PTO 104 | Ownership Journey


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.


Listen to the podcast here:

2nd Anniversary Special: Nathan Shields and Will Humphrey’s Ownership Journey

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.”

PTO 104 | Ownership Journey
Ownership Journey: Having a coach improves you not only as a business owner and leader but also as an individual and a father.


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.

PTO 104 | Ownership Journey
Ownership Journey: When you can improve your business to the point where it gives you the freedom, space, and energy to share with other people, that's when your life changes.


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 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 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.

PTO 104 | Ownership Journey
Ownership Journey: A true consultant is someone who recognizes the needs of the person that's calling and not necessarily the need to acquire another client.


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.

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About Will Humphreys

PTO 104 | Ownership JourneyWill 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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PTO 52 | One Year Anniversary


It's been a year! I can't believe that I've made it this far and the guests I've been able to have on the podcast! I'm really proud of the content that we've been able to share, it's invaluable to PT owners (if I do say so myself). There are some episodes that stick out, and we'll discuss those today. There are also some things that I've learned which I'll share as well. In order to do that we're switching seats - I'll be the guest and my friend and partner, Will Humphreys, will be the host. Thank you for your support and wish us luck in the next year!


Listen to the podcast here:

What I've Learned - The One Year Anniversary Special with Will Humphreys

We are switching seats. I'm not going to be the host of the podcast. I'm coming up on a year anniversary and in order to celebrate that, we're going to do a little year-end review. I'm going to have my good friend and partner, Will Humphreys, be the host and ask me the questions. He's got some questions to ask me about my experiences with the podcast and some of the guests that stood out. I thought it would be a change of pace. We have some insight to share based on the experiences that I've had and I thought it would be a good way to celebrate. Let's get to the interview of me, your host, Nathan Shields, as the guest.


We're taking a different track and I'm going to be in the hot seat for once and be the interviewee. My friend, Will Humphreys, is going to be the interviewer. Will, thanks for joining me. It's good to have you on again.

Thanks for having me back. It’s an exciting switch of roles. I'm glad to be a part of it.

I appreciate your support. You get to ask your questions, interview me about the podcast or whatever experiences you might want to ask about with what's been going on with the Physical Therapy Owners Club or whatever's on your mind. I'm going to turn it over to you.

I appreciate the opportunity to be with you in this space like this because it's very different than what you've done up to this point. I've had the privilege of sitting on the sidelines as you've done what very few people have done before. There's a huge need, in my opinion, of podcasts and information to help prevent what you and I went through as we started our PT practices. First one, I want to acknowledge that you're coming up on your year mark of having launched this podcast. Congratulations on that first and foremost.

Thanks. It was June that we got started and I thought I'll try this for about six months and see how it goes. Maybe I'll hit a year if I want to but it's been exciting to meet other physical therapy owners, to meet other influencers in physical therapy. I've gotten to meet some great people. It's been a cool experience that I'm excited to continue past this year mark.

A lot of people are totally open if you just reach out to them. Click To Tweet

If you go to podcasts in general, you'll see when I looked into them, there are not many in physical therapy to begin with. The ones that are there, there are very few that three to five episodes and they're done. For you to be this long, the first thought I have is what was it that kept you going? What kept you going month after month to doing all the work, to meet people, introduce yourself to them, start new relationships and then create this powerful podcast?

I tapped into my network initially because you and I both know some great owners and I haven't interviewed them all. We know some great owners and we know some great consultants and coaches. I got the opportunity to meet these people. I find myself after every episode getting energized. My family would recognize after each interview that I'd come out and I'd be a little bit happier, fun and excited. I'd come across other people in the PT sphere that I met either as a referral from an interviewee that I had done an episode with or someone who had written an article in the Impact Magazine for PPS.

I'd meet these great people and they'd be willing to join me on the episodes and be amazed at how much knowledge and how many resources are out there for physical therapists. I could share some of this content with people. That energized me as I kept going. During about the six-month mark, I had another question as to whether or not I wanted to continue another six months and my wife was like, “It's obvious, you’re enjoying it. You love it.” The grind is simply finding the interviewees and finding the guests.

There's a lot of energy that you get from meeting powerful people and sharing that with others. I wonder if there is any cathartic healing of the old you when you expose these resources to others that you didn't have when you started?

PTO 52 | One Year Anniversary
One Year Anniversary: There’s a lot of energy that you get from meeting powerful people and sharing that with others.


I'd do a little phone interview with my guests before the recorded interview because some of them are skeptical. They’re like, “Who are you? Why are you doing this and how are you going to monetize yourself on my name?” That's the conversation that's going in my head, but they actually come on and they want to know what's happening. I talked to them, shared a little bit about the podcast and I asked them, “What are you doing? What's top of mind for you? What's inspiring you nowadays or what issues you're coming up against?” They tell me, “I'm working on this. I'm seeing a lot of this with my physical therapy owners.

This is what I'm dealing with in my clinics right now and this is how I'm getting over it.” I think, “We haven't even covered that topic yet. I need to share this with the group because there's obviously a hole in the content that I'm providing and you can fill it.” When you ask if it's cathartic to my younger self, maybe it's because I wish I had that when I was a new owner. I wish I had some insight on this topic. That gets me excited to say, “I can take this person, this resource and connect it to that person over here and they can benefit from each other.” That gets me excited. That's where I find I get a lot of energies when I can be the matchmaker between some of these people.

In your career, you have the initial podcast that talks about how you started your journey and why you became a PT. I don't want to spend too much time on that because the audience can go back to that and dive more in-depth into you. It makes me curious, as someone who's known you for years as to what other parts of your career did you find that same kind of energy? I know there are times when it was gone. As you look back through your journey, at what points do you recognize that energy?

Initially, it was when I was a new owner. It’s when I was actually starting to see it gain some traction and like, “This actually could work. I'm actually supporting my family. Doctors are referring to me, trusting me and patients are referring their friends and family to me.” That gets you excited that’s like, “This concept that I have is coming to fruition. I'm able to capitalize on it and fulfill my purpose and also support my family. Everything's matching up.” You gain greater visions and that becomes run of the mill. Maybe you get busier to the point where I'm treating 50 hours a week. This dream isn't so much a dream anymore.

I’m not living the dream I thought I was, then I get bigger and open up a second location. “I'm a multi-clinic practice owner and here's this new dream that's coming to fruition and it's working great.” You see those little steps here and there as you grow. You and I, then as we partnered and worked together, we'd have sessions where it was exciting to get in the vision, to maybe align our values, create missions, goals for the upcoming year and find that next executive that was going to help offload us. Those things will give us energy. Little steps along the way that were helpful and to see some of those dreams come to fruition are exciting.

Learn, earn, and then return. Click To Tweet

It's so powerful to have been a part of that journey, to see you start your clinic, to build it up, ultimately have it merged with others and become a great larger company and Empower Physical Therapy. I look at what you've created in Alaska. I don't think others can hear it because it has to come from someone other than you. Otherwise, it sounds like you're bragging. You've become a thought leader in diagnostic physical therapy, EMGs and diagnostic ultrasounds. You have been a participant in Hands-On Diagnostics Seminars, which is the country's leading authority on all things diagnostics. It's neat to see as you've accomplished these things. You've moved your family up to Alaska with your seven kids, take them on so many great challenges and you've overcome them. It begs the question for me, what was it about the podcast that it was in your head, what was it the itch that you had to scratch around creating the podcast?

It goes back to wishing that I had a resource like this when I was a younger owner. When I listened to podcasts initially for the first time a couple of years ago, I'd heard about them but I didn't know what they were, take the effort to actually push the podcast app on my iPhone and see what that world was. When I finally did that, I immediately tried to see what podcasts could be applicable to me. We were still businessowners at that time down in Arizona, living there, working with you and looking for something that could be a resource for us where we were at that stage and recognizing there's not a lot to see whatever was out there at the time. It was more marketing-based or treatment-based and not entrepreneurial business-minded PT owner based.

They didn't seem to be a lot of that out there and that was years ago. For two years, I stood going, “I wish there was something out there.” I've found other entrepreneurial business podcasts but nothing PT-specific. When I finally figured out how to actually produce a podcast and get it out there, then I was like, “I can finally do this.” It felt like a calling to me to make sure that I introduced these successful industry leaders that a lot of people don't know about and say, “They're doing some great things. They've got some successful actions that you could replicate or you could learn from them. You don't have to recreate and reinvent the wheel. Learn and even reach out to them if you want to.” A lot of these people are totally open if you reach out to them. I felt the need to make sure that the audience and these influential people were connected.

I love how you say that too. As you discovered these people helping get their stories out, a part of that energy was to be able to share those positive messages with others. A lot of your audience are people who are in a similar position. Either they're in the earlier stages of where you were when you started your company or they're down the road a bit and they've played that game. They're still challenged by it but they've wanted it to a certain degree. What would you tell them were some of the challenges you faced as you branched into this new chapter of your life?

It’s trying to find a purpose. Shaun Kirk sticks out because we talked about it quite a bit in his podcast and this is one of the more popular podcasts that I have. With other people as well, it comes up on a routine basis that figuring out your purpose is what will drive you to push through any issues that you're having at any particular time when you get stuck per se. Your purpose is not always the same. Things change in your life. Your purpose as a single male changes when you get married and your purpose change again when you have kids. Your purpose changes when you become a business owner. There could be an underlying general foundation that you have but some of the purposes that you work off of change over time.

PTO 52 | One Year Anniversary
One Year Anniversary: Figuring out your purpose is what will drive you to push through any issues that you're having at any particular time when you get stuck.


The difficult thing for me as we've gone through this transition of selling our practices and living in Alaska is to find the purpose, something that drives me and that pushes me to work towards something higher, push through any problems that I'm having in getting it done. Setting on my mind on something specific back in that is a change. I could see that happening with people who might come up to four or five clinics. They're like, “Now what? I've got an executive team and things are going smoothly and things are great.” It's at that point where they have to find another purpose. What's your next goal? What's your next purpose for doing this? Maybe they're working off that if they've got grander visions, but it is finding that purpose and setting those new goals.

It’s interesting as you're talking because having known your journey, it reminds me of that adage that in our careers it's, “You learn, earn and then return.” You're at that point where maybe the podcast, there was a little bit of a return to others and getting back to that same position you were in.

I feel that for sure. When I think of the person that I'm talking to for the interview or setting it up, I've got him set up. He's a guy with two kids living in Texas. He's got a single clinic and he's working 50 hours a week seeing patients and not necessarily having time that he needs to work on his business, but he's got grand plans. However, he's not experiencing the stability and freedom that he was hoping for as an entrepreneur or as a new clinic owner. Financially, he's doing okay but he doesn't have the time for his kids that he wants and he doesn't have time to maybe do other hobbies that he's looking forward to in those things.

I look at that guy and I'm like, “This is for him. I want to introduce Dee Bills and how she can help you with the front office issues. I want to introduce you to Shaun Kirk and see if you were assessing the six areas of your clinic. I want to introduce you to Christopher Music. Are you setting aside money for your whole household, for your future and is the business making money for you?” All these people that I’ve had on the podcast, I'm thinking, “I wish I had some of these little tidbits of information that could have helped me push to do a little bit more sooner, get there faster and not have to go through the hardships that it takes that a lot of these people experienced because there are resources.”

You’re describing your ideal customer as it were, your ideal audience and they're like, “That's me. Nathan hit it on the head. That's who I am.” You don't get this opportunity very often to speak directly to your core audience. If you had something you could say to them right now, what would you tell them directly?

Invest in your business like how you invested in your education. Click To Tweet

I would tell them to invest in their business as they invested in their education. I had this great conversation with Shaun Kirk or it could have been Jamey Schrier. Sorry if I’m not attributing it to the right person. Nonetheless he said we go into physical therapy school, we'll spend $100,000 or maybe more on some of these schools to get an education with no guarantee that we're going to pass the exam, that we're going to be successful at all and that we're going to be able to pay off our loans and that we’ll have a job. There's no guarantee whatsoever of any of that but we're willing to spend six figures on it. When it comes to investing in our business education in terms of coaching and consulting, then it’s like, “$1,000 a month? How am I going to afford that?” You spent six figures on your education with no guarantee at all. Whatever it is, $500, $1,000, $2,000, $5,000, you and I have both spent more than that on coaching and consulting, to let that be a hindrance, to gaining some wisdom from other people who are willing and able to help you be successful.

I am of the belief that almost anybody that you reach out to that I've talked to on my podcast if you joined up with any one of them, would help you be successful and help you get the stability and freedom that you're looking for. I pray that they would simply make that step to reach out, step out and network. That's my mantra. I started my story off thinking that the key to stability, freedom in a physical therapy clinic and owning it is to reach out, step out and network. Those are my three things and there's a hypothesis at the time, but it has actually become a truism for me. It's real. You have to step out of the clinic and work on your business. You can't be treating 50-60 hours a week and think that your business is going to go where you want it to go unless you make a change. You’ve got to step out of the clinic and do something different if you want to meet your goals. Number two, you've got to reach out and find a coach or consultant. You've got to find somebody who's going to hold you accountable when you are the pinnacle of the organization, there's no one to answer to unless your wife's hounding you. There's no one to answer to business wise to make sure you get things done. You’ve got to have a coach or consultant and reach out to one of them.

Number three, you've got to network and find that or recognize that you're not the only one in the world that's having these small business problems. Whether it's reaching out and networking with other physical therapists or other small business owners, you’ve got to be part of some network that allows you to ask questions or get a different person's perspective. Get someone else's perspective, to challenge you on the ideas that you have. Someone to hold you accountable so that you actually get things done and move in a direction that you want. Otherwise, you and I both know there's a lot of burnout in physical therapy. You don't see a lot of 60-year old physical therapy owners out there that are still rocking it and seeing a ton of patients. The reason is because there's a big amount of burnout in our profession. In order to avoid that, you've got to get back to your purpose but follow the mantra, reach out, step out and network.

I know there are lots of people who are hearing that, “I've got a little bit of hope now.” Shifting back to the podcast a little bit, you keep mentioning these many guests. I'd like to do a best of scenario here. In your case, I would like to ask you if you had to pick up a story that you heard that impacted you the most or significantly, what would you pick?

The first one that comes to mind is an interview that I did with Michele Kehrer. She owns Balance Chicago in Chicago and she is full of energy. She is Wonder Woman on crack. Here's a woman who developed talent and expertise, a niche in physical therapy and decided to open up a clinic. She didn't have any referral sources. She didn't have a clientele. She took on 3,000 square feet in the middle of Chicago with nothing. She went out there and her personal life went to crap over the next two years. There was a divorce. She was diagnosed with cancer and coming back from that then a year or two later getting diagnosed again with the same cancer. They're not knowing where it comes from and to the point where she is an incredible arc of personal development growth. I love Michele's story.

PTO 52 | One Year Anniversary
One Year Anniversary: In order to avoid burnout, you've got to get back to your purpose, follow the mantra, "Reach out and step out to network."


The other podcast that sticks out in my mind is interesting simply because he's a newer PT owner. He figured some things out pretty quickly. He thought and he finds that with a lot of these coaches and consultants. You and I might have had the same mindset when we were coming out of physical therapy schools, that if I can improve my skill set and become the best physical therapist, then the success and the money will follow. No one cares about your skill set because you're going to get paid the same in the insurance company's eyes. It’s all about how you develop your systems, your team and how you establish that customer experience.

Roy Rivera is a podcast listener who reached out to me via email. He said, “I really enjoy your podcast. I want to give a shout out. I think you're doing great.” We bantered back and forth via email. I said, “What are you doing?” He's like, “I'm in Houston.” I asked him, “What are you doing? How have you become successful? How are you experiencing success?” He said, “I don't do any marketing. I simply use social media.” I'm like, “I need to do an episode about that right now.” That was a cool story because he's found a niche in Houston and he has a clientele that works for him. He circled the customer experience all around that. To give you a brief quip about what's made him successful, with every discharged patient, whether it's on his schedule or someone else's, he sits with them in a room and says, “How's your experience?” They said, “It was great. I love it.” He said, “Do me a favor. I need you to go to Google and Yelp. I need you to rank or review us. Would you mind doing that?” They say, “Great.”

They'd give them a card on how to do it and that kind of thing. He'd send an automatically generated email three to five days later and say, “Thanks again, please follow these links if you haven't already to review us on Yelp and link in Google.” He said when you look up Yelp or Google reviews for Houston physical therapy, his is the top search. Those are the stories that get me excited to bring those people in front of the audience and give them the energy and know that you don't have to have all the stars aligned to make this thing work for you. You have to remember your purpose, focus on the customer experience and on your company.

Another thing that I heard that you didn't directly say but I want to complete that thought is consistency. You keep going back to the idea of you don't have to be perfect, but do the best that you can. Ultimately, it's those consistent even smaller steps that I've seen you take that have impacted not just your family's life but everyone's. The story that you shared is interesting because I heard from a business consultant I was talking to, she shared with me that usually, businessowners wait until the three D's occur for them to pivot and actually become an owner of a business and not have their business own them. Those three D's are death, divorce and disease. One of those three D's usually shows up before people realize, “I can't keep doing this to myself.” I look at those stories and you've had so many powerful podcasts. There's nothing but value throughout them. Were there any surprises? Was there anything, either in an interview or a person that floored you and took you back?

It’s one thing that comes to mind because I hadn't heard this before. Christopher Music shares it often in his teachings for financial advice to private practice owners. That is to set aside 10% of your revenues for yourself off the top. Not 10% of your profits, 10% of your revenues go into your bank account. When he said that on the podcast, I was like, “What? Are you serious? Are you kidding me?” I thought about if I had done that years ago, I would have a ton of money. His mindset is, “You make it an expense line in your company. It's another line item. That 10% goes to the household and you don't touch it.” The funny thing is the mindset is like, “I need to cover my expenses and a little bit more.” Essentially, you start doing a little bit more to cover that new line item that's 10% of revenues and you make it work. That was one thing that took me off guard and I wish I had done it. Looking back, hopefully someone else is taking advantage of that advice. The other one that I thought was, it wasn’t new to me but I was like, “If we did more of that, it would be so much easier on us as owners.” That was an interview that I did with Craig Ferreira of Survival Strategies.

Remember your purpose, focus on the customer experience, and focus on your company. Click To Tweet

When we're talking about improving the productivity of physical therapists in general and talk a lot about stats across the number of the podcast episodes, we’re making sure people are tracking their stats and you're following stats. It's an objective assessment and not subjective but he said, “The expectation for productivity starts in the interview process. It's not part of their training after you've hired them. It's part of the interview process.” It’s like, “This is what our expectations are and this is how you're going to be judged on whether you're being successful physical therapist or not.” Having communication like that with not just your physical therapists but anybody beforehand as you’re going through the hiring process would be so beneficial in helping them understand what it looks like to succeed in our company. What it looks like to not succeed.

This is when you know it's going poorly when you're not meeting these numbers or when you're not fulfilling this goal as a team. Have some of that. It ties into the conversation I had with Jamey Schrier about hiring A players and getting to know what drives them. Of course, you're going to lay out what the expectations are but also find out what's driving them and how can you fulfill their purpose. Maybe they know that their husband might get transferred in a year but they're scared to say it and if you provided an environment of communication where you're discussing what the expectations are but also, “How can we support your end goals?”

Things like that could come up, “I'm only going to be here for a year.” If you knew that and were able to have that conversation before the hiring even occurred, how valuable would that be. This is Jamey’s story. He hired somebody like that and they found out a few months in advance, the year mark came around and her husband was going to get transferred. That employee was able to then help them find her next replacement. It was a win-win for everybody. We're meeting our goals. Communication, I looked at that and thought not that it was a surprise to me but it was like, “I wish I could have done more of that.”

Part of the beauty of this podcast is that by being in this space with these thought leaders and by generating those discussions we’re getting knowledge. As we learn and grow, that knowledge is such a big thing for physical therapy owners to be able to become a little bit more powerful day-to-day, even if it's one step at a time. I look at this and I have been so amazed at the people you've gotten on there and I want to ask you. What’s something that you've learned, not from people but from doing this? Having spent this year interviewing these people and having taken a risk of putting yourself out there. It's not easy to put yourself on a podcast, stamp your name on it and go, “I'm making a stand.” What would you say that you've learned overall from this process?

I went out with this hypothesis and the idea that stability and freedom come from stepping out, reaching out and networking. The one thing that came to mind is I cemented that in my head, that's for sure for certain. The other thing that I learned is there are a lot of people out there that are willing to provide information, support, resource, advice, whatever you want to call it if you know who they are and reach out to them. I was surprised at how easy it was to talk to Jerry Henderson of Clinicient and Heidi Jannenga is a busy woman but she'll make time for the podcast. People that are leaders in our industry are willing to share some of their information and it takes some effort to find them and to look for them.

PTO 52 | One Year Anniversary
One Year Anniversary: The expectation for productivity starts in the interview process. It's not part of their training after you've hired physical therapists.


That's why hoping that this can be a little bit of a one-stop shop to say, “If you're looking for this issue, then here's a consultant over here that can help you out. If you're having this problem, listen to this episode and maybe he'll talk to you about a book that you need to read.” I learned that people are very willing to offer some help. It's been easier to get ahold of people than I thought it might be. I'm reaching out to some of these people who write articles in Impact Magazine and asking if they want to do interviews and they're open to it. Some of them are easier to get ahold of than others but they're willing to talk and share some of their excitement about the industry or what they're passionate about.

Let's talk about the future. What are your plans? What is the future for the PT Owners Club?

The Physical Therapy Owners Club, it's been a grind to make it work. We’re dropping an episode every week. We're going over 50 episodes. I'm probably not going to be dropping them as frequently. They are going to be coming two to three times a month and sometimes we'll get four out a month but it's not easy to get guests. I'll have some people that come back around. Shaun Kirk will be another one that comes up here again and he's my most popular podcast in terms of listens.

I've got Heidi Jannenga coming on again. I've got an interview coming up with Jerry Durham. He's been in the private practice room for years and a successful consultant as well. I've got him coming up here also. It's been a little bit more of a grind, so I'm going to have fewer guests. However, I'm going to take a stab at doing some podcasts where it's me talking and that'll be new for me. That's taking a step out on the ledge. Doing the podcast itself, it takes a little bit of risk because I hated hearing my voice. Getting past that and putting myself out there, I'm very proud of the content that I've created. That content has to be created from within me and then expressed out to the audience.

That's a different level and that's somewhere I haven't gone before. I'm going to try my best to do some episodes where it's me talking and I don't have someone to interview and go back and forth with. I'm going to start doing some coaching. You'll hear more of that in future episodes where I'm making myself available based on my experience and what I've learned both personally and professionally and by doing the podcast where I can help other physical therapy owners achieve their goals, hold them accountable. Maybe even provide some advice here and there as they need it to say, “Have you considered doing this and why aren't you doing that?” I’ll provide some of that to also return and give back.

We've made a year! Yay, PT Owners Club! Click To Tweet

I am excited for what's coming next. The foundation you've built is obviously speaking for itself, all the people who have listened to who have been benefited. Thank you for making the decision to be bold and to do something totally different. On a personal note, I want to say it's such a privilege to work with you, validate and give that external proof that whatever you do is going to be successful. People need to learn from honestly your mistakes and being able to grow. The thing I love most about you, Nathan, is that your heart is genuine. You're one of the most authentic people I know. As you move forward into the future, I see nothing but a benefit and value as you move forward being yourself. I know firsthand all your strengths, all your weaknesses and people will be fortunate to be able to spend time with you, whether it's a podcast or a coaching relationship. With all you've experienced, if I hadn't gone through it, I would want to sign up with you immediately as a mentee. Is there anything you would like to share?

I've shared a lot. I'm excited about physical therapy in general because we meet such a huge need out there, whether it's filling the void for opioids and the opioid crisis, to the number of Baby Boomers that are coming out on a daily basis that are going to need our services. I'm excited about that. I worry that physical therapy owners if they aren't pulling their head out of treating patients every day and seeing what's happening in the landscape, they might get blindsided by some of the changes that will come with healthcare. I only say that because you can look at other parts of the medical healthcare spectrum and maybe extrapolate to what we'll be having with physical therapy. What I see in people that I talk to you is that it's going to be hard for the individual practitioner to stay the course, treat and survive as we did several years ago.

There's going to be more consolidation to these ACOs. Hospitals are going to acquire physical therapists like they're acquiring family practices. That's where I'm talking about. They're doing this in other parts of the healthcare spectrum. We can extrapolate it to us because you can see how hospitals are requiring family practices. They're acquiring physiatrists and orthopedic groups. When they do that and bring in physical therapy, then they can keep it all under one house. You can see that with Banner Network in Phoenix. Now, it has its own insurance. It all stays under Banner and they don't have to network with any other outside physical therapy groups. The consolidation of insurance companies are the same. If you don't know your statistics, if you don't know your niche, if you don't have a solid footing in the community and have your head up and looking forward, you could get run over.

I'm hoping that some of these guests that I bring can shed some light on that. I did a little bit of that with Jerod Bowen and Jerry Henderson, we talked about some of the future of physical therapy and where that's headed. There's still an opportunity there to do that and you can have a seat at the table but you can't do it if you're treating patients 50 hours a week. There's an opportunity out there not to mention the diagnostics. You throw in some diagnostics on top of the PT that you're doing, then you're setting up a different type of value that you bring to the community that other physical therapists don't. It’s not only for your community but also for the profession because the other healthcare practitioners will look at you like, “I didn't know physical therapists could do that.” We can do EMGs, we can do ultrasounds and we can be diagnostic. If we want to be the gatekeepers to musculoskeletal healthcare, then we need to have some diagnostics in our pocket in order to do that appropriately.

I know you're so passionate about what you're doing. This is Will Humphreys interviewing the great Nathan Shields. This is the guy you want to reach out to if you're stuck on anything. If he doesn't have the answer, he knows somebody who does. Feel free to reach out to him anytime, day or night.

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About Will Humphreys

PTO 52 | One Year AnniversaryI am a father of 4 boys, married 20 years and a part-time comedian. I am passionate about physical therapy and startups in my field. I am also fascinated by culture and team building in health care companies.




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PTO 32 | The Future Of PT

I'm excited to bring back Dimi, Dr. Dimitrios Kostopoulos, PT, DPT, MD, PhD, DSc, ECS, as we discuss the seven facts that will be and are changing the future of the PT industry. Dimi runs a number of physical therapy businesses - clinics, continuing education company, diagnostics - and also been on a number of local and national PT boards. He has perspective, and thus I believe he is expert on what is happening to our industry and able to predict what will be coming in the next five to seven years.


Listen to the podcast here:

7 Facts That Are Changing The Future Of PT with Dr. Dimitrios Kostopoulos

I have a repeat guest, Dr. Dimitrios Kostopoulos or Dimi as we like to call him. He wants to talk about the seven facts that are changing the future of physical therapy. Dimi is a successful business owner. He has a continuing education company, Hands-On Seminars, a diagnostics company and has been on a number of boards of physical therapy in the past. I'm always interested in the insight, future thinking and vision that Dimi has regarding the profession. We'll be covering a number of different topics. As you read the different facts that Dimi lets out, I want you to consider how you might need to change in the future. I don't believe that the way we're currently practicing outpatient physical therapy is sustainable with the changes that are coming. I want you to consider what you might need to do in your practice, to make simple changes in order to navigate what's happening in the industry and in healthcare in general and where we are going to position ourselves as physical therapists in that landscape. Read the facts, consider where your standing is as a physical therapy owner and what you might need to do to change. Dimi has a lot of insights. Change is coming. We need to consider what we're going to do in the face of that change.


I'm excited to bring back Dr. Dimitrios Kostopoulos from New York, Cofounder and CEO of Hands-On Diagnostic Centers and Services. Thank you again for coming back, Dimi.

Nathan, thank you for the invite. It's awesome to be here.

You reached out to me because you've had some revelations about the future of physical therapy and what's happening. I was excited to bring you on because I'm always excited about your insight. What got you to come upon these seven factors that are changing the future physical therapy?

If we consider that we are very close to the year 2020 and if we consider how physical therapy will be beyond 2020, I strongly believe that it will be very different than what it is now. It will be very different because of necessity. There are signs that show us that it will be very different. Development on the professional front as well as socioeconomic, marketplace conditions and developments dictate that we are going to have very significant changes in the physical therapy front in the years to come. It will be crucial for physical therapists, especially those in private practice who want to survive, to understand the depth and breadth of those changes and how they can survive in a new climate of physical therapy. I should say not survive, but thrive in a new climate and the future clients of physical therapy.

It's not necessarily about survival because physical therapy will always be there. Whether or not your clinic survives a lot of these changes is up to how well they adapt and take on some of the regulations that are coming our way, implement those and handle some of the hospital networks that are invading some of their space. What are some of the signs that you see coming forward?

The idea is that physical therapists, especially those in private practice, understand and perceive the polls of the professional landscape and act accordingly. It’s managing to position themselves and their companies ahead of their competition and being able to dominate the future marketplace. Many people who are dominating many practices, who are dominating the physical therapy marketplace may not be able to continue dominating that marketplace unless they evolve. The big question is, will you as a physical therapist in private practice be one of them? One of the people who will not just survive but also thrive in the future environment. You asked me about these changes. What are these facts that are changing the future of physical therapy? There are seven facts. I'm going to go over each one of them.

Many practices who are dominating the PT marketplace may not be able to continue dominating that marketplace unless they evolve. Click To Tweet

Insurance Payment for PT Services Will Decrease

Fact one is that insurance payment for physical therapy services, especially private practice physical therapy, is projected to decrease for the next several years until at least the year 2022. We have a variety of indicators to support this fact. The Physical Therapy Business Alliance did their own research. They made the projection that reimbursements for PT services are going to decrease year after year until the year 2022. In 2015, there was a study that was published in the journal of the American Physical Therapy Association. The title of this study was Utilization and Payments of Office-Based Physical Therapy and Rehabilitation Services Among Individuals with Commercial Insurance. This study identified that although most physical therapy services are being provided by physical therapists, physical therapists receive the least reimbursement for the physical therapy services they provide compared to other healthcare providers such as physicians, chiropractors and others who also provide physical therapy services.

The Centers for Medicare Services announced their merit-based incentive program. This program promises to have very significant implications in the Medicare reimbursement for physical therapy, especially for those people who private practice. Remember that based on that program, if the services are being provided by a physical therapy assistant, there will be a 15% reduction of the allowable Medicare fee because the service was provided by your PTA instead of a PT. The American Physical Therapy Association opposed to that but the truth of the matter is that is the fact. This is something that is happening. The merit-based system is a complicated system that essentially will divide the therapists into low-performing and high-performing therapists. If there is a high performer, there is a low performer. You can't have all high performance unless you compare them with an absolute value. If you compare them amongst themselves, if you have a high performer, you're going to have a low performer.

Unfortunately, we all think that we're providing the best physical therapy out there but this is going to separate the two, the high performers from the low performers. Hopefully, they're a little bit more objective about it.

Those who will be considered low performers, they’re going to shift some part of their reimbursement into those considered high performer therapists. It remains to be seen but here are the indicators putting forward the fact that we're going to have reductions in reimbursement. I'm making a general statement, reductions in physical therapy reimbursement. I'm not talking about Medicare only. The reimbursement you are receiving from any insurance carrier of what is considered reasonable and customary reimbursement is being determined by two factors: the Medicare reimbursement in your region and the workers' compensation reimbursement in your region. If you think for a moment of what is your average Medicare reimbursement rate in your region and what is your worker's compensation average reimbursement, all of the other insurance carriers are reimbursing somewhere around these two numbers. If Medicare reimbursement ends up going down, then that is going to cause other insurances to follow suit and reduce their reimbursement for physical therapy too.

They're going to follow whatever Medicare does and if those reimbursements decrease, they'll find an excuse to decrease as well. They'll use the same formulas and whatnot. It's a race to the bottom almost. How do we get to the lowest common denominator here? If there are incentive-based programs that are going to become a part of Medicare, you can imagine those same programs are going to become part of commercial insurances as well.

PTO 32 | The Future Of PT
The Future Of PT: It will be crucial for physical therapists to understand the depth and breadth of changes and how they can survive in a new climate of physical therapy.


PT Practice Owners Will Settle For 12% Profit Margins

I'm going to dive into fact two, which is very much related to fact one. The fact two is that more and more physical therapy private practice owners ended up settling for profit margins of 12% or less. They end up working the highest number of hours ever since they started recording these statistics. You are a member of the P2P network of the Private Practice Section. The P2P network of PPS APTA did a benchmark study that looked at the profit margins for private practice physical therapists around the country. Their ranges on profitability are from 7% to 16% and that averages somewhere around 11%, 12%. The profit margin for physical therapy across the nation is about 11% to 12%. Stop for a moment and think of this. If we end up having a reduction of services, let’s say reimbursement across the board or somewhere around 10%, then what happens with a profit margin of PTs? It’s going to decline to zero.

Another organization called Sageworks, they did an earlier study and identified that across the board profit margin for PT in private practice is 10% and in a declining fashion. They defined why they are in a declining fashion. There is a very interesting thing to consider. Besides inflation that increases while your reimbursement remains the same or decreases puts a dent in your profitability, the other thing that happens is that salaries to staff physical therapists are in an increasing trend. It’s because the demand for physical therapists is very high. The supply of physical therapists from university graduates are not able to meet the demand and regulations have become tighter. Therefore, foreign trained physical therapists that were coming into the country from places like India, Philippines, Australia and South Africa have decreased substantially because of the tighter regulations in immigration. We do have a greater shortage of physical therapists to be hired. That causes an increasing trend in the salaries that a private practitioner has to pay in order to be able to hire and retain quality staff.

The graduates coming out of school are expecting higher salaries. I don't fault them simply because a lot of them are coming out of schools with $100,000 in student loans or even more. They need higher salaries to sustain the student loans that they've taken on. The demand is always going to be there for physical therapy. I know it's hard to find physical therapists that will join your team.

Expansion Of The PT Practice Scope

Nathan, I've been giving you the negative stuff. It's not all about gloom and doom. Physical therapists are very innovative people and they are looking for solutions. Not only solutions of variability but solutions to do well financially from their profession. Fact three, physical therapists from around the world call for the expansion of the scope of physical therapy practice. There was a breakthrough article published in the October issue 2018 of the Physical Therapy Journal. The title of the article is Reflections and Future Directions on Extending Physical Therapist Scope of Practice to Improve Quality of Care and Preserve Health Care Resources. This an international collaboration, 3PPS from the US and several others from UK, Australia and South Africa. In that article, these professionals are citing the various areas of expansion of the scope of physical therapy practice in other countries outside the US. For example, physical therapists in other countries not only are they able to order X-rays, MRIs, ultrasound scans, electrophysiological testing but also order blood tests. They are able to perform joint and soft tissue injections. They are able to prescribe medications. This comes in total alignment with my core belief that physical therapists have to become the primary care providers for any musculoskeletal problems that patients get. For them to have an expansive role in participating in the proper diagnosis of the patient's problem and also managing the patients, not just treating but managing the patients properly.

Those therapists who will embrace the change, who will work through the change, will be able to survive and thrive. Click To Tweet

We have the foundations to do that. Increasing our scope for musculoskeletal care is necessary and we're the best providers to do so.

Full Recognition For Electrophysiology Study Payments Performed By PTs

Our associations are creating a significant impact. I'm going to give you fact number four. The Centers for Medicare Services, CMS, with the strong involvement of the American Physical Therapy Association and the Academy of Clinical Electrophysiology and Wound Management, fully recognized the full payment of electrophysiology studies performed by physical therapists. In an unprecedented move, the federal government issued a directive to all Medicare intermediaries directing them to immediately pay a physical therapist for the global service. Meaning both the professional component and the technical component of properly-certified physical therapists for electromyography testing, nerve conduction testing and evoked potential studies. This was a huge win for the profession, especially since the CMS language was very clear and direct about this.

A huge win for expanding our scope of care and being recognized for it.

PTs Recognized To Perform Musculoskeletal Ultrasound Studies

If you remember the American Institute of Ultrasound Medicine, AIUM recognized physical therapists as the approved providers to perform musculoskeletal ultrasound studies. The PTs were recognized at the same level as medical doctors in providing and getting reimbursed for a musculoskeletal ultrasound, which is huge. AIUM is the organization that many insurance carriers utilized to decide which provider they are going to pay for the musculoskeletal ultrasound.

That's another huge breakthrough for expanding our scope. The musculoskeletal ultrasound can be so easily implemented into the everyday outpatient experience that most physical therapy owners provide. It’s such an easy implementation to add to our services, to provide better care. We can see what's going on instead of using our best guesses based on special tests and see what's physiologically happening inside the joint.

Diagnostic Testing Results To Change In Patient Management

I’m going to speak fact number six. This is the result of a study that Hands-On Diagnostics performed. It was a multicenter study. It included 465 patients. The study looked at the effectiveness and the implications in patient management and patient satisfaction. When appropriate patients receive the diagnostic testing, it would be the physical therapy environment by the physical therapist such as electromyography testing and musculoskeletal ultrasound. The results of the study were astonishing. 62% of the patients who received EMG and musculoskeletal ultrasound testing by their physical therapist had a change in their management which was caused by the results of the diagnostic studies. A patient who went to a physical therapy practice, the physical therapist performed a physical examination, wrote a treatment plan, but then decided to do either an EMG or an ultrasound study because something was not going right with the treatment. The patient filled out an assessment form and revealed that the patient could be a candidate for these diagnostic tests. The therapist performs these diagnostic tests and in 62% of the time, that original treatment plan had to be altered because of the results of the studies. That’s pretty amazing.

PTO 32 | The Future Of PT
The Future Of PT: The supply of physical therapists from university graduates are not able to meet the demand and regulations have become tighter.


Going into a study like that you'd think, “Maybe some diagnostic testing would change 25%, 33% of the plans of care that were laid out by these experienced.” These aren't brand new physical therapists but experienced physical therapists that are doing all the “appropriate test” measures and whatnot. To say that 62%, almost two-thirds of the plans of care were changing based on diagnostic tests says a lot.

What is ironic about this is there’s a different study that was done by a group of urologists was published at Muscle & Nerve Journal. It was entitled, The Usefulness of Electrodiagnostic Studies in the Diagnosis and Management of Neuromuscular Disorders. This study found that electrodiagnostic studies lead to a change in diagnosis in more than half the patients and lead to a change in management plan in more than 60% of the patients. It's interesting that when that study was done in a medical environment, they realize that electrodiagnostic studies end up causing in 60% of the cases a change in patient management. When we did a similar study in a physical therapy environment, we found that 62% of the cases, the patient management changed. It's very comparable.

It’s almost the exact same results. It goes to show that we could benefit from some diagnostics to assist us.

Another thing is how patients understand their problem when they see a physical therapist. You're going to get greater compliance when a patient understands their problem and then becomes willing to participate in the solution. In our study, we found that 90% of the patients strongly agreed that they were better able to understand their problem. Able to manage their problem because of the answers they got through the diagnostic testing performed in the physical therapy clinic.

Think out of the box. What you learned at the university when you graduated was amazing but not necessarily enough for the future. Click To Tweet

Diagnostic testing makes everything more objective. When you get an ultrasound, “Here's the picture of the bone spur in your shoulder. Here is where the tear is in your rotator cuff or with the electrodiagnostics. Here is your level of nerve damage is that L-four on the left side. These are the findings that show that.” There's no guessing anymore. Having some diagnostics on our side makes not only our plans of care improved, our treatment efficacy improved, but also improves our standing with patients and with the medical community that we're doing and treating the right things.

PTS Will Study, Change, Evolve, Get Involved And Change Their Operation

We put all these things together that I discussed thus far. The decrease of insurance reimbursement for physical therapists in private practice, the very low 10% to 12% profit margins for physical therapist in private practice. The fact that physical therapists around the globe are talking about expanding the role of physical therapy in including a lot of these diagnostics. The fact that our associations are creating conditions. Circumstances with the involvement of the federal government for the recognition of physical therapists. Performing both musculoskeletal ultrasound as well as electrodiagnostic studies. That creates an environment to have a different type of physical therapists tomorrow. You're going to have physical therapists who will embrace these changes, who will study, change, evolve, get involved, and change their whole operation in their practices.

Incorporating diagnostics and you're going have some physical therapist school will deny the change. In my opinion, those therapists who will embrace the change that will work through the change, they'll be able to survive and thrive, the same way that many physical therapists have done across the country. I'm going to plug Hands-On Diagnostics, it’s imperative because it's data. We have data that physical therapists who are performing diagnostics are able to retrieve reimbursements from insurance five to ten times greater than the single physical therapy visit. That can create a huge impact on somebody’s facility. Not only offering an amazing service for their patients but also getting paid well for that service.

To speak to what you're talking about in regards to the future of physical therapist, you bring a realization that physical therapy as it is constituted might not exist in the next ten years. There will have to be some evolution to what we're doing and what we're providing. It isn't to say that our practices will go away. That's not the case whatsoever. We need to expand our scope. We need to be doing more to create a bigger footprint in the medical community. We do that by including diagnostics into the services and becoming the gatekeeper like we want to be. That cannot only improve physical therapy that can improve the healthcare system in general. We know that if we are the beginning point for any musculoskeletal condition, then the cost of that episode of care is going to decrease substantially.

The thing is we have developed the systems and technologies to help somebody implement this in their practice very easily. When you came into HODS, it was still in its infancy stages. Many changes have taken place and HODS has become the only organization worldwide to offer both a residency in clinical electrophysiology and a fellowship in musculoskeletal ultrasound sonography. Helping therapists to achieve board certifications at the record time.

PTO 32 | The Future Of PT
The Future Of PT: You're going to get greater compliance when a patient understands their problem and then becomes willing to participate in the solution.


These changes are huge. There will be a huge impact. What would you say to a young physical therapist who's starting? Maybe being into his clinic as an owner for less than a year, what would you say to someone new regarding some of these things that we've talked about?

Think out of the box. What you learned at the university when you graduated was amazing, awesome, fantastic but not necessarily enough for the physical therapy of the future. Physical therapy beyond 2020 is different than physical therapy before 2020. I would say look around, think of what the changes to come are. There are other changes that I did not mention. The areas of telemedicine, for example, are very important areas that will evolve both as clinical models as well as educational models. You have to look around at various areas and really jump ahead of the competition. When you have the marketplace, you have competitors. In the physical therapy area, there are competitors. The way to get ahead of the competition is to identify specific niches that the people need, want, buy and offer them massively. You can become the leader in what you are offering in your area.

Set yourself apart by looking ahead. Someone who has a new practice like that can be nimbler. They can pivot and move into other niches, specific types of care in other parts of the industry that maybe a practice with four or five physical therapists can't do. Thanks for your time, Dimi. I'm excited to see what the future holds. I know you'll be at the forefront of it with all of your hard work.

Thank you for the invite, Nathan. Anytime, you and your audience can reach upon me.

How can they reach you?

It’s very easy, I’ll even give my cell phone. I keep open communication lines with everybody. Anybody can reach me at 917-538-2242 or go to If you get to go to, enroll to receive for free the Diagnostics for PT Magazine, which is a quarterly magazine that can be mailed out to you free of charge, if you would like to find out about the latest things in the physical therapy industry.

It's got a lot of great information in there as well. Thanks again, Dimi. I invite anyone who is interested in looking forward to what the future might hold for physical therapy. Reach out to Dimi and give him a call.

Nathan, thank you for what you're doing for the profession.

Thank you, Dimi.

Important Links:

About Dr. Dimitrios Kostopoulos

PTO 32 | The Future Of PTDr. Kostopoulos is a Board Certified Clinical Electrophysiology Specialist with over 29 years of clinical experience and over 20 years experience in electrophysiology testing. He is one of very few Electrophysiology Specialists who have achieved a Doctorate of Science (DSc) in Clinical Electrophysiology Testing.

He is a Clinical Affiliate Assistant Professor. at Charles E. Schmidt College of Medicine at Florida Atlantic University, past member of SACE (Specialization Academy of Content Experts) for the electrophysiology board exam of ABPTS and serves as an elected member of the Nominating Committee of the Academy of Clinical Electrophysiology (ACEWM) of the APTA. He is also an Adjunct Faculty of Springfield College teaching the Clinical Electrophysiology module.

A world renowned, leading expert and best-selling author in Myofascial Pain and co-founder of the Hands-On Companies (Est. 1992 in New York). Dr. Kostopoulos has extensive training and teaching experience in different areas of manual therapy with an emphasis in Trigger Point, MyoFascial, NeuroFascial Therapy and Manipulation.

He earned his Doctorate (PhD) and Master’s degrees at New York University and his second Doctorate of Science (DSc) degree at Rocky Mountain University (Clinical Electrophysiology). Dr. Kostopoulos has obtained his MD degree as a medical graduate from UHSA School of Medicine.

He has numerous publications; he is an Associate Editor for the Journal of Bodywork and Movement Therapies published by Elsevier and has taught thousands of students worldwide through Hands-On Seminars.

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PTO 29 | Recruiting Top Talent


Sabrina Starling, PhD, PCC, BCC, wrote the book on how to find the top talent to join your team, literally. After noticing that recruiting and hiring "A" players was exponentially more difficult in rural settings she decided to write the book on it - How to Hire the Best (available on Amazon). She has worked with a number of physical therapy owners in the past and has recognized some of our pitfalls. She shares with us how we can get out of our own way and hire the most talented people to share our visions and join our teams. A number of factors are at play, and she goes through them all, greasing the wheels on capturing top talent will pay off in spades - productivity, culture, profits, stress (relief), growth, etc. Spend a few hours a week and the difference will be felt for years.


Listen to the podcast here:

How to Recruit Top Talent with Dr. Sabrina Starling

PTO 29 | Recruiting Top Talent
How to Hire the Best: The Rural Business Owner’s Ultimate Guide to Attracting Top Performing Employees

In this episode, I get the opportunity to talk to Dr. Sabrina Starling about recruiting and attracting top talent to your company. Dr. Sabrina Starling is known as the business psychologist and author of the series How to Hire the Best. She's also the Founder of Tap the Potential business consulting. Dr. Starling's How to Hire the Best series grew from a desire to solve the toughest hiring challenges interfering with her clients' growth and profitability. She was a business coach in a rural setting and had small-town entrepreneurs looking for top talent. What sprang from her experience working with entrepreneurs in rural areas catapulted her into becoming a world's leading expert in attracting top talent in small businesses. It has earned Tap The Potential the reputation as the go-to resource for entrepreneurs committed to creating great places to work.

Tap The Potential specializes in transforming small businesses into such profitable great places to work that they celebrate by sending their business owners on a four-week vacation to celebrate their accomplishment. You can't do that unless you're leaving behind the top talent to run your businesses. With Dr. Starling's background in psychology and years of driving profit for small businesses, she knows what it takes to find, keep, and get exceptional performance out of your biggest investment and that is your team members. She also does a weekly podcast called Profit by Design and she and her co-host, Mike Bruno, can bring you tips, tools, and strategies to grow a sustainably profitable business that allows you to live the lifestyle you deserve.

Take a read to this episode regarding recruiting top talent, A-players but follow-up on my next episode. I'm going to talk with Dr. Starling and Jeff McMenamy, a friend of mine, a therapist in Wyoming who is thriving and has multiple practices. Look out for that episode because we're going to talk a little bit also about the support that a coach can provide a business owner, specifically, Jeff, in his case. He has been working with Dr. Sabrina Starling to improve his capabilities as a leader and owner of his physical therapy practices. In this episode, we're going to focus specifically on Dr. Starling's experience, her book, How to Hire the Best, which also has a corresponding website, and we'll talk about attracting and recruiting top talent.


I'm talking to Dr. Sabrina Starling and I'm interested to bring her onto the podcast because of her insight specifically about attracting, recruiting top talent. Also, she's an expert on it. She has a book about it. She will explain to us a little bit about that, but how that also leads to improving profits and improving lifestyle. Before we get into that, thank you for joining me, Dr. Starling.

Thank you, Nathan. I'm so excited to be here and talking to your audience about this very important topic.

All of us struggle with attracting and recruiting top talent. That might be the most important word, top talent. We can always find someone off Craigslist or something like that, but to get the top talent into our office and become a team member is essential. It's something that I don't think a lot of us focus on as physical therapy owners. We might hire out to recruiting firms or do our best with social media and Craigslist or something like that, but I'm anxious to bring you on to talk about how we can do it ourselves. What it necessarily takes to attract them and recruit those top physical therapists, top office staff or top executive team members. Before we do that, Dr. Starling, do you mind sharing a little bit about you and how you got into your profession, where you're at right now and your experience with physical therapists?

I am a psychologist by training and I was working in a rural mental health clinic out in the middle of Wyoming where there's more antelope than people. I got very burnt out in just delivering therapy services to severely mentally ill people. I thought “I want to work with people who are healthier” and that was years ago and that was when life coaching was fairly new. I started learning about becoming a life coach and I thought, "Here's my path. I'm going to become a life coach and I want to help people with work-life balance." I have a lot of clients seeking me out for work-life balance and the majority of them turned out to be small business owners. As I was taking into things with them, I was realizing they don't have a work-life balance problem. They would love to be taking vacations and spending more time with their family. These are not people who I would have to twist their arms to do that. What they had is a team problem. They had the lack of the team that they needed and because of that, they were working hard in the business themselves.

For years I just accepted, we're in a small town, this is a rural area. Because we're in a rural area, we can't get good help, we can't attract good talent. We just have to make do. As a psychologist, a lot of my clients were asking me to help them coach their team members, to take their warm body team members and make them into top performing employees. "Surely, we could use some good psychology on them, Sabrina. Make them work harder and be more engaged and be more excited about work." That was like pushing a boulder uphill. The results that we got from that effort were so negligible. It was not worth it. Here's the other thing that I saw going on is I saw business owners passing on growth opportunities and that hurts me at my core. I'm an entrepreneur at my core, I cannot pass on a growth opportunity.

Bringing people in and experiencing turnover is a slow kiss of death for a small business. Click To Tweet

Tell me about that a little bit. Number one, it's amazing that you're here, that you spend all that energy. You have this background in psychology and you're trying to help these people improve and that was like pushing a boulder up the hill of these very sluggish people. I want to note that for the audience, here's a trained psychologist that was trying to get people who didn't go anywhere to go somewhere. It didn't work. Tell me a little bit about some of the opportunities that you noticed were being missed.

I saw business owners looking at, for example, a physical therapy business. I've outgrown my space. I have the opportunity to grow, but that's going to mean that I have to hire people. If we take on more, I'm already working 60 or 70 hours a week myself. If we grow and I can't get the team that I need, then it's going to be me doing that work and now it's all on my shoulders. Now, I'm working 90 hours a week. That's not sustainable. Instead of growing, they would choose to stay small. It was when I woke up and you have those thoughts as you transition from sleep to wakefulness. Sometimes you have bright ideas and I happened to have a bright idea. That moment this question went through my head of, "What if it's not true?”

I was thinking about, "What if it's not true that because we're in a small town in a rural area, you can't get good talent? What if there are business owners who have top talent in their business and they're in rural areas? If those people exist, maybe they know something. If I interview them, maybe I can find out what they know, and I can share it with all the business owners I'm trying to help." That put me on a quest like, “I'm going to figure this out.” I started looking around. I went to books. I love to read so I started looking for business books. Are there any books out there on hiring talent in small business? There are books out there on hiring talent, but they're geared to corporations, larger entities, businesses that have an entire HR department. They're not there for the small business owner who's still wearing a lot of hats themselves in the business. I thought, "There's no book out there. Maybe there are some business experts I could interview who could point me in the right direction."

One after another, I interviewed entrepreneurial thought leaders and they kept saying, "It's a need out there and no one's addressing it." That's when I thought, "I'm going to solve this problem. I'm going to figure this out." I started talking to small business owners who had some great employees on their team and nobody told me, "I'm happy to talk to you. I know exactly what I did, and I want to share it with you." They all said to me a variation of this, "I'll talk to you if you need to talk to me, but I have no idea how I got these people on my team. I'm grateful I have them. If you find out the solution, the answer to this big question, please come back and tell me because I don't know what I'm doing either." I thought, "I've bitten off more than I can chew. I'm not going to be able to solve this problem."

As I interviewed one business owner after another and I asked them to tell me the story about this great team member that you have on your team, they all kept giving me a variation of the same story. It came down to good networking. I thought, "Isn't this interesting? We all are doing this good networking, but no one is claiming it as a system. No one's looking at putting a system in place in their business to attract more great team members like the couple that they have. What would happen if we got more intentional about this and more systematic about it?" That's how my book, How to Hire the Best was born.

That's cool to hear because you don't talk a lot about networking to find your top talent, but when you think about it, the A-talent out there, the top performers, they hang around each other. When you have a lot of B and C-players on your team the A-players won't stick around. They're feeling like they're getting dragged down or they're not meeting what their expectations and their performance as well as the company's performance. What a great perspective to come from is that if you can tap into those A-level performers from a networking standpoint, they're going to be able to direct you to other A-performers.

Being mindful of not having a team full of warm bodies. My saying about that is if you have warm bodies on your team, you might as well be spraying A-player repellent all over your business because they don't want to come and hang around. If you are intentionally working on creating a great place to work, all of a sudden now you're positioning the business to attract A-players. If you intentionally network and you have a great place to work, all of a sudden what felt like it was this impossible problem to solve, how do you get talent to your team? All of a sudden now you have a steady pipeline of people who are waiting for the opportunity to work for you and that's the ideal place to be.

PTO 29 | Recruiting Top Talent
Recruiting Top Talent: Having these core values in hand as you start to recruit is absolutely essential because one of the things that many PT clinic owners do is they go looking for skill set.


When you have A-team players waiting on the bench to come and join your team. The type of people who say, "If you ever have an opening, please let me know," then that's the ideal situation. From our personal experience, my business partner, Will Humphreys, focused on recruiting some physical therapy schools and the students coming out of there. He spent a couple of years honing that and improving the business at the same time so that once he got a couple of those A-type students, those top of the class students to come and join the company, they invited their closest friends to come join the company as well. It changed the dynamic when it comes to recruiting. In that we're able to create a culture and develop a network. By doing so, hiring those A-players and fulfilling our promises led to them spreading the word and getting other A-players that were coming out of school to come and join us as well.

Then it all starts to flow, and I want to give a shout out too because when I wrote my book How to Hire the Best, I wrote it for small business owners in rural areas and I was working with different small business owners. One of them is a physical therapy owner and we were trying to figure out. He was struggling, and he needed to recruit some PTs and OTs. In a rural area, there's no college around within an easy drive where they are pumping out students. What do you do? How do you get these folks? We had to get creative and that's where I started to learn myself thinking about recruiting talent. Just like you think about marketing to attract your patients to your business. If you do a spray and pray marketing approach, you're going to get patients of all different varieties. They're not going to put in the best patients. You're not going to enjoy working with them. They're not going to succeed. They're not going to do their exercises and the follow-up that they need to do to recover. To grow a successful clinic or multiple clinics, you have to have a focused marketing strategy. The same happens when it comes to attracting talent. You need to have focus on it, intention, and strategy behind it, then systematize.

Can you share with us a couple of strategies that you've used in the past to recruit?

First off, just like marketing, when you're trying to attract patients, you have an avatar of a type of patient that your company is best suited to serve. When it comes to recruiting, we want to have an avatar of our ideal employee. If you look at the team members that you've had in your business or that you've had in the past who have worked well and fit well in your business, what qualities do they have? What are they like? Understanding that typically just like in marketing, the patients who are most drawn to you and who want to be a part of your business and work with you, they're coming because they have core values in common with you. There are some common threads. That applies when it comes to recruiting also. If you look out at your best team members, what are those core values of yours that they share? The core values are the glue.

For some business owners, we're starting at the ground level in identifying what are those core values because those are the foundations of your culture in your business. Your personal core values as the business owner are what drives the culture. Sometimes business owners will say, "I don't know what my core values are. Maybe I'll have a team meeting and I'll ask my team what our core values are." Please don't try that approach, especially if you have warm bodies on your team. This is a self-reflective approach. You have to reflect on your core values and make those into the immutable laws of the business. If you have readers who are just starting to think about this, a simple way to start identifying your core values are two questions. What's made you proud lately in the business and what's ticked you off lately in the business? The things that have made you proud point to your core values.

When we're proud of something, it's because they align with our core values. My daughter went with into her school and they helped out at the food bank. I am proud of that and that's one of our core values at Tap the Potential, be a gift from your gifts. We use our gifts to serve our clients and in our greater communities. I feel proud of her because she's being a gift from her gifts. That's one way to identify core values. Then the next way is to look into what's ticked you off recently. One of the things that ticks me off is poor service and I experienced poor service from a business. I think, "They're not doing what they said they were going to do. They told me they were going to do one thing, they did another." My number one immutable law is, "You can count on us. We do what we say we're going to do.”

Notice this is all in my language because I'm talking about my business. These things I'm saying may resonate with you, but you may have a different way of expressing those things. You want to narrow down your core values into your own language and use common language and common phrasing. Then at that point, you go to your team and say, "Here's the core values I'm coming up with for the business. Tell me how do these relate to you and how do they hit home for you?" Then just watch around the room as you share. Some people will be smiling, eyes lighting up, leaning forward in their seat. Other people leaning back like, "Really?" arms crossed, that's not a good sign. They're probably not going to be with you long. What you're doing is you're calling out they're not a good fit, and now it's becoming obvious why they're not a good fit.

A-players are hardly ever unemployed. Click To Tweet

Having these core values in hand as you start to recruit is absolutely essential because one of the things that many PT clinic owners do is they go looking for skill set. If someone has the degree, they've passed the round one of qualification. That’s not right. What we do is we want to hire people who are a great fit for our culture. Then look at do they have the qualifications for the job because if someone has the qualifications but they are not a good fit for your culture, they're going to become a cancer in your culture. That's going to be the person that you interview. They look good on paper. They talk a good talk. Talk a good game in the interview, but you get them in your business and a few weeks later you're going to be beating your head against the wall because they drive you crazy with the choices and the way they do things. It's not about skill set. The first criteria needs to be fit with your culture.

That's the conundrum of physical therapy owners that are in small towns is that it's hard enough to get someone to come to your town because you're in a small town. When you narrow it down to someone that needs to have a PT license and they are willing to move to a small town, then you're thinking, "They're at least willing to come here. They're a warm body. That helps me change some temporary goals." Can you speak to the loss that's incurred when you get a poison on your team?

It costs thousands of dollars of your time, your effort to interview, to recruit them. You get them on. You train them. You start investing that way. The turnover, the best thing that can happen to somebody only stays a week, the worst thing is they stay three months and then the rest of your good employees get totally frustrated. They start losing faith in you and so you risk losing your great employees too. Bringing those people in and experiencing turnover, it's this slow kiss of death for a small business to do that. You mentioned small towns. You're in Alaska, I used to live in Wyoming. There's a phenomenon that goes on. You get a guy who wants to move to Alaska or he wants to move to Wyoming because the great outdoors and all the fishing and the hunting, but the wife not so much. You sell him hard to come and it's a great place to live. He is going to be totally happy, but if you don't take into context his entire life and if he's bringing a family with him, he's not going to stick. He may be a great fit culture-wise for your business. He may have the skill set, but if he's leaving in a few months because his wife is miserable, that's costing you a lot too.

How do you overcome that?

It goes back to one great strategy is recruiting from schools and developing those relationships with the academic departments. As you're doing that, being clear about the culture and your workplace and what makes your business unique compared to all the other options that students have. You just want the right people to pay attention and you want to say enough about what makes you unique and what your culture is like so that the wrong people just say, "I'm not interested," and don't even take up any of your time. The problem is when we're desperate to hire, we are out there trying to sell our business to somebody and make it sound like, "It's the best place ever and you're going to love it for this reason or that reason. I know your wife, she wants the shopping malls. There's one an hour and a half from us." Just being straight up honest, "This is probably not going to be a good fit for you," and then go onto the next person and talk to the next person. Don't keep trying to sell somebody because ultimately, if you create a great culture and a great place to work around your core values and you attract like-minded folks, your turnover is going to be low. You are not going to need twenty applicants a year for two positions. You are just going to need two or three applicants for each position and then you get to pick.

You talked a little bit about intention and I want to know your thoughts about the intention when it comes to recruiting and hiring. What do you mean by intention and how do you explain that?

Most of us, business owners, don't start thinking about hiring until we're desperate. We put it off as long as we can because we know it's going to be a long arduous process and at that point, it's already too late. We're having to resort to desperate measures. If you start at the point where you have a steady lead generation in your business. You’ve figured that piece out like how do you get lots of patients coming through the door, how do you get those referrals going from the doctors and how do you get the right doctors referring the right patients to you? You've got all that figured out, the next thing that you're going to be looking at is a capacity issue.

PTO 29 | Recruiting Top Talent
Recruiting Top Talent: When we work from our strengths, we are 900% to 1200% more productive than when we work from our Achilles heels.


That's where if you start at the point where you have good conversion, lots of good patient flow coming through the doors and then you start thinking about, "If my business grows at the pace that it's been growing, how many team members am I going to need in the next year to three years?" Then start being intentional around how you're going to recruit those team members and put just as much priority on that as you put on marketing. Then you're going to be in a much better place. You're not going to be at a point of desperation trying to just take anybody that will sign on with you.

This is a common problem I'm sure you see across the board in that the small business owner, in our case, the physical therapy clinic owner maybe doesn't take the time to look one to three years ahead. Is that a common issue? 

You're wearing so many hats and you're juggling so many responsibilities and then thinking about recruiting, it feels like, "That's just one more thing I've got to think about." In reality, it doesn't take a lot of effort from week to week as long as you are intentional about it and you recognize it is a priority. "I need to be starting to think through who are our ideal employee is going to be and where are we going to get them from, what pool?” Every physical therapy clinic has a pool of places to get their ideal employees from, you just have to discover it.

If a physical therapy clinic owner came to you and they're in a bind. They're a small business and you've been through this before. They need to bring on a physical therapist, but they're in a small town, their backs against the wall. I'm working 60 hours a week. What's the first step? How do you coach them to take the first step to move along in the process?

It goes back to identifying the qualities that you need in a team member and your values. The piece that I haven't spoken enough to is the qualities that you need in an ideal team member. You have to identify the roles that you're going to need to fill in your business in the next one to three years, the key results from each of those roles that will drive the profit of the business. What does each position produce and how does it relate to profitability? Then you want to think about what qualities, what personality strikes does someone need to have to produce that result exceptionally well, day in and day out? A prime example of this is someone at your front desk, they deal with a lot of people and they manage a lot of details. That is somebody who needs to be a people person who's detail-oriented. They need to be energized by dealing with people.

If you put an introvert who's great at managing details and who's smiling and can be friendly. If you put them at your front desk and you need consistent, exceptional performance from them day in and day out, they're going to be flagging a bit, burnout because they're not operating from a strength. When we work from our strengths, we are 900% to 1200% more productive than when we work from our Achilles heels. Somebody who needs a job and they're an introvert and they want your front desk position, they may tell you, "I like people. People are great," but every day they are going home from work and they're zoning out in front of the TV because they are totally wiped out by all that interaction. If you hire an extrovert who's great at managing details, now you have the right person at your front desk. They're energized by that work and they're getting more and more productive every single day because their energy goes up from what they're doing.

They want to talk to people and that goes back to what is the ideal employee? Because when we post an ad or when we throw it out there on social media, we just typically list the bare minimums. If you can type, if you know how to work in Excel, if you can schedule a patient, then you're qualified and you're just checking off the boxes. Instead of putting an ad out that says, "This is the personality type that we want, and they've got to be energized by talking to people. They've got to be excited about meeting people and disappointed when people don't show up. They have a belief that what physical therapy is doing is the thing that they need to do in order to attract the patients back in and make the difficult calls." Putting an ad out like that can filter out a lot of the candidates pretty quickly to get you to the ideal candidate.

A-players are a joy to lead and manage. They're enthusiastic about the why of the business, the vision, and the mission. Click To Tweet

When someone reads it who is not a great fit, they need to read it and say, "I would hate that job," so they don't even apply. Then you're saving yourself a lot of time, but the other reason that identifying the personality strengths that someone needs to do the job exceptionally well, day in and day out. The other reason why that's so important is that when you're networking and let's say you're at a party like the holidays are coming up. You're at a Christmas party and you're talking to somebody that you've just been introduced to. You're telling them about your clinic and you say, "I am looking to be introduced to someone who is outgoing. They love people and they're great at managing details. Who do you know who's like that who comes to mind?" All of a sudden now real faces are popping into that other person's head. Notice I did not say, "Who do you know like that who is looking for work?"

Because the other thing is that A-players are hardly ever unemployed. Our traditional way of finding people to fill the roles in our businesses is to put an ad out there, to post on Craigslist, Indeed or Monster and just assume that the right people are going to show up, but A-players are not out there looking. They're working elsewhere. When you're networking, you want to ask, "Who do you know who's like that," and give a good description and say, "Would you be willing to introduce me to them? Would you make an introduction?" You're not even talking about that you have a job opportunity in your clinic. You're just saying, "Would you be willing to make an introduction?" That's how you start to build your network of A-players for the different roles in your businesses. Back in the day, we would have Rolodexes. You would imagine you would take that name down and put it in your Rolodex file and that went away for the next time we have a front desk opening, I'm going to call them.

You want to have some database that you're keeping when you're collecting information about these people. You want to get into conversations with them and say, "So and so told me about you. They spoke so highly of you about how you love people and how great you are at managing details. I just wanted to share with you a little bit about what it's like to work for us and not necessarily now, but maybe sometime in the future if you're ever looking for an opportunity, you want to circle around to us and see what we have available." Then you're also doing a little bit of screening in that conversation because you're gauging their energy level.

You might share a couple of stories about your values and see how they respond and see if they are resonating. If it's all checking out, you're saying, "I would love to stay in touch with you. Would you mind if I add you to our newsletter, so you can learn more about our clinics and when we have openings we'll be posting it in our newsletter?" Now you have a way of staying in touch with them. They're curious. They're so flattered that they've been referred to you and you've connected with them. You've started to build a relationship and now you're starting to create a system for staying in touch with people so that you have a steady pipeline of A-players when you have positions to fill.

That takes so much stress off of the owner. When someone turns in their two or four-week notice, whatever it might be you say, "We're going to start. I know where to go first. It's not like you're starting from ground zero. I'm going to start making the calls." Hopefully, you've got one or two people in line for whatever position it is, and that's the ideal situation. It is to get to that point so that hiring and recruiting is like the pinnacle of your company because it leads to so many other things. I'm glad you brought it up that it all ties back to profitability. Each position has a product that lends to profitability. That goes to show when you get A-players and have a system in place for recruiting and attracting and retaining A-players that all suddenly leads to improved profitability.

Payroll is the biggest expense in a small business. If you have warm bodies on your payroll, you have a lot of expenses. That's a big profit bleed like money's just going out the door, but if you have a lot of turnover, that's impacting the profitability of the business. If you can nail it down to, "These are the results that I need from the roles that I have," and then you bring in people who have the strengths and can deliver on those results, you will see the profit in the business going up and up from that. I am a firm believer in it's not about revenue, it's about profit. It's not about what comes into the business. It's about what the entrepreneur gets to keep and how that entrepreneur is rewarded for their risks that they're bearing as an entrepreneur.

We talked about profits. What are some of the other benefits to that? They're self-evident, but what have you noticed in your experience as you've helped people improve their recruiting and attraction methods?

PTO 29 | Recruiting Top Talent
Recruiting Top Talent: Offering internships is a great way to screen people. You pay them relatively low and you get to see firsthand how they perform and how good of a fit they are.


Going back to my story that I told about how I got into this. I didn't start out wanting to be the small business hiring expert. That's where I landed, but it was by accident. What I was trying to do was help some of these business owners take a vacation like they're so overworked. I would say, "You're so fried. Just take the weekend off, you need a vacation," and they would all give me a pushback, "I cannot. Who's going to get the work done if I'm not here? I need to be in the clinic. I need to be doing the emails myself because if I don't do it, who's going to do it?" The biggest benefit of hiring great team members is that you, the business owner, have people that you can trust to handle things in your absence. When you combine great team members with strong systems in your clinics, you don't have to be the one in there doing all the work yourself. You can be away from the business, things can run in your absence and you can have some peace in your life.

That’s one of my biggest concerns when I was starting off as a physical therapy owner in the beginning years. I remember telling all my friends and family, they say, "How's the business going?" I said, "I love doing the physical therapy, I just hate managing the people and all that comes with managing the business." I found that as we attracted and hired more people and helped them with the systems and train them appropriately, things became a lot easier. Now as I go back to treating, I don't get as much fulfillment from that unfortunately, but I get excited about creating something bigger. 

A-players are a joy to lead and manage. They're full of energy, they are passionate. They're enthusiastic about the why of the business, the vision, the mission, and it feels like we're all in this together. We're working towards a larger goal. Then I can teach the business owners and the managers in the business some coaching skills and it's like dropping a tomato seed into fertile soil. The tomato plant grows and it produces a lot of tomatoes and you just had to put some water on it. It wasn't a lot of effort. If you are trying to do that same amount of effort with a bunch of warm bodies, it is draining. For your audience who are feeling like, "Nathan hit the nail on the head. I like treating. I don't like dealing with and managing people. I just want to treat all the time." Look around at who you're trying to manage and be honest with are they A-players? Are they the type of team members that I want and is that the problem?

I love the question not to backtrack too much, but the question that you put out in the very beginning, what if it's not true? When we have these fixed ideas, what if they weren't true? What if recruiting in a small town isn't difficult? What if you just flipped in there and said, "Recruiting in a small town is easy because there are tons of people who would love the small-town lifestyle, especially in the wilderness of Wyoming or Alaska, you name it." What if it's not true? Then when you asked that question, and I'm sure you've done it millions of times as a psychologist, it unlocks a lot of thoughts and ideas that can come forth at that point and lead to further action.

I want to throw out one other little ninja strategy that your PT owners can take advantage of and that is offering internships in your clinics. Because what better way to screen people than pay them relatively low and they come and work for you and you get to see firsthand how they perform and how good of a fit they are. It's also a great opportunity to woo them if they are a great fit because now, they're making connections and friends in the clinic and they want to stay.

A lot of the more successful physical therapy clinics out there, even from my own experience in my graduating class, 75% of the people that had jobs, were jobs that they had from the internships that they did. It makes it so easy and you have no commitment to them. That's why if they don't work out then we're obligated to let you go.

Those department heads, when you successfully employ their students over and over, it makes them look good because they're able to say, "We're able to place X percentage of our students in jobs and they stay in those jobs. They're happy." That's creating a win-win situation.

Everyone has something that they can contribute that further somebody else on their journey. Click To Tweet

Dr. Starling, what's the name of your book?

How to Hire the Best.

I'll have people reach out and look for that. Is it on Amazon?

It is available on Amazon. If you want to get my masterclass, which is a free masterclass where I go more in-depth into how you build your A-player attraction system. You can get that at

Can they also order the book there?

You can order the book from Amazon.

If people wanted to reach out to you directly, what's your availability there?

The best place to find me is at my coaching company,

Thank you so much for your time. Is there anything else you'd like to share with us?

If you want to hear more about building a sustainably profitable business to support you and the lack of style you desire, we have a podcast called the Profit By Design podcast. You can find that or whatever platform you listen to podcasts on.

I was a guest on it. It was a lot of fun and I love it. I asked you beforehand, how you describe your podcast and it's all about building a sustainable, profitable business to allow you to lead the lifestyle of your choice essentially. As small business owners, we're all looking for that.

I love bringing on guests like you, Nathan, and hearing their stories and just learn from each other as entrepreneurs. Everyone has something that they can contribute that further somebody else on their journey.

We're going to have a follow-up podcast here with you and one of your clients from the past. I invite all to look out for another podcast where Dr. Starling and I are going to talk with Jeff McMenamy of Teton Physical Therapy. He’s someone that's worked with Sabrina in the past and share his experience in working and growing from a small business that was having a lot of the small business issues that you were talking about and now being completely successful, profitable, and living a lifestyle by choice.

I'm looking forward to that conversation.

Thanks for joining me. I appreciate it.

Thank you, Nathan.

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About Dr. Sabrina Starling

PTO 29 | Recruiting Top Talent

Dr. Sabrina Starling is known as The Business Psychologist™ and author of the series, How to Hire the Best, and is the founder of Tap the Potential business consulting. Tap the Potential specializes in transforming small businesses into highly profitable, Great Places to Work, then celebrates by sending business owners on a 4 Week Vacation to celebrate their accomplishment.

Dr. Sabrina’s How to Hire the Best series grew from her desire to solve the toughest hiring challenges interfering with her clients’ growth and profitability. What sprang from her experience working with entrepreneurs in rural areas catapulted her into becoming the world’s leading expert in attracting top talent in small businesses, and has earned Tap the Potential the reputation as the go-to resource for entrepreneurs committed to creating Great Places to Work.

With her background in psychology, and years of driving profit in small business, Dr. Starling knows what it takes to find, keep and get exceptional performance out of your biggest investment — your team members.

Tune in weekly to the Profit by Design Podcast as Dr. Sabrina and her co-host, Mike Bruno, bring you tips, tools, and strategies to grow a sustainably profitable business that allows you to live the lifestyle you desire.

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