PTO 137 Jamey Schrier | Driving Referrals


"How are you showing up in the world?" is always a central question in marketing. For Jamey Schrier, PT, driving referrals is an essential first step in building up your business authority and reputation. Joining Nathan Shields once more, he talks about the best way to present yourself to referral sources, patients, and communities, which is an essential part of your marketing message. Nathan also discusses how to be clear with your goals, choosing the proper target market, and how to come across the public in the most engaging ways. He also explains why it is important to focus on delivering tangible solutions than mere therapeutic methods, making your PT practice more than just what is happening within your clinic. 


Listen to the podcast here:

Driving Referrals to Your Clinic With Jamey Schrier, PT 

I've got multiple-time guests coming back to be on the showJamey Schrierappreciate you coming back.  

I appreciate you having me, Nathan. 

Thanks for coming on. We've been talking about a bunch of different topics and trying to figure out what the connection was. We want to talk about how we make more connection with the audience. How do we provide them what they need? How do we prepare our messaging so that they want what we're giving? Maybe I'm not saying it the right way because we were thrown a lot of things out there. First of all, let me say, if you haven't heard my show with Jamey in the past, go back to those. I've had you on what or times now.  

I think so, at least 2, perhaps 3.  

Marketing is all about how you show up in the world.     Click To Tweet

Jamey hagot a great personal story. If you can find his first show from our first year of doing shows in 2019, go back and listen to it and what drove him to become a coach and consultant now for PT owners. Make sure you go back and read those because he's got some great wisdom to share and great value for you. We want to talk about how to connect. Where do you want to start this off, Jamey? I don't have a certain direction I'm going with this because we can provide some great value with simply the discussion, but where do you want to start here?  

Let's start by grabbing people's attention. What we're going to do is talk about driving referrals to your business. That's the essence of what we're going to discuss because a lot of this comes down to how do we connect. How do we bring in referrals to our business starting with understanding how to connect with the people that we want to come into our business? We're all caring and compassionate people that went out on our own to start a business. I've never met a business owner that wasn't busy, overwhelmed, and stressed in doing that but yet, we all have this challenge of getting consistent referrals in our business that of course convert into new patients or new clients. What we were talking about before is we’re discussing where's the real problem here.  

Not necessarily the tactical thing, which I can certainly provide some tactics, some tools and some tips, but where is the problem in doing it and what can typically be done? That's an area I've spent a lot of time and personally being a former private practice owner for years and now the Founder and CEO of Practice Freedom U, this is what we discussed. This is what we live for and this is what we do every single day. It’s providing this business knowledge to help people grow and flourish knowing that we haven't been taught this, we're out there, and there's a million clinical courses to help you treat your back better. This stuff is a little rarer. Where would you like me to begin? I can go in any direction you like.  

We can talk about driving referrals and start with where you were with your workshops. Most people are going to go once they get a referral for XYZ Physical Therapy and sit in their car with that prescription, they're going to Google XYZ Physical Therapy and see your website or they're going to say, “My back hurts. How am I going to get over my back? Let's start with the webpage because a lot of people nowadays are going to see your presence online. As your experience with what you shared with me, 99% of those physical therapy websites is hard to tell exactly what they can do for me, the patientThey're focused on saying, “We've got this certification, we do this service, we do that service. We do this kind of thing.” The messages seem to be off, they're highlighting themselves, and not highlighting the result or the product that they're producing.  

If we take a 30,000-foot view here before we dive into the ground level and get into the weeds a little bit, the 30,000-foot view is marketing is all about how you show up in the world. That's what marketing is. How do you and your company show up in the world? It could be your personal brand, but even your personal brand is still about you, your practice, and how are you showing up in the world. How do other people see you? When you look at it from that perspective, you want to consciously and intentionally show up in the world the way you want to show up in the world because if not, other people will pigeonhole you and stereotype you that, You're a physical therapist, you’re good at doing some stretches, but we're the ones that take care of people with back problems. We're the ones that take care of this.  

PTO 137 Jamey Schrier | Driving Referrals
Driving Referrals: With so many PTs in the world, make sure you are bringing something impactful and important.


That has happened to physical therapists for 50, 60, 70 years. The reason is because we are not communicating clearly and effectively how we want to show up in the world. It's confusing. We have a great saying at Practice Freedom U and it says, “Confused people, don't…” What it means is any time there is confusion, you are going to have someone that does not make a decision or if it's your staff is confused, they’re unproductive. If there's someone out there in the world that's thinking, I have a back problem. Who should I go see? If your message is confusing and it's not clear on whether or not you can help me, then I'll go somewhere else. I'll go to someone else that's speaking a louder message, a clear message, or maybe a message that's showing up either on the website.  

That's one of the big things from a higher-level perspective which as owners, we have to take that perspective first. We never want to dive in first. We have to look at it from that perspective first so we could make sure we're moving in the direction that we want. That's number one, marketing equals how we show up in the world because if you don't, someone else will have a plan for you and start to dictate how you show up in the world.  

How do you help someone get clarity on their message? That can be a difficult one. I know for Will and I with our practice, it took some work talking it out. We had to get back to what was our purpose and get clear on what were our valuesStart there before we can start talking about what we can offer to the world, how we present to the world, and that it derives from that. That's where we came from. What do you recommend?  

Nathan, that's not fun. I don't want to do that. Read books, you start with that, that’s not fun and yet here you are saying, “Do you know what we do in our program? We start with mission, vision values. Do you know where Donald Miller, Michael Hyatt, Tony Robbins people and others start? A mission, vision, values. Now, you might call it something unique. You might wrap it up in a different bow, but that's where you have to start. You have to start with, “What are you about?” Before you communicate that out in the world, you have to ask yourself. I'm going to be very honest with everybody. The world does not need another physical therapy practice. We will survive without you. However, the world needs you. We want to make sure that you are bringing something that’s impactful and important.  

You have the ability to do that but I don't want you to show up as someone else. Be unique and communicate at least to yourself, What is your practice about? Your vision or your mission? What are you about? Where are you going? What are you trying to do? What impact are you trying to make in the world? What impact are you making in your community? Why did you get into physical therapy? Why did you open up your practice? These are the questions that make you think. I get that most of us are impatient and we want this now but these questions are going to come up again and again as you start marketing, building your referral sources, building your presence online, and doing the other things that we do to drive referrals. We have to start there for sure.  

If you don't get clear in what you're about, then other people will just tell you what you're about.   Click To Tweet

I've had marketing people on in the past and they say, “If you can improve the customer experience and create a culture, that can improve your marketing efforts three times. That's where this starts from. When you're clear on your message, your purpose, mission, vision, values and all those things, then that drives the culture of the business and then you start developing something that people can get behind and people can buy into. Remember, when people buy, they never buy logically, they buy on emotion. If you can translate that into your message, that means the connection becomes greater. It's hard for me to work with PT owners because many of them don't have a clear purpose. I don't know if you've had the same experience, but that's where we'll start. As I'm working with clients, it’s okay, let's get clear on this and their purpose. You've probably seen this as I have. We're going to be the best physical therapy that provides hands-on treatment and a one-on-one approach.  

I was yawning when you said that. We're going to be the commitment to excellence and the best therapist place. That was mine. I got it from the Oakland Raiders back in the day.  

No surprise that we're a commoditized entity at this point because we all say the same thing. Physical Therapy is not your purpose and not your whyPhysical Therapy ends up being the vehicle through which you've lived out that purpose. You could be a roofer and live out that purpose as long as you're clear on that purpose, what it's doing for the community and those around you. It's important to get that clear in and that then drives the marketing and can improve referrals because people buy into that culture. They buy into what you're doing so much more than the services you provided.  

The way your prospect, your client and your patient are going to look at it as they have a problem and they want a result. What you're providing as a therapy provider is the solution to that. You're the bridge. There are lots of solutions. As you said, Physical Therapy has been considered a commodity which means Physical Therapies are Physical Therapy. We're grouped into it's all the same. It doesn't matter. It's interesting if you ask any physical therapist that they would not say that at all but if you ask other outsiders, they may say that. That goes back to my point that if you don't get clear in what you're about then other people will tell you what you're about.  

To your point, if you provide a better customer experience or customer journey as it’s often called, it comes from the Hero's Journey, that is critical in how you can generate referrals. What you have to understand before that, after the vision, after the mission, after you divide those values and this principles in which you live bywhat you understand, and what your business is about, the next most important step is understanding your audience. That means you have to first of all, figure out who is your audience. Let me tell you a quick story. We have something called the Velvet Rope Policy. Imagine this. If COVID is over, you go down to Miami, you're walking along, and you see this club. You hear the music on and you see this Velvet Rope. What's the first thing that you think when you see the Velvet Rope and there are people on the other side of that? What do you think, Nathan?  

There have got to be some special people in there.  

There are special people on the other side of that rope. They’re VIPs. You're thinking, They must be important people. You might also be thinking, “Am I one of those very important people? Am I VIP?” Here's what happens. Here's the psychology behind the Velvet Rope. The Velvet Rope is the target audience of that club. These are the celebrities, the big people, the big spenders, and the people that will attract other people to the clubThat's their audience, but here's the mistake that people make in our businesses. We're not clear on our target audience.  

One of the things that we discussed in our Practice Transformation Workshop that came up is, I'm afraid of becoming too niche. I can help many people and they go wide. They say, I can do this.” When you do that, nobody knows exactly, can you help them? By having that Velvet Rope and by being very clear, not only do you dial in your message to your ideal audience but other people go into that club too. Not just the VIPsMost of the club is not made up of the VIPs. Most of the club are the regular people outside. The false misnomer, the myth that is happening is that if you spend your time focusing on your niche audience, your target audience then you're not going to attract other people and the opposite is true. 

I have a couple of examples. One is Amazon. When Amazon first started, what did they sell? They sold books. They did not start with selling 42 billion items as they do now. They focused on books. They dialed in their messaging. They dialed in their operations. They dialed all of that in. Once that was dialed in, they started to expand what they offered. That's a perfect example of niche. Another example that came up in our conversation is Lululemon. It came up funny and someone brought it up. I bought a pair recently of ABC pants. Have you ever heard of ABC pants? 

PTO 137 Jamey Schrier | Driving Referrals
Driving Referrals: If you're clear on your target audience's fears, worries, needs, and frustration, that's gold on the messaging you will use.


I've got a couple of them.  

People were cracking up because what does ABC stand for?  

Anti-Ball Crusher 

A couple of friends of mine were wearing them. They played golf with them. They went out to dinner with them. They hung out with them. A lot of times, all on the same day, they never changed. I'm like, “That's cool to complete in their stretching. Do you think I'm Lululemon's target ideal customer? Heck, no. I'm the furthest from them but it doesn't matter. I understand who their customer is. My wife wears some of that stuff but I still paid them money to purchase something. When they do an ad specifically on the ABC pants, that ad is going to be reaching their particular audience, which is you and me, basically your 30, 35-year-old to 60-year-old male. That's who they're going to target. One of the things that we have to do right from the get-go and after where we established our vision, mission and values is to dial in our audience.  

When you dial in your target audience, you're clear on their fears, worries, wants, needs and frustrations. When you are clear on that, that becomes gold because that's the messaging that you will use. You can use it in workshops. You can use it when you speak to referral sources that I know seems to be a dying focus with people and our profession. We are specialists. People are referred to a specialist. That’s a fact. What we're talking about a lot of is that messaging online. "What is our website's message? What are we putting out there if you're using social media, Facebook or whatever? I don't think you need to be an expert at being a social media person. As you've mentioned, you've had a lot of other internet marketers or internet people on. There are talented people that can help you do it. Our job is to understand our audience and be able to speak clearly in our messaging to our audience no matter what medium it's in. You hire someone that can help you put all the tactical stuff together in order to do that. That's the next step, Nathan, that we need to begin before diving into all the other stuff.  

I had a bad experience with a website designer that I was sharing with you prior to our conversation and as I was discussing that experience with my coach, it led back to the fact that I wasn't clear on my message. They're lost in the woods as to what to design for me because my message wasn't clear and the same can be said for the physical therapy teams. If they're not clear with their message and who that specific avatar is, get it down to, “Is it a man or a woman? How old are they? What are their cares and concerns? What are their family and community look like? All those things. Get detailed so that you can speak to that. As you said, the fear comes up then what about everyone else.  

As you said, I don't know how many times I've seen it. My friend, Angie McGilvrey down in Florida had the hurricane come through. They had to start all over again. They decided, “We're going to do it this way. They are going to focus on social media, but their focus was going to be on 30-year-old female CrossFit athletes. That's their avatar. They’re busier than they've ever been before now because they treat those CrossFit athletes well. CrossFit athletes have families. They have friends who are CrossFit athletes. You and I both know if I have a rotator cuff issue, I want to get my rehab from the guy that works with the Major League Baseball operations. I want the specialists. I want the guy who's known for being good with the athlete rotator cuffs. I'm nowhere near an athlete and I'm not going to throw a ball more than 50 miles an hour but I want that dude. As your niche, you aren't limiting yourself. You're saying, “Here's where we focus. You can also be part of the groupWe're still going to take you that it allows you then to focus on your messaging.  

The more information you know about your audience, the more you'll be able to connect with them. Click To Tweet

This is an example that will hit home. Surgeons have done this. Everywhere across the country, if you look at multiple places that do, let's say orthopedic surgery, what you will see on their site, you will see very clearly the surgeon and the specialty, the back guy, the knee woman, the ankle specialists or the shoulder specialists. What they realized is that people are referred to a specialist. Nobody wants to see, I have a back problem. Can I see the generalists? I want to see the generalist, not the specialist in shoulders.” Here's what you don't see, “I have a good friend, Dr. Goldsmith. He’s great guy on the site. He's the back guy. What's interesting is he tells me that 60% or 70% of his patients are not back problems.  

I said, You're the back guy. He goes, Yes but they call me for everything.” As you said, they refer their friend, neighborkids, and their spouses. As a business owner, it hits me. I'm like, “That's brilliant.” In the workshop, I was telling you, we had one of the participants and they’re pediatric therapists. We went on the site and there was a picture of a child on the site. There was nothing verbally saying what their niche was. There was just a picture of a kid and they had all of the different diagnoses and all the different treatment techniques. It was way too much information but it never answered the question, “Can you help me with my problem? It became confusing and she's been doing this a long time.  

She was like, “I never realized that. I was like, “How much time have you spent getting clear on who your audience is and what your message is? What do you want them to know that is important to them, not you? What's important to us is our certifications. What's important to us is how much information we know. We want to throw up on people of how many years we've been doing and how many certifications. That's fine. Do that at your next conference with your other colleagues. You can show off all that stuff. Your audience doesn't care. The person that has back pain wants to know, “if you help them with their back pain so they can go back to playing basketball. If the answer is, yes, they come to you. If the answer is no, they don't. Either way is fine. When the answer is, I'm not sure, then you are potentially losing, who knows how many potential referrals. It's not a financial thing. You're losing the ability to help somebody, which is what we do, which is why we do all this.  

They may go somewhere else and maybe not get the help or they may go nowhere and try to look for the magic pill even though you could help them so well but they don't know that. They don't know what you know. If you do those first two steps, that mission, vision values, and start getting clear on your audience, start diving in like you said, “Tell me everything about them. Where do they live? How much they make? What do they like? Do they have a dog or do they have a cat? Are they married or are they not? What kind of car do they drive? The more information you know about them, the more you'll be able to connect with them. That's what this game is about. That's where the art of marketing comes in. It's the ability to connect with people. You have to start there. Iyou start there and find a good reputable person, let's say your website or other digital things, you are going to be much more successful at generating referrals consistently because you know how to connect with your audience. That's the part that's missed. We take a bunch of money that we don't have. We give it to somebody in the hopes that they're going to do all of this work.  

The expectation is, I give money, they give me a bunch of referrals. What they're saying is, “Yes, I can help you get referrals but I can't answer all these questions. Hopefully, they can do what they promised to do which is the links, connections, put the images up and all the stuff up. That messaging I've spent tens of thousands of dollars. I won't call it a waste. I will call it a lesson. It was an expensive lesson I hadI went to school. I paid $50,000. I got an F but I learned. I learned that there were some things that this person in this company did that I wish I knew but a lot of it was. I wasn't being clear in what exactly I wanted. That was the problem because wasn't clear. That's on me and that's on every single owner. We have to start focusing on that which of course begs the question we've talked about in the past, which is, I'm busy. I don't have time. I'm dealing with all the stuff. I'm like, “There's the real issue. What do you focus on and how do you carve out time?” That could certainly be for another time management topic. 

That’s completely another episode. As you're talking about that, I remember I had Aaron LeBauer on. If you don't know Aaron, he has his own cash-based or out-of-network private practice and is successful at coaching others in setting up their own cash-based private practices. Interestingly, in his practice, they don't bring up the words physical therapy. They talk about what they can do for their patients. They have an ala carte menu. Part of what we can provide you is physical therapy. That's one of the menu items. That's interesting because I brought him on to talk about how to market an out-of-network owner to ask someone to pay cash when they could go down the street and have their insurance pay for it all. That's a higher level of marketing acumen that you've got to attain to get people to pay cash for something that could be for free.  

PTO 137 Jamey Schrier | Driving Referrals
The 7 Habits of Highly Effective People

Yes and no, Nathan, so give me a chance to respond.  

I was going to say, it's interesting though that his focus wasn't physical therapy. That's not what we provide. It's a service that we offer but that's not what we do per se. What we do is we live out our purpose, providing you a pain-free lifestyle, getting you back to the functional activities you want to do, helping you enjoy your family, your friends, and your neighbors, and helping you play with your dog. That's what we do. Physical therapy happens to be a vehicle.  

Stephen Covey in his book, The 7 Habits of Highly Effective People said, “Begin with the end in mind.” It’s one of his famous sayings, and everyone grabs and uses it like me. What does that mean? In this case, the end is the outcome and what people want. They are coming to you with a problempain, a disability, balance issues, and their kid not able to play a sport. What they want is the outcome. Clear as day. That's what they want and that's what you want when you do the same thing. You want the outcome. What is not as important is the part where we spent our whole life, which is learning the solution from the problem that they have to the pain. That's not where the conversation begins. Is it important that they understand? Yes, perhaps. It all depends if they have those questions 

A lot of times, they don't ask every little thing that you're going to do. They connect with you, build rapport, trust you and say, “This is the place for me. Sometimes, they want to know so exactly what the process is. You can share that with them, but what has to be clear first is, can you help them solve their problem? That's the biggest problemI know Aaron, I've been on his show. He is smart and he understands the fact that the less you can talk about the widget of how you help somebody. A widget can be a product or a service. We're going to talk about the widget service, the dry needling widget service, the myofascial release widget service, the exercise widget service, and the pool therapy widget service. These are solutions to help people get what they want.  

People don't care about that initially. They may or may not care eventually. What they care about is, I’m in pain. Are you going to help me get here? If so, what do I do? How do I get with you? We have to be clear on that. As an owner, potential director, manager of your business, and as a clinician, it is very confusing in our heads that that's how our people are thinking. We need to make sure that when we're looking at marketing and our business that we step out to that 30,000-foot view and make sure we put this marketing hat on to start looking at our business from their perspective. From the perspective of our avatar of our ideal client. When you do, things will start to become so much clear and you will start to be able to get more people coming to you because they will understand the question. Can Nathan helped me get what I want? You said something about cash-basedCan we operate out of network? I’d love to dive into that. 

To add on there in my conversation with Aaron and also to what you're saying is one of his first questions in that initial evaluation goes back to imagine six weeks from now and completed your physical therapy, what would have happened? What does your life look like to say that this interaction with us and what we're doing to help you with your shoulder, back or knee has been a success? What does that look like? Starting with the end in mind, he takes that so far as to put it in part of his initial evaluation process and to get compliance, to get buy-in to say, I can help you do that. On subsequent follow-up visits is that's what they're going to allude to. 

Remember on our first visit, you said at the end of our treatment, we want to get here. How much closer are weThis is what we needed to get there. It's less, so much about mini me, my OCSECS, CSCS and CSS. No one cares about all the letters but it's what can you do to help me get to that goal. He takes it not from his marketing and getting that message clear then putting it into his first initial visit with that patient is, “Tell me, what are you here for? What do we need to get to in order for this to be successful?” Keeps compliance that way. 

You don't need many relationships to blow away your numbers. Click To Tweet

There are three ways to get referrals in your business to step out of the fray. You can get referrals online. We know about that through your website and different social channels. You get referrals through referral sources. It does not necessarily mean just doctors. There are lots of other people that have influence over your audience. When you're clear on your audience, you'll know who those people are. The third way to get referrals is one of the ways that we love to get referrals which is word of mouth. It happens when you're delivering an amazing experience to people, and we want the experience to be consistent and to happen regardless of who they are when they come in.  

That’s what you're talking about with what Aaron was saying. When you start focusing on the experience, it starts when they call your office, they come in, and go through the evaluation. You're always looking at the experience that you're delivering from their point of view. We can go into lots of detail about how to do that and all the different touchpoints of that experience, leading up to the discharge and then the experience after the discharge. That increases the ability for one patient to turn into multiple patients by referring others and shouting on the mountaintops how great you are. To the one point about beginning with the end in mind and the evaluation is a funny story. I had a mentor for many years, Dan Sullivan, strategic coach.  

It’s a great book he put out. Who Not How is crazy awesome.  

One of the most powerful things that he always talked about is delegating and the Who Not How. One of his biggest things that he developed was something called the R-Factor Question. It's called the Relationship Question. The Relationship Question says, “If we were sitting here blank time from now and we were going to look back on now, what would have to happen personally, professionally, depending on who you're talking to for you to feel good about your experience or do you feel happy?” Once you see that, you realize that there are lots of ways to take that question to that perspective and use it throughout your thing.  

Aaron is using that question, “If we're sitting here eight weeks from now, what would have to happen for you to feel good about your progress here? You're taking people into the future and into the possibility of what is going to have you feel good. That's some tactics and strategies of how to connect with people build rapport. When you do that, you reduce cancellations. The key is driving the referrals to begin with. That happens in of those 3 areas through a referral, an internal referral or word of mouth. Putting out there in that digital world and allow people to come to you and come to your website.  

It's more important than it has been in the past. We saw that with the pandemic where we couldn't visit doctor's offices, and there was no way to connect with our community unless we did use other avenues to get to them. It's important that we're clear on that message so we can connect with our community directly and have more of that connection without relying specifically on the physicians all the time.  

You and I talked about this. I want to caution people not to jump ship and say, “It's not where the doctor is at. It's all online. We’ve got to go online. We’ve got to get the people online. People are referred to a specialist. People ask their friends. I have this thing called Listserv in our community. We have a community of 400 houses. Every day, there is someone saying, “Does anyone have a recommendation for blank? Many times a week, it's always something health-related. What's amazing is multiple people then provide the solution or provide the answer like, “You’ve got to see my person. Sometimes they're so adamant about their person. They're like, “You’re going to go see them? I'll give you their information. I'll call them for you. I'll help you set up an appointment.” These are your raving fans. This is how people are referred to specialist.  

Now, they may then go online to do it or the reverse will happen. They're online in your Facebook Ad or social media post comes up and they go, “Whatever, then the person mentions that and you're like, “I've heard of them. They don't know where, but they saw you out in the universe and their world. Most of us are within a community, we're not trying to promote ourselves nationally. We're in a community where it's easier for you to do that because it's a confined area. I want to caution people not to stop building relationships with referral sources, with referral partners.  

Here's a tip on that. I want you to look at your referral relationships. People that have an influence over your audience, you have to identify your audience before we’ve spoken about that and I want you to look at them as they're your client and your patient. I want you to start looking at the referral partner as they're your target audience, not who they're referring, they are. What would you want to know about them? Would you show up? I have a blog that talks about one-night stands. You’re going to love it. It talks about we treat a lot of our referral sources like one-night stands. It's a one-way relationship and we want to get what we want where we want to call them up. “I'd like to meet with you because I want you to send me some referrals. Can you do that please? That's not a relationship.  

To your point, COVID said, “We can't visit doctors anymore. I'm glad that happened because we have to wake up. People have been asleep at the wheel and not woken up to the fact that it's about relationships, and it's always been. If you start to focus on these doctors, try to create a relationship, truly try to be interested in them, see how you might collaborate, and serve them better which ends up meaning helping them somehow with your expertise and your solution to their clients and patients. That mindset shift will help you develop key relationships.  

For most practice owners, let's say $500,000 or $1.5 million in revenue, you don't need many relationships to blow away your numbers. Get a handful of people. Get five good relationships sending you a couple of people a week. That's 50 new patients a month. Most likely you would blow away your numbers beyond belief. Your next problem would be hiring therapists to see everybody or getting a bigger space, which isn't a problem because there's plenty of space out there available. That mindset shifts of looking at them the same way you would look at your patient. You want to have two avatars. You want to have a referral source avatar and a patient avatar. Start there.  

I love that because you never try to think about who your perfect referral source is or what your message should be, what do they want to know and who is seeing your perfect avatar patient? That's a good mindset shift as you're considering your marketing strategies because those guys and girls that I know that did fairly well through the pandemic got through it okayThe people that they had the doctor's cell phone numbers because they had developed that relationship over time. They didn't have to rely on going into the office and dropping off candy. They had got the relationship with the physician to the point where they could say, “How are you guys doing? Do you need anything from us? We're still open. FYI.” They could market to them directly because they had taken the time to develop relationships with these people.  

Unlike a one-night stand, when you develop a real relationship, it can withstand things like this. It can withstand competitors. People are trying to move in a little bit. It can withstand a lot of things. Icomes back to why haven't we looked at it that way? Our perspective with doctors is they have served one purpose and that purpose is to feed me, people. If they don't, there's something wrong with them. This is a systemic problem that we need to shift the way we think about this. That could be the greatest collaborators with us. If we step up our game and start to look at it as how we can work together, how can I provide a service and help to you? That means increasing our own communication skills, ability to connect, and build rapport.  

These are things we haven't been specifically taught in that we have to learn. When you do, there's not a lack of people that need us. What was the latest AVTA number? Eight percent of the population comes to physical therapy but 150 million need or could benefit from physical therapy. Where's the other 92%? It's not because we're not good at what we do and you're not knowledgeable enough or smart enough. It's because we are not spending time educating and learning how to connect with them with their wants and their needs. When we start to do that, there is plenty for everyone.  

PTO 137 Jamey Schrier | Driving Referrals
Driving Referrals: Many people don't give that much attention to PT because not much time is spent educating and learning how to connect with them and with their wants and needs.


It's sad to know about physical therapists who worry about the competitor within a couple of mile radius. It's understandable to know what they're doing because it feels like with a mindset of scarcity, then we're all fighting over that 8%. Whereas if we improved our message and got that out to the community, we could be playing in a much bigger pool that is 92% of 150 million and not fighting over the 8% that are getting the therapy that they need. There's so much more to be had if we got clear on our message and focused on those people who need it.  

The shameful part of it is a lot of these people that you're referring to are very smart, talented people that are providing in a very small way and amazing servicesThey don't look at it as a business. More importantly, they don't look at themselves as an owner or as the CEO. As the CEO, your job is to 100% focus on not only where the company is going but servicing your customer. You have at least two customers. You have the patient that comes in and you have the people that refer patients that come in. If you spent a little bit of time and did some basic stuff, you can't get any less people connecting with people, building rapport, and showing them value.  

You can only go up. That's what we've seen with our program and with our clients. I'm sure you've seen the same thing. This is why we do this. My mission is to help every single practice owner and practice that wants to build and grow to do it because we have an endless number of people who need our services. It's not because our high is only ten people. That would be a problem. It's a blue ocean out there. It's endless. We do such great work. We need to have a little B-School for the practice owners. We need to get a little business education with the practice owners and that's what we try to provide and help them in.  

We’re going on for a while now and I appreciate you taking the time. We could go on for more. We had many tangents if we could have gone down thereIf people want to get in touch with you, Jamey, how do they do that?  

If you want to get in touch with me, go to PracticeFreedomU.comYou can check us out. Also on there, you can download my book, The Practice Freedom Method: The Practice Guide to Work Less, Earn More, and Live Your Passion. It’s not a bad three things to do. It's about my experiences as a practice owner and all the trials, tribulations, and disasters I've had but I was able to figure out a path and now trying to impart some knowledge to help some others.  

Thanks again for taking the time. I appreciate it as always.  

It’s my pleasure. I appreciate you and what you're doing, Nathan. 

Thanks, Jamey 

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About Jamey Schrier

PTO 137 Jamey Schrier | Driving ReferralsJamey Schrier, P.T. is the Founder and Chief Executive Officer of Practice Freedom U, a business coaching and training company. He’s an executive business coach and leadership trainer. Founder of Lighthouse Leader®, Jamey helps physical therapy owners create self-managing practices that allow them the freedom they want and the income they deserve. He is the best-selling author of The Practice Freedom Method: The Practice Owner’s Guide to Work Less, Earn More and Live Your Passion.
A graduate of The University of Maryland Physical Therapy School, Jamey specialized in orthopedics and manual therapy. He was the sole owner of a multi-clinic practice for more than 15 years. Jamey’s passions are basketball, tennis, golfing, and reading. He and his wife, Colleen, and their 2 kids live in Rockville, Maryland.

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There is no perfect formula for growing and expanding your PT business, but as with most other industries, the way to learn is to look at those who have been there and succeeded. Jeff Ostrowski, PT is an owner/partner of 35 clinics across SE Pennsylvania, starting from a single clinic 30+ years ago. Over the years he has taken on partners, added more clinics, expanded existing clinics, and merged and purchased other clinics. He has experienced almost all the possibilities for a growing and expanding practice. Nathan Shields brings him on the podcast to discuss some of the most frequently asked questions about PT business expansion, such as "when is the best time to add another location", "when is the best time to add another PT", "when should I consider adding more square footage", etc. Jeff has been through enough over the years that he knows what has worked for his growing company. Listen in as shares his insights on the podcast.


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When To Grow & Expand With Jeff Ostrowski, PT

I'm excited to bring on Jeff Ostrowski. He is the Owner and Partner in Excel Physical Therapy in Southeastern Pennsylvania. They have 35 clinics and continue to grow. We'll get to his story, but I want to bring him on about some important topics in regard to growth and expansion that a lot of new owners and even long-time owners have questions about. He has been around the block a few times. First of all, Jeff, thanks for coming on. I appreciate it.

You're welcome, Nathan. It’s good to be on the show. I enjoy your show. It's good and helpful. I'm glad to contribute.

Thanks for being a part of it and for taking the time. We haven't met each other that much. We talked on the phone a couple of times, but you've got a lot of wealth of knowledge and wisdom. I know you are a big part of the P2P group and PPS in getting that established. First of all, thank you for your efforts in doing that. That's huge to establish that kind of networking and network. It's a great resource for the physical therapist. Thanks for doing that.

You're welcome. It's a wonderful resource for private practice owners. If you have readers that are PPS members and they're not in the Peer2Peer Network group, they ought to join that too. I've been involved in PPS for a long-time. I was on the board of directors for seven years and the editor of IMPACT Magazine for three years. I served on a whole bunch of different committees and task forces. Like you said, I've been around PPS long-time and this Peer2Peer Network thing is one of the most valuable things that I've seen come along. I want to do a little endorsement for everybody who's reading. I certainly can make myself available to your readers to talk more about it if they have questions about PPS or Peer2Peer afterward.

Tell us a little bit about you. You've been in the industry for some time. You've been an owner for a while as well. Tell us a little bit about your professional story and what got you to where you are with such a large company.

I started the practice back in 1990. I've been a practice owner for many years. I've started by myself. I brought on one of my best friends and business partner within a few months of opening that up. We grew that up and then we merged with another company in our area back in 2011. That was a great experience. It was an awesome company that we merged with. We've had good success. We probably doubled the size of the company since we've merged. I've gained a bunch of great friends in those partners from the other business that we merged with as a result. We took what was good about our company and their company, put those things together with a lot of humility and no pride of authorship.

I took the best of both worlds, put them together and created something special in our industry and that's where we are. It might be of interest to your audience that I’m semi-retired many years ago. We hired on a management team, CEO, CFO, some regional directors and some other management talent to run the day-to-day operations of the company. My partners and I were able to step out of day-to-day operations and move into a retirement mode. We still work. We're on the board of directors and we handle special projects in the company and do stay very involved and very aware of what's going on, but we have a good leadership team in there so we're off doing other things now. It's pretty neat.

Congratulations on getting to that point. Through your experience as an owner, you've seen all the stages, it seems like. You've not only brought on the next PT, which was your friend, but you also opened up another clinic. At some point, I'm sure you had some leadership team that you guys worked with either before or after you merged with the other company. It seems like you've gone through essentially all the steps of building a corporation so you can go back and give us some good advice.

There are two things we can talk about there when it comes to growth, what's known as the same store growth. That's how do you grow a clinic from 1 to 2 to 3 therapists and so on and then there's the growth through a new clinic, startups, de novo clinics. There's a lot of different nomenclature for that out there. There's the growth through mergers and acquisitions, but I think our success has been in the first two, in the same store growth and then opening up new clinics. There are lots of similarities between the two.

PT Business Expansion: When it gets really busy, patients don't get as much attention from the therapists. It can be profitable for the owner, but frustrating for the client.

Let's start from the beginning. For a lot of physical therapists, whether they're new or have been around a while, if that initial step of going from one PT, which usually is the owner, to bring on that next physical therapist, bringing on that added expense then, “How am I going to keep them busy? What am I going to do? How am I going to offload patients? How am I going to rent myself back up? How do I handle all that?” What would be your advice for that initial step to bring on that other physical therapist?

I'm reflecting on the days when I was the only PT and the practice was growing. It was extremely exhilarating at that time because patients were coming in and I was like, “I can't believe people are coming in here and I'm having so much fun. I'm enjoying this.” Although we weren't very good, we are getting paid back then. It was a great time to grow. It does take a certain trust or jumping off the cliff to bring on the next PT because I fully understand the mentality of, “I'm the owner. It's my name and reputation at stake here. I don't know if I can find someone to do it the same way that I want it done.”

A lot of times the owner is very overwhelmed with day-to-day. They're seeing tons of patients and then they also have to run the business and they don't necessarily have time to invest in training new staff, a new PT. Even hiring seems pretty daunting sometimes because you have to interview and it's a very competitive market to hire therapists in the last several years. It's tough. You got boxed into a corner and the way out of that is a couple of things. Number one is in this day and age, the schools, at least in Southeastern Pennsylvania near Philadelphia, are putting out much more qualified therapists now than they have since I can remember. The PTs that are coming out of school are ready to work. There's been an improvement and advancement in the profession as far as that goes.

You still have to train them. You’re still going to manage them, monitor their performance and their statistics, but it's much easier than it was many years ago, in my opinion. You have to be capitalized too. You have to have some money in the bank because when you bring that new therapist on, it's going to put you underwater financially for a while until you can get their schedule filled up with patients. They're self-sustaining in terms of their contribution to the revenue of the business or the clinic. You've got to be ready for that. Meaning, you have to have some cash reserve. You have to have very carefully mapped out financial plans and budgets so that you know what you're up against and what your cash position is going to look like as you bring this person on and you ramp that up.

That probably gets in the way of a lot of people early on. It certainly did for me. I didn't understand the idea of capitalization as much as I do now. You've got to have that. A mistake that's often made, if I look back at my history, I can see it very clearly is when times are good and your schedule and therapist’s schedule is filled, you can be very profitable in that area. If you watch closely, you will start to see signs of stress on your business. When everybody's schedule is filled up, you'll start to see your charges per visit go down. You'll start to see the time that patients wait to get an appointment starts to increase. You'll start to see that patients don't schedule as frequently as they did on a per week basis.

You also start to see that your quality measures and there are many of those. There are outcomes measures, Net Promoter Score and patient satisfaction. You'll start to see those things slip a little bit because when it gets busy, patients don't get as much attention from your therapist. They don't like it as much when it's busy and although the owner right in that zone can be very profitable, that is short-lived, because what happens is all the hard work that they have done starts to fall apart. During that same period of time, they probably slow down their marketing a little bit because everybody is busy and you don't have time for it and that falls off. You then get on this up and down roller coaster phenomenon and you never break through to that next therapist in your clinic.

That’s one of the reasons why I push some of my clients to consider bringing on that physical therapist because they, as the owner, need the time to manage those things. Our natural tendency is, “I am productive when I'm seeing patients.” That changes when you have an ownership hat and a lot of those holes in the bucket start forming as you take your eyes off of the business. One of the things I try to stress is to make sure that you know your financials. Talk to your CPA or bookkeeper often so you know exactly what hit that PT will make on your business.

The amount of time that you spend in your policy, procedures and training gives you a huge return that doesn't show up monetarily. Click To Tweet

You can get certainty on what the environment's going to look like, but also have a little bit of faith knowing that this is another investment. When you started your business, there's no guarantee that your business was going to succeed. There's no guarantee this other physical therapist is going to succeed. When you do bring that physical therapist and it gives you time to work on the business market and be carefully managing all those statistics that you're talking about, then things can go much more successfully. You can grow successfully as well without slipping in all those areas that you mentioned.

You said that well. I'll add to that is as the owner who can't get to that next level of managing the business because they're so busy, they're overwhelmed and they're underwater. They start to not like it. The owner gets tired, burned out, jaded and cynical. That early enthusiasm that you had when you first opened your doors quickly, you get beaten up. That starts to go away after a while and you get embittered. That has cascade throughout your company. It's you, as the leader of the business are showing up for work every day with a negative outlook and a bad attitude and, “This is horrible.”

It's hard to attract and retain good staff when you have that kind of mentality. When you go home to your family and you're all salty about how bad your day was, maybe you feel like kicking the dog. If you had one, it will be hiding under the bed when you walk in from a day's work, but it's definitely not fun to live that way either. I can tell you this from experience and a lot of your readers probably have lived through this too. That's a very important part of all this. We want this practice and business to enhance our lives and not detract from it.

The stress of hiring that first PT and this is my theory that I've built up over the past couple of months. You're going from one PT yourself to two PTs. That's a 100% increase. The stresses could be about the same, at least financially. Maybe that's not a 100% increase in your expenses, but it's a significant change in your expenses. Going from 2 to 3 PTs, that's a 50% increase and it's not as hard to bring on that third person. It doesn't hit the expense account as much. As you add more physical therapists, the expense ratios are a little bit different, but in doing each of those steps, as long as you keep your eyes on the business and train your therapists appropriately, recognizing that you need to step back in your treatment availability and time spent. You can do that successfully and each subsequent hire can be a little bit easier to tolerate both in terms of money and energy. Do you find that to be true?

That's exactly right. You spread out the overhead of the business over more revenue-generating PTs. Each one has less of an impact on your bottom line if you will. As you're doing that too, you're developing systems, whether they're marketing systems or operational systems, hiring and training systems, so that each time you bring someone on, not only is it easier financially to bring them on, but you have systems in place that makes it easier to get them onboard and productive as quickly as possible. Those are key things. Those investment and building training systems, especially building, hiring systems, having a marketing program that runs on autopilot so that you're not running around with your hair on fire all the time with those other things.

That's one thing that my company had been very successful at. My partners are amazing. We've spent a lot of time putting those programs together. My one partner, Todd, could be one of the smartest hard-working guys I've ever met in my life and probably is. He uses this ecology, “Your business is an ecology,” and everything works together and contributes to the health of the whole organization. It's not one thing, it's a lot of everything and they all need to work in alignment. That sounds like a lot of big words and it sounds easy to do. It's not. It takes time and effort to build all those things, but those investments pay off extraordinarily well once you get them in place.

That's what a lot of young owners or newer owners don't recognize is the amount of time that you can spend in your policy and procedures and time spent on training materials is a huge return that doesn't show up monetarily. It is multiple times more productive than treating that patient. It is a grind to put some of that stuff together, but for the sake of the business and for your mental health, it's a huge step in the right direction. It makes things easier.

It's another reason why an owner who wants to grow can't be gobbling up all their time treating patients because these things that we discussed, it all takes a lot of time to put together. If you're 40 or 50 hours a week in the clinic, you're not going to have time or the energy to do this other stuff.

PTO 116 | PT Business Expansion
PT Business Expansion: Train your therapists appropriately, recognizing that you need to step back and focus on management someday.

In terms of stepping, not just into adding another physical therapist, what advice would you give to owners in terms of considering moving up to a significantly larger space or finding another location? Is there a formula that you've used in the past, in your company or yourself to say, “We're performing at such and such rate? Now is a good time to expand, get a significantly larger space or a new space altogether.” How would you address those situations?

Let's talk first about the larger space. There are some metrics out there that people use in terms of a square foot per full-time equivalent and they're all over the place. Those metrics depend a lot on what's the payer mix, net payment average per visit in your market and stuff like that. That's going to be very individually based, but it's the same mentality that I described before when you bring on a new PT. If you're going to get to the point when you walk into it, first of all, it's going to look and feel very busy. There's a buzz in the air.

You might have patients waiting for pieces of equipment. You might have patients waiting longer in the waiting room because there's not enough space for everybody in the building who is who's coming in. You will also see that manifest in your statistics and the same thing is going to happen. You're going to see the visits per referral are going to start to go down because people don't like being in this busy space. This happens a lot. The therapist also feels very busy and they feel bad about that for patients. I've hired thousands of PTs over the years and we want to go to work and have success. We want to be able to take good care of people.

Most of us went to PT school with this vision that, “I want to help people. I love this profession. I love what I do. I make a difference and it feels good. When I go home at night, I might be tired because it was a long day, but I feel I lay down at night and put my head on my pillow feeling like, ‘I did good work.’” That feeling is what we want to capture here and preserve and fight to preserve. If you try to cram a lot of patients into a small space and the schedule is busy, the PTs don't feel like they can have success. They start to not feel good about going to work after a while. They get burned out and they don't do their best work. It's nothing conscientious that they do. It's just a natural erosion of their enthusiasm.

It shows in the statistics.

It absolutely does. The patients come in 1 or 2 less visits than they would before. Their cancellation rates go up. The friend and family and past patient referrals that you were getting before might start to go down because people aren't as happy with the care as they once were. You might have more turnover amongst your therapy staff. Watching those statistics in the same way, it'll point you to the same exact thing like, “We're bursting at the seams here. It's time to take on some new space.” That's a tough decision because most of the time, you're going to be signing leases that are about five years on average. You've got to map out your growth for five years to make sure you don't run out of space in a year.

Again, you've got to have good financial planning, good budgets, good advice and a good understanding of what your growth rates are going to be so that you know that if I have three therapists now, several years from now, I'm going to have 6 or 7 in this clinic. I need maybe not 2,500 square feet, but 5,000. It's like you described before when you hired that new therapist on. You're going to have a little suppression in your cashflow in the beginning until that therapist builds up. It’s the same thing with taking a new space. You're going to have to budget it in there, “We have more space than I need for a while here until we grow into it.” That's how we always looked at it in terms of taking on new space.

It's very much about feel, but a lot of the feelings do translate into the statistics. Patient compliance goes down a little bit, therapists aren't pushing the patients to come 2 and 3 times a week. They're okay if the patient only comes once a week. They're not seeing the results. Whatever your measure is, whether it's your square footage or your efficiency, the number of appointments that are filled on a PT schedule on average. If you're running about 80% to 90% clip on a routine basis or regular basis, then that's a good time. If you continue to work hard at that pace, people are going to get burned out.

With the right people on board, growth comes easily and becomes inevitable. Click To Tweet

It's a good time to consider either a larger space or if you are looking at another geographical location nearby, that's a good time to do it because you don't want to do that when you're running it 60%. Even though you might have these great ideas, “There's this perfect location over here that I want to open up.” You don't want to extend yourself and open up that new location or get that greater space because it's a great opportunity if you're not maximizing the efficiency of what you currently have.

That's going to put you financially underwater. It's tough to resist those temptations. You've got to optimize your current setting before you go expanding into new locations. There are a couple of things that are important. You need a referral base there. You need to know that there's going to be some patients that are willing to come in and maybe some physicians that are willing to refer. I think the most important part of a new clinic is the leadership of that clinic. Who is going to go in and run that clinic? That goes back to your hiring, training processes and leadership development. Because I think you could take a perfect location with an average leader and you'll have an average result and conversely, you could take in an average market location, put a strong dynamic leader in there and you'll have a fantastic result. The leadership development piece of this is absolutely critical.

That builds off of a comment that Steve Anderson made in the previous show. It’s exactly what you said. Even in the Northwest where he was, they found when they open up clinics, it wasn't the location so much that they were looking for as much as who. First is who then the where or the what. Once they established, “This person has been with us many years. We vetted. They're a high producer and they have the desire. We've worked them through the leadership management program that we have or whatever that might be. Now, that we have the person let's go look for the location.” Whereas some people might say, “I've got the perfect location. I need to find somebody to fill it.” That's not the way to go.

That's great wisdom by Steve. He's had great success. I couldn't say it any better. It's the person first, the location second.

Did you ever purchase clinics even in a young stage where you might've had 2 or 3 clinics and then you’re looking at possibly purchasing another?

Yeah, I have. I've purchased two other businesses in my career.

Tell us a little bit about that. Looking back on your experience, what advice would you give owners nowadays? Honestly, I've got a couple of owners who even at their current size one, maybe two clinics talking with or being approached by people locally in the community who are looking to get out. What advice would you give yourself in that scenario when you're considering possibly purchasing something at a young stage?

This is a financial discussion. You have to map this purchase out financially. How are you going to pay for it? How much are you going to pay for it? How are you going to pay for it? Can you afford it? The difficulty that most acquisitions run into or acquirers run into is the integration of the business that they bought into their business. In my experience, it's much harder than I thought. It takes longer and it's more expensive to integrate. You've got to put all that and factor that all into your financial planning. You may find when you do it that it's more advantageous to go and open up new clinics and hire new therapists than it is to buy other businesses.

PT Business Expansion: When you hire a new therapist or open a new clinic, you're going to have a little suppression in your cashflow in the beginning until that investment builds up.

We've learned some hard lessons in the acquisition area. We’ve made 1 or 2 mistakes with some acquisitions, not accounting for the integration costs. There’s also this cultural piece of it. You run your practice one way and this runs a little bit differently. How do you put those two together without alienating the people and having to start over again with hiring new people and all the rest of it? Tread very carefully here. It's very sexy to go out and buy businesses and it's a way that some of the big companies in our industry are growing dramatically through acquisitions, but the difference is they have capital partners. Meaning they have a lot of cash to use.

They have teams of people that integrate businesses and they have a lot of experience doing it. How a business is going to fit and how that's all going to work much more than smaller practices do? I don't want to discourage people from doing it because it's done and I know people that have done it successfully. The smaller you are, the more pressure it's going to put on your organization financially and culturally. You got to go take it carefully. Don’t fall in love with the idea of it without falling in love with the financial side of it first.

I talked to a friend about that because he was considering the purchase of a clinic. I said, “There are simply pros and cons to it.” When you're looking at purchasing a clinic, you're buying a book of business that is running. It probably has referral relationships, has contracts and has a team that's already working. You want to be tight with a good CPA that knows about mergers and acquisitions. How to read financials and teach you about it as well.

The cons are the things that you may not consider when you're talking to a CPA and that is, “Is it a cultural fit? Are you value-aligned? How's the team going to take it if I manage them differently? Are the benefits going to be the same? Are they going to lose if I purchase them because my benefit package is different than theirs?” There are many things that you might not be looking at right off the top, where maybe the pro of opening up your own clinic instead of purchasing one might be a better way if you simply have the right people. It's going to cost less, but you don't have the immediate revenue flow that an established clinic might have. If you have the right people, you will stand that and you can be very successful.”

We know this is a people business and this happened to me. I've had patients call saying, “I want to see Joe.” “Joe's not here anymore, but you could see Mary. She's a good therapist. We have her.” “I like Joe. I want to find Joe. He was my guy. He's my therapist.” It's a people business. Patients tend to follow their therapists. If you're buying a business where the owners or the staff, for whatever reason, decide not to stay with the new business, you're going to regret the fact that some of those patients are going to go away. That's something you've got to factor into it too. There's going to be some loss of patients there because it's a people business.

That brings up another thing. To go back in terms of stages and where owners are at with ownership, how do you deal with stepping out of treatment care and telling patients who liked what you did, especially when you're the owner and your partner that you were no longer treating? How did you make that transition and highlight your staff? You wouldn't tell them, “I've got a great staff and I've trained. I'm still on site.” You want to almost allay their fears, especially when the referring physicians are saying, “I want you to go see Jeff.” In my case, they almost didn't remember the name of my clinic. They said, “I want you to go see Nathan.” They knew that I had other physical therapists on staff, but that's how they knew of my clinic because I had that relationship. How did you successfully make that transition out and tell those patients that wanted to see you?

That was a tough one. I remember that I was very nervous about that. I know a lot of owners are because you feel like you have an owner mentality and you're probably a good therapist, number one. Number two, you have this owner mentality where you take good care of people and you relate well to people and all the rest of it. To get out from under that is difficult. You're going to have some loss during that period of time. There's going to be some patients who are upset by that, but I found it was very few. In the beginning, I would have to talk to every single one of them and say, “I picked this person that you're going to see. I trained them. They do it exactly like I do. In fact, in some cases, they're better than me for A, B and C reasons. However, I will be watching and monitoring. I'm always here for you when you need me.”

Once you’ve build a reputation for your business and your practice, it will see you through even in times of transition. Click To Tweet

The vast majority of patients were willing to take that leap of faith and trust with me if it was explained that way. The physicians were the same thing. I remember those days with the prescription. They don’t say, “Go to Excel, go see Jeff.” It was the same conversation. I had to go to each one of them and explain, “I am getting busier. I am growing. I can't see all these patients. Can you allow you some of your patients to see new therapists that I bring on?” Most of the physicians were fine with that. They understand completely because they're in practices that are growing too and they understand how that works. Sometimes, they would want to meet the therapist and then that was cool.

It was a great marketing opportunity. Eventually, the prescriptions or referrals, they didn't say see Jeff anymore. They said, “See the other therapist.” That was a great day for me. I was very proud when that happened. There's nothing better as a PT that when you develop your own reputation, were physicians and patients identify you as a therapist and it's an awesome feeling. It's something to cultivate in your staff and that creates great culture and great momentum. It enhances your reputation as a business and practice when that word spreads that way.

There is a lot of anxiety and fear in making that handoff, but I think a lot of it honestly is pride because you have results. You've built something up and that could be the one thing that’s stopping you from making that jump is thinking, “Everyone's coming to see me.” There's a little bit of a pride element to that because it is what you've established for maybe over a few years.

Not a lot of good things happen when you're too prideful. I've learned that lesson. It is trust. You have to trust other people. Some of the trust can be built by picking the right people and training them properly and your trust level goes up and you do that.

I never tell that to people that I'm talking to that you've got to get over your pride. It's more about laying their fears. There might be people that will stop seeing you, but that means that they have to go to another place and establish a new relationship. I don't know if a lot of patients are willing to do that if they're that upset, but there is that possibility that there's going to be a few. I say, “Brainstorm and work with your front desk,” because they have to believe the story that they're telling patients that call them and say, “I want to see Nathan.” We need to figure out a story so that they are completely confident and believe the story that they're telling the patients, otherwise, it's not going to carry very well.

You build a reputation. If you lose a therapist or you bring on a new therapist, the reputation of your practice, if it's cultivated, nurtured and worked on all the time, it will carry you through those transitional periods. That goes back to where we started this conversation about having the systems in place, investing in training, accountability and management and how do you fix a PT who's off the reservation with one of their statistics and get them back on the reservation. How do you pick the right people with the right values that align with your practice? That's the ecology that my buddy Todd always talks about.

With you, as an owner, I'm assuming you went into it without a lot of business experience. How did you learn the statistics, numbers, measurements, how to develop policy and procedures and hold people accountable?

I had a little bit of a knack for it because I had that analytical brain from a statistical perspective, but along the way, I've had some mentors. I have a friend that is like a brother to me. A guy that I grew up with who got a practice up in North Jersey. He started his practice right around the same time I did. We helped each other. I learned a lot from him. That was one thing that helped me. I have a couple of consultants along the way. I moved into a new neighborhood many years ago and I got to be real good friends with one of my neighbors and he had an engineering business, but then he went into financial consulting.

He was the first guy that set me up on the whole P&L statements and balance sheet and taught me how to read and look at all those things. That was Brian and he changed my life at that point because that was when I finally though a light bulb went off about how to run a business. A couple of other PTs that I've had along the way. Kim and Michelle come to mind. People that were good with organization, administration and details. Edward was another one, a sharp guy. When we merged with the company I mentioned earlier, they had a lot of intellectual property in terms of systems and financial statements that took us to a new level.

Not knowing your story that much in-depth, I assumed that there was a point at which you came across someone who could teach you the ropes and you could get some training. My mantra with the show is if you want to expand, grow, get the freedom and profits that you want, you have to step out and meaning step out of training, you have to reach out and find some coach. Executive coach or consultant to teach you how to run a business and you have to network and work with other people who might be in similar situations, even if they're not in physical therapy. I assumed that it was probably part of your formula as well.

Our industry has a huge array of very talented consultants out there. There’s plentiful advice out there that you have to pay for. In many cases, it's worth it. It certainly was to me over the years to pay for that advice. It's your tuition. You can learn it the hard way. We're smart people. We can learn it, but why not take advantage of what's already out there? Even in PPS back to the private practice section, there's a wealth of resources in there. There are all training and different tools for marketing, finance, operations and so forth that weren't available many years ago. We have come a long way. I want to give some more accolades to PPS. The taskforce, work and tools that they put out during the COVID-19 crisis and pandemic was an amazing work that the board did during that period of time. That stuff is all still available. If there are people out there who are still working through recovery, which most of us are, I'm going to point out PPS and say there’s a lot of good tools there for you to use.

Looking back on what we've covered and we've covered a wide expansive of growth avenues, is there anything you want to go back and add to, or anything you want to add here towards the end of the program?

When you're busy in a clinic, that's a point where you're probably making good profits because you're busy and everybody's loaded up with visits. That could be a very attractive place for an owner to try to live because the profit margins are high. However, that's going to come with consequences that things are going to start to break. It is inevitable. When you're super busy, things are going to break. Watch those statistics, everybody. If you're starting to see those pressure points start to break down, that's a sign that you need to hire on new therapists or expand your clinic because you're going to start to come down the other side of that and your profitability is going to start to erode and you're going to spend a lot of money to build it back up again. Keep that kind of growth curve going smoothly up into the right and not herky-jerky rollercoaster-ish. That's the key to success.

Take that as your cue to take the next step and then take that step in faith, knowing that what you've done so far has been successful, continue to add to it. Thanks so much for your time. It was great talking to you in sharing your wisdom, your knowledge and your great help. I appreciate your work with PPS and Peer2Peer. If people wanted to get in touch with you or reach out to you individually, are you willing to share your contact information?

The best way to reach me was with my email. I'm happy to answer emails and if I don't know the answer to it, I know a lot of people out there. I can put you in touch with them. They would probably do know the answers. My email is

I recommend people reach out if they have questions. You're available and you've got plenty of experience in the space. I appreciate your time. Thanks for coming on.

Thanks for having me. You are doing a great job. I love what you're doing, love this profession and there's so much opportunity out there for us if we work together and we share our knowledge. There's a wealth of opportunity out there. We're doing great work. We have value. Let’s grow this pie as big as we can and we can all get a big bite of it. Good luck, everybody.

Thanks, Jeff. 

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About Jeff Ostrowski, PT

Professional: B.S. in Biology Juniata College, Huntingdon, PA 1984. Graduate of the Thomas Jefferson University Physical Therapy program, 1986. Founder of Excel Physical Therapy, 1990. Partner in E&A Therapy, 2011-present. Licensed Physical Therapist in Pennsylvania 1986-present.

Volunteer: Board of Directors of the Private Practice Section (PPS) of the American Physical Therapy Association (APTA) 2011-2017; Treasurer PPS 2017-2018; Managing Editor of the PPS APTA member magazine Impact 2008-2011. Past President (2011-2014) of the Southeastern District of the Pennsylvania Chapter of the APTA 2011 -2014; Board of Directors of the Pennsylvania Chapter of the American Physical Therapy Association 2011-2014; past member of the PPTA Finance Committee 2014-2017; PPTA Legislative Ambassador Key Contact; APTA PAC Ambassador in Pennsylvania; APTA and PPS Legislative Key Contact.

Personal: Lives in Glen Mills, PA, a suburb of Philadelphia; married with two children, ages 23 and 21; Enjoys sports, fitness, cycling, golf, drawing and reading.

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