the right person, but she's established those systems, procedures and policies to make sure that her department not only run smoothly but would run smoothly even if she wasn't there. That's a testament to how she set up and why we're so successful with our own billing department. You talked about new patients. What were some of your successful actions in gaining new patients and growing your clientele?
Understanding marketing was definitely a big piece. All we did before was consulting stuff. I'd go visit doctors' offices on a consistent basis and beg for business. We started doing YPRs which is called Your Patient result form. Basically it's the patient handwriting a testimonial for you. We started gathering those. We were taught that by our consultant. We started sending that to all the doctors' offices. Pretty soon we had doctors saying, "I've got your patient's success stories. That's awesome." It was a way to show physicians that we get people better and we do a good job. That was successful.
It's not your testimony, it's the patient's testimony that provides the evidence for them. It's awesome.
Then we started doing a monthly newsletter to our patients. We send something out to them on a monthly basis. In the beginning, you just think this isn't going to work. I send out a piece of paper to patients and they're going to start sending you more business. Lo and behold, we started getting more and more. Back when we started, return patients was like our number fifteen top referral source as far as coming back to us and stuff. Now, our return patients and patient referrals is our number two referral source now as a company. It wasn't that we weren't doing a good job. What I realized was that if you think about Coca-Cola as a product, they are in your face all the time. Everywhere you go, there's Coke stuff everywhere. The reason is that they're communicating to you. They're reaching out and they're communicating to you. What I realized was if I stopped talking to my wife and I don't talk to her anymore, there's a good chance we're probably going to be divorced within six months to a year.
I learned you need constant communication to maintain relationships. Even though it was just a piece of paper with my logo on it with some information about us, it was a constant communication which maintained our relationship. I'll never forget this. I had a patient who just absolutely loved us and thought we were the best in the world. I saw her for her back or something like that. She got better, she left. Three years later, she came back for her neck and I noticed she had a new scar on her knee that she didn't have before, which means she had a knee replacement. I was like, "When did you get your knee replaced?" She's like, "Last year." I'm like, "Why didn't you come here for therapy?" "I didn't know I could come back here. My doctor sent me someplace else." I was just like, "No." That was a huge eye-opener to me. This is before I was doing newsletters. As soon as I started sending the newsletters, people are like, "No, I got a therapist. Their name's Kinect." They forget your name after a while.
They might remember your name, but they don't remember the clinic's name. They don't know that they have the power to say, "I'm going to go to this place no matter what my doctor says."
Constant communication is what I learned. You have to be constantly communicating with who you're trying to get as a patient, past patients, current patients and physicians. That was the biggest marketing piece. If you're not communicating with them, they don't know who you are.
Looking back, after you broke off from your partner or maybe even before you joined with your partner, what would you tell your younger self about clinic ownership? What advice would you give?
We talked about a lot of different stuff that I wish I would've known at the beginning. Definitely, if I would've known it with my first business partner, we could have been successful because he and I got along really well. I have two things I always tell people and that is establish systems and processes. What I mean by that is it's down to the T of like how do you answer the phone, how do you collect the co-pay, all these different things you need to be written down and have a system in place that suits you and your purpose. Then know and learn how to hire the right people. If you do those two things, you're going to be extremely successful. Another piece of advice would be to be patient. You don't build Rome in a day. It takes time. There's always a way around an obstacle or a challenge. The other thing too is don't be afraid of challenges. Just be patient, figure out solutions, and work around them and you're going to get where you want to be. The other things I'd probably say is you need help. Reach out. You need consultants. You got to know people who've been there before you and learn from them. Always be learning.
You don't have to act on your own. We'd like to think that our challenges are unique to ourselves. Maybe we're not thinking this specifically, but we have this feeling like no one's felt like this before, no one's gone through this. Every entrepreneur, whether it's physical therapy or not, has been through a lot of the same issues and concerns. It's just a matter of us reaching out and sharing those issues, taking the time to pay for a consultant coach to guide us through them. We're not necessarily all that unique even though we like to think we are.
You bring up a good point. I will never forget this. When I was going with the consulting group, when they gave me that first bill of what it was going to cost for them to consult with me, I was like, "Are you kidding me? I can't afford that. I look back at it now and I go, "You can't afford not to do that." I made my money back and doubled it within a year. It's a huge investment piece. The other thing I was surprised about was how many groups there are out there that you can join and be part of to help you. I know you guys belong to EO and different groups like that. Even just back in the beginning, you and I are literally like two to three miles away from each other. We talk all the time now about stuff. You can learn from all of the PTs in our industry, whether they're a mile away or twenty miles away. The more we as a profession could come together and share ideas, the better off our profession would be.
Honestly, one of my purposes behind the podcast is to develop that network. That's on my plan for the future of world domination and physical therapy.
If we don't come together, our profession, the insurance companies are going to continue to dominate and control us. If we can come together, we can change it.
Even though I feel like outpatient physical therapy, independent physical therapy ownership, is the backbone of the PT industry worldwide, I don't think it's seen that way by the profession itself and the associations. Hopefully, we can tip that on its ear a little bit and make a dent in the universe. Last question, what's your end game? What does Sean Miller do next in his next life?
I'm still trying to build this into a bigger platform that helps people. An opportunity that's actually sitting before me right now that I'm working on, I'm working on an opportunity to really make this a bigger deal. What I love about it is it's going to maintain the core of high quality patient care. Another big piece for us that's in our company is a great work environment for therapists as well. It's not just a job to them but they can be part of something bigger. We're working on that right now. Beyond that, I love helping people. I love helping other business owners. Anything like that, I'm definitely down for.
If someone wanted to reach out to you, if you're open to it, can you share your contact information, whether it's email or social media account?
If anybody wants to email me if they've got questions or they'd like to know more about us and stuff like that and they'd like reach out to me, my email is always the best way. That's Sean@KinectPT.net. I'd be more than happy to reach back out anytime.
Thanks for sharing your experiences, Sean. It was great having you. I love talking to you and you're always an inspiration. I love learning from you even from our simple conversations. I appreciate you taking the time especially to be a one of my first interviews for the podcast.
Honestly, it's an honor to be part of it. I'm excited for you and what you're trying to do with it. Anytime you want me on, I'm definitely willing to. I can't wait to hear from other people as well.
Thanks. I appreciate it.
Growing up Sean always felt the desire to make an impact in others life. It was in high school when a friend got hurt playing sports that Sean was introduced to the power of physical therapy and the impact it has on people’s lives. From that experience Sean has set a course in his life to be a Physical Therapist and change lives. Receiving his Bachelors of Science from Brigham Young University in 1999, Sean then pursued his dream of getting his education in Physical Therapy. In 2001 Sean graduated from Texas Woman’s University in Dallas, Texas. Moving to Arizona in 2002 working for others Sean became very proficient as a Physical Therapist. He now specializes in treating vertigo, balance, and orthopedic cases involving the shoulders, cervical (neck), and knees. After years of treating patients full time Sean realized that he was just 1 Physical Therapist and only had the ability to treat so many patients at one time; It was this realization that sparked the dream of owning his own practice. “What if we had multiple therapist all with the same skill and passion? The impact would be even bigger than just 1 therapist”. From this Sean along with his brothers opened Kinect Physical Therapy in 2012. “Opening Kinect Physical Therapy has been one of my greatest challenges, but to see the larger impact we have on the communities and in our patients is why I do this.”
Sean when not making an impact on others life’s enjoys spending his time with his wife and their 4 children. He is often found on the sporting fields coaching his boys teams, at the lake wake surfing or headed to the beach to enjoy the waves and surfing. His favorite quote that he lives by is: “We are what we repeatedly do, excellence therefore is not an act but a habit.” – Aristotle.
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!
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."
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.
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.
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.