PTO 152 | Greater Impact in the Community

 

Making a greater impact in the community is a dream for many medical professionals. Alicia Backer, PTA has spent the past 7 years developing a culture and a clinic that is focused on doing just that. In this episode, Nathan Shields interviews Alicia as she shares what her clinic does to find team members who share their mentality and are ready to do some of the things they do to integrate themselves into the community. Alicia and her team have generated a fun culture that looks forward to working and playing together. Their patients sense that and gravitate to them as clients.

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Making A Greater Impact In The Community With Alicia Backer, PTA

I’ve got Alicia Backer, PTA, out of Thief River Falls, Minnesota. Alicia, thanks for joining me. I appreciate it.

Thank you, Nathan, for having me.

I don’t have a lot of PTAs on the program but you wrote a great article in the April IMPACT Magazine about becoming a community alliance champion and you had some good insight that I liked. It spurred some thinking on my own and thought it was worthwhile to bring you on and talk about the things that you brought up in the article and want to get into that. Before we do that, tell us a little bit about you. Where you’re coming from? What you’re doing nowadays?

I’m from Thief River Falls, Minnesota. It’s up in the Northwestern corner. We’re pretty close to Canada. It gets pretty cold up here. Most people don’t think there are humans that can survive this element but we do. I work at a private practice outpatient clinic. I live in a town that’s approximately 9,000 people. It’s pretty rural. We have a lot of outside communities that come in to see us, too. I graduated from the Physical Therapy Assistant Program in 2010. I’ve been in a physical therapy community for several years now and had some good experiences in a few different settings that gave me some of the knowledge that we’ll talk about. I have 5 kids, step kids, 2 of my own and 3 step-kids. It keeps me busy outside of all the other stuff that I do at work and for different parts of the physical therapy world.

Do you do something in your clinic that provides a lot of outreach to the community? Your article was about community alliances. What things are you doing then in terms of reaching out to the community in your setting? Your supervisor allows you to reach out. I’m assuming you have different aspects that you’re involved in the community. What do you do?

I’ll take it back a few years before I started working in private practice. I worked for a larger outpatient clinic in a hospital setting. While I was a part of that setting, I never was involved in marketing opportunities. I wasn’t involved in the process of planning it, what it meant, I didn’t care. It was much more based on productivity and seeing lots of patients. I didn’t have any knowledge at all working in private practice but once I started working here, we’re community-based. We have a high percentage of direct access patients. Instead of marketing to physicians, we spend more time marketing to the community. There’s a large employer in town that probably has about 6,000 to 8,000 employees that has a great insurance policy and they give us a high percentage of their direct access business.

We’re involved a lot with them. We partnered with them to create a work readiness program or injury prevention program for their business which was a huge step in the door for people getting to know us by coming in and being present and giving them that program. We do a number of things in the community. We put on the raises and we host chamber events. A lot of our employees are coaches in the community. There are a lot of things outside of the marketing box that we do that you don’t necessarily think are marketing. It’s not paying for marketing. It’s being present. It’s your time rather than money.

Is there an expectation in your clinic that you do some of those things that you lead out and either generate the race yourself outside of the ownership, taking responsibility for the team members in the community, certain things in the name of the clinic?

It only takes to have one person that's not coming to things or isn't fully engaged to bring down the morale. Click To Tweet

When we hire our people, the expectation is pretty much set in the interview. That is a big part of what we do and what makes our clinic successful and a part of our culture. We have a pretty unique culture. When we hire people, we make sure that they know the community events that we do. It’s not required but it is a volunteer. We look for people who are very highly engaged and high achievers that are looking to also do that type of stuff. We have a great team. There are eight people that work here. Everybody is excited when we do events. It makes it fun. It doesn’t make me worried when I delegate tasks because I know everyone’s going to follow through. I’m not great at delegating. I like to do everything myself. That also helped me learn more about the right way to go about marketing because involving your team, which are your huge stakeholders in this. It’s huge in your success.

It’s part of the interview process. It’s coming from the culture you’ve generated. I would assume if your supervisors or the owner was hiring somebody and they shied away from doing community events and weren’t that excited about it, they’re just not a fit. They’re not going to come in the first place. The fact that you bring it up in the interview process sounds like a huge part of it. You guys know who you are and you’re looking for a certain type of person.

When we hire people, I can’t say that we wouldn’t hire someone based on that solely but it does sway to us pretty heavily in one direction or the other because we have made that mistake in the past. It does end up not working out in the long run. You feel like when you have all the team members on board, everything feels good. Everybody’s enjoying it. Things are going well. It only takes to have one person that’s not coming to things or isn’t fully engaged to bring down the morale.

Those people probably self-select more than anything. They’re very, “I don’t fit in. This isn’t a fit for me.” It seems obvious, maybe like a natural party-wise, but the fact that you guys make it part of the initial process, you’re upfront about it. It sounds like there’s not necessarily an expectation that the team members are going to generate community-based events but the people need to be excited about doing so.

That’s an option, too. We can probably hear passion projects or people work on passion projects. That is what we say to them. “We want you to be involved but you’re never required to plan anything but if you want to, you’re more than welcome to do so.” We welcome all the ideas and creativity. Anyone who brings something to the table, it’s always talked about. You never shut it down because there’s always a way that you can figure out how to make it work.

The fact that you also have a culture that’s open to that because there are many scenarios where it is about productivity. “We’re talking about the members. Let’s move on. How can we improve?” It’s not as much about the culture so much.

We have a staff meeting every week that we hang out at lunch. It’s very informal. We talk about certain stats and stuff but everyone gets a chance to talk about whatever it is that they have to talk about that week. A lot of times, it’ll be about planning our next event. How we should make it better and what we should do or somebody will bring something new to the table that you’re like, “That’s crazy. I never thought of that but it’s fantastic.”

When you go out to these community events, what have you found are some must do? What mindset do you have going into these community events?

PTO 152 | Greater Impact in the Community
Smile & Move (a reminder to happily serve)

I always think about smiling and moving. It’s a book as well. Sam Parker has a book called Smile & Move. I don’t know if you’ve ever read it. It’s fantastic. I stumbled across it. It totally resonated with how I live. I thought, “This is amazing.” When you go to a community event, if you’re smiling, people are going to think that you’re approachable and likable. Moving means to serve people so be engaged. I don’t ever go to an event saying, “I work at Rehab Authority. I’m a physical therapist assistant. Have you ever been to PT?” It’s more like getting to know them then eventually it comes up, “What do you do?” You can talk about, “This is what you do. This is why you’re here. If you ever need us,” it’s more of a casual, “This is where we’re at. We’d love to help you,” but it’s never pushing yourself on.

You talk about this quite a bit in the article is having confidence in what you’re doing can help a lot of that. It makes it easy to smile and move if you have that confidence that lacks in our profession, knowing that we are the musculoskeletal experts. For some reason or other over the years, we’ve shied away from that. Some people might be afraid of saying that but if you go to these events knowing that you’re the musculoskeletal expert in town, your area, your niche, you name it, it makes it a lot easier to stand strongly in your space and be open to helping.

I know when the patient comes in our doors and has set up that visit or that free ten-minute consult. Once we get them in our doors, I know we’re going to help them. We’re going to do the best that we can. I have all the confidence in our staff to do that. It’s getting them there. We sell our culture and the type of people that we are by how we act and that we’re likable, you smile and we have fun. One of our core values is we have fun. That’s one of the top ones. If you get the patients in here, they forget why they’re here and the pain that they’re in. They are having a good time. A lot of times, they don’t even want to leave. It isn’t about selling what you do necessarily. It’s getting them in your doors.

Many people buy on what they feel. Buying is an emotional experience. Physical therapy is not exempt from that. I talked about this in an episode long time ago with Jerry Durham about improving the patient experience. Simply by focusing on them and the experience around physical therapy, not so much about the therapy itself can improve engagement, increase internal referrals, improve culture and an ability to have a greater impact in the community.

Culture is my favorite thing to talk about because I live in a great one. It’s easy in respect but first, you have to surround yourself with great people, which you talked about in hiring. You got to make sure. Just because they’re not the right fit for you doesn’t mean they’re not a good therapist. We all have a place that we are meant to be. Having expectations that we’re a high achieving, high energy makes a relationship. It’s all about building relationships with people then they’re going to keep coming back. They’re going to tell other people to come here. A lot of times, patients will come in because their friend has told them to come here. They’re like, “My friend said I need to come here because you are so much fun.” It’s never initially because, “You’re going to help my pain. You’re going to make me feel better. It’s because you guys are fun,” we love hearing that.

Tell me a little bit about that. It’s not necessarily related to your article but are there certain things that your owner has done to generate that culture? Whether it’s a routine. You talked about the weekly staff meetings and your agenda lens to that. You know your core values. Those are established and you probably talk about that quite a bit. What are some things that have generated this culture you’re talking about?

It first starts with good people. We have great people here. In the environment that we’re in, we have a pretty open clinic. We have two private treatment rooms. We solely use those for evals, anything that requires an enclosed room, exposed skin and then if anyone feels uncomfortable in that area. There’s a very small percentage of those people. We’re set up to have a great environment for not just us to communicate with each other but patients to talk to each other. We yell at everyone when they walk in the door and when they’re leaving. They relate us to Cheers, Everybody Knows Your Name. When they graduate from therapy, we announce it over a megaphone. We have a dance party. We have a graduation gown. We always do the extra. We have Fresh Cookie Fridays every Friday. We have dress-up days a lot where we’re dress ridiculous. They love that.

I bet National Physical Therapy Month is a month of a party for you.

COVID really challenges the marketing calendar because when everything's closed down for a year, you just fall off the wagon. Click To Tweet

We have a chili cook-off and a pumpkin painting contest. It’s pretty intense.

You got the patients involved and all that good stuff.

It’s fun. We do a lot of competitions, too, like sprinting and flippers or something random. These people are crazy weird but they’re fun.

The cool thing about your open gym concept, it’s one thing to have it. The other thing is to get what we called crosstalk. It’s like shouting to the therapist on the other side of the room or having a conversation over there. Inevitably, whoever’s between me and that other person is going to get involved in the conversation, too. We’d even generate that by having a whiteboard that would have the trivia of the day. If you don’t have anything to talk about, there’s something on the whiteboard to talk about.

You can think of so many things to put on a whiteboard. Fun-Fact Friday, where we talk facts about each staff or competitions. It’s great.

Culture is so huge. You talk about culture, thinking that this is what’s going to get the best-aligned employees and retain them. It carries over. The patients feel that as well. It improves the patient experience and the desire to come. They might know that so-and-so down the street provides a certain amount of physical therapy that might be equal to, maybe even better than yours. If they simply like coming to your place more than 2 to 3 times a week, they’ll probably going to come to your place.

That’s the best part. Therapists are competitive. It’s our nature. We want to be the best.

Talk to us a little bit about the marketing approach as you talked about in the article. It sounds like you know who your niche is. Your marketing strategy revolves around where those people are most of the time. In the community or on social media, you’re spending time in those spaces.

PTO 152 | Greater Impact in the Community
Greater Impact in the Community: It's all about building relationships with people. And then they're going to keep coming back and they're going to tell other people to come here.

 

Being so rural, we do see from 0 to 100. We see women’s health, vertigo, all the things. When we get a new therapist in our clinic or interviewing, we ask them that like, “What is it that you’re passionate about? Do you love pelvic health?” You have to cover all the niches per se if you want to maximize your success. When we go out, we have a new therapist who loves athletic rehab or sports injuries. What direction would you go to market that? If you love women’s health, where do you go to market that? How can we make that good? We take a case by case and we market to that population.

I love the wording that you use because as you bring in that person, you talk to them about where their passion is and what they want to focus on maybe but you don’t then stop the conversation. The next question is where are you going to go to find them? Many times, maybe you had this feeling as a new grad but newer grads come out thinking, “I’m going to join this clinic. Some other person’s going to provide me new patients,” and they don’t have to do any work for that.

You have to push especially if it’s a newer grad. You have to encourage them along and keep motivating them to like, “What’s the next step?” We had one here, start women’s health program. That’s an area that doesn’t have a lot of PTs are interested in that area. It’s a huge need and super rewarding. She’s working through that process. I said, “What are you going to do next?” She’s like, “I know I need to do it but I just like,” “Go. Get it done. Take action.”

I love how you set them up for that success, recognizing that they have some responsibility and accountability to develop their niche and that growth in that. This isn’t going to be handed to them. They have an active role in that. It was at the very end and there’s a lot like the last paragraph, you talked about the importance of a marketing calendar. Talk to me about that.

COVID challenges the marketing calendar because when everything’s closed down for a year, you fall off the wagon. We talk about that in our weekly staff meeting. In the year, we know in a timeframe we’re doing these things. Say around Christmas time, we always do this. We always have a Christmas dress-up week. In the summer, we always have friends and family appreciation day. We’re in the big parade in town in July. We have hosted a 5K in August. We were constantly talking about what’s next and what more do we want to do. They’re having a CrossFit challenge in town. How do we get involved in that? There are some kids that want to do a scholarship because of mental health awareness. How do we help them? You hear about something and it doesn’t always work where you can’t necessarily get involved but it’s worth giving it a try.

The cool thing is that you’re talking about on a routine basis as well and you’re looking ahead on the calendar. Say something like Halloween comes up, you start talking about it on October 27 and like, “What are we going to do in four days for Halloween?”

You don’t love it.

It sucks because we’re under the gun and there’s pressure. I’m assuming that these events don’t take you by surprise. You’re able to be fairly well prepared for them and that makes it more fun.

It really isn't about selling what you do necessarily. It's just getting people in your doors. Click To Tweet

It does. When everybody is on board, it’s pretty easy.

It makes it so much easier especially if you’ve done it before. If you have some traditional things that you’re doing, you know what we got to do and what everyone’s strengths and weaknesses are, you play to people’s roles and everyone knows what they need to do. It’s also, at that time, a lot easier to add on and make it an even better 5-star, 6-star, 7-star experience.

That’s a lot of the challenge when somebody is maybe opening their own practice or looking into starting a marketing plan is they want to do so much like, “We got to do this.” You’re better choosing the populations in the areas that you’ll receive the most return from and also knowing your payer mix, where you should focus most of your energy there and then build on it. That’s what got me a little bit more knowledgeable on this subject. When I started working here, it was just one PT and I. He opened it. We quickly needed help in the front office area. It was three of us for a long time. I’m also the clinic administrator so I take some of the buffering between the rehab director and the rest of the staff.

I was doing everything. I’m an achiever and maximizer. I feel good at the end of the day if I get all these things done. If I don’t, I feel lousy about it. I wanted to do everything and be a part of everything. I used to be bad at delegating tasks because I don’t always trust the people who are going to do them as good as I can. I got to the point where I started not enjoying them as much because I was feeling tired and burnt out. I realized that I needed to rely on people and trust that they were going to do as good of a job, if not better. It did turn out that way. I did start encouraging other people to take on more roles with these different events. I have my one area that I love. I love running so I love doing the 5K. Somebody else loves planning Halloween. Delegating those tasks so that you continue to enjoy them rather than feeling like it’s a bunch of work was huge for me.

You sound like a lot of burned out PT owners that I know. It’s the same thing with most owners and maybe your owner feels the same way or he or she doesn’t feel that way because you do all that for him or her but it’s that same thing. “I got many things on my plate. I know I can do them better if I do them myself,” but then you can only do so much. For me, it had to come down to, “Could they do 80%? Would I be happy with 80% of what I could do? If that’s okay then let’s hand it off. Let’s systematize it if possible or find someone who gets excited about that.”

For me, I’m not excited about marketing, like going to the doctor’s office to talk to the doctor who doesn’t want to see me and get past the front desk person whose job is to deflect and redirect me. I don’t want to do any of that. I had a PTA, she was awesome as a PTA but when I talked to her about marketing, she’s like, “I would love to do that.” Inevitably, there are people on your team who have strengths and get energy from things that don’t give you energy and are not your strengths. You have to rely on those people. That’s how you get a diverse marketing strategy in place and expand your presence in the community.

You’re talking about the calendar. That’s where we started with this conversation. It’s revisiting it and staying consistent. You don’t have to have 50 things on the calendar for the year. Pick something once a month, big or small and try and be consistent with that then you can always add to it.

You talked about payer mix in the article in here. We’re in a business. You don’t want to go towards the low payers all the time. If you know where the insurances are that pays better and you can find your niche within those and find out where those patients live, work and breathe then that can make things a lot easier on the business.

We have a couple of businesses in town. The one I talked about who has no medical responsibility. It’s 100% free healthcare and that’s all direct access. That’s huge for us but then you also have another large employer that has a high out-of-pocket responsibility. We market to them. We want to see them but we don’t spend a ton of our energy over there. That’s why we started the program with this business because we wanted to keep them coming through our doors.

PTO 152 | Greater Impact in the Community
Greater Impact in the Community: Get out and put in the extra effort and do more than people expect.

 

That’s smart in that way because every owner has to deal with that if they’re taking some insurance but even if they’re not taking some interest, they want to find their ideal client. That ideal client could be a certain athlete, a geriatric population, a certain patient within an insurance payer but knowing who that is and targeting your message towards them will generate more of those. It also has some carry-over to generate more patients from the other ones that aren’t your niche. We covered a ton of stuff. Is there anything else that you remember or recall from the article or from your personal experience that you think is valuable in reaching out to the communities and establishing good relationships?

You spend at what is it like the 80/20 Rule, 80% of your time preparing for your marketing plan and 20% is doing the work. You need to spend time thinking about these different things. Making sure you got good people and you utilizing your assets, using your people then get out there and find things to do that you enjoy. There’s nothing on our marketing calendar that I don’t look forward to. It doesn’t seem like work. It takes some energy. You usually are exhausted after the event’s over but I would do that 100 times before going and talking to a physician. It’s nothing against doctors but I literally would rather watch paint dry.

It sounds like based on your experience now and to flip that 80/20 Principle, you know what your 20% of work is that gets you 80% of the results. You’ve found a groove there. You have probably been to some community events where you’re like, “I won’t do that again.”

This is one thing I want to leave you with, 2020 has been challenging for everybody. We’re all coming out of it now. We’re feeling good here at our clinic, finally but everyone has gotten a little bit lazy. Getting out and about and putting in the extra effort and doing more than people expect like the whole Zoom meetings, get face-to-face if you can. Go and see people and start doing these things again and don’t just say, “We didn’t do it in 2020. I don’t know if we want to do the race this year.” Do it because you end up doing it. You realize, “This is why we did it in the first place.” It’s so rewarding.

Thanks so much for your time. Thank you for the article. If people want to read it, it’s in the April IMPACT Magazine. There’s a lot of good information in there. If people want to connect with you and maybe talk to you a little bit more about it, Alicia, how would they do that?

I will give you my email. It’s ABacker@RehabAuthority.com.

Thank you so much for your time. I appreciate it.

Thank you, Nathan.

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About Alicia Backer

PTO 152 | Greater Impact in the CommunityAlicia Backer is a Physical Therapist Assistant and Clinic Administrator at Rehab Authority in Thief River Falls, MN. She started her journey in 2010 when she graduated from Northland Community & Technical College in East Grand Forks, MN.

She has experience working in various settings since graduation but has spent the past 7 wonderful years working in the private practice community. Alicia was recognized as Rehab Authority’s Administrator of the Year in 2015 and 2016 as well as being chosen as MN APTA Outstanding PTA in 2020. She has presented at numerous national conferences including PPS and CSM as well as many local venues.

Alicia has been a co-developer of Injury Prevention and Performance Enhancement Programs and has created and implemented work readiness programs. She is an editorial board member for Impact Magazine where she has authored articles on clinic culture and building community alliances and has served on a PTA Advisory Board for Northland Community and Technical College from 2017-2021.

Outside of the physical therapy community Alicia coaches women’s basketball at a local junior college and works with young athletes as a speed and agility coach. Family also keeps her busy as she chases her 2 kids, Camdyn and Josie, to all of their activities while also finding time to run, read, and enjoy friends.

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PTO 151 | Masterminds

 

Enriching the entrepreneurial mindset is a process that involves executing strategies and having the openness for new ideas. A great group of peers that would guide, motivate, and help you develop your skills would be a great way to enhance your skills and learn new things. Stephen Rapposelli, PT has been a long-time listener to the podcast and takes advantage of the opportunity to put Nathan Shields on the hot seat in this episode. They talk about why he likes the podcast, the best books to read, and a few things in-between. They delve into a great mastermind group, how to become a better CEO, the pros and cons of a PT, and a non-PT mastermind group. They also discuss the difference between masterminds and coaching.

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Becoming A Better CEO Via Masterminds, Books, And Expanding Your Vision - Q&A With Stephen Rapposelli, PT

In this episode, I've got a frequent flyer. He's been on a number of times and it's been a little while. I've got Stephen Rapposelli, a physical therapist from the great state of Delaware. Delaware is representing on the show. Stephen, thanks for joining me again.

This is excellent. I want to preface this show by letting your readers know ahead of time, Nathan has no idea what I'm going to do. This is a huge experiment where the host does not know what's going to happen and we're just going to see how it goes.

That is true. Stephen is catching me off guard. He says he's got topics in mind, but he has not shared with me those topics that he would like to discuss. We’re going to go off the cuff.

I'll read them off to you if you're ready.

I'm going to essentially turn over the show to you at this point and let it fly. This is Stephen's show at this point.

This is a mishmash of different topics but they're all timely. This is going to be an interesting conversation. Number one, why I like your show. Number two, mastermind groups. Number three, being a better CEO. Number four, the future of orthopedic outpatient physical therapy. Number five, especially, I had a bonus for your readers, some recent books that they would like to read probably. Readers, Nathan has no idea what I'm about to say. I'm watching your reaction very intently. I like your show and I got no dog in this game. I can assure you, I listened to every one of your episodes because I find them valuable and I'm going to tell you why. First of all, you have no idea where this show is going to go and you're okay with that. How cool is that? You're a guy who's pretty comfortable in being flexible, adaptable and letting your guests go where they want to go if that's where they're going to go.

As long as they're presenting value, let’s go ahead.

A lot of shows don't do that. Number two, you have great guests. I have enjoyed every one of your guests. You curate a wonderful set of people, me being top of the list. In general, your guests are great. It's a good mix of theory as well as tactics. As a CEO, there are times when you want to get down into philosophical ideas and that's wonderful. There's a place for that. There are times where you want some tactics and I've seen a good mix in your show of both. Finally, your show with your guests is in general conversational and that is entertaining because there are a lot of things that are vying for our attention as CEOs. If it doesn't have an element of entertainment, you're going to lose people. Consistently, week after week and it continues to get better, you have good conversations with people. Hats off to you. I hope you feel good. Now, let's see if we can knock you off your perch a little bit.

Let's throw some mud on this.

Masterminds, it seems like everyone is in one. It seems like they're everywhere. Nathan, what is the purpose of the mastermind group? I asked you because you have one.

I've got two now. The purpose of the mastermind is essentially an internal concept. When you look at ancient civilizations or go back to the Knights of the Round Table, it was a mastermind. Go back into the Bible, they had what we call the apostles, a mastermind group, you name it. Masterminds have been around forever. Coining the term mastermind, if I'm not mistaken, was done by Napoleon Hill in Think and Grow Rich. I leaned towards his definition. That it is a gathering of individuals who are together to help each other overcome, learn, explore and become better, where one plus one equals three. The accumulation of minds is gathered to affect and improve a single individual. That's the purpose of the mastermind.

Compare and contrast mastermind with coaching.

You will get more out of it the more you put into it. Click To Tweet

At least in my mastermind, I'm going to be the moderator per se. I'm not necessarily taking a turn in the conversations, but each person gets their time to talk about their issue, their concern, and where they want help. I'm going to moderate and say, “Joe over here might be able to speak to that,” or take your turns and then I can elaborate from a place of experience as well. The mastermind is going to be a lot of different varying inputs into one individual's issue. Whereas the coaching is going to be singular input based on experience with more guidance.

Where you could see a mastermind coming together sometimes as a brainstorm, sometimes as multiple experience shares where coaching is going to be one-on-one, individually, and it's going to come from, “This is where I'm seeing a weakness and this is what I need you to do next.” It’s like what a coach would do. Let’s say on a basketball team or a personal trainer, “You have a weakness here. We need to strengthen that. Go off and do those exercises and when we come back, I'm going to hold you accountable.” If a mastermind’s working well, then they will hold each other accountable but that can be difficult at times.

Is there a place in the CEOs world for both a coach and a mastermind group?

For sure and there has to be. I haven't referred to it much as I'm looking over the past year of show episodes, but my mantra of reach out, step out and network. The formula for a successful owner in PT practices is number one to reach out and get some training. That could be a coach or consultant. Step out means step stepping out of full-time patient care, and three is to network. Networking, if you're going to get a lot out of your network, you need to be communicating with them on a regular basis and we don't naturally do that. The mastermind is another word for networking in my mantra.

You have two mastermind groups. Why do you have two?

Simply, I had a group of five guys and I had another three that wanted to join a mastermind. I thought it might be a good time to split up and have four and four, so now I have two groups. That makes it easier. With that group of four plus me, we'll spend a couple of hours or a month talking about issues.

Is being in more than one okay in your mind?

For sure. I see no harm in that. I'm coming from a place where I've had multiple coaches over the years. I've been a part of multiple masterminds. I'm doing these masterminds through Physical Therapy Owners Club. I'm also part of one of the peer-to-peer masterminds where I'm not a moderator, I'm just a member of the group. I also have a local mastermind here with some friends where we talk more about personal stuff, and not necessarily business-related stuff. I'm personally in four masterminds at the moment.

That last statement is a perfect segue to my next question for you, which is what are the pros and cons of a PT versus a non-PT mastermind group? What is the value of all PTs forming a mastermind versus non-PTs and you, participating in that mastermind group?

The PT mastermind, the conversations we're going to have are specific to the business. We don't delve into personal issues much. Sometimes we can if that's affecting our business. I've been a part of business masterminds that have spoken to both depending on where the owner is. If they're going through a divorce, we're not talking during his or her segment about his business, we're talking about their divorce." My focus with the Physical Therapy Owners Club is the PT-specific business-related issues and anything else that might be affecting the business outside of that. Whereas the non-PT-related one, honestly, there's a little bit less format to it. It's a little bit more free-flowing. We do have one guy who essentially leads, but we come together as far as what we're going to learn together, the books we're going to read and issues that we're dealing with. Sometimes in that situation, one or two people might dominate a little bit more of the conversation than the others. Whereas in the PT format, I try to keep it a little bit more strict.

You might agree with me, Nathan. In general, we PTs are some weird people as business owners. Sometimes we're our own worst enemy. When we talk business with non-PT business owners, you could be shocked. You can be shocked at the response of other non-PT business owners in how we think. You probably have experienced a non-PT business owner saying to you, “Are you out of your mind,” about certain things. You have to come in with a little bit of humility and openness to be able to think differently because we are, whether it's by our genetic blueprint or training that we see the world a certain way that not everybody else does.

PTO 151 | Masterminds
Who Not How: The Formula to Achieve Bigger Goals Through Accelerating Teamwork

Usually, the reaction I received in those situations was, “Why you are guys doing it that way?” We have been brought up in this industry where we accept some things as truth, and when you talk to other owners outside of PT and they say, “Do you have to do it that way?” My only response was, “That's how we've always done it,” and not necessarily that it's right.

That's part of opening your mind up, which is extraordinarily scary, yet important as you continue to grow as a person both personally and professionally.

That's why it's good to be part of networks that are not PT-specific. Find some more generalized small business networking groups. The first networking group that Will and I joined was Entrepreneurs' Organization, which is a national organization of small business owners and that's the group I'm talking about. I have an electrician, a website designer, a graphic designer, and a dentist in my group. We would share these issues and that's where I get the kickback. Sometimes I would get some bright ideas and from their industries that could be applicable to mine. It opens up your perspective and your mind a little bit.

I came back from a peer-to-peer conference in Alexandria, Virginia and I love my peer-to-peer network. These are PT owners who get together, a subset of the private practice section and a more concentrated experience. It's a great mastermind group and I try to think about what made it great. As a group, we meet every week. It's a commitment. I thought I knew these people because we meet every week and I do, but then we went to the conference and we had 2.5, 3 days together in a room. It was an exponential jump in value.

The reason I say that is you need to make the commitment to get to a level of trust that only comes with sharing a portion of yourself. Rudyard Kipling tells us that that is the only true gift, a portion of yourself. We are called to lay ourselves out. There are very few opportunities for a business owner to get the feedback that is necessary to make them better, because nobody in your organization is going to give you that, they're not because the dynamic is different. If you can get a level of trust and allow yourself to have that 360-degree feedback where people really get to know you and understand what makes you tick, that's mastermind group gold right there.

The hardest thing to do in the mastermind and that can be difficult is to be vulnerable, and also to come in with some humility. Maybe it's a gendered thing. When you have a number of male owners, we guard our weaknesses, we cover them or we put forth our best foot in order to hide the weaker foot. I say that simply because I haven't had any females in my mastermind groups up until this point. In order to get the most out of the mastermind, you have to be more vulnerable. You have to ask more questions and that comes from a place of humility and not knowing and understanding that I don't have all the answers. It's the only way you can get a lot out of it.

Diving a little bit deeper at that and I'm going to reference Patrick Lencioni's book, The Five Dysfunctions of a Team is you have to have a level of trust. If there's no trust, you won't feel safe in being vulnerable. Even that word vulnerable can make some of your readers tense up a little bit like, “Here we go,” but that's where the good stuff is. That's where you need to go as a business owner to improve yourself. That's what a mastermind group when done well, does and it only comes from you making that emotional deposit into that group.

From the surface or at the beginning of the mastermind experience, all the attendees come into it thinking, “What can I get out of it?” If you go into it with that mentality, you're not going to get a lot out of it. I like to make it analogous to a potluck dinner. If everyone comes to the dinner thinking what am I going to eat, then there's not going to be anything to eat. Everyone has to bring something to the table in order for all to benefit. You have to flip that mindset from people who are thinking about the mastermind and what they can get out of it. You will get more out of it, the more you put into it. It's a mindset I have to get people to change.

Your nickname is now Alexa to me because I suspect that you've been listening to me as I'm writing stuff down because I literally wrote down your third thing, which is network. Network with a purpose, which means you go into it giving, you don't go into it getting. When you give, that's when the getting comes back to you automatically and in abundance. What can you give? That's key. Let's keep going forward into topic number three, which is how to become a better CEO.

If you and your readers are interested in becoming a better CEO, I have a couple of tips. Number one is you got to eat the frog. That's the concept that comes from Brian Tracy who says, “Do that least palatable thing first thing in the day.” Nobody wants to eat the frog. If you wait until the end of the day to eat that frog, that frog is not going to get eaten. Eat the frog first thing. You and I both know that there are things in our lives where we would prefer not to do. We can come up with all kinds of ways to delay that inevitable. There are things that you don't want to do. Honestly, the thing that you don't want to do is the thing that you must do. As Ryan Holiday would say, “The Obstacle Is The Way,” another great book.

One of my coaches said something similar. I'll never forget it. He said, “If it looks like death, run to it.” I can say from a coaching perspective and from my own lived experience, the one common thing that is the dread of most owners and maybe this isn't just PT-related. It's a small business thing and there's a reason why The E-Myth Revisited was written. It was because owners don't want to write down the policy and procedures and put systems in place. Many times in my coaching scenario, I can get them to the point but at some point, the owner has to sit down and write or according to Michalowicz even videotape it. Something has to be done in order to put systems and policies and procedures in place for everything that's done in the clinic. It takes time, it's laborious, it's no fun, there's no immediate reward, and no one's going to pay you for it, but that's one of those eat the frog things that has to happen.

That's been one of my annual goals for decades. It's the most unsexy thing you're going to do as a CEO, but it's one of the most valuable. You can have a whole episode on that and I think some of your previous guests have had wonderful tips about doing that.

It would be best if you made that commitment to get to a level of trust with your group that only comes with sharing a portion of yourself. Click To Tweet

It's the only way you can replicate yourself. You get to that point in your business growth cycle where you move from a mom-and-pop organization, where you're not only checking people out at the register and stacking inventory and purchasing all the materials for your store to going to an enterprise where other people are doing it for you and there's a level of expectation that needs to be met. In order for that to run well and be successful, they need to follow systems and procedures. It's a tough part.

Here's a controversial statement, and I don't know where you fall on the spectrum, but I've come to the conclusion that I'm either reading too much or I'm reading not enough. It's one of those two. In 2015, I started my personal development journey and I would say, “I'm going to try to read one book a month,” just getting my life in order and my head straight. That year I wound up reading an average of one book a week. I read 54 books that year, a tremendous amount and some of them were great. I kept going for a while. I have a stack of books right next to me. Two of them I’m going to recommend to you, but a lot of us can get caught up in that, “I can't get enough. I have to get that next book that's going to give me that 0.25% edge that I'm looking for,” versus going back to that original 53 books and reread the great ones over again and get that down pat.

For example, every year, I read The 7 Habits of Highly Effective People. You can't read that enough. You really can't. It will take you your lifetime to implement just the concepts in that book. I can give you a dozen other ones, at least, that are just as profound. We need to be careful that the next best thing isn't necessarily around the corner and isn't necessarily in that next book that somebody recommends, although I'm about to recommend two books. We have that schizophrenic thing of, “I'm either reading too much or I'm not reading enough.” Do you ever get that feeling?

Yes. I listened to a podcast about 1 year and 1.5 years maybe. A really smart guy and he said, “I'm not impressed anymore with the number of books that people read. In an ideal world, I would rather recognize someone for the few books that were read and fully implemented.” If I were to turn the tables on you, Stephen, of those 54 books, did you implement at least 54 concepts that year into your business? If someone were to read one that's chockfull of stuff that you could implement, let’s say Traction by Gino Wickman.

I know plenty of people that have read it, but when I go back and say, “Have you considered an organizational chart for your organization? What is the structure of your business?” They're like, “I don't know what you're talking about.” Let's go back to page 96 of Traction, which I know you read and he gives you some examples of organizational charts. A business owner could read Traction and take a full year to implement all that stuff or Clockwork where he talks about making videos. The whole concept behind the book is to get to a four-week vacation where you have no connection to the business. In the end, he gives you guidelines for what you need to do at months 18, 16, 12, 8, as you're getting closer and closer to your vacation. If you took the concepts of that and implemented them, that's the only book you need to read during the year business-wise. You focus on some of those things. Maybe it doesn't take twelve months but if you read less and focus more on implementation, probably it would be better for your business and you as a CEO.

You got to wonder sometimes when you come in with all these fresh new ideas when you come back from reading that course or taking that Tony Robbins thing or whatever, the next thing your know your staff is feeling whipstalled because you're coming in and you're changing everything up. Sometimes, I think you got to stick with your knitting. The next concept, you must do less, in general. As a business owner, you should be doing less. The problem that happens to all of us is because you can do everything, it doesn't mean you should do everything. You remember back in the day, you could do it all. You can document, you can treat, you could clean the bathroom, you could write a policy or you could do that schedule. What happens and what you're doing is you're diluting your focus. The best thing that you can do for everybody is to do less and do those fewer things better. It's a very hard lesson to learn.

What your team members want from you is they want leadership and guidance. They don't want you to come in and clean the bathrooms and treat patients. Even though you might feel like you're not pulling your weight, that's not true at all. What they want is leadership. What does that look like? It means implementing a sound policy, procedure and structure. They might kick back and the people who aren't aligned with your business will kick back against the implementation of structure and procedure. They will self-select and you'll get rid of them and you'll find better people. They want better people around them. They want someone to be the head of culture and generating a culture in their business. They want someone who's looking forward and saying, “We've got vacations coming up in eight weeks. What are we going to do so that's not a hiccup to our business? Let's make this all smooth.”

They want someone who's going to recognize them when they do well, reward them when they do well. They also want someone who's going to hold them accountable when they are falling out of line. Whether they know it or not, they need someone to guide them directly. They want that. If we're doing less, we're doing more of those things that they want. That’s the tough part is as PTs, we've spent how many years through schooling, recognizing that, “I hammer this one nail and I get paid for it. I treat patients and I get paid.”

Even when you start your clinic and you're the alone therapist, “I treat a patient, I get paid.” I'm coming in as a coach and telling you, stop treating patients and you'll get paid more. They're like, “Hold on, I just spent the last twenty-plus years of my schooling and education in my life to learn that I hammer this nail and I get paid. Now, what am I going to do? I'm not a therapist anymore? That's what I've been working the past years trying to do. What am I then? How do I have value and where do I find my worth?” There's a mindset shift that has to change for most owners to get to that point where they recognize that they're more valuable doing what the business needs and not treating patients.

That is excellent and it is a mindset. Sometimes when you feel that you can't pull yourself out of clinical care, there is a mindset there, there's a reason that it happens. Some of it is based on fear, to be honest with you because people are wrapped up in their identity in what they've been doing. They don't realize they have a higher calling and they can help more people if they would train other people to hammer the nail.

The fear is legitimate because part of it is, “What am I going to do with my time now?” Because they don't know what to do. No one's taught them how to be an executive or an administrator, “I'll pay my bills and I'll look at some numbers, but then what?” Once they start recognizing how much the business wants them to work on it, then they start recognizing the plethora of things that they have to work on and then it tips the scales and like, “I've got too much to do. I need to start prioritizing.” There is a fear initial thought like, “If I have all that time, what am I going to do? How am I going to be valuable?”

That goes from a mindset where you exchange your time for money versus when you exchange value for money. If you have a lot of value, the time has nothing to do with the value. The last point about how to be a better CEO is to use the WAIT method, Why Am I Talking? That's what that stands for. As an owner, you walk into that room, you can take a bowl of oxygen into your way or the highway and you can pretty much dictate how things go. Because you like to get things done, GSD, Get Stuff Done, that's at least how I call it, you just go in a bowl in a China shop and you get it done. What happens is you make everybody stop. You keep people from being their personal best and bring a perspective that you need. Start every meeting, write the word WAIT down in front of you on a piece of paper.

PTO 151 | Masterminds
Effortless: Make It Easier to Do What Matters Most

This conversation reminded me of a quote from a guy that does something called Mind Your Business Podcast. The quote he said was, “When you value your time more than money, you'll have more of both.”

That's one to meditate on.

Going back to what you initially said that you need to do less or recognize that when you value your time more than money, you'll have more of both. Because you're going to use your time wisely at that point. The American mentality is to work hard, work long, and it pays off. Whereas that's not the society we live in nowadays. It worked well up until 2000 or so, but now in the information age, your value comes more from what you provide as a leader than it does as a worker.

With that said, let's get into the controversial part of the show, the future of orthopedic outpatient PT. I want to start a ground rule with what my dad told me, which is your most important function as a CEO and as an executive is to think. These statements are designed to make you think. It's a little bit controversial. I may believe this stuff, I may not, but it's designed to make you think. In general, we're steadily losing our edge in the marketplace as PTs. We are putting obstacles in our customer's way to use us by our own mindset and the way it's been done in the past. The marketplace is different now. The reality is we all as customers, as consumers, all want a combination of good, fast and cheap. As PTs, we should offer two of those unapologetically. There should be good and fast, good and cheap, cheap and fast.

If you want next-level business smarts, offer your customers to pick what option they want. If somebody walks into my office and they have an acutely sprained ankle, they want a fast. That's all they want. “I got to get in now.” Somebody calls in and says, “I want to be treated by Nathan and only Nathan." "Nathan's first appointment is two weeks from now." They're choosing good over fast. If someone wants cheap, "I don't want any out-of-pocket expense at all." "Here's the list of exercises. See you later." It's not going to be good and it's not going to be fast, but maybe you need to start thinking like a business owner of can you offer people that choice and you do it in a diplomatic way, you have to send the message correctly. We need to start thinking like that as physical therapists in delivering services because we are losing market share. Not a lot of people say this in public but I will. Why not? We're losing market share to pretty people on YouTube and TikTok who look good in a bathing suit because they're telling a better story than we are. They're telling a story better than we are as physical therapists. We don't even know how to tell our own story the right way. That is, “What's your customer wants? Not being able to tell your story well is how a business dies.

We're starting to see that, I believe, in all of the things that make people outraged when they see, “Did you see that guy on YouTube who was telling me how to fix my back pain fast and he wasn't even a PT. He didn't even have any medical background than I do.” Guess what? He removed all obstacles to his customer and he wins, you lose. We need to start thinking differently as PTs. You need to find out what your customer wants and give it to them. I'll tell you a funny story. Back in the day when I was treating people and it will be at the end of the day and they were coming in for a bad neck or whatever.

She would say to me, “When you put me on that heat, my neck, it feels so good. I would pay you just to put that on.” After about twenty years of hearing that, it finally dawned on me what if you did offer then to somebody? What if you said, “You come in here, I'm going to put you on heat. I'm going to put you on the heat for fifteen minutes and we’ll close the lights off. You're going to lie here in a dark room. Your husband can't call you, your kids can't talk to you. You can basically take a nap if you wanted. We thought that was the funniest, goofiest thing until I put a name on it.

We started a napatorium and people paid for it. You might say, “You're crazy, you're unprofessional, you're cheapening this profession.” You know what? That's $15 or $20 cash that we didn't have before. That's how a business adapts and survives. For people who say, “I'm done with physical therapy. I wouldn't get stretched out. I love it when you stretch me out.” We started a Stretch-N-Go program where we charge cash for people to get stretched out. We've doubled that line of business since January because we put a funny name on it, but we gave people what they wanted and we presented it in a very clear way. If physical therapists don't start thinking like that because people don't search for physical therapy, they search for, “I want my back pain to go away. Who can help me make my back pain go away?”

No one wants to go to physical therapy.

I don't even know how to describe physical therapy and I'm a physical therapist.

They may still mistake us with chiropractors and massage therapists after how many decades. What's interesting to your point that came across my mind this week as I read the Impact Magazine and recalled something that a mentor of ours said 6, 8 years ago. This is a guy who owns large multiple practices. He's a chiropractor that owns large medical practices that include chiro and diagnostics, all the bells and whistles under one roof and has done very well. In fact, he even owns an insurance company. He said, “FYI, do you guys know that physical therapy as you know is not going to exist in another couple of decades?” I'm like, “What?” He said, “It takes too long to take that time out of someone's day and you have to come too often and people want it done quicker, faster and cheaper.” I thought he was silly but I could see what he was saying.

Lo and behold, I read something in June '21 Impact Magazine. Someone referred to Telehealth and referenced, and I'm counting this to be true, but studies are showing that some of the TelePT services are getting similar results to physical therapy services. Why would insurance companies pay for someone to go to a clinic anymore? If they had a slew of physical therapists in a call center during TelePT, why bother sending someone to a brick and mortar?

It’s okay to ask questions because you don’t have all the answers in the world. Click To Tweet

That hurts your feelings, doesn't it, as a physical therapist? Honestly, the marketplace doesn't care.

It's going to go that way. It also had a great article about concierge PT and it provides some concierge services. It blew my mind. I thought, “Why aren't we offering discharge patients a monthly subscription to have access to ask us a question 24/7 to our clinics? Say, pay us $20, $25, $50 $100 a month and you'll get 24/7 physical therapy advice consult. You can call about your sprained ankle and you don't have to come into the clinic, we'll FaceTime. You can call about your exercise equipment or, “This flared up, what exercise should I do?” If it goes beyond that, then you say, “I need you to come into the clinic or let's set up a Telehealth evaluation,” and bill their insurance. Outside of that, just have that accessibility. Those concepts came to my mind as I read the magazine this week, and I thought, “Maybe my mentor did have something there.”

That is mind-blowing. For example, I'm assuming that you go to the dentist for regular checkups twice a year. Why do you do that, Nathan? You don't want your teeth to fall out. Why don't physical therapists give twice-a-year checkups for the musculoskeletal system and charge people $200 to do that? Not everybody cares about that but that's okay. You don't have to have everybody. You just have that segment that values what you're offering. At my age, I will definitely value that. If you can look me over twice a year and tell me the things that I need to work on because my right shoulder and internal rotation are getting tighter. My left gluteus medius is weak and you're going to give me a specific exercise, I'm going to pay you $200 for that. That's something that we should be thinking of.

In addition, cash-based services. There is nothing wrong with that. It was drilled into my head that as a PT, you do not make recommendations on equipment, you do not sell equipment, you do not sell anything for cash, it's all through insurance. Honest to goodness, that is like walking into McDonald's buying a hamburger and then refusing to sell you the French fries. That's like, “I'm going to take a big Mac.” They're going to go, “You can get French fries, but why don't you go down the street to get those, because they're a little bit cheaper.” You’re like, “What?” That's what we do as physical therapists all the time. Shouldn't I know what the best pillow is for your neck? Shouldn't I know what bed is good for your back versus the MyPillow guy? We're going to get out of control if we keep going. Let's finish this with a couple of good books that I think are good. Are you ready?

I want to know.

Who Not How by Dan Sullivan and Benjamin Hardy.

Most influential book I've read in years. There's my impact filter. I've never shared books before. I've shared at least fifteen copies of that book.

That book is super good because it changes your mindset from thinking not how am I going to do it, but who am I going to get to do this. Because you don't do your taxes, do you? You get your accountant to do it because they're better at that than you. You're paying him for a result and that's not going to jail. That's painful. That's the book in a nutshell, but you should read it. Everybody should read it, I think.

I've even thought about doing a whole show about it.

You should. That's excellent. The other one that I like lately is Business Made Simple by Donald Miller. You might say to yourself, “You've been in business for 30 years, what the heck you reading a book called business made simple?” Even after 30 years, you should be open to learning some things. The thing that I love about Business Made Simple is this other book, Building a StoryBrand. It is making your customer the hero of the story, not you. You're the guy. There's a separate show. That book really puts your thinking upside down and you look at all your marketing a different way after you read that and you understand the concept of how customers respond to that message.

I love both of those books. The one I'm excited about right now is called Effortless by Greg McKeown. He had a bestseller called Essentialism a few years ago and then I heard him on Tim Ferriss’ podcasts. It’s a great book, great ideas. He's not going to give you a lot of nuts and bolts like the Who Not How but, I love Effortless and the importance of finding those things that are easier for you and letting go of some of the other things. For example, starting from ground zero and building up instead of saying, “Look at this complex issue, how can we simplify it?” Start with, “What is the minimum viable product we've got to achieve and how do we get from point A to point B with the least amount of steps?” Essentially, that's Effortless in a nutshell.

It's a great non-trivial exercise when you recommend a book to be able to synthesize the major points because it forces you to distill out of that. What was it about that book? That's a great exercise for somebody to do. It’s to say, “Why am I recommending this book Effortless? What's so good about it?” Also, trying to verbalize that.

PTO 151 | Masterminds
Business Made Simple: 60 Days to Master Leadership, Sales, Marketing, Execution, Management, Personal Productivity and More

It solidifies that in your head.

I hope that you weren't uncomfortable in this show. I think you did very well.

I'm not uncomfortable at all. It's always great having you on. You're always going to throw me for a curve somehow.

Seriously, you had no idea what I was going to talk about. That was real, authentic interaction and that's super valuable. As someone who values their time, that's why you tune in to a show like yours because you know it’s going to be authentic and you're going to get genuine value out of it.

The last question I have for you is how do I title this episode? You left me in a lurch. We covered a ton of stuff.

You'll come up with something. Don't miss this episode no matter what. I hope this discussion spurred some thoughts in your readers and they will reach out to you, either on your Facebook page or the email, and start a dialogue. That's what we as PT owners need more of. That is some cutting-edge thought to open up our minds.

I always love it when the audience emails me simple questions, business questions, maybe we'll hop on a call if necessary via email. I love seeing the interactions that people have had on the Facebook group, people coming from different backgrounds, but also with different questions that aren't necessarily for me like, “What do you do about this?” To see other people in the group respond to them gives me some fulfillment.

You're definitely doing what you should be doing. This is your ministry.

Stephen, thanks so much for your time. If people wanted to make you part of their network, how would they do that? Are you willing to share your contact info?

They can search for me on LinkedIn, they can email me directly. I'm one of those crazy Italians, so I have a long last name. It's SRapposelli@PPTAndFitness.com. I'm hoping nobody wrote that down correctly, but if they do, they can reach me that way. I'm always happy to help anybody. I've got nothing to sell, but I'm hoping we can move the profession forward. That's what it's all about.

Thanks for your time. I appreciate you taking the time.

I'm always a better man after I speak to you, Nathan.

Thanks, Stephen.

Peace.

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About Stephen Rapposelli, PT

Stephen opened his private practice in Delaware in 1992, at the tender age of 26, because he was told by his former employer that he couldn’t afford to buy into that existing business. He has since grown to 3 clinics and has been voted best PT business in his state for numerous years.

He also serves as Vice President of the Delaware PT Association, as well as sitting on the IMPACT editorial board. Stephen plans on devoting the rest of his career to promoting independent practices across the country.

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PTO 122 | Sustained Growth And Success

Brandon Buehler, PT is routinely asked, "What is the secret to your success, especially in a difficult PT market like California?” To that question, he responds that he keeps his focus on truly living their practice’s purpose and values, and infuses those into discussions and staff meetings. He joins Nathan Shields to explain how this enabled them to establish a team culture that has grown from within to establish seven clinics in southern California. Brandon admits it takes a lot of hard work, but the added effort to establish solid and living purpose and values is what makes it fun and fulfilling.

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Listen to the podcast here:

The Secret Sauce For Sustained Growth And Success With Brandon Buehler, PT

I've got a guest on that I've wanted to have for a long time. He's part of the network that Will and I were a part of as we grew our clinics over time. He was in a group with other people on my show that I've had before like Vinod and Blaine. I still haven't had the girls on from Magnolia, Amy and Lisa but these were all people that we looked up to. Brandon Buehler, who is the President and Founder of Coury & Buehler Physical Therapy in California. He’s one of those people I'm excited to have on. Finally, after a couple of years of doing the show, I've got him on. Brandon, thanks for joining me. I appreciate it.

It’s my pleasure. Thank you so much for inviting me.

I'm excited to bring you on because you guys have been successful especially in a difficult area of the country in California. I think when we knew you back in the day, you had maybe 2, 3 clinics and now you guys are up to seven. You've been successful in your model and I've always looked up to you guys because you've always been well-founded. That's a lot of what I want to talk about with you because I know that's the basis of your success. Before we get into a lot of that, do you mind sharing with us a little bit about how you guys got to where you are? A little bit of the story of Coury & Buehler Physical Therapy and what's made you guys successful?

I'll show you a little bit about how I got into physical therapy and then how that led into the birth of Coury & Buehler Physical Therapy. My route to becoming a physical therapist was a circuitous one. Initially, I had no idea what I wanted to do. I went to UCI and it was an engineering major. I was good at math and science so I figured engineering sounds right. I started in that and I did well. I enjoyed it but towards the end of my first year in college, I got in a bad car accident and suffered a bad back injury. I had pain for months and when I saw multiple doctors and MRI. I was referred to different specialists and medications thrown at me like crazy.

It wasn't getting better. I'm like, “This is crazy.” A friend of mine said, “Have you tried physical therapy?” I said, “What is physical therapy?” I had no idea what it was. I went to physical therapy and within one week, I was already starting to feel better. Within three weeks, I said, “This is what I want to do with my life. I can be an engineer of the body instead of an engineer for other things.” That's led me down the path. That's one of the reasons that I'm passionate about our profession. We can help people naturally that we don't have to be spun in this web for months or years of pain until they find me getting physical therapy as we hear it all the time.

A patient had five years of headaches within about a month of treatment with us, the headaches gone and tears rolling down her eyes. She asked me a common question we hear from a lot of people, “Why didn't I get it earlier?” That's a good question. It is something that us, as a physical therapy community need to solve. Why few people getting into us? Why are they seeing specialists, MRI, surgery and medication only to often fail that and then come to us?

We fall short in that regard. The marketing efforts of physical therapists over the years have been so focused on, “Talk to the doctor and get that referral from the physician,” that we've failed as a profession to market what we do to the communities at large. Even nowadays, I've been a therapist for many years, the question continues to come up like, “What makes you different than a chiropractor? Are you a massage therapist? What do you guys do?” Many people don't know and that's a failure on our part.

One of the sad aspects of our profession is we all feel like we're competitors. It's a crazy thing. In my world, we see such a small percentage of our community. We're always worried more about our competitor down the street doing the fact that 99% of the people in the community aren't getting into either one of us. We work to band together. We couldn't handle the business we have, instead our patients are going to a chiro or getting MRIs, medication, surgery and seeing specialists. It is something we can work on. What you're doing, Nathan, is you're working on that. You're trying to bring people together and through consulting, networking and these types of podcasts. Other people who've been here like me are sharing some similar ideas.

That's a lot of what the pandemic has led owners to do is to not focus on physicians because that physician pipeline essentially got cut off in a lot of places. How are we marketing now to get those referrals in the door, to get those patients in the door and see them because people are still getting injured, whether we have lockdown or shutdowns? It doesn't matter. They still need physical therapy. A lot of my shows have been about how to use social media, how to do the direct to consumer marketing route and spread our message so that we don't necessarily rely on physicians to also get it out to the people that physical therapy is available to them.

PTO 122 | Sustained Growth And Success
If we combined our efforts and promoted our profession, that alone would have a dramatic influence on all of our business.

Imagine if our profession, all of us, whether they're next door or the next city over, if we combined our efforts and promoted our profession. That alone would have a dramatic influence on all of our business. The concept of rising tide would in full effect on that. That’s my story about becoming a physical therapist in terms of how Coury & Buehler Physical Therapy started. My founding partner Rich Coury, we met as I was doing internships at a place and we became instant friends. He was maybe a couple of years ahead of me. We weren't far apart in age. We clicked and connected as friends. I finished up there and started working somewhere else and he was working somewhere. We would hang out a lot.

We would grab drinks or lunch. He came over and hang out with my wife and me. We were friends, but we also were both passionate about the profession. We would spend many evenings talking and dreaming about, “What if physical therapy could do this? What would it be like if the place we worked at providing this type of care? Is this constant dreaming envisioning of the ultimate physical therapy company? What would the dream vision of a physical therapy company look like?” We talked and talked. I remember one night my wife saying, “Are you guys going to keep talking about this or are going to maybe follow up on these dreams? You seem like you have the passion about it.”

Rich and I met one day and said, “This is the time. We have this vision. The physical therapy model that we think is better and will provide better outcomes and results for patients. Let's do it. What do we have to lose, my house? That's about it. Let's move forward.” It's been a fun ride. Since then we've grown since day one and that was about many years ago. During the first couple of years, we found that to be a challenging time but we grew quickly early on I think just because of our good looks and our charisma with treating.

We hit this wall where we're kept. We felt like we're limited in what we could do. We didn't know what to do and how to get to the next step. That's where we started luckily to meant that we needed help. At that point, we got some consulting. We started networking with incredible physical therapists like yourself, Will, Vinod, Lisa and Beth and all these great therapists. Getting help from different people, talking and reading books, taking on the posture from that day forward of being a learner in terms of not as a physical therapist, but as a business owner and practice owner who wants to improve the profession.

That's something that I've always loved about you is that you've always come from a place of so much wisdom. I've read books that you've recommended to me during the course of conversation. I don't even know if you remember that you've recommended books to me, but you've been someone who's always been looking for more information. You are a learner trying to absorb as much as possible to improve yourself, not just professionally, but also personally. That's kudos to you and it goes to the typical pattern of a successful physical therapy owner that I've seen in 99.5% or 100% of the successful PT owners I interview. They recognize that they need help.

We didn't learn any business things in physical therapy school essentially, so we need to get some business acumen. Networking is huge in that regard and helping you know that, “I'm not in this boat alone. There are other people who have done some successful actions that they're willing to share.” The networking alone can be a huge aspect of it. There are always books that can give you inspiration, insight, and that stuff. I'm reading one called Grit by Angela Duckworth.

It's an awesome book. I haven't read about the topic that we're going to discuss but in the course of our discussions prior to this interview, you told me that other owners and younger owners might come to you and say on occasion, “What do you guys do? What makes you successful?” I thought it was great that you came back to we really live our purpose and our values. That's where I want to take this because we've discussed this on the show before not you and I, but other guests about how to establish a purpose. How to establish values and exercises you can take your teams through and how important it is? I know that you guys live that stuff. You guys reference back to it. You use your purpose and values as a filtration system for the choices and directions that you go to and your physical therapy ownership. Tell me a little bit about that. What was the Genesis of finding your purpose and values? Then we can get into, what are you doing to keep it alive and well?

I appreciate you bringing this up because this is something I'm passionate about. It is funny. We have people come up to us often either calling us in PT network meetings or wherever like, “What is your secret sauce or what tricks you got? What are you doing?” Everyone thinks we have some magic thing that we're hiding behind the scenes for our success. Everyone's looking for that one answer. What's that one book that turned it for us or that one marketing guru we're following? We all want that in life. We want the pill that'll make us lose weight. We want the one exercise that'll give us big biceps.

We all know that it's much more than that. It's more complicated than that, but the reality is my answer to everyone is that it's our commitment to our purpose and values. I know it can sound commonplace for people to say that or to throw that out there. For our company, it's been true. I told you about the story of how Rich and I started the company and his dream, but a lot of our dreaming and visioning is starting to talk about our purpose, vision and values. Back then, we had no business training. We were young therapists. We didn't know what it meant to create a purpose statement and core values, but we were smart enough to know that those things mattered.

In a small business that experiences ups and downs, having a stable and lived purpose and values is like a lighthouse in a storm. Click To Tweet

We started talking a bit about it. We didn't necessarily use the word purpose and values, but we would talk about what we wanted to be about. We talked about how we wanted the company to operate and the type of people we wanted. We started in those early days formulating our purpose and values and the same concepts from day one before we started the company. I was telling people, I started the company about 1.5 years before the company started. It started with Rich and me talking about it and dreaming, visioning and creating these fundamentals. Once the company started after one year or so, we decided to get real fancy and write the things down we talked about. Put it on the wall.

It's a piece of paper. It was a rudimentary version of what we came up with. Those things evolved a bit as we started to find out more. When you're at a company, it's like you go from being a teenager to an adult. Your company evolves and develops. Over time, our values did not change, they matured. What happened maybe about many years ago is our company growing. We also have grown a leadership team, which is phenomenal. We decided to sit down as a leadership team and to relook in a new union of time. We call it our vision statements, purpose, values and BHAG.

We spent a whole day, maybe two days offsite, just looking at that. What we did is we didn't add to it, we simplified it. We looked at every single one and said, “This is too complex. Let's be real with who we are, our purpose and values. Those two are great, but that's not us. Maybe we liked it, we agree with it, but let's focus on what we know we will die for.” We went from maybe 8 or 9 to 6 core values. We refined some of our other statements that we have what we call team creed. We have our BHAG. We have a care statement. We took what we've always had, and we refined it. That's become the foundation. If you want to know what our process for success, it would be those things.

What I want to highlight is you thought it's important that you guys took two full days, one would be enough for me, to focus on this.

Two full days after already having stuff in. We've already met years formulating and refining it. We decided to take two days to refine it on the stage for the next many years to reach our BHAG.

Purpose and values shouldn't necessarily be changed all that much. Maybe they get altered a little bit. As you said, you mature and you change a little bit because life and business environment change over time but you took things and simplified it that sparked a memory in our ownership. We recognize that we spent too many hours in meetings. We simplified and became more efficient in that regard. The same thing, we had these values, but we didn't have any definitions behind them. We took the time to come down to some concise phrases that weren't more than a sentence that describes those values to be more concise and clear about what they meant to the company.

Even though we all had our own individual definitions, we felt it necessary to define what those values meant in our company. What that look like? How does that show up? We also had some other things. We had cultural values as well, that was separate from our core values. The fact that you took much time and were that specific and intentional about it, could you say after doing something like that many years ago, it provided more clarity and maybe even a better foundation, a jumping-off point for continued expansion and growth?

We've always focused on them and made them part of our organization. At that point, it was another turning point in the company where we decided to more fully commit to our purpose and values than ever. At that point, we got more committed to making sure that every part of the organization was ran based on those values or reflect those values. We committed to instilling that more in the company and found other creative ways to make those alive in our organization.

Let's get a little bit deeper into this specific. What are some of the action items you take to have your purpose and value lived through each individual in the clink? How does it get from the owners and distilled down into the everyday actions that even someone at the front desk? If you use technicians to get down to the technician, what are some of those things that keep it alive and don't collect dust on the show?

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: Your company evolves and develops over time. Your values evolve a bit as you start to find out more.

One thing is interesting is you hear a lot of people talk about, “I've done that. I got that.” Most of my friends not in physical therapy, I try to connect with a lot of my friends who have businesses outside of our industry. I love learning from people outside of our industry, but I find the majority of people I know who have done this, it's something they put on the wall. It's like, “We got it in the break room or it's in a policy manual,” which means everyone read at once and then forgot about it. It's a mistake a lot of us make. Purpose, values and vision statements, those only have an effect on the company if they are ingrained in the fabric of the company.

We talk a lot about Pinocchio at some point became human because he got a soul. We talk about our company is not human until it has its purpose and values breathed into it. Another way to say it is that the personality of our company is based on our purpose and value statements. It's the person that's who we are as a company. We have to be lived and breathed. There are multiple ways we do that. Starting with, first of all, recruiting and hiring. The first entry point of the company starts with measuring every single purpose to our purpose and our values. We use some statements that even our recruitment ads about our company because we want to try to track people who are attracted to that. When we do our interviews, the first questions are all against our core values and our core competencies for that position. Right off the bat, we're asking questions based on each of our values because we try not to take generalizations or trying to get specifics on how they maybe align with the value of teamwork.

You can say you do, but tell me how and what that means to you and describe it. Based on the initial screening interview, you can get an idea if someone aligns with their values and if they don't, it doesn't mean they're bad or were bad. This is who we are. We sell maturity and growth to do, but we know who we are. We know the type of people we need to bring on. Our companies not for everybody without a doubt. We know who we're for. We are for a certain type of people who align with us and the people who do aligned with our values or our track, they do well in our company. The first thing we do is we hire based on that.

We did the same thing. We've listed our values. This is our purpose. This is how we do things in our company. It's interesting as you do more interviews, I don't know if you're still doing a lot of the interviews, but as we were doing the interviews, you watch body language. As you're starting to talk about values and the people who are bought in start leaning forward a little bit more and they light up a little bit. The people who aren't bought in, you could tell in their body language. They don't care as much. I agree. It starts there. You start discussing those at the forefront and so that they recognize that these are important to us and you can find those people that work well with you. It's easier to do as you do more and more of those interviews.

What's hard in our clinic or with my coaching clients is we'll talk about purpose and values at the beginning. I think a lot of companies go through this and that the owners get this bright idea that, “We're going to establish purpose and values.” Two to three months down the road, it was like, “Did we talk about that one time? I forgot.” It has some initial momentum and then falls off. I know you guys do more about that and you're going to share a little bit more with us. I just want to interject a little bit, but go ahead.

Once we hire someone based on our purpose and values and someone we think is aligned to that. The first thing they do is go through a training course on that. It takes them several hours. They could read the purpose and values, but we created a several multi-hour course that takes into the reach component and goes in-depth on what that looks like. We even have some fun video examples. We'll read. We're trying to impress that into them. It's one thing to say teamwork, but what does that mean? What does that look like? We try to press that into them and then have them answer questions. Not just like ABC, but some essays. They got to think about it and write it down because we want people to process these things.

That's the next thing. They go through that and during their onboarding, we're making sure that they understand and agree with it. There have been times where maybe we brought someone on and then during the training we realized, “I don't think they're a good fit. We're finding maybe they don't align with these values.” That's the initial thing we do. During their onboarding, the first few months, their managers are continually watching and making sure this person is the best fit. They continue to match this person to who we want to our purpose. This person agrees with our purpose, this person agrees on these values. Can they live at our team creed? If they don't, they're not bad. We're not bad. It's like, “You are probably not a good fit. This is who we know we need and I don't think you align best with this. You'd better in a different setting.”

Those are some of the easiest firings, aren't they? When you do a value-based firing like those actions that you're doing or performing aren't living up to this value. You're not exemplifying teamwork when you act in this manner. If professionalism was one of your values, it's not professional and we can't tolerate people who come in late consistently. That goes against professionalism. We're going to have to let you go. You're not a bad person. We don't tolerate people who don't align with the values.

Most of our hiring are more based on values these days. Those are the big things. Beyond that though, the question is how do you make it a day-to-day part of the organization? It’s because it has to be and if not, it'll become that type of thing where like, “What did we want to talk about? Isn't it on the wall in the break room?” There are multiple ways we do this and different things we experiment, try and have fun with. I'll go through some of the different ideas. One, we have a display. It's displayed everywhere. It's on our website. We don't hide it. It's in every one of our clinics. It’s somewhere were patients could see it. It's in different admin areas or breaks rooms. It's displayed to remind people. During our weekly meetings, we try to focus on a different value each week that we were cycling through them to continue to drill through. Maybe every couple of months, they're getting back through the cycle.

The secret sauce to our success? It's our commitment to our purpose and values. Click To Tweet

You're talking about and maybe, “Have a short couple minute discussion about a particular value.”

A real quick and maybe a minute or two. This is the night of the week. You talked about it. Maybe share a win based on it. Maybe we'll take a couple of minutes and camp on that and have a quick discussion about it or bring up a patient experience on that and things like that. We do a weekly email from one of the founders, Rich or I. Every email we always try to highlight or one of the values of the week and talk a little bit about that or maybe share a story about that trying to interject that into it. Our HR manager sends out a weekly value of the week award winner. Another great way to promote either a purpose, one of the values or one of our vision statements. Somebody who's living out one of those aspects. They're getting recognized and sharing a fun story about them. It's a sneaky way to remind people of that value because we'll get your coworker to live this out. Remember, it's one of our core values and that's part of our purpose.

We did the same thing. We didn't do it anything weekly like that, but at our annual parties, we would have a value award for a particular employee and highlight some of the things they did over the course of that year that exemplified that value. I'm sure your HR person is doing that same thing but on a weekly basis. This person exemplified blank because they did blank, that exemplifies this value. I think that's great. That recognition brings that to people's minds, especially the receiver of the award.

Our leadership team met and we are starting to finalize our awards for our annual Christmas party. One of the big aspects of our awards is our value awards and we give out awards based on each value. I worked on that and coming close. That's another way to do it. Those are some of the main ways we do that. Each manager during reviews or the reviews are off that's part of the route integrated into the review process as well. We're always finding fun ways to interject that in or sometimes we'll send out a random story or video to remind people of something.

We did the same thing with our reviews. It was not only value-based recruiting and hiring and value-based firing and value-based reviews. In our reviews, to get a little bit more specific, we would have the person that we're reviewing fill out essentially the same sheet that the supervisor would fill out. That was here are the values. What did you do in the past year, six months or whatever the timeframe was to exemplify those values and maybe even give yourself a score or maybe on some other things? The person who was being reviewed would say, “These are some of the things that I did.” The supervisor would say, “These are some of the things that I've seen you do and how can you improve on some of those values, live those even better and more fully in the company.” I love that you brought that up. It reminded me that you take values into recruiting, hiring, firing and exemplify on a regular basis, but also bring it into things that might have pertained to a salary increase or a promotion. You want to promote those people and you want to give salary increases to people who live out those values.

One of the best byproducts of this is culture it helps create. We're very protective of our culture. You probably have read Good to Great by Jim Collins. There's one part of his book that stuck out to me. It's one of the most memorable quotes from a business book I've read. He talks about your goal is to have your values infused into your company. He says, “Your culture is so strong. You have a cult-like culture.” Anyone who joins the organization either gets swept up into these values or they stand out like a sore thumb and get injected like a virus.

I'm like, “That's a powerful analogy or description of what it should look like.” You can create such a strong culture in your company based on your values and your purpose where people who joined the team get swept up in it or they stand out. There's no in-between. The people who stand out, it's like that group pressure where you better join and get out. We're not perfect at that, but we see that at times. When we're doing well, you see that and it’s a good place to be. Culture is everything. Your team depends on having been working in a great place, a place they love and believe in. No one wants the drama. No one wants the other stuff.

It takes some years and some intentional effort to get to that point but I know that over time we can develop that culture, such that people have finally gotten to the point where the purpose where they're waking up knowing how they're going to fulfill that purpose that day. Not that they're waking up and going to a job and punching the clock. It elevates things to another level for the people that buy-in once you establish a strong culture like that. These are people that will stay with you through thick and thin, work hard and maybe even for less than where they would get other places because they buy into exactly what you are fulfilling in them and as a company. It creates so much strength.

COVID is a tough time for people. You see everyone handling it differently. Now more than ever, our teams need a North Star, a guiding light. They need to have something to look to. There are a lot of confusion and chaos in our offices. There are frustrations. Everyone's a little bit have difficulties outside of here. There's this challenge and reminding, “I know things are harder. I know we have more in tribulation in our offices, but this is who we are. Focus on this.” We’re headed towards that goal. We just get to look up. I know this stuff stinks, but remember, this is what we're about. We're about changing people's lives. The other stuff settles down a little bit, it’s like, “Compared to that, this stuff's not as important.” People are sick or different things going on because of COVID, but if we can continue to focus on a purpose, it helps people be aligned.

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: Our purpose, values, and vision statements only have an effect on the company if they are ingrained in the fabric of the company.

Has that been a stable thing for you as you've gone through the COVID experience these several months? You have seven clinics and you're a successful guy, but you got bruised, battered and hit like every other PT on are out there. Did you find yourself reflecting back to the purpose and values and may be either shifting them a little bit or relying on them more in order to get through it?

As a company, we decided to close down for three weeks. We decided to mostly because we wanted to regroup. We wanted to decide as a leadership team on how do we run the company? What do we do? We want to provide care but in the safest manner. We took time, but Rich and I were back in day one. We came back to the office and felt like it had to be here. The very first thing we started talking about is, “Let's remember what we're about.” We can sit here, cry, complain and get frustrated. There are all these things we could talk about, but we know what our purpose is. We know what we need to do and let's focus on that.

Sometimes we talk about our purpose being like a lighthouse. You're in a storm and lost at sea, which direction do you go in? You see the lighthouse, you’re like, “I know where to go.” There are many times in our company history for ourselves and our team that that's been the case. It’s like, “We know where the lighthouse is. Let's go in that direction.” We were all bummed out. Seeing our company closed down brought tears to my eyes, but that didn't last very long. Within minutes I'm like, “I'm not going to cry about it. I'm going to focus on what we need to do because I know the purposes. That purpose includes what we need to do for patients and our team.” We started moving forward.

I can imagine that your weekly newsletters over this period of time in 2020 have had to focus more on the bigger picture perspective, why we're doing this? These are the decisions that we're making and this is why and how it relates to where we're going. Did you find that you had to reflect back on that a lot?

Yes.

Especially with the decisions that you were making, were there some things that you changed in your workplace due to the pandemic? Maybe you let some people go or you changed some things around on how you treat but still, you bounce those things and filtered them through the purpose and values.

We did have to make some changes. The biggest change was changing our treatment model to have less people in the office at one time. Administratively spacing people out. We have a lot of moms, we had to support them. Some couldn't come back to work yet. Some needed to work from home. Shifting things around. We're often comparing things and decisions against the purpose, but this is a time where we at it continually do that and remind ourselves of this is what we're about. This is not best for the business, but this is who we are as a company. This is our hardest decision based on revenue, but this is who we are as a company. We need to make this decision.

When you first established your purpose and as you've refined it over time, I wonder how you defined it. As I'm working with my coaching clients and I asked them their purpose which has something to do with, we provide great physical therapy care to the residents of blank. I want to tell them, “That's what you do. That's your job as a person and as a company,” but it's more about the why. I'm wondering if that's how you've thought about your purpose over time and came upon it. It was like, “You do physical therapy, but for what purpose?” It goes back to a higher purpose which I talked about with a 30-minute key and that is helping people live pain-free. If that was your higher purpose or support the surrounding community so they're healthier. How you go about doing it is you provide physical therapy. How do you define purpose and how it helped you clarify what your purpose was?

We're on the same page. We have always seen purposes as the most important question. The purpose for us is the, “Why.” That is the first and foremost, question decision that any business makes to help make all the decisions under that. You see a lot of businesses in our industry and not in our industry, start a business and they haven't made this decision and they're making these decisions. The problem is these decisions can be right or wrong. If they're not, they don't know they don't figure out the why. When we came up with a purpose, that was the thing we were talking about, like, “Why do we exist? Why are we here? Why are we doing what we're doing?”

Those are the overarching type of theme. What we also decided is we felt like our purpose needed to transcend our industry. I feel like your purpose is in your industry. It’s not as bad. Our purpose is to help people out of pain and that’s awesome but we felt like, “Maybe our purpose should be bigger than that,” because it takes us out of the industry and is more important in our industry. Our purpose is to enhance the lives of people in our community. Our focus is helping our patients get out of pain, this includes our team and the people around that you work with even vendors. Vendors come in to enhance our lives. Whoever we're dealing with. The neighbors in our building, let's enhance their lives. It gives us a little bit of a different perspective on what we do overall.

The personality of our company is based on our purpose and value statements. Click To Tweet

As people start defining their purpose, it becomes less about the physical therapy they provide and what they can do for other people's lives and broadens the influence to not just the patients. As business owners, we want our team members to feel a certain way, to have a certain experience and experience a certain culture. We want to be the ones that establish that culture to better their lives as if we were working on a patient one-on-one. We want to enhance their lives and we want to enhance the patient's lives and thus affect the community in multiples. As you establish that purpose, it becomes less about the physical therapy itself and the care that you provide, not less about that, but to also include the workers, the people who are supporting you and the people that you interact with in helping the vendors, the workers at the physician's offices to include everybody that you come in contact with. It expands to more and more people.

Everyone in the team and what our position is can be part of that purpose. It's bigger than just helping patients in pain. Enhancing lives may look different for each person in our company but we can all be a part of that.

Were there some books that were influential to you in regard to purpose? You mentioned Good to Great but were there others that guided you along in that regard?

All of the Jim Collins books touch on that. Simon Sinek’s Start With Why and the Scaling Up book as well. There are others, but those helped formulate some of our thinking.

Is there anything else you want to share in regards to the purpose and how you guys live it and breathe it in Coury & Buehler?

It affects and influences most of our decisions. In terms of how we run the company on a day to day basis. Big decisions we're making in terms of a standard to measure our company with. Rich and I, when we meet, sometimes we check each other on this. We'll be talking about things and be like, “Remember this is our value. Does that align with that? We talked about this, we know what we're about.” We check each other all the time. If we didn't have that, we'd be making dumb decisions.

One of the things I'm most proud of is our company is, it's not Rich and I, we have a team of partners. That came out of Rich and I, when we were going through our purpose and values realizing that there are a couple of values that compelled us to expand the ownership team. We had some incredible physical therapists that we felt like based on what our purpose, our values and some of the things that we want our culture that we needed to provide that opportunity for them. That stemmed out of the purpose and values that we’re going through.

That's the easiest route to expansion is to find those people in your company that you've not only vetted but figured out they align with you. There's a great Jim Collins phrase, “You find those people who are truly aligned with you.” It's to expand when you have those people on your team and open up other clinics, grow or provide them leadership opportunities. It makes growth so much easier and fulfilling.

It's fun to see them grow and reach their dreams.

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: The people who align with your values will do well in your company.

You provide that foundation from which they can build off. It's not there unless you have those purpose and values and have them well-stated because they've been with your company for a period of time. They align with you through all the decisions that you've made with them over time. To help them expand and start up a satellite clinic and get the next clinic going. They're simply living those purposes and values. You don't have to train that up all over again. They continue the cycle all over again. That makes it so much easier.

We've never brought someone from outside for a higher position. Everyone starts in a position. Anyone in management or above has grown up in the company. They are moved up in our system.

Thanks for your time, Brandon. It was great to have you on, you've got a wealth of knowledge and wisdom. I finally got you on the show so you could share that.

Thanks for having me.

Do you have any contact information you can share or a website people can go to check out your clinics?

My email is BBuehler@CBPhysicalTheraphy.com. My cell is (714) 345-0426.

You've grown a ton. It's impressive. You've always been someone that we looked up to. I'm glad that we could tap into some of your wisdom. Good luck with everything. 2020 has been a tough one but I know you guys are in a great position to withstand it and grow going forward.

I appreciate what you're doing for our profession. I love your podcast. I love that you're helping coach and consult for other physical therapists because our profession needs that. Kudos to you for what you're doing for our profession and for all the help you're providing for physical therapy private practices out there.

That's nice of you. I appreciate that. Coming from you, that's a huge compliment. Thanks.

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About Brandon Buehler

PTO 122 | Sustained Growth And SuccessBrandon decided to become a physical therapist after being involved in a car accident and had to go through months of treatment in order to return to playing soccer in college. After experiencing how physical therapy helped him return to his normal activities, Brandon decided that this was the career that he wanted to pursue. He has a passion for helping people return to their sport or daily activity without pain or limitations.
Brandon has extensive training in orthopedics and manual therapy through the Institute of Physical Art. He places high value in continuing education and training at CBPT. Brandon emphasizes the importance of quality and personalized care with one-on-one treatment for every patient.
Brandon is also the co-founder of POISE (Prevention of Injury and Sports Enhancement), Richard Coury, MPT, assisting athletes in preventing injuries, helping them in full recovery to their sport and improving performance on the field or short.
In his spare time Brandon enjoys spending time with his wife and kids, running, working out, hiking kayaking & paddleboarding.

He enjoys spending time with his close friends, especially enjoying a meal from his barbeque.

As a native Philadelphia, Brandon is always on the way to pizza.

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PTO 122 | Sustained Growth And Success

Brandon Buehler, PT is routinely asked, "What is the secret to your success, especially in a difficult PT market like California?” To that question, he responds that he keeps his focus on truly living their practice’s purpose and values, and infuses those into discussions and staff meetings. He joins Nathan Shields to explain how this enabled them to establish a team culture that has grown from within to establish seven clinics in southern California. Brandon admits it takes a lot of hard work, but the added effort to establish solid and living purpose and values is what makes it fun and fulfilling.

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Listen to the podcast here:

The Secret Sauce For Sustained Growth And Success With Brandon Buehler, PT

I've got a guest on that I've wanted to have for a long time. He's part of the network that Will and I were a part of as we grew our clinics over time. He was in a group with other people on my show that I've had before like Vinod and Blaine. I still haven't had the girls on from Magnolia, Amy and Lisa but these were all people that we looked up to. Brandon Buehler, who is the President and Founder of Coury & Buehler Physical Therapy in California. He’s one of those people I'm excited to have on. Finally, after a couple of years of doing the show, I've got him on. Brandon, thanks for joining me. I appreciate it.

It’s my pleasure. Thank you so much for inviting me.

I'm excited to bring you on because you guys have been successful especially in a difficult area of the country in California. I think when we knew you back in the day, you had maybe 2, 3 clinics and now you guys are up to seven. You've been successful in your model and I've always looked up to you guys because you've always been well-founded. That's a lot of what I want to talk about with you because I know that's the basis of your success. Before we get into a lot of that, do you mind sharing with us a little bit about how you guys got to where you are? A little bit of the story of Coury & Buehler Physical Therapy and what's made you guys successful?

I'll show you a little bit about how I got into physical therapy and then how that led into the birth of Coury & Buehler Physical Therapy. My route to becoming a physical therapist was a circuitous one. Initially, I had no idea what I wanted to do. I went to UCI and it was an engineering major. I was good at math and science so I figured engineering sounds right. I started in that and I did well. I enjoyed it but towards the end of my first year in college, I got in a bad car accident and suffered a bad back injury. I had pain for months and when I saw multiple doctors and MRI. I was referred to different specialists and medications thrown at me like crazy.

It wasn't getting better. I'm like, “This is crazy.” A friend of mine said, “Have you tried physical therapy?” I said, “What is physical therapy?” I had no idea what it was. I went to physical therapy and within one week, I was already starting to feel better. Within three weeks, I said, “This is what I want to do with my life. I can be an engineer of the body instead of an engineer for other things.” That's led me down the path. That's one of the reasons that I'm passionate about our profession. We can help people naturally that we don't have to be spun in this web for months or years of pain until they find me getting physical therapy as we hear it all the time.

A patient had five years of headaches within about a month of treatment with us, the headaches gone and tears rolling down her eyes. She asked me a common question we hear from a lot of people, “Why didn't I get it earlier?” That's a good question. It is something that us, as a physical therapy community need to solve. Why few people getting into us? Why are they seeing specialists, MRI, surgery and medication only to often fail that and then come to us?

We fall short in that regard. The marketing efforts of physical therapists over the years have been so focused on, “Talk to the doctor and get that referral from the physician,” that we've failed as a profession to market what we do to the communities at large. Even nowadays, I've been a therapist for many years, the question continues to come up like, “What makes you different than a chiropractor? Are you a massage therapist? What do you guys do?” Many people don't know and that's a failure on our part.

One of the sad aspects of our profession is we all feel like we're competitors. It's a crazy thing. In my world, we see such a small percentage of our community. We're always worried more about our competitor down the street doing the fact that 99% of the people in the community aren't getting into either one of us. We work to band together. We couldn't handle the business we have, instead our patients are going to a chiro or getting MRIs, medication, surgery and seeing specialists. It is something we can work on. What you're doing, Nathan, is you're working on that. You're trying to bring people together and through consulting, networking and these types of podcasts. Other people who've been here like me are sharing some similar ideas.

That's a lot of what the pandemic has led owners to do is to not focus on physicians because that physician pipeline essentially got cut off in a lot of places. How are we marketing now to get those referrals in the door, to get those patients in the door and see them because people are still getting injured, whether we have lockdown or shutdowns? It doesn't matter. They still need physical therapy. A lot of my shows have been about how to use social media, how to do the direct to consumer marketing route and spread our message so that we don't necessarily rely on physicians to also get it out to the people that physical therapy is available to them.

PTO 122 | Sustained Growth And Success
If we combined our efforts and promoted our profession, that alone would have a dramatic influence on all of our business.

Imagine if our profession, all of us, whether they're next door or the next city over, if we combined our efforts and promoted our profession. That alone would have a dramatic influence on all of our business. The concept of rising tide would in full effect on that. That’s my story about becoming a physical therapist in terms of how Coury & Buehler Physical Therapy started. My founding partner Rich Coury, we met as I was doing internships at a place and we became instant friends. He was maybe a couple of years ahead of me. We weren't far apart in age. We clicked and connected as friends. I finished up there and started working somewhere else and he was working somewhere. We would hang out a lot.

We would grab drinks or lunch. He came over and hang out with my wife and me. We were friends, but we also were both passionate about the profession. We would spend many evenings talking and dreaming about, “What if physical therapy could do this? What would it be like if the place we worked at providing this type of care? Is this constant dreaming envisioning of the ultimate physical therapy company? What would the dream vision of a physical therapy company look like?” We talked and talked. I remember one night my wife saying, “Are you guys going to keep talking about this or are going to maybe follow up on these dreams? You seem like you have the passion about it.”

Rich and I met one day and said, “This is the time. We have this vision. The physical therapy model that we think is better and will provide better outcomes and results for patients. Let's do it. What do we have to lose, my house? That's about it. Let's move forward.” It's been a fun ride. Since then we've grown since day one and that was about many years ago. During the first couple of years, we found that to be a challenging time but we grew quickly early on I think just because of our good looks and our charisma with treating.

We hit this wall where we're kept. We felt like we're limited in what we could do. We didn't know what to do and how to get to the next step. That's where we started luckily to meant that we needed help. At that point, we got some consulting. We started networking with incredible physical therapists like yourself, Will, Vinod, Lisa and Beth and all these great therapists. Getting help from different people, talking and reading books, taking on the posture from that day forward of being a learner in terms of not as a physical therapist, but as a business owner and practice owner who wants to improve the profession.

That's something that I've always loved about you is that you've always come from a place of so much wisdom. I've read books that you've recommended to me during the course of conversation. I don't even know if you remember that you've recommended books to me, but you've been someone who's always been looking for more information. You are a learner trying to absorb as much as possible to improve yourself, not just professionally, but also personally. That's kudos to you and it goes to the typical pattern of a successful physical therapy owner that I've seen in 99.5% or 100% of the successful PT owners I interview. They recognize that they need help.

We didn't learn any business things in physical therapy school essentially, so we need to get some business acumen. Networking is huge in that regard and helping you know that, “I'm not in this boat alone. There are other people who have done some successful actions that they're willing to share.” The networking alone can be a huge aspect of it. There are always books that can give you inspiration, insight, and that stuff. I'm reading one called Grit by Angela Duckworth.

It's an awesome book. I haven't read about the topic that we're going to discuss but in the course of our discussions prior to this interview, you told me that other owners and younger owners might come to you and say on occasion, “What do you guys do? What makes you successful?” I thought it was great that you came back to we really live our purpose and our values. That's where I want to take this because we've discussed this on the show before not you and I, but other guests about how to establish a purpose. How to establish values and exercises you can take your teams through and how important it is? I know that you guys live that stuff. You guys reference back to it. You use your purpose and values as a filtration system for the choices and directions that you go to and your physical therapy ownership. Tell me a little bit about that. What was the Genesis of finding your purpose and values? Then we can get into, what are you doing to keep it alive and well?

I appreciate you bringing this up because this is something I'm passionate about. It is funny. We have people come up to us often either calling us in PT network meetings or wherever like, “What is your secret sauce or what tricks you got? What are you doing?” Everyone thinks we have some magic thing that we're hiding behind the scenes for our success. Everyone's looking for that one answer. What's that one book that turned it for us or that one marketing guru we're following? We all want that in life. We want the pill that'll make us lose weight. We want the one exercise that'll give us big biceps.

We all know that it's much more than that. It's more complicated than that, but the reality is my answer to everyone is that it's our commitment to our purpose and values. I know it can sound commonplace for people to say that or to throw that out there. For our company, it's been true. I told you about the story of how Rich and I started the company and his dream, but a lot of our dreaming and visioning is starting to talk about our purpose, vision and values. Back then, we had no business training. We were young therapists. We didn't know what it meant to create a purpose statement and core values, but we were smart enough to know that those things mattered.

In a small business that experiences ups and downs, having a stable and lived purpose and values is like a lighthouse in a storm. Click To Tweet

We started talking a bit about it. We didn't necessarily use the word purpose and values, but we would talk about what we wanted to be about. We talked about how we wanted the company to operate and the type of people we wanted. We started in those early days formulating our purpose and values and the same concepts from day one before we started the company. I was telling people, I started the company about 1.5 years before the company started. It started with Rich and me talking about it and dreaming, visioning and creating these fundamentals. Once the company started after one year or so, we decided to get real fancy and write the things down we talked about. Put it on the wall.

It's a piece of paper. It was a rudimentary version of what we came up with. Those things evolved a bit as we started to find out more. When you're at a company, it's like you go from being a teenager to an adult. Your company evolves and develops. Over time, our values did not change, they matured. What happened maybe about many years ago is our company growing. We also have grown a leadership team, which is phenomenal. We decided to sit down as a leadership team and to relook in a new union of time. We call it our vision statements, purpose, values and BHAG.

We spent a whole day, maybe two days offsite, just looking at that. What we did is we didn't add to it, we simplified it. We looked at every single one and said, “This is too complex. Let's be real with who we are, our purpose and values. Those two are great, but that's not us. Maybe we liked it, we agree with it, but let's focus on what we know we will die for.” We went from maybe 8 or 9 to 6 core values. We refined some of our other statements that we have what we call team creed. We have our BHAG. We have a care statement. We took what we've always had, and we refined it. That's become the foundation. If you want to know what our process for success, it would be those things.

What I want to highlight is you thought it's important that you guys took two full days, one would be enough for me, to focus on this.

Two full days after already having stuff in. We've already met years formulating and refining it. We decided to take two days to refine it on the stage for the next many years to reach our BHAG.

Purpose and values shouldn't necessarily be changed all that much. Maybe they get altered a little bit. As you said, you mature and you change a little bit because life and business environment change over time but you took things and simplified it that sparked a memory in our ownership. We recognize that we spent too many hours in meetings. We simplified and became more efficient in that regard. The same thing, we had these values, but we didn't have any definitions behind them. We took the time to come down to some concise phrases that weren't more than a sentence that describes those values to be more concise and clear about what they meant to the company.

Even though we all had our own individual definitions, we felt it necessary to define what those values meant in our company. What that look like? How does that show up? We also had some other things. We had cultural values as well, that was separate from our core values. The fact that you took much time and were that specific and intentional about it, could you say after doing something like that many years ago, it provided more clarity and maybe even a better foundation, a jumping-off point for continued expansion and growth?

We've always focused on them and made them part of our organization. At that point, it was another turning point in the company where we decided to more fully commit to our purpose and values than ever. At that point, we got more committed to making sure that every part of the organization was ran based on those values or reflect those values. We committed to instilling that more in the company and found other creative ways to make those alive in our organization.

Let's get a little bit deeper into this specific. What are some of the action items you take to have your purpose and value lived through each individual in the clink? How does it get from the owners and distilled down into the everyday actions that even someone at the front desk? If you use technicians to get down to the technician, what are some of those things that keep it alive and don't collect dust on the show?

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: Your company evolves and develops over time. Your values evolve a bit as you start to find out more.

One thing is interesting is you hear a lot of people talk about, “I've done that. I got that.” Most of my friends not in physical therapy, I try to connect with a lot of my friends who have businesses outside of our industry. I love learning from people outside of our industry, but I find the majority of people I know who have done this, it's something they put on the wall. It's like, “We got it in the break room or it's in a policy manual,” which means everyone read at once and then forgot about it. It's a mistake a lot of us make. Purpose, values and vision statements, those only have an effect on the company if they are ingrained in the fabric of the company.

We talk a lot about Pinocchio at some point became human because he got a soul. We talk about our company is not human until it has its purpose and values breathed into it. Another way to say it is that the personality of our company is based on our purpose and value statements. It's the person that's who we are as a company. We have to be lived and breathed. There are multiple ways we do that. Starting with, first of all, recruiting and hiring. The first entry point of the company starts with measuring every single purpose to our purpose and our values. We use some statements that even our recruitment ads about our company because we want to try to track people who are attracted to that. When we do our interviews, the first questions are all against our core values and our core competencies for that position. Right off the bat, we're asking questions based on each of our values because we try not to take generalizations or trying to get specifics on how they maybe align with the value of teamwork.

You can say you do, but tell me how and what that means to you and describe it. Based on the initial screening interview, you can get an idea if someone aligns with their values and if they don't, it doesn't mean they're bad or were bad. This is who we are. We sell maturity and growth to do, but we know who we are. We know the type of people we need to bring on. Our companies not for everybody without a doubt. We know who we're for. We are for a certain type of people who align with us and the people who do aligned with our values or our track, they do well in our company. The first thing we do is we hire based on that.

We did the same thing. We've listed our values. This is our purpose. This is how we do things in our company. It's interesting as you do more interviews, I don't know if you're still doing a lot of the interviews, but as we were doing the interviews, you watch body language. As you're starting to talk about values and the people who are bought in start leaning forward a little bit more and they light up a little bit. The people who aren't bought in, you could tell in their body language. They don't care as much. I agree. It starts there. You start discussing those at the forefront and so that they recognize that these are important to us and you can find those people that work well with you. It's easier to do as you do more and more of those interviews.

What's hard in our clinic or with my coaching clients is we'll talk about purpose and values at the beginning. I think a lot of companies go through this and that the owners get this bright idea that, “We're going to establish purpose and values.” Two to three months down the road, it was like, “Did we talk about that one time? I forgot.” It has some initial momentum and then falls off. I know you guys do more about that and you're going to share a little bit more with us. I just want to interject a little bit, but go ahead.

Once we hire someone based on our purpose and values and someone we think is aligned to that. The first thing they do is go through a training course on that. It takes them several hours. They could read the purpose and values, but we created a several multi-hour course that takes into the reach component and goes in-depth on what that looks like. We even have some fun video examples. We'll read. We're trying to impress that into them. It's one thing to say teamwork, but what does that mean? What does that look like? We try to press that into them and then have them answer questions. Not just like ABC, but some essays. They got to think about it and write it down because we want people to process these things.

That's the next thing. They go through that and during their onboarding, we're making sure that they understand and agree with it. There have been times where maybe we brought someone on and then during the training we realized, “I don't think they're a good fit. We're finding maybe they don't align with these values.” That's the initial thing we do. During their onboarding, the first few months, their managers are continually watching and making sure this person is the best fit. They continue to match this person to who we want to our purpose. This person agrees with our purpose, this person agrees on these values. Can they live at our team creed? If they don't, they're not bad. We're not bad. It's like, “You are probably not a good fit. This is who we know we need and I don't think you align best with this. You'd better in a different setting.”

Those are some of the easiest firings, aren't they? When you do a value-based firing like those actions that you're doing or performing aren't living up to this value. You're not exemplifying teamwork when you act in this manner. If professionalism was one of your values, it's not professional and we can't tolerate people who come in late consistently. That goes against professionalism. We're going to have to let you go. You're not a bad person. We don't tolerate people who don't align with the values.

Most of our hiring are more based on values these days. Those are the big things. Beyond that though, the question is how do you make it a day-to-day part of the organization? It’s because it has to be and if not, it'll become that type of thing where like, “What did we want to talk about? Isn't it on the wall in the break room?” There are multiple ways we do this and different things we experiment, try and have fun with. I'll go through some of the different ideas. One, we have a display. It's displayed everywhere. It's on our website. We don't hide it. It's in every one of our clinics. It’s somewhere were patients could see it. It's in different admin areas or breaks rooms. It's displayed to remind people. During our weekly meetings, we try to focus on a different value each week that we were cycling through them to continue to drill through. Maybe every couple of months, they're getting back through the cycle.

The secret sauce to our success? It's our commitment to our purpose and values. Click To Tweet

You're talking about and maybe, “Have a short couple minute discussion about a particular value.”

A real quick and maybe a minute or two. This is the night of the week. You talked about it. Maybe share a win based on it. Maybe we'll take a couple of minutes and camp on that and have a quick discussion about it or bring up a patient experience on that and things like that. We do a weekly email from one of the founders, Rich or I. Every email we always try to highlight or one of the values of the week and talk a little bit about that or maybe share a story about that trying to interject that into it. Our HR manager sends out a weekly value of the week award winner. Another great way to promote either a purpose, one of the values or one of our vision statements. Somebody who's living out one of those aspects. They're getting recognized and sharing a fun story about them. It's a sneaky way to remind people of that value because we'll get your coworker to live this out. Remember, it's one of our core values and that's part of our purpose.

We did the same thing. We didn't do it anything weekly like that, but at our annual parties, we would have a value award for a particular employee and highlight some of the things they did over the course of that year that exemplified that value. I'm sure your HR person is doing that same thing but on a weekly basis. This person exemplified blank because they did blank, that exemplifies this value. I think that's great. That recognition brings that to people's minds, especially the receiver of the award.

Our leadership team met and we are starting to finalize our awards for our annual Christmas party. One of the big aspects of our awards is our value awards and we give out awards based on each value. I worked on that and coming close. That's another way to do it. Those are some of the main ways we do that. Each manager during reviews or the reviews are off that's part of the route integrated into the review process as well. We're always finding fun ways to interject that in or sometimes we'll send out a random story or video to remind people of something.

We did the same thing with our reviews. It was not only value-based recruiting and hiring and value-based firing and value-based reviews. In our reviews, to get a little bit more specific, we would have the person that we're reviewing fill out essentially the same sheet that the supervisor would fill out. That was here are the values. What did you do in the past year, six months or whatever the timeframe was to exemplify those values and maybe even give yourself a score or maybe on some other things? The person who was being reviewed would say, “These are some of the things that I did.” The supervisor would say, “These are some of the things that I've seen you do and how can you improve on some of those values, live those even better and more fully in the company.” I love that you brought that up. It reminded me that you take values into recruiting, hiring, firing and exemplify on a regular basis, but also bring it into things that might have pertained to a salary increase or a promotion. You want to promote those people and you want to give salary increases to people who live out those values.

One of the best byproducts of this is culture it helps create. We're very protective of our culture. You probably have read Good to Great by Jim Collins. There's one part of his book that stuck out to me. It's one of the most memorable quotes from a business book I've read. He talks about your goal is to have your values infused into your company. He says, “Your culture is so strong. You have a cult-like culture.” Anyone who joins the organization either gets swept up into these values or they stand out like a sore thumb and get injected like a virus.

I'm like, “That's a powerful analogy or description of what it should look like.” You can create such a strong culture in your company based on your values and your purpose where people who joined the team get swept up in it or they stand out. There's no in-between. The people who stand out, it's like that group pressure where you better join and get out. We're not perfect at that, but we see that at times. When we're doing well, you see that and it’s a good place to be. Culture is everything. Your team depends on having been working in a great place, a place they love and believe in. No one wants the drama. No one wants the other stuff.

It takes some years and some intentional effort to get to that point but I know that over time we can develop that culture, such that people have finally gotten to the point where the purpose where they're waking up knowing how they're going to fulfill that purpose that day. Not that they're waking up and going to a job and punching the clock. It elevates things to another level for the people that buy-in once you establish a strong culture like that. These are people that will stay with you through thick and thin, work hard and maybe even for less than where they would get other places because they buy into exactly what you are fulfilling in them and as a company. It creates so much strength.

COVID is a tough time for people. You see everyone handling it differently. Now more than ever, our teams need a North Star, a guiding light. They need to have something to look to. There are a lot of confusion and chaos in our offices. There are frustrations. Everyone's a little bit have difficulties outside of here. There's this challenge and reminding, “I know things are harder. I know we have more in tribulation in our offices, but this is who we are. Focus on this.” We’re headed towards that goal. We just get to look up. I know this stuff stinks, but remember, this is what we're about. We're about changing people's lives. The other stuff settles down a little bit, it’s like, “Compared to that, this stuff's not as important.” People are sick or different things going on because of COVID, but if we can continue to focus on a purpose, it helps people be aligned.

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: Our purpose, values, and vision statements only have an effect on the company if they are ingrained in the fabric of the company.

Has that been a stable thing for you as you've gone through the COVID experience these several months? You have seven clinics and you're a successful guy, but you got bruised, battered and hit like every other PT on are out there. Did you find yourself reflecting back to the purpose and values and may be either shifting them a little bit or relying on them more in order to get through it?

As a company, we decided to close down for three weeks. We decided to mostly because we wanted to regroup. We wanted to decide as a leadership team on how do we run the company? What do we do? We want to provide care but in the safest manner. We took time, but Rich and I were back in day one. We came back to the office and felt like it had to be here. The very first thing we started talking about is, “Let's remember what we're about.” We can sit here, cry, complain and get frustrated. There are all these things we could talk about, but we know what our purpose is. We know what we need to do and let's focus on that.

Sometimes we talk about our purpose being like a lighthouse. You're in a storm and lost at sea, which direction do you go in? You see the lighthouse, you’re like, “I know where to go.” There are many times in our company history for ourselves and our team that that's been the case. It’s like, “We know where the lighthouse is. Let's go in that direction.” We were all bummed out. Seeing our company closed down brought tears to my eyes, but that didn't last very long. Within minutes I'm like, “I'm not going to cry about it. I'm going to focus on what we need to do because I know the purposes. That purpose includes what we need to do for patients and our team.” We started moving forward.

I can imagine that your weekly newsletters over this period of time in 2020 have had to focus more on the bigger picture perspective, why we're doing this? These are the decisions that we're making and this is why and how it relates to where we're going. Did you find that you had to reflect back on that a lot?

Yes.

Especially with the decisions that you were making, were there some things that you changed in your workplace due to the pandemic? Maybe you let some people go or you changed some things around on how you treat but still, you bounce those things and filtered them through the purpose and values.

We did have to make some changes. The biggest change was changing our treatment model to have less people in the office at one time. Administratively spacing people out. We have a lot of moms, we had to support them. Some couldn't come back to work yet. Some needed to work from home. Shifting things around. We're often comparing things and decisions against the purpose, but this is a time where we at it continually do that and remind ourselves of this is what we're about. This is not best for the business, but this is who we are as a company. This is our hardest decision based on revenue, but this is who we are as a company. We need to make this decision.

When you first established your purpose and as you've refined it over time, I wonder how you defined it. As I'm working with my coaching clients and I asked them their purpose which has something to do with, we provide great physical therapy care to the residents of blank. I want to tell them, “That's what you do. That's your job as a person and as a company,” but it's more about the why. I'm wondering if that's how you've thought about your purpose over time and came upon it. It was like, “You do physical therapy, but for what purpose?” It goes back to a higher purpose which I talked about with a 30-minute key and that is helping people live pain-free. If that was your higher purpose or support the surrounding community so they're healthier. How you go about doing it is you provide physical therapy. How do you define purpose and how it helped you clarify what your purpose was?

We're on the same page. We have always seen purposes as the most important question. The purpose for us is the, “Why.” That is the first and foremost, question decision that any business makes to help make all the decisions under that. You see a lot of businesses in our industry and not in our industry, start a business and they haven't made this decision and they're making these decisions. The problem is these decisions can be right or wrong. If they're not, they don't know they don't figure out the why. When we came up with a purpose, that was the thing we were talking about, like, “Why do we exist? Why are we here? Why are we doing what we're doing?”

Those are the overarching type of theme. What we also decided is we felt like our purpose needed to transcend our industry. I feel like your purpose is in your industry. It’s not as bad. Our purpose is to help people out of pain and that’s awesome but we felt like, “Maybe our purpose should be bigger than that,” because it takes us out of the industry and is more important in our industry. Our purpose is to enhance the lives of people in our community. Our focus is helping our patients get out of pain, this includes our team and the people around that you work with even vendors. Vendors come in to enhance our lives. Whoever we're dealing with. The neighbors in our building, let's enhance their lives. It gives us a little bit of a different perspective on what we do overall.

The personality of our company is based on our purpose and value statements. Click To Tweet

As people start defining their purpose, it becomes less about the physical therapy they provide and what they can do for other people's lives and broadens the influence to not just the patients. As business owners, we want our team members to feel a certain way, to have a certain experience and experience a certain culture. We want to be the ones that establish that culture to better their lives as if we were working on a patient one-on-one. We want to enhance their lives and we want to enhance the patient's lives and thus affect the community in multiples. As you establish that purpose, it becomes less about the physical therapy itself and the care that you provide, not less about that, but to also include the workers, the people who are supporting you and the people that you interact with in helping the vendors, the workers at the physician's offices to include everybody that you come in contact with. It expands to more and more people.

Everyone in the team and what our position is can be part of that purpose. It's bigger than just helping patients in pain. Enhancing lives may look different for each person in our company but we can all be a part of that.

Were there some books that were influential to you in regard to purpose? You mentioned Good to Great but were there others that guided you along in that regard?

All of the Jim Collins books touch on that. Simon Sinek’s Start With Why and the Scaling Up book as well. There are others, but those helped formulate some of our thinking.

Is there anything else you want to share in regards to the purpose and how you guys live it and breathe it in Coury & Buehler?

It affects and influences most of our decisions. In terms of how we run the company on a day to day basis. Big decisions we're making in terms of a standard to measure our company with. Rich and I, when we meet, sometimes we check each other on this. We'll be talking about things and be like, “Remember this is our value. Does that align with that? We talked about this, we know what we're about.” We check each other all the time. If we didn't have that, we'd be making dumb decisions.

One of the things I'm most proud of is our company is, it's not Rich and I, we have a team of partners. That came out of Rich and I, when we were going through our purpose and values realizing that there are a couple of values that compelled us to expand the ownership team. We had some incredible physical therapists that we felt like based on what our purpose, our values and some of the things that we want our culture that we needed to provide that opportunity for them. That stemmed out of the purpose and values that we’re going through.

That's the easiest route to expansion is to find those people in your company that you've not only vetted but figured out they align with you. There's a great Jim Collins phrase, “You find those people who are truly aligned with you.” It's to expand when you have those people on your team and open up other clinics, grow or provide them leadership opportunities. It makes growth so much easier and fulfilling.

It's fun to see them grow and reach their dreams.

PTO 122 | Sustained Growth And Success
Sustained Growth And Success: The people who align with your values will do well in your company.

You provide that foundation from which they can build off. It's not there unless you have those purpose and values and have them well-stated because they've been with your company for a period of time. They align with you through all the decisions that you've made with them over time. To help them expand and start up a satellite clinic and get the next clinic going. They're simply living those purposes and values. You don't have to train that up all over again. They continue the cycle all over again. That makes it so much easier.

We've never brought someone from outside for a higher position. Everyone starts in a position. Anyone in management or above has grown up in the company. They are moved up in our system.

Thanks for your time, Brandon. It was great to have you on, you've got a wealth of knowledge and wisdom. I finally got you on the show so you could share that.

Thanks for having me.

Do you have any contact information you can share or a website people can go to check out your clinics?

My email is BBuehler@CBPhysicalTheraphy.com. My cell is (714) 345-0426.

You've grown a ton. It's impressive. You've always been someone that we looked up to. I'm glad that we could tap into some of your wisdom. Good luck with everything. 2020 has been a tough one but I know you guys are in a great position to withstand it and grow going forward.

I appreciate what you're doing for our profession. I love your podcast. I love that you're helping coach and consult for other physical therapists because our profession needs that. Kudos to you for what you're doing for our profession and for all the help you're providing for physical therapy private practices out there.

That's nice of you. I appreciate that. Coming from you, that's a huge compliment. Thanks.

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About Brandon Buehler

PTO 122 | Sustained Growth And SuccessBrandon decided to become a physical therapist after being involved in a car accident and had to go through months of treatment in order to return to playing soccer in college. After experiencing how physical therapy helped him return to his normal activities, Brandon decided that this was the career that he wanted to pursue. He has a passion for helping people return to their sport or daily activity without pain or limitations.
Brandon has extensive training in orthopedics and manual therapy through the Institute of Physical Art. He places high value in continuing education and training at CBPT. Brandon emphasizes the importance of quality and personalized care with one-on-one treatment for every patient.
Brandon is also the co-founder of POISE (Prevention of Injury and Sports Enhancement), Richard Coury, MPT, assisting athletes in preventing injuries, helping them in full recovery to their sport and improving performance on the field or short.
In his spare time Brandon enjoys spending time with his wife and kids, running, working out, hiking kayaking & paddleboarding.

He enjoys spending time with his close friends, especially enjoying a meal from his barbeque.

As a native Philadelphia, Brandon is always on the way to pizza.

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PTO 107 | Improving Patient Compliance

 

As a PT patient, Vikram Sethuraman was surprised to receive his HEP written on a single sheet of paper, handwritten by his PT. He thought to himself, "Wow, is this the best you've got?" and decided he was going to use his entrepreneur course to help the PT industry move into the digital age when it comes to patient engagement. He founded and developed PT Wired as a tool to improve patient compliance and engagement, thus improving patient results and PT owners' bottom lines. Focusing on the patient experience will translate into a cascade of benefits for the patient and the business—that's the focus of PT Wired and the custom-branded mobile clinic apps they create. In this episode, Vikram sits down with host, Nathan Shields, to tell us more about the amazing things he is doing for the PT industry and more.

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Listen to the podcast here:

Focus On Improving Patient Compliance And Engagement With Vikram Sethuraman Of PT Wired

In this episode, I've got Vikram Sethuraman. He is the Founder and CEO of PT Wired. Check out his business at PTWired.com. Vikram is going to go through exactly what his company does and how it improves patient engagement and retention. I want to highlight a couple of things that came up simply because he noted and I'll share it here. If most patients are going to drop out, they're going to drop out within the first three visits. The average PT clinic loses $150,000 per year because patients don't complete plans of care. I would challenge you to do whatever you can to improve patient retention through the full plan of care because the benefits are vast and amazing and will significantly improve your business.

Vikram's app is one way to do that. I want to highlight it in this episode. Whether you use that app or whatever it might be, focus your time and effort on what you can do to improve patient retention. Track the statistic if you can because most EMR programs don't. I would recommend you do that even manually, but whatever you can do to maintain that engagement and maintain that retention is going to benefit you and the patients. They're going to come more often so make sure you do what you can to improve patient engagement. He's got a ton of great info to share here on the show, but they're on PTWired.com. We'll go to the episode now.

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I have the Founder and CEO of PT Wired, Vikram Sethuraman. It’s a new software program in the industry.

Thank you for having me, Nathan.

Thanks for coming. I appreciate you reaching out to me because I'm always open to talking with the founders and owners of those things that can make ownership easier and can improve our capabilities. I've had different owners of different products over the past years. I've always appreciated the insights that you guys provide and the passion that you have to help the industry. Tell us a little bit about you, Vikram. Where did you come from? Where did you get the idea for PT Wired? Share a little bit about how you started your journey into what you've developed.

Unlike a lot of PT software companies and organizations, a lot of these companies have been founded by physical therapists who have insider knowledge on the needs of PT clinic owners. That wasn't the case for me. I'm not a PT nor a PT clinic owner. I got into the physical therapy space through my experience as a patient. When I was in college, I was an athlete and had a hip labral tear. I had hip surgery for repair and then 1.5 years of physical therapy. It was an intense experience for me. I got the real point at which I felt healthy and 100% again that I fully credit with physical therapy. I had the surgery and then had a lot of pain that came back. It wasn't until I found a good physical therapist that worked closely with me that I overcame the injury and got back to full health.

During that experience, one of the first things I remember is going into PT, fresh out of my surgery, and getting a piece of paper with my exercises scribbled down on there. As a younger guy who was always on my phone, I quickly thought, “There could be an app that could be much more valuable if it had videos, notes and if I can message my PT.” My brain went off on a tangent there of all these different ideas. Coincidentally, I was in an entrepreneurship class at the time. Believe it or not, the origins of PT Wired were from a college class on entrepreneurship where my project was this PT Wired app. When I graduated, I had kept working on it. I enjoyed it. I saw some potential for it. I decided to keep working on it. Fast forward, here we are. It's out in the market being used by over a hundred organizations, thousands of PTs and thousands of patients.

Less Dropouts. More Discharges. Click To Tweet

Tell us a little bit about your app. What makes it unique? Is it simply a home exercise program app in and of itself or is there more to it than that?

This ties into me not being a PT. When I first went into this, it was only designed as how could this benefit me as a patient based on my experience. It was framed for the patient, but what I quickly learned is the clinic owner's side of this. Patient satisfaction and patient experience is one part of it, but it has to be in the context of the clinic owner, their needs and values. That's what we learned. That led us down this track of still building a home exercise platform, a powerful tool to engage patients more effectively. What we learned was the need for engagement to reduce patient dropout and an additional platform for marketing. It's a home exercise platform where the product has grown to. It's designed to get your patient to download the app to access their exercises, but then become a marketing platform that you can use to keep them engaged, push promotional content, ask them for reviews for Google and Facebook, ask them for feedback, and all of these other features that we can get into.

That's how we are positioned. The big difference for us is rather than them downloading a PT Wired app or some generic app from the App Store with their exercises, every single clinic gets its own app in the App Store and the Play Store, fully branded to your practice with your logo and name. If your clinic is Active Physical Therapy, it'll have your logo and your name on their phone. The entire idea is to sell to the patient the idea that your clinic, no matter how big or small, built this app from scratch yourself. They don't see our name and that creates an impressive-feeling for your patient, that you're going the extra mile to give them the best quality of care.

What I love about it is that you can create this app specific to each physical therapy clinic. I love the opportunity that you provide within that to have patient engagement. I've shared in the past that studies have shown that 10% to 15% of patients that come into physical therapy complete their full plans of care. That leads to hundreds of thousands of dollars of loss for the average outpatient PT clinic every year. The number comes out to around $150,000 per year on average that every clinic owner loses because patients aren't completing their plans of care. If you can bump that number up another 10%, 15% or 20%, you can save much money without a significant amount of effort.

If you can keep those patients to keep coming in, number one, they're going to get better results. Number two, they're going to complete their plans of care. Number three, if they're getting better results by completing their plan of care, they don't only benefit you as the owner financially, but your reputation is significantly better. They're going to say, “I achieved my goals.” That's going to turn around and go to the doctor and turn to their family and friends and be a good marketing source. It's a great opportunity as long as we can do as much as we can to stay engaged.

You're saying 90% of patients don't finish their full course of care and 30% of patients drop out within the first three visits. It is a massive opportunity for improvement. A lot of people when they're thinking about, “How can I grow my business? How can I get more revenue for my practice?” the first thing everybody thinks about is bringing new patients in the door acquisitions. What we like to focus on is that's important and that's the first step, but that shouldn't always be the main thing you're looking at. If you focus on the patients you already have, it's way easier to retain a current customer than acquire a new one or to sell more to an existing customer than to sell to a new one.

That's the idea. We are trying to do everything that we can to extend the journeys of these patients to get more people to discharge rather than drop out and learning more while all in the process. Another thing to know is if a patient drops out, it's not always a bad thing. It may mean that they reached their functional goals earlier than they were expecting to or maybe the number of visits they had allocated to them. That's important to know. For example, if we can see on our app that this patient who is not coming in anymore had been doing all of their exercises and having great results and progressing well, that's important to know because this is a fan. We can ask them for a Google and Facebook review.

PTO 107 | Improving Patient Compliance
Improving Patient Compliance: 90% of patients don't finish their full course of care. 30% of patients drop out within the first three visits.

 

We can check in through the messaging system on the app to see if they're still doing well and reactivate them if not. There's a lot of insight you can get from that. Whereas on the other end, if you can see clearly this patient hasn't done any exercises and has not progressed, you can detect a bit earlier when they're likely to drop out. You may intervene by sending them a message saying, “I noticed that you haven't been logging your exercises as much. Are there any questions I can answer?” Communicate that you're there and that you're more accessible than only when they're in the practice and the clinic and physically with you.

That's cool and there is that opportunity to communicate in the app itself. To have the back and forth communication from a patient to a provider.

A full HIPAA compliant messaging platform through the app. There's at the provider level and because it's a custom branded app, it opens the door to other marketing efforts. For example, when COVID-19 first hit, imagine if you could instead of sending out an email, putting something on your website or send out a push notification to everybody who has the active PT app downloaded that says, “This is what we're doing. We're sanitizing equipment and everybody's wearing masks. We're closed down for now, but we will reopen.” These are messages that you can get straight to the patients on their devices in a branded way. It creates a more connected experience when they're disengaged in between those visits.

You can send mass messages in that regard. All this is on top of the home exercise program part. You’ve got videos of each exercise and you can form templates and programs within the app itself for particular diagnoses or body parts and individualized for each patient.

We have about 5,000 exercises. We own our own video studio. We have a whole content team. We shoot 50 to 100 every other week. We’re constantly expanding the video library. We take requests free of charge. We also have the ability for users to upload their own videos if they want to. Anything that is uploaded is exclusive to that practice. It's not like you're putting out your content for other people to use. It's protected and that's all included. With regard to the exercise program creation, another important thing we know is building exercise programs quickly. A lot of PTs opts for paper because it's fast. They can write down, hand it, and then you're done. We knew that that was the baseline that people are working with. We have things like exercise, program templates, favorites, smart search system with filters and tags to make sure you can get to exactly what you need as quickly as possible.

You've had 100-plus clinics using this. What are some of the benefits and comments that are coming back to you from the owners and users of the app? What are some of the highlights that they are talking about?

From the standpoint of ease of use, that's been one thing we were proud of, knowing how important it is to be able to build something that seamlessly integrates with the workflow of the PT. We've heard a lot about how quickly it's gotten and we've improved it over the years. I'm not going to say that it was perfect right off of the get-go, but that's one thing of creating exercise programs quickly. In terms of the patients, it's all about creating super fans. Being able to get those patients and experience that gives them the wow factor.

It's way easier to retain a current customer than acquire a new one or to sell more to an existing customer than to sell to a new one. Click To Tweet

They are wowed that a clinic with maybe 1 or 2 locations and 3 or 4 physical therapists has their own custom app. It blows a lot of patients away. They don't see what's going on in the background. They don't know who PT Wired is. Being able to ask patients for feedback through popups on the app saying, “How are we doing from 1 to 10?” and being able to ask them to leave a Google and Facebook review. Those have been the big things that the clinic owners have loved, how impressive it is to their patients that they have their own app that's engaging. It shows that they're going the extra mile to deliver the best expense.

This isn't a home exercise program app to show the patients exactly what exercises you want them to do. It also can track. The patients can click and say, “I did this exercise this day. I did this exercise and these many repetitions.” They can post that and the provider can see what's been done.

On the app, they can mark exercises as complete. All the completion data is accessible to the provider. Another thing we do on the patient side is to give them awards and achievements as they do their exercises. They'll get these medals and trophies as they hit streaks and the number of exercises and routines completed. Going back to the marketing elements, some clinics have incorporated that into marketing efforts where they'll say, “If you get the 25-exercise trophy, show it to our front desk and we'll give you a free Active PT hat or shirt,” or something like that.

They can use it for games and that tracks their progress, especially as it pertains to home exercise programs. We used to do games for coming to all your visits in a certain week or during the month, you come to all your scheduled visits. That puts another spin on it and the opportunity to gamify if you love the experience and say, “If you keep up with your home exercises, we can track you on our app.” That forces them to the app and it rewards them if they do. It not only rewards them if they go to the app, but it also rewards them if they do their home exercises, which ultimately benefits them.

We went through a Behavioral Economics focused accelerator here in Durham, North Carolina run by Duke University. We were working with these people who have PhDs in Behavioral Economics. We're focused on that and working to make these small adjustments and feature changes to the app to maximize the impact on behavior. One of the things we did was the trophy and gamification. We'll have patients email our tech support saying, “I forgot to mark back exercises, but I did them and I'm going to lose my streak. Can you help us out?” Another thing is for the patients. At the beginning is an educational tool. They're looking at the app because they want to see the videos, the instructions, the list, but after they do it a couple of times, they'll learn the exercises.

The trophies and the metals keep them still documenting everything on these. Once they learn it, if they say, “I don't need the app until I get new exercises,” we'll then miss out on that data. If we have them hooked to working towards a medal, a trophy or a t-shirt from the front desk, that keeps them on the app which then allows you to put promotional content saying, “We've got a free back pain workshop. Refer a friend to physical therapy.” All these other things that you could put on the app that they'll still be exposed to because they're continuing to open it to mark their exercises.

What a great opportunity to back up what you're already doing. They're giving out home exercise programs, but you can back that up by having a game or a reward system behind it. It automatically does, but you can tie that back to the clinic by getting something physical. I like what you're saying about rewarding the referral system. Every physical therapy clinic that I know that's super successful has a robust internal referral program, where patients are bringing their family and friends in for physical therapy because the team is asking for those. To be able to do that through the app, it gives you another avenue and reminder. It backs up the program that you're already doing.

Improving Patient Compliance: If a patient drops out, it's not always a bad thing. It may mean that they reached their functional goals earlier than they were expecting.

 

To do it in a way that is more selective and automated, we can see all the patients who are having the best experience based on the data that we're collecting. Being able to identify those patients and then ask them for the referrals and reviews, that's going to be the best impact for your practice.

What makes PT Wired different than other companies that are doing the same thing? There are other companies in your space. What makes you guys more unique?

It’s our branded element. You don't go to a generic app or some different brand. It's all under your own name. That’s the root big differentiator and that makes all the other marketing elements more impactful. For example, we've got a partnership with a company, Practice Promotion. I know you've had Neil on. They do websites, but they also put the blogs on the websites. One of the things we do with them is the blog that you get on your website is accessible on the app. You get a blog button. You can read all the articles. Even though the patient may go on there for their exercise program, then they'll see all this other content.

That's a big idea. You're not going to get a patient to download an app if you say, “You'll see our blog and any updates.” If you say, “You'll have your home exercise program and you'll be able to message me directly,” then they'll download it because it's a lot more valuable to them. Once you have it on their phone, that's when you can do all these other things like asking for reviews, push promotional, content, give updates, these other things because they already have it on their phone as an HCP tool.

Can patients also book appointments or request appointments through the app as well?

They can request an appointment. How that works is they pick a preferred provider and the time and location. That comes through as an email to the front desk. We don't have an integration with a scheduling platform at this time. It's not a seamless book and appointment updated all that stuff though. That's a goal. That's what we want to do in the future that they can request appointments.

You're a small business owner and you've dealt with a ton of other small business owners as far as the physical therapy space and talking to PT owners across the country. What are some things that you're surprised to see that we're not doing in the PT space or things that you utilize that you think PT owners would benefit from using if they were to come into the 21st century? A few of us are a little bit not as tech-savvy. Maybe it would benefit us to do things up to date.

The number one indicator for a patient that is likely to drop out is when they're not doing their exercise programs. Click To Tweet

I think project management tools are helpful for small teams, especially in a situation we're in where you may not be as physically with your team as much. My team uses one called ClickUp. It's a lesser-known project management software, but an up and coming one. It's very customizable. I would highly recommend that. In terms of more general small business marketing, people would be surprised how easy it is to do something like setting up Google Ads for their practice. Something that says dry needling and rally or whatever, get a Google Ad for that. There may be much less competition than you would expect. I think to learn something that would be helpful, but those are two that we use.

Most owners either might not know the space well or not feel comfortable with some of the technology behind it. I had Jamey Schrier on where we talked about his huge recommendation during the slowdown. It is to bring things into the 21st century. He recommended a few project management apps as well to communicate with your team a little bit better. It's not posted some paper and simply email, but tracking projects that you have, whether it's regarded to policy and procedures, compliance, audits, you name it. Use some of these software programs to track your progress. It's not all pen and paper. That's essentially what you did with your home exercise program platform. Anything else you want to share with us, Vikram?

Focusing on dropout is a big thing that will help a lot of people. The number one indicator for a patient that is likely to drop out is when they're not doing their exercise programs. It is low adherence to them. A lot of people have the mindset that they can only do much. They can only give the patient the exercises and then it's out of their hands. I would encourage people to rethink that a little bit. There are a lot of other ways you can still engage patients. We can't do the exercises for them, but there are a lot of small things. On our website, we've got a free e-book on how to optimize your home exercise program experiences. Things you can do for adherence to make patients more adherent and make them less likely to drop out. Small things like wording, cues, engagement, and tracking to create that type of experience. I would highly recommend that people pay attention to those metrics of adherence and dropout. If you work on those a lot, you may never need new patients to focus on that. They’re maybe good to go.

As I'm working with my coaching clients, I purposefully steer away from marketing efforts initially because I look at it like holes in a bucket. If you have these holes in a bucket, as far as retention and maximizing the care that you provide for each patient. If you've got a ton of holes, you could add more patients to the bucket but they're going to fall out through the holes. As you start plugging in some of these holes, then you recognize that, “Maybe I can still improve and grow without much more marketing. When I do marketing, it's going to accelerate even greater because I'm retaining those patients better.”

You’ve got to fill the holes in the bucket using something that you can retain those patients because those are the low-hanging fruit. They're already in your clinic. You don't have to spend a lot more money to retain them. You have to spend a little bit more time and energy on doing. I also like what you said about a lot of times we think that we can only take the patients far and then it's out of our hands. I believe the same thing. That is the case when you're using a pen and paper. All you can do is hand over the piece of paper with their home exercise program, saying “Here, go do these two to three times a day. Keep stretching and let me know how it goes.” I love how the app keeps you engaged with them and gives them something to go to. It's much more than the home exercise program, which is cool. Thanks for your time. I appreciate you coming on, Vikram.

Thank you much for having me, Nathan.

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About Vikram Sethuraman

 Vikram is the founder of PT Wired, the only 100% custom-branded mobile app service for physical therapy practices. Vikram founded PT Wired in 2016 after his experience in physical therapy as a patient. Today, PT Wired powers over 120 physical therapy practices as #1 highest-rated Physical Therapy Software company on Capterra, winning 2020 awards for Best Value and Best Ease of Use.

 

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PTO 98 | Social Media Marketing

 

Social media marketing and advertising may be new for many physical therapists, but amidst the COVID-19 crisis, it is a marketing avenue that physical therapy owners need to consider. Joining Nathan Shields today is Edric Zheng of Medical Patient Referrals. Edric provides some of the basics about the why, how, and what is best to do when it comes to marketing on Facebook. Stick to the end for useful strategies in making irresistible offers, generating good content, broadening your audience, building a database and many more.

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Facebook Marketing For The Physical Therapist With Edric Zheng Of Medical Patient Referrals

My guest is Edric Zheng out of New York. He is with Medical Patient Referrals and he is an expert on social media marketing. I thought it'd be appropriate to bring him on, as owners have the time to consider their digital presence, the marketing that they do digitally, especially as we've been forced in that direction with the Coronavirus pandemic. First of all, Edric, thanks for coming on.

Marketing is only as powerful as your sales process. Click To Tweet

Thank you, Nathan, for having me. I appreciate it.

Tell us a little bit about you, Edric and what you do for physical therapy owners, but also a little bit about your backstory and what got you to the point where you are now.

What I do is I set up a direct access patient generation system using Facebook ads to help them acquire new patients with social media and to take advantage of all this traffic they have available to them. My background is I've spent a few years in digital marketing, learning copywriting, running ads, and creating profitable campaigns. Also, spending a ton of my own money trying to figure things out for my eCommerce products as an affiliate in my previous life for other health companies and nutraceutical products. That's how I got good at Facebook ads. I’m using those skills and taking it to help physical therapy owners with their patient acquisition systems and processes.

You've been spending a lot of time trying this, trying that, and refining content when it comes to Facebook ads. Why specifically do you focus on Facebook ads? Why are Facebook ads beneficial for physical therapists?

The reason why I focus on Facebook ads in the past was there’s so much opportunity there. Almost everyone that I know is on Facebook. Probably the same for yourself as well.

PTO 98 | Social Media Marketing
Social Media Marketing: Facebook has around 2 billion users worldwide, and the biggest growing demographic on the platform are people over the age of 45.

 

It's probably two billion Facebook users or something like that on my side of the country?

People spend 30 minutes to two hours a day every single day on social media and the biggest growing demographics on Facebook are older people, over the age of 45. People are getting on so they could spend more time connecting with their family and look at photos of their children and things like that.

How did you utilize Facebook to drive direct access and patient generation?

What do for a client specifically or for my own company?

We want to be more PT specific. What do you do specifically for physical therapists to help them get direct access and patient generation? To some extent, we already have some direct access capabilities with physical therapy.

It all started with creating an irresistible offer for someone to want to come in and start a conversation with you. For example, it could start with maybe like a free consultation offer if you want to be super basic or free discovery visit, a second type of offer. It could be a workshop if you haven't experienced hosting those types of things. It could be something super unique that you do and that no one else has ever seen before, like a free laser therapy session or something like that. It all started with coming up with an irresistible offer and then putting that on Facebook.

Physical therapy only needs to be specific or at least have a niche in which they can offer or somehow be able to share some of their knowledge base in order to gain that traffic and that interest.

When it comes to paid advertising, all you need is an ad text and an offer and you can start promoting that to almost whoever you want. You can start showing your offers and what you have to offer, the value that you can provide. You can start showing that to thousands of people if you have a couple of bucks to spend on Facebook.

With the number of people on social media, especially Facebook, during the COVID-19 crisis, it's an opportunity to gain a bigger audience. Click To Tweet

When I consider Facebook and talking to some of the marketing specialists, you want to get that patient in front of that patient as much as possible so that they click and buy or sign up for whatever offer you're providing. There's added value in simply gaining an email address and that’s building your list so you can send them future offers.

Getting an email address means that this person is interested in what you have to offer. It means that this person has back pain, knee pain or maybe has been involved in a motor vehicle accident or just has gotten out of surgery. They’re looking for related content. They're looking around and they're trying to find out who they can trust. If they're on your email list, that means you have a line of communication with them where you can continuously provide value, educate them, and build that trust until they're ready to come in and start a conversation with you or get the help that they need.

How does someone go about creating a successful marketing campaign on Facebook? What process do you recommend they go through?

If you wanted to, physical therapy owners can look at the different clinics in their city. Go on their Facebook pages and look at their ads that they're currently running because that's all public information that Facebook has made available to all advertisers to promote transparency. Being able to reverse engineer what's already out there and what's been running for a long time is probably the best way to start to do what's already working.

How long do you recommend someone keep a Facebook ad up before they determine if it's successful or not? Do you give it 2 or 3 days or do you give it 2 or 3 weeks before you look back and assess what the statistics are?

PTO 98 | Social Media Marketing
Social Media Marketing: When it comes to paid advertising, all you really need is an ad, a text and an offer. Then you can start promoting whatever to almost whomever you want.

 

Since we have a lot of data already on Facebook ads, a KPI that physical therapy owners should look out for is the cost per lead metric. If they're seeing their cost per lead go above $20, pause that ad and then to try again. Try a different offer, image, video, and angle. You want to try and get your cost per lead to around $10 because that's where we know that you can have a lot of success if you can get there.

You're saying $20 is the point at which you want to reconsider what you're offering and what that looks like in the design and whatnot. When you say $20 per lead, that's not necessarily a converted lead. That's just simply $20 per lead.

That $20 is just someone who's seen your ad, who's given you their name, email, phone number, and is interested in whatever you have to offer on Facebook, be it a free consultation or a $21 evaluation or something like that.

You want to keep that number then below $10, is what you're saying?

Yes, if you can keep it around $10, that is ideal because you're not going to convert every single lead. That's why you want to have a good amount of leads coming in at a solid price.

What are some of the most successful things someone can do as they're setting up this strategy? What are some of the components of having a successful Facebook strategy?

For us, it always boils down to four things. Number one is your offer. What do you have to offer to get someone to want to come in or give you their information? That's probably the most important thing. Number two is your creativity, which could be your image, a video or a testimonial that you're attaching to that Facebook ad. That's the second thing that people pay attention to. The third thing is your headline. Does it stop people from scrolling on social media? Does it get them to pay attention to what you have to say? The fourth thing is your body text. It’s whatever else you want to put into the Facebook ad and things that you want to say to keep them reading in on your Facebook ad. Whatever you write in your ad, it has to be whatever the conversation that the person is already having in their head. If you can answer that conversation and you can put that in the text format, you're going to have a lot of success.

Do you find more success with video-based advertisements versus those that are simply text?

For sure. Video allows you to build a lot more rapport and a lot more trust that you can't do with photos or with text.

How long should a video like that be? Do you have any recommendations?

If you're going after an audience that doesn't know who you are yet and people around your city, it’s maybe around 3 to 5 minutes providing value and educating people so they know that they can trust you and they can use what you have to say.

It's an obvious answer but I'm sure in the body of the text, you're wanting to refer them over to the landing page and a YouTube channel that you might have generated or other social media as well?

If you take them to a landing page, you can sell them some more, you can provide some more testimonials, and you can tell them more about your product, whatever you have to offer. It gives you another chance to sell them again and to qualify someone before they come into your funnel.

Effective advertising starts with an irresistible offer for someone to want to come in and start a conversation with you. Click To Tweet

For me, creating content is my biggest fear. I can do it and I'd do it, but for someone who isn't into developing that content, how would you guide them to make an irresistible offer that gets that client or that potential lead to reach out?

You have to put yourself in the perspective of your end client or your end customer and think about what is it that they want and what they find valuable. Put yourself in their shoes and think about whatever it is they would find useful. I would test that as an offer or a content to give away.

One of the books that I refer to is called Building a StoryBrand by Donald Miller. Interestingly, he recommends the same thing. When you're advertising to somebody, you don't want to come across as the hero in their story. If you're advertising to somebody, they want to be the hero of their own story and you want to be essentially the guide like the Obi-Wan Kenobi that takes this person who doesn't know their strengths and what they're capable of and develops them. That way, they can become the true hero. That's good advice. What you're saying is that you want to talk to them as if you are the guide, but not the hero to their story. We have to remember as physical therapists that we can't use our jargon, our vocabulary, especially the specifics. You want to get down to their level and talk about, “Do you have back pain that's keeping you up at night?” Without getting into the technicalities of it, per se. “We have the four things that you need to do to sleep better.” Something like that. By saying that, do you find that content that has a list of the 4 or 5 things or how to blank that kind of thing? Is that helpful?

Yes. Those types of content always do well. A good way to know if your video content is doing well is there's a metric you can look at on Facebook ads. It's called Cost per ThruPlay, and that's how much it cost you to get a fifteen-second video view of your ad. If that's under $0.06, that piece of content is good because that's another good metric to look at in your Facebook ad.

These are all metrics that you manage via Medical Patient Referrals but it's something that people can also look at themselves if they are admins on their page?

Exactly. These are numbers that we've found over time to establish a good baseline for success.

When someone's considering Facebook ads, buying ads and putting them out there, should they have more than one going at a time or just stick with one and see how it goes? What kind of mindset should they have as they're considering purchasing Facebook ads?

PTO 98 | Social Media Marketing
Social Media Marketing: Video advertisements allow you to build a lot more rapport and a lot more trust.

 

They should definitely have more than one ad running at a time because this way, you can see what ad is performing better and why it's performing better. Let's say you run two ads at the same time. With one ad, you're using a picture of a knee and the second ad is you're talking about the back. Maybe the cost per lead with the back is half the price of the knee. You're getting more bang for your buck, then you’re going to focus more on the back end and do as much as you can with that.

Do you find that some of your clients are having more success with Facebook ads during the slowdown, COVID-19 because people are more engaged in social media and Facebook itself?

The cost of advertising is definitely cheaper because a lot of people have quit and dropped out of the race. That leaves room for people who are still willing to try, adapt, and do new things. It gives them more breathing space since everything is cheaper. We're still generating increases in new leads. We just have to change up the angle a little bit. Instead of advertising in-person consultation, what we're doing is we're advertising a free discovery call or a free phone conversation, which leads to a virtual evaluation, which leads to a virtual rehabilitation program.

What would be your tip or advice for people to get those leads to convert? Is there some secret or magic that you like to consider when it comes to converting those people?

Number one is the quality of your campaign. Having yourself on video, getting the patient testimonials on video and putting that into the ad. Also, calling out who it is you're looking for. The pain that they're having, putting down into the text, and stepping into their head and into the conversation that they're having will not get you that qualified increase. Number two is when you do generate that inquiry, you can't wait three days later to call them. You have to try and get to that inquiry right away. Setting up notifications when you generate that lead and having someone in charge of that process and calling them right away when they're still hot, still super interested in what you have to offer, and that conversation is still going on in their head.

The cool thing about you is we talked a lot about getting patient referrals and leads. Sometimes, those leads take multiple touchpoints. It's not common that you're successful with just one touchpoint and the patient converts. That's why it's cool that you recommend more than one going out at a time. You can get your Facebook ads down to a certain locale, community, and demographic. Once you develop that community, then you can hone in on the issues that are arising in that community. Your content and your output can be specific. That's when it seems like it's more powerful in the capabilities of converting the increase, would you say?

If you’re advertising to somebody, they want to be the hero of their own story and you want to be the guide. Click To Tweet

Definitely.

Have you also used any of this for recruiting purposes? Because I see the capability of physical therapy owners using Facebook ads to recruit for other physical therapists, especially when a lot of physical therapists are out of work to recruit physical therapists via Facebook ads. Have you done that in the past or do you see the possibility there?

I've done a little bit in the past as a small test but that didn't work out too well because we're just targeting like a small population. The cool thing with Facebook is you can target by what they put in their Facebook profile. If they put physical therapist, you can target specifically only physical therapists that live in this specific city within 30 to 40 years old, if that's the age range you're looking for.

Can you also advertise to a certain locale or can you advertise the multiple states in your region?

Yes, you can choose exactly where you want the ads to show and who you want to see the ads.

I bring that up because I see that as a potentiality, even though you haven't done a lot of it yourself. It's an easy crossover to say, “I can use this to not only get patients, at least leads and subsequent conversions, but I also could use Facebook ads for recruiting purposes and that would be cool to try out.”

You have to keep in mind that the person that does have that job title, physical therapist, is probably already with another company. You have to create an angle and an offer that would attract someone who's already working for someone else, and go from there.

You've shared with us a ton of stuff about Facebook ads specifically. Is there anything you want to add or anything that we didn't cover that you would recommend people consider when they're putting out Facebook ads?

Something that people can consider is number one, for $1,000 in marketing budget, they can generate about 100 phone numbers of people within five miles from their clinic who have things like back pain, neck pain or any or any type of chronic pain. They can get them interested in a consultation with one of the doctors at the clinic. The next time maybe someone thinks about buying coffee or buying a sandwich at a store, that $5 to $10 could be spent or invested into Facebook ads and could generate you a patient that's worth $1,500 or $2,000 and get you 2 or 3 more referrals. Keep that in the back of your mind. That's the power and the potential of what a Facebook ads has to offer for clinic owners.

PTO 98 | Social Media Marketing
Social Media Marketing: To create great content, put yourself in the shoes of your end clients to know what it is that they really want.

 

In Medical Patient Referrals, you don't just focus on Facebook ads, but you also have some back-end stuff, whether that's an email marketing campaign for every lead that comes through and also text messaging campaigns to past patients as well.

Marketing is only as powerful as your sales process. If your sales are weak and you're generating all these leads, but you have no idea what time these leads are coming in, not recording any of the calls, not getting back to them quick enough, and not following up, it's so much potential being wasted. What we've done is we've built out a solution where as soon as the lead is generated, it gets populated in your dashboard and your whole team gets notified. They get added into this email and text sequence where for the next 2 or 3 weeks, they're getting testimonials, content, and value sent out automatically.

If someone does schedule someone from Facebook for that evaluation in the office, then my system will know and then it'll send them reminders leading up to that evaluation. It helps with the no shows as well. After someone comes out of that evaluation, the system is going to know and it's going to send them follow up emails, asking them about their experience, how their visit went, and when they want to come back for a second visit. If they already got treatment, want to leave feedback, and leave a review. It's all automated. It makes things so much easier for the clinic.

It's great that you have that because you don't want to get their information and just leave them hanging, especially for three days at a time before you respond back to them. If you can push them into an email marketing funnel and have automatically generated emails that send out testimonials and whatnot, that's when the power comes through. It reminds them that they had some interest, to begin with, and hit those multiple touchpoints that are needed to eventually get them to convert. That's great that you guys automatically provide that. If people wanted to reach out to you and find out a little bit more about you and what you're able to provide, how are they able to do that?

As physical therapists, we can’t use our jargon in advertising. Click To Tweet

They can go to my website, MedicalPatientReferrals.com. Hit the live chat button and start a conversation with me. Get on a call. I can see what’s going on with their clinic and then I can show them the stuff that we have built out. Our campaigns, ads, and the success our clients have seen. If that's something they're interested in, we can work together.

I appreciate your time. Thanks so much for coming on, Edric.

Thank you so much, Nathan, for having me. I appreciate it.

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About Edric Zheng

PTO 98 | Social Media MarketingDropped out of school to start pursuing online marketing. Went from 0-15k a month in my first 3 months of online business, which was publishing books on amazon. Transitioned into affiliate marketing and selling pharmaceutical products (Skin creams, diet pills, muscle pills). Where I learned how to create profitable AD campaigns on Facebook & Google and spend over 2 million dollars in advertising profitably. Which later morphed into taking my ad buying skills and starting a marketing agency in the medical industry helping private practice owners create a profitable patient generation system on Facebook.

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PTO 97 | Marketing For Physical Therapy

 

The way physical therapists market has been affected and will be changed forever because of the COVID-19 pandemic; it's forced to go digital in the way we treat and connect. In today's episode of the Physical Therapy Owners Club, Nathan Shields talks to Tracy Repchuk, a multi-awarded pioneer in digital marketing who has worked with social media, branding, and websites for over 25 years. They discuss the ways physical therapists can market for the better and learn from this slowdown. It's time to turn our attention to digital.

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Listen to the podcast here:

Marketing For Physical Therapy During The COVID-19 Crisis And Beyond With Tracy Repchuk

I'm excited to bring on Tracy Repchuk. She is a marketing expert and I've met her a couple of times and I've seen the work that she's done, especially at this time during the Coronavirus crisis. It's important to recognize the importance of the marketing that we're doing to sustain our clientele and stay in communication with them. I thought it'd be important to bring her on. Tracy, thanks for coming on. I appreciate it.  

Thank you, Nathan, for having me. I'm excited to be sharing what's happening out there.

If you could let us know a little bit about you, what you've been doing here and also what you're doing nowadays to help private practice owners with their marketing efforts?  

I started a software company at the age of nineteen in 1985. I've been in technology and in marketing my entire life. In 1994 before it was even the internet, that's when I was doing development for banks, JC Penney, Walmart, the Lottery Corporation and large corporations because they didn't know what this was. I knew when I saw it that it was a future, that everything was becoming this. I was an extremely early adopter. In 2006, I went all-in on internet marketing and exploded. I moved from Toronto, Canada to California because I knew this is where the market was at that time. It had not been accepted yet in Canada. It's interesting though because this is an example, what we're going through, in a way was going to happen. The virus accelerated it, is what ended up happening. We were all going to be online in some bigger way. It rushed it by 5 or 10 years. It's turned into a disrupter. Uber and Lyft was a disrupter for taxis, Redbox and Netflix blew away Blockbuster. By the time 2000 came around, those that did not adapt to the new technologies, clung to the Yellow Pages, they perished. They're gone.

Normally, this type of thing has been localized or niche-specific. In this quite case, it's global. It's a planetary reboot. The world will be new. You're going to need to adapt rapidly. That's my excitement quite frankly because everything I've been trained for is happening and what I can do for companies, restaurants, retail, physical therapists, chiropractors, yoga, Pilates. Anyone with a physical location, it's time to take a look at where to go. I've been talking about what you do and where you go for years now. We're right and ready to move into this new era.

It's interesting because this shouldn't necessarily be a pause for a lot of the business owners out there, but rather a reset and consider what you've done and what you need to do differently in the future. If your business is the same coming out of this as it was going into it, then you've not taken advantage of the opportunity. I don't know how well you'll survive going forward. It's a great message to share like you're talking about for physical therapy owners to consider how they can take advantage of telehealth services. How can they sell their services on digital platforms and social media platforms? There's a lot of effort that should be looked into putting our businesses more digital and not rely on the brick and mortar. That's hard because as physical therapists, we want to be manually engaged. We have to recognize that there is a market out there for the other things and we can take advantage of it, frankly.  

PTO 97 | Marketing For Physical Therapy
Marketing For Physical Therapy: We can add all of the technologies that exist for us to leverage and build a more systematized and streamlined infrastructure online.

 

What's interesting is one of my specialties is to systemize, streamline and scale. When you only have a brick and mortar environment, scaling often involves high costs and expense as well and you're carrying huge debt loads. The beautiful part I'll say about what is occurring is we can add all of the technologies that exist for us to leverage. We can build a more systemized and streamlined infrastructure online. That's going to help you scale and make more money without necessarily adding buildings or offices unless you want to. It's great when that is a choice and not the only route so that you can figure out what you want to do. How do you want to make money going forward and how do you expand?

To me, I know it's an extremely exciting time because it's making companies think out of the box. What I love about physical therapists is you are built for health. You want to help people. You want to make sure that they understand how they can repair an injury or how they can get more mobility, especially without drugs. It's the savior of the planet from what's happening now. Two things the online environment can give us, and one is exposure. Instead of us having that localized message office by office, when the entire PT industry or people start to shout it from the rooftops what you do. It's an ambiguous think quite frankly, and people think it's specialized that it's not for them.

I came into the physical therapy world when my mom had a huge incident that resulted in her entire back crumbling. She had the entire thing repaired with pins and rods and through numerous surgeries and then ended up in the hospital for seven months doing physical therapy, during which time I stayed and assisted her. Hence, the beautiful part that I had an online business and could do that has that gift of time. The other part was what respect I built for what you did. That's where my passion became, I need to get out the message about what you do. That's where I entered into the physical therapy arena and started to help physical therapists to move online. This is what we'd be doing, but now it's game over. Get on now.

I like the points that you brought up and that is number one that spreading your message or at least relying on the office space to grow your business can be much more expensive and time-consuming and energy-consuming. Whereas, if you expand more digitally, it doesn't cost as much to expand and grow. Number two, we can market directly to the consumer if we take advantage of it the right way and not rely so much on physician referrals but rather go directly to the consumer because all 50 states have direct access in some form or another at this time. We can bypass the physician referrals and go directly to the consumer and say, "If you have an acute injury to your back, because you're a weekend warrior, come and see us.” For some reason, chiropractors are able to get that message out, but physical therapy hasn't been able to do that. If we work together as a group during and after this crisis, we can get that message out via social media, through digital marketing, what you have it, and help people understand that you don't have to go to see a doctor to see us. You don't have to have gone through surgery to see us. We can see you right now. That's a message that you can get out even for those people who aren't affected by the virus and then sustained as we ramp back up.  

We were all going to be online in some bigger way. The virus just accelerated the process. Click To Tweet

To me, this is part and parcel of a combination of how do you get people no longer addicted to opioids by spreading the message that there is an alternative. You can get natural-based therapies that most people are not aware of. This is the reason that prescription drug abuse, in particular, happens because people don't know. "If I get adjustments or if I do this or get a correction on an injury, I don't need to be in that pain." The biggest problem is when they choose that the alternative route is they don't want to end up out of pain. All they end up is masking it and it never gets repaired. It's important. Honestly, this is the greatest catalyst you’ve got for the PT industry and my other passion is nutrition response testing. Anything that deals with making the world a better place and helping a person to get healthier without any introduction of alternative elements other than your own body telling you how to heal.

I like how you brought that up because it made me think of two things. I thought this is going to be good for our profession in that it's going to force our hand into telehealth services. Our profession is going to be changed forever because of that. We've been forced into some telehealth services to a greater extent than we were before. Number two, this is going to force us to get our message out digitally that physical therapy owners, in general, are behind the curve when it comes to modern technology use and social media use. Some people have done it well, but I would go out on a limb and I  think it's a big limb and that I don't think we've used it to our capabilities to push the message that we can see you directly, that your acute issues can come to us directly. We can see you without a doctor's referral that is forcing our hand in direct to consumer marketing. I don't think I realized that before talking to you. I did regarding the telehealth, but it's going to force out the physical therapy owner's hand to be more aware of their direct to consumer/digital approach. As you're working with somebody, where do you start? Do you start with the website? Do you start with their Facebook accounts or their Instagram or all of the above? Where do you start initially? 

I’ll tell you where I normally start and then I’ll tell you the COVID-19 start. It's an important piece and I'd be talking about that again for years. It’s with the landing page and the list building. We need to focus on accumulating the database because that is going to be your greatest asset. It's also the reason that it's important is as you're now going to expand through social media, we don't want to expand through social media unless we have somewhere to send them. It has to be the landing page. We have to be list building so that we can do email marketing. Why is that important? It still has the highest return on investment. It is the way that I'm advising clients now is to get emails out to your database and triple your communication to them so they feel heard and taken care of. They're in worry as well, especially if they do have injuries. They know that they should be doing something and they feel like they can't.

PTO 97 | Marketing For Physical Therapy
Marketing For Physical Therapy: We can get more people no longer addicted to opioids by spreading the message that there are alternative, natural therapies which most people are not aware of.

 

It's one of the original technologies that have to become stable and should have been years ago. The other reason I love landing page technology, especially for PT's, is how we can create what we call the lead magnet. This gift, which I've been creating for many physical therapists now, is an educational tool and that's what they need. The five ways to whatever to get off of opioids or the five best strategies for pain reduction of your back, your knee. We pick the target market, we create an asset to give. The beautiful part about where we have gone is all of that marketing at that time was kept local.

You can grow at a certain rate. There are only so many people that might need you. Now with the introduction of this global pandemic and the fact that we should be out in a bigger way, it doesn't have to be local. It's great when it's local. I do a lot of the strategies to focus on that, but the bigger picture is the more people that have this gift or guide and content in their hand, the more people will understand what physical therapy as a whole is. This is how we elevate the entire industry at the same time as you're moving into a position of leadership and authority because you're the one delivering this information. We add fuel, which is social media. We start on Instagram and then we start on Facebook.

We create a community on Facebook. What I love about Facebook is it is the platform for community building. You can become a leader, not only in your community, which is wonderful, but overall for maybe a specific thing you deal with. I have physical therapists, some focus on sports injuries, some focus on back injuries. If you have specific needs then you can build an entire platform around that and attract all people. There are two billion people on Facebook. There's your entire market. You have many people to draw from. This is how we're going to educate.

I say, "Let's get the landing page and list building in place." What I'm saying to people now is we need to get the Zoom technology in. We need to get you in front of it and have you doing Facebook Live and we need to start talking telehealth. Both of these pieces have to get in rapidly so cashflow continues and you become the stable datum in your marketplace as that person of authority that says, "Welcome, everybody. I understand." Originally you're talking to people that are in your community, but as you grow and as you start to do more Facebook Lives, you can say, "We're going to be talking about how to remove or eliminate a back pain that you have from sitting too much."

You can start joking with things. "We're going to help you with your Netflix knee." I don't care what you're talking about. Don't be afraid to connect it to what most people are ending up doing and start to outflow. The beautiful part is if we do this in conjunction with the landing page, we're database list building at the same time. I have even, not just for my clients but for myself, quadrupled my outflow. I've been doing a Facebook Live almost every single day since we were put into lockdown and quarantined and my numbers have exploded. That's what can happen for every business that turns around and does it.

We are experiencing a planetary reboot. We need to adapt rapidly as the world changes. Click To Tweet

I've been pushing my clients and my readers to make sure that their promotion and marketing don't suffer and decrease. That's the last expense line you want to rid of. I like how you're saying at this point where you would typically have them go through a landing page process and develop that all out. It's time to move fast and quick. The best way to do that is to get onto social media, develop your community. When you say list building, you mean collecting email addresses essentially. Probably the quickest way to do that is to create that Facebook page or the community. You should have a list of past patients that you can invite to it. You can maybe boost the page or something like that if you want to, but develop that immediately with your past patient email list, that database to begin with. Then build on that by inviting more people and get them to create more data or more content if you will and start developing more and more lists. That's a way that you can immediately start building up that list of subscribers. 

Here's the cool part. As you do a Facebook Live, especially if it's content-driven, you're going to talk about the knee, the back, the shoulder, whatever. Now you have content. The average Facebook Live, let's say it's 20 and 30 minutes, you can break that apart into over 200 pieces of content. Even if we only do one thing and that one thing is to take the whole video and move it into YouTube. If you move it into YouTube and you do the necessary keyword optimization, here's the reality of YouTube. All of the deals in the world aren't going to be found if you do not search engine optimize with keywords. It's a critical and key part. It's exactly what I've been doing with my client. All we're doing is taking their content to YouTube and we're keywording it.

In general, I'm getting on page one of YouTube for searches in the top four spots when it's properly keyworded right off the bat. There is no loss in that content. Let's say you did a Facebook Live and you're like, "Nobody was there." No worries. One is going to replay on Facebook. Facebook Lives, it's going to continue to replay it for you and then we're going to take it and now build an asset from that. That content, we can pare it down even smaller. You can start thinking membership site. You can start thinking added-value for clients. That's what we're doing with one of my clients, which is a Pilates studio.

When we were shut down in California and she was shut down, she was like, "How on earth do I pay my rent, pay my mortgage?" She had eight staff. The rent on her studio was enormous. For some of the PT's, you're in the same boat, you have the equipment, you have studios and you have staff. We went into crisis management at that point and that is, how can we get money in this studio? The immediate answer was getting a Zoom camera in front of her and build out the website so that she could take money for classes immediately. We were recording those classes by Zoom.

PTO 97 | Marketing For Physical Therapy
Marketing For Physical Therapy: We don’t want to expand to social media unless we have somewhere to send them. That’s where the landing page and database building come to the picture.

 

They were going out there and then we were taking that same class, putting it into a replay page as an added bonus for purchasers and then we were taking that class and putting it into a membership site. Now, as people go through, they can buy a week's class, they can buy a one month class and/or they can buy access to the membership, which means they get access to every replay on Pilates in this situation. It has exploded. She went from, "How am I going to live?" to one week later, she had 65 people going through her classes, which was more than the physical studio because of the volume you can deliver to in that situation. It's great when you, one, know that you have the technology to help somebody in that situation, but two, you can see somebody who was extremely distraught. I'm sure there are many people out there like that. This technology will work for you, we just have to think out of the box on how.

How does that cross over to physical therapists? What could they do? What content do you recommend that they come up with that kind of growth if you will or accelerate maybe their digital presence or their online content?

We have physical therapists that are leveraging Zoom for telehealth. They're leveraging Zoom for Facebook Live. At first, your Facebook Lives are targeted at your current database and they're like, "This is what we're doing. This is what the office looks like." After that, you want to start taking a look at what is a niche you can talk about. Generally, to make money, you need to go nine miles deep and an inch wide. You'll come out as a physical therapist and let's say you specialize in athletic rehab. Let's say you specialize in back, sports, shoulder or golf, whatever it is. If you have that particular niche, I will start to talk about that. That's how you're going to attract not just your PT client-base, which you've already moved into there, but now you're going to attract those people that are interested in that particular topic. How you do that is not just through Facebook Live. You'll set up events because events on Facebook get promoted. Somebody sees, "Here's an event coming up on Facebook and it's on the three tips to increase your running speed." "Great, I want to know that." The PT can talk about that.

In the beginning, that is a lot of outflow without monetary income except for telehealth, but what I like about that is the power of positioning and the power of educating on what physical therapy is. Plus now, as the people start to follow you and you get 40, 60, 100, 200 followers on Facebook in your community, all you have to do at that point, and I always pilot everything before we build it and say, "What if I opened up out a community, a membership and you paid $47 a month and I would continue to do education and assessments, whatever you want to put in there? Who is interested?" If you get ten people that say, "I would like that. That's great." I always do it based on ten. You get ten people that say, "Yes," then you start to build and honestly the build starts simple. You don't have to fill it with 52 months of content. You're going to be building the content as they're in it. They're going to pay you to build the content. This is where social media starts to come into play. Before, more social media, more followers, we couldn't capitalize on monetization at that point yet, but we sure can when we have a membership site built. Now, we can funnel them in through that and start to build up a community of people that want our results that are running, better golf, health, out of pain, whatever it is that their goal is. This is what your membership community will start to focus on.

Digital marketing will work for you. You just have to think outside the box on how. Click To Tweet

The alternative to that is building a course. You want to build a five-module course on that. Whatever route you choose, the beauty is it's scalable, salable and evergreen, which means Facebook Ads, Instagram Ads. More content to drive to this marketing media that you're building is the ability to create six figures without any extra cost to whether it be your office infrastructure or more staff. It's what I call a plan B. Plan B means if you were pulled out of the workplace, if you had to take care of your parents, like what happened to me, or if you had to take care of a family member, whatever. If you had to stop, would it be sustainable? With that infrastructure of the digital environment in place, the answer is yes. If we build this and rapidly and something like this occurs again. It's occurred how many times now? At least seven. I was in Toronto during the SARS. It was similar to this only it wasn't a global pandemic. It was in Toronto. We were the ones that were shut down and into lockdown. My business already went through a year of what we're going through right now. I knew and I did at the same time make these assessments and that's why I have so much experience on how the heck do you go digital because I needed plan B way back then and that's when I started talking about it. It's time to get plan B in place. I love to help people do those.

My biggest issue has always been creating content. I'm not one that can spin out content. Is that something that we would expect out of you or any marketing specialists that we hire on at this time?  

You don't need us to create the content. You need us to take that video, SEO it on YouTube, and then build a membership site, put the video in the membership site, maintain the infrastructure, the communications, and email marketing. You have the PT knowledge that already your marketplace is waiting for. All you do is seven bullet points before you start talking and you already know what you're going to say and there is the training that you're giving them within the membership site. There is no need to get nervous about the content you're going to give or whether you know what you're doing. You know what you're doing. You can demonstrate things on a doll, whatever it is you’ve got to do to show somebody how to do something that can help them with whatever outcome that they're looking for. The knowledge is all in you. The marketing and technology are not and that is a piece we handle.

It seems like it goes without saying that you're pushing video over written, a blog or anything like that.

It is 2020 and beyond blowout. More video is consumed and uploaded than in the last 30 years of all three major networks. All search is coming through the video line. People are even bypassing Google now because they don't want to read. They want to watch a video because five billion people are watching on their phone and consuming content and reading is a pain in the butt on the phone. We are media watching junkies, Netflix, Hulu, Amazon Prime. That's what's happening. Media is key and the good video combined with what Google is looking for and what the YouTube search engine is looking for, which is keywords, is your secret sauce. That's where you're going to punch to the top for everything someone's looking for. That's it. Once you've done that, you can start to embed selling in your videos that are on YouTube by saying things like, "Go to my landing page, go to my channel, go here,” everything. There's this circular way of optimizing every piece of content you produce, driving them ultimately to a membership or a course.

PTO 97 | Marketing For Physical Therapy
Marketing For Physical Therapy: If you have a specific niche, you can build an entire platform around that and attract all sorts of people there.

 

Not to get too much into the details in regards to video, but is there a certain amount of time that is optimal, as a 15-minute versus a 30-minute video? Backgrounds like this, does that matter too much? I'm wondering about any details that you recommend if someone is to post a video on social media?  

It depends on which social media platform. On Facebook, they like the longer the better. That's how you can get more people watching because you're constantly going to be fed through the news feed while you're still on. If you're a blip on the news feed and you're off, that was it. That was your shot. The longer is better on Facebook. Why? Let's say you're doing a training video on YouTube because we're going to take that content. Thirty minutes is fine on YouTube. The average person is consuming 40 minutes at a time on the YouTube platform. This is only going to go up during this time. That was before.

We know on average we can do 40 minutes. My videos are 40 minutes. YouTube wants over ten minutes. If you have a quick key tip, then that's 3 to 5 minutes, something fast. Let's say somebody had a headache and you're like, "How to get rid of your headache in two minutes?" That could be a video. You touch here and you do this and you put whatever. I only know how to translate it so someone pays for it. It all depends on what you're doing. To me, most of mine are longer and highly consumed from that perspective. You've got content. What do we do? Now we take that video and we embed it in the blog post, we're hitting another platform, then we do have Instagram on it. We do a LinkedIn on it, and then we do a Facebook promo on it.

It's a constant circle of leveraging content that you've already created and making sure that it can get consumed wherever your person might be. It’s because LinkedIn is B2B, it doesn't mean there are a lot of people incorporate suffering from physical therapy needs. It's interesting. It’s the same with Instagram. Even though that's the younger platform doesn't mean that a Millennial who's been jogging or playing tennis doesn't need a physical therapist. That's the beauty of what you do. Cross-platform promotion needs to happen so we can find the sweet spot. Once we know it, that's where the fuel pours in that area.

That's why I'm glad there are people like you out there because doing all of that blows my mind. I don't want to touch it. I don't want to put in all the keywords. I want to do my thing and then give it to someone to work with. Either that person is on your staff or you hire it out to someone like you who's a specialist at it. I'm sure the dollar put into you will go a lot further than having someone in the house through it unless they are super expert.  

This is not a time to shrink and go into survival mode. You need to market and promote more than you ever have to rise to the top. Click To Tweet

There's the other thing. Let's say you had a social media person on staff. We can work with people like that because what they're often missing is strategy. They're like, "I'll do this or this is a cute post." We're watching too. We have to know what all the trending keywords are, what all the trending hashtags are and we need to make sure that all posts optimize five different sets of hashtags for everything that's going on. They may not know that, but when they're talking about that, then there's like, "I understand what I need to do." That helps the office as well. For those of you who do have staff, but perhaps they need a little more guidance, that's where we often come in. We teach them specifically on what they're doing to help you and then we move either to another part of the company or you don't need this anymore, whichever happens.

A lot of times you lean on that social media person to be your strategist when maybe they're saying, "Here's a cute video. I'll post that. Here's a recipe that our audience might like,” and post that. It's what anything that we put out there is okay mentality instead of being strategic and focused on the content that they produce.  

That goes to part and parcel of increasing your conversions, increasing your brand and your elevation of authority and influence comes strictly from the strategy that goes behind the post.

If people wanted to get in touch with you and see what you provide and how you can help them, how would they do that?  

There are two ways. You can check me out at TracyRepchuk.com. You can check any social media platform with /TracyRepchuk or you can take a look at the funnel, what I want you to have. My landing page, which is FastActionResults.com and you'll see the process. I bring people in, I give you a gift. At that point, if you need to schedule a strategy call so I can take a look at what you've got, where you're bleeding and how we can help repair it, then that can happen immediately. You click and schedule.

Thank you for your time. Is there anything else you want to share with the audience? 

The thing I would share as a final note is you need to market and promote more than you ever have. You said it at the beginning, Nathan, and that this is not a time to shrink. This is not a time to go into survival mode or hunkered down. You have to do the opposite of what everyone else is doing so that you're the one that rises to the top and becomes the cream. The only way to do it is to get out there bigger than you ever thought you would.

PTO 97 | Marketing For Physical Therapy
Marketing For Physical Therapy: Keywords are the key to social media marketing. That’s where you’re going to punch to the top for everything someone’s looking for.

 

Maybe a lot of market owners have time now if they have slowed down and/or shutdown. If you've got time, now is the time to consider maybe your digital presence and that strategy a lot more.  Thank you for your time, Tracy. I appreciate it.

Thank you, Nathan. It's been great.

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About Tracy Repchuk

PTO 97 | Marketing For Physical TherapyTracy Repchuk leads and empowers you to develop a freedom-based business by systemizing, streamlining and scaling to success

> 7 Time #1International Bestselling Author including 31 Days to Millionaire Marketing Miracles from Wiley Publishing

> World-renowned speaker in over 37 countries including China, Dubai, Brazil, Africa, Australia, Singapore, UK and more

> Award winning entrepreneur, writer and speaker since 1985 when at the age of 19 she started her software company

> Over 20 awards including from Senate, Assembly, the White House and President Obama

> Pioneer on the internet developing brands, websites, SEO and now social media since 1994 and currently serving on the Forbes Coaching Council, Amazon Influencer, and Linkedin Advisor programs

> Featured expert in over 22 National and Local TV as a trusted resource for technology, internet and social media including ABC, NBC, CBS, FOX and featured in 3 motivational movies

> Runs her own 501c3 foundation to help underprivileged women to gain life and business skills so they can be independent and run a business from anywhere with confidence

> Global leader in strategic thinking for increased market reach serving thousands of clients around the world to help you reach millions with your message.

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PTO 76 | Direct To Consumer Marketing

 

If you consider marketing to physicians "Marketing 101" for PT owners, then obviously, marketing directly to consumers (potential patients) would be "Marketing 102." And if Marketing 102 for PT owners were a college course, Matt Slimming, PT would be the professor. Recognizing the changes happening around him - POPTs and hospital network consolidation, referrals from physicians are down 50% over previous years, etc. – Mark realized that he needed to access patients in a different way. Whether it's improving SEO, getting patient reviews, or utilizing social media ads, he found that there is a greater pool of patients available to him when he markets directly to the surrounding community, plus he won't have to rely solely on the doctors to keep his eight clinics steady busy! It may be a new concept for some of us, or maybe some of us have tried it and not seen the results. Listen to what Matt has to say and maybe he can guide you to online marketing strategies that have been proven.

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Listen to the podcast here:

Marketing 102: Direct To Consumer Marketing With Matt Slimming, PT

I have Matt Slimming out of the Greater New Orleans area. Matt is uber-successful. You can tell he's a transplant from Australia. He came to America and has established and grown his physical therapy clinic to eight clinics at this time, I believe. He's doing something right. Matt has come up against some of the similar issues that we have as independent clinic owners in obtaining new patients with as many physician-owned physical therapy clinics that pop up, hospital networks that have gained ground in many urban areas. Based on the inspiration of an episode I did with Mike Bills, I'm excited to talk to Matt a little bit more about online marketing and getting your patients not from physician referrals, but focusing on direct to consumer marketing and how he is able to get more patients that way. Matt is going to share with us what has been successful for him in his online marketing and social media marketing approach that has led him to be successful and continue to grow and get new patients in this current environment. Let's get to the interview.

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We have Matt Slimming, Founder and Owner of STAR Physical Therapy in the Greater New Orleans area. First of all, I'd like to thank you for coming on.

It's a pleasure, Nathan. Thanks for having me.

Matt, if you don't mind, I've heard great things about you. You've got a great presence within the New Orleans area, eight clinics. Congratulations. Tell us a little bit about what got you to this point where you've been able to grow to where you are.

What's allowed us to move forward was the struggle that many clinics have of suddenly finding themselves competing with an ever-increasing amount of pops and hops and start-up clinics coming from every nook and cranny. It happens to a lot. I was speaking to an owner in North Carolina and experiencing the same thing. Suddenly, they're everywhere. They seem to love to jump into the nice areas that people want to move to. Chances are if you're in a nice area, it's either undergoing a dramatic increase in competition or it's about to. We found ourselves in that situation where we had at that time three clinics and we found that we weren't growing anymore. We were starting to slip backward in one of them.

How long ago was this?

This was about 2010, 2011.

Were you starting to see some of these pops in hospital networks coming in?

Pretty aggressively. Also, our community that we're in, which is on the Northshore of New Orleans, our main clinic early on was designated as the place that New Orleans was growing to. Therefore, all the business owners wanting to get there before the crowd got big. We saw an influx of new businesses, the new PT clinics. We had to work hard at marketing. A couple of years later, it was about 2015, direct access became a reality in Louisiana. In 2011, we started the market aggressively and we started to do a little outside marketing. In 2015, we realized that we now have the freedom to market in a way that attracts the direct access consumer. Since then, we've been studying online marketing. Gradually, our business has shifted over the years to where that's the main focus of our organization is online marketing to gain the audience and the new patients through that media.

It's interesting that you say that because in 2014 or 2015, you got the direct access opportunity in Louisiana. It sounds like you guys jumped up on that quickly. It seems like a lot of physical therapy owners drag their feet when it comes to marketing direct to consumers. What do you attribute that to? Why aren't owners taking more advantage of direct access in their states? All of us have direct access at this point. Some may be better than others but we do. Why aren't physical therapists taking advantage of that? 

In some communities, it is a concern that they might ruffle some feathers and that they might offend referral sources. The orthos have been against direct access with good reason that they would perceive that they might lose market share. We understand that. A lot of physicians in a lot of communities hold the belief that we shouldn't have direct access, that we don't have the skills and knowledge for that and the education for that. Because of that awareness, a lot of good PTs with great relationships with physicians didn't want to rock the boat. Why mess with something that's doing okay? That combined with the, "How do you do that in a way that works?" A lot of guys tried a few things, it didn't work for them so they said, "Forget that. We'll keep on rolling."

PTO 76 | Direct To Consumer Marketing
Direct To Consumer Marketing: We should not keep someone from getting the care that they need that might be better for them.

 

It's tough to swallow because like you said, there's not only competition coming around every clinic out there but there's also the fact that physician referrals are plummeting. I don't know about your experience, but my experience is if a physician is referring out to physical therapists nowadays, the majority of them are saying, "Here's the prescription." They’re giving it to the patient, "Find a physical therapist that you like." They're all good. We're commoditized in their view. We've always had that subservient attitude. We want to be subservient to the other healthcare providers and not ruffle feathers.

That's a different conversation for a different day about my issues with that but a lot of it goes to how do you do it? Do I now become the local car dealership that posts advertisements for other chiropractors that are doing it? How do we do it effectively? How do we do it in a smart sense that makes us look well but also shows that we are the experts? Maybe there's a part of that too where we haven't necessarily been the gatekeepers in the past. Are we prepared to be the person that sees that for that patient right off the bat because they've typically gone through somebody else first and been screened out?

To answer the second thought, we all deal with initially the idea of, "I have much more responsibility now. I've got to catch those red flags or yellow flags. I've got to make sure I know what I'm doing." There are a lot of PTs, and some PTs in our group, that we had to educate on how to do direct access well. That's the first thing we have to be good. We got to know that we're not going to hurt someone, that we're not going to keep someone from getting the care that they need that might be better for them.

As you're dealing with more direct access care and maybe as you bring on the physical therapist onto your group, especially new grads, is that one of the first things you're doing in your training with them? Are you saying, "If we have direct access now, these are some of the things that you need to sure up?" Are you doing some training in that regard?

We don't have our new PTs do much direct access work initially. It might be months that they're working with us before we allow them in that process. What we find is most PTs have the education to the DPT where they're effective at doing direct access. I didn't know that when I first came to the US. I went back and got my doctorate and that's what allowed me to have that knowledge. Most PTs now, they're coming out with good knowledge. There are more nuances perhaps that we have managing and massaging the direct access than just the clinical stuff.

We can do it. If it's a hurdle or it's a fear, it's a matter of training yourself a little bit more and getting ready for that opportunity so that as you do the marketing direct to consumer, you show yourself well. You become that actual gatekeeper and gain confidence. It's the repetition and the work that breeds confidence. The confidence doesn't come first.

It's a good point, Nathan. There are two groups, those guys who are confident and happy to be putting it out there and then the other guys who are just as great skilled as a PT but don't feel like they are the expert. The reality is that PTs are the experts at musculoskeletal problems from a broad area. We need not be concerned that, "I'm not the smartest PT in my community. There are guys out there who have more initials after their name. I shouldn't be the one doing this." No. You know enough to help people better than most of the physicians in your area, probably would initially is what you can do for them. We always have an obligation on ourselves to be intentional about helping our fellow man and getting the word out there about what we can do.

You guys had three clinics back in 2010. I imagine you might've grown a little bit here and there between then and 2014 and 2015. You've grown to eight clinics. Do you think most of that has come from your direct to consumer marketing? 

A part of it, I wouldn't say most of it. Without that direct access marketing, we wouldn't have had the confidence to open other clinics. We know that we can be successful with zero physician referrals. We can still make it work. It's nice to have that behind you to say, "This will still work." We'd be foolish to only rely on that. We're all in communities. We all need only to be good neighbors and we all need to collaborate. One of the nicer things about direct access and being successful in online marketing is that we can now refer to physicians much better. That's a treat when you offer pods in the area looking to chat with you because you sent them a couple of patients last month. That changes dynamics entirely and it's a refreshing place to be able to live.

What are some of the successful actions that you can share with us that you're doing online and developing that patient referral base that is separate from physicians?

Because most states have direct access, it is a must for PT owners to take advantage and market to their local communities. Click To Tweet

A lot of people start and try something. It doesn't pan out well until they say, "It's not for me," which is unfortunate because in every community, there's a way to do it that works. The first thing is we have some real strength as physical therapists. We are the good guys. Patients that leave your clinics will think of you as a friend. If they see you in the supermarket, they're going to give you a high five. They're going to introduce you to their wife. You are the good guy. You didn't bilk them, you didn't even charge them out the kazoo. You're reimbursed poorly as a physical therapist. No one thinks you're tremendously paid. You don't have that burden to deal with. We also can share comprehensively what we do and what we know.

Those two things are a real strength because a lot of other disciplines in healthcare, they’ve got some stuff under their hood. They cannot afford to be comprehensively honest and transparent because there is some weird stuff. I don't want to point at any particular type of doctor but we've got an opioid crisis. That would be an example of some stuff under the hood that might be hurtful. We haven't got that as PTs. With those two things in mind, we can be confident about marketing online. Being transparent about who we are because we're the good guys and what we know because what we know works and it doesn't come with side effects.

That's the base that we work from. We have to couple this educational approach because you can feel free to educate along with a degree of sales knowledge. It certainly isn't good to go out. They're good enough at least to go out there and tell what you know because you may help some people, but the chances are people aren't going to act on what they learned from you through some online medium. They're only going to get the help they need when they see you in the clinic. We have to couple that with some direction, some sales techniques that will bring these people into the clinic and that's in the form of a funnel. If you can imagine a funnel that you've got all these people that join your funnel at the top of the funnel and your goal is to get them through as many of those folks through to be patient as possible or at least of those that need your help.

You only want to help those that need your help. We don't want to be serving people that don't need our services. We have this funnel. You want to attract a broader group at the top of the funnel and you want to keep as many of those coming as a patient as the need to. There's a lot that goes into that funnel. First of all, I will say you don't want to be marketing physical therapy because when you ask someone, "What would you go to a physical therapist for?" you get all kinds of answers and it won't be negative. It won't be back, knee pain, shoulder pain. We've got to be approaching them with, "You've got this problem.” Let's say it's knee pain. You want to have your marketing be focused on how you're going to help that knee pain. From there, you draw them in with some good information.

We have a process that takes those people in through phone calls, texts, emails, and then possibly through some other ads going back to them to educate them a little bit more. Once you identify them, we call that retargeting. You draw these people through the funnel by more and more education until they feel A, that they are educated about what's going on a little bit and about how you can help them. B, they trust you because they've heard from you and they've seen your stuff in numerous channels, but they've also heard from you, your different ways. Now, they're starting to trust you. Once you've achieved that, it's much easier to go that last little step of the puzzle to say, "Come on in to the clinic and I'd loved to meet." There's a long process, but that works.

A couple of things regarding your process. What is the percentage? Is it 10% to 15% of people that need physical therapy or would qualify for physical therapy get it? Maybe it's even less, like 5%. When you're considering marketing to the consumer or the community, physical therapists are fighting for 5% from these physicians. We’re all fighting over 5%. If we could open up our minds and get a greater perspective that there's 95% more out there that need our services and what they don't have is that they don't know us. They don't know what we do. They don't know how we could help them. They can't like us because they haven't met us. If someone's going to buy, they're going to have to know, like and trust you.

What you're talking about then is developing this pattern so that you can show them who we are, what we do, like the message that you're sharing. They have to like it or they'll turn you off and they have to trust you that, "This does work." This guy does know what he's doing and I can put my knee and the faith that they're going to help me with my knee in their hands. There are a lot of thoughts to go that are going around in my head as you're talking because this is the direction we needed to go more towards. That is direct to consumer marketing. Take advantage of the direct access and how we go about doing that is education. Don't start with physical therapy because if you say, "Blankety-blank physical therapist is the best rehabilitator in the Greater New Orleans area," it's not going to get you anywhere.

I read a book called Building a StoryBrand by Donald Miller. People don't want to hear how you are the hero. They want to be the hero of their own story. You are otherwise the guide. You're the Obi-Wan Kenobi to the Luke Skywalker, they're the Luke Skywalker. They're looking for their Obi-Wan. If you can set yourself up as the Obi-Wan to fight the evil and get the bad guy, then they can become the hero of their own story. It goes back to a lot of what I hear from marketers is that they don't want to necessarily hear about how you're going to heal their knee pain. They want to know how you're going to get them back to golf or tennis or things that they want to do, a lifestyle.

It's often said that people don't make decisions based on information. They make them based on feelings. That's how most of us make most of our decisions. That's the case with me. We analyze everything, but in reality, we would be paralyzed if we analyze everything to the point of decision. We all do things on emotion. Nathan, it's important to be fit for them to feel comfortable and to like you. Thinking that you will be a good guide where they can say, "Show me the way," what a relief that is for people.

What are some of the successful actions you're doing online to create this funnel of available patients and to maintain them? Are you on social media? Is it email campaigns? Are you using some postcards? What are you doing?

PTO 76 | Direct To Consumer Marketing
Direct To Consumer Marketing: We have an obligation to ourselves to be intentional about helping our fellow man.

 

We're doing work on Facebook and Google and email campaigns. Those are our main ways that we're reaching people now. Our website captures a lot. If you do all this stuff well, it's great for your SEO because it directs people back to your website. I'm a great student of Facebook and I utilize it for work fantastically I feel, but I am not a great partaker of Facebook. I'm not one that can sit there and look at whatever I was thinking now about the same thing or something. My wife tells me that every single lady that she knows is on Facebook. Thankfully, our wives, the ladies, the ones who make decisions about our healthcare, those are the folks that you want to hit. Those are the folks that make good decisions based on their emotions. They've got great instincts. If you can connect in the Facebook world, ladies and seniors are probably prevalent on Facebook, a bit more than younger fellows. It's a great opportunity for us that there's a great group to connect with.

You have to consider it. You and I probably do the same thing. If someone's going to send you a referral to a place, what's the first thing you're going to do? You're going to google them. You're going to see what their website looks like. See the picture. Who's treating me? Do I like that staff member? What does their website look like? Is it easy to navigate? What is your clinic? What does the inside of your clinical look like? If you're considering that person, my wife and I are the same way. If we're considering any vendor that we might want to use, throw it up on some community page on Facebook and say, “Who's a good physical therapist out there? Who's a good doctor for blankety-blank?” You'll get 4 or 5 replies. My wife does photography and she gets business because she's in a group or in different small business groups in the community. When someone on Facebook says, “Who do you guys recommend for some portrait photos?" my wife will come up. The same thing can be said for physical therapy. You're on physical therapy, I'm sure as your clinics, are you doing some Facebook ads as well?

We do a lot of Facebook ads. What connects with people changes all the time. What's working now won't be working very well in several months. With Facebook, there are a couple of keys. The first thing is you want to measure and track every single ad that you put out there. There's a lot of great information that Facebook provides for us. From as little as cost per action you want whether that's a lead or a click-through to how many people viewed it. You can look at likes, all those things. There's so much data that Facebook provides. Whatever ad that you do, you can check and analyze then measure how successful it is.

What we see now is that surprisingly, picture ads are still effective if they're done well. They've got to connect with the individual. What will connect in one community is different from other communities. The key is to be measuring. We'll throw out 6 or 7 ads for one particular opportunity. Let's say we have a funnel that we've put together a shorter resource online and we're trying to direct people to the shorter resource. We know that when they get into this shorter resource, there will be opportunities for them to connect with us through message and through email. They can set up an appointment with that shorter resource. We use seven different ads perhaps for it that will direct people to that shorter resource. There might be 2 or 3 picture ads. There might be a slideshow testimonial. There will definitely be a couple of video ads in there. We make video ads of different types.

The key is to measure every week we feel what's working and what's not. You stop the ads that aren't doing as well until you end up with the best 3, 4, whatever that are killing it for that. It changes over time. It used to be that the talking head ad would do well where it’s me sitting up there on Facebook saying, "Does this problem hurt? Let me talk to you about this problem." It used to work great. People either get tired of seeing the same face or it might be that they're tired of that type of ad. We've evolved into doing video ads that are more creative to them. There are a lot of great ways that you can get a good video that you can create and turn into a compelling ten-second message. It tells the story they need to understand in order to take action and click. That's the first thing. You've got to try different things and every community is different and it changes over time. Measure and get rid of what doesn’t work and keep on finding what's working better and better.

At your size, do you have someone that's creating that content? Do you have a team in place? Do you have physical therapists that are creating some of that content for you on a regular basis? How does that work?

That is my job, Nathan. The creative is me. I'm a frustrated marketing guy. I went into PT by default or something, but I love it. I find that fascinating science is creating an interesting creative. You've got to have that. You've got to have something that jumps out at people. That's my responsibility. We have other people in other paths that we follow too.

I'm not that creative guy. All that for me is like nails on a chalkboard. The important thing to take away is to find that person or get a team around. It might be this past episode that I interviewed Mike Bills. His physical therapists are responsible for creating one blog post a quarter or one article a month or something like that. It doesn't have to be a lot and maybe one video every quarter. They're developing this library of articles and videos that they can repost if necessary along the way so that content creation isn't all dependent upon one person. If it was depended upon me, it wouldn't happen and it wouldn't happen well. For someone like you, and there are plenty of owners out there that are the creative type and it's an outlet and fun and exciting, that's a great way to go but for the guy who might be a little bit overwhelmed, you've got to find, "Is there someone on my team that can do that?" Are there resources out there now? Do you use some other resources out there to help you out?

I can get video from different sources. There are websites where you can find a short video. The tricky thing is you can't type knee pain and there wasn't a video for knee pain. You've got to think outside the box. For example, we had a knee pain funnel and we want always to catch their attention. We've found this great video of different people dancing. This video phrase through had a couple of seconds of five different types of people, old people, young people, hip hop, all crazy stuff. The message was, "If your knee can't do this then you need to do X," which was the next step in our funnel. You've got to think outside the box and find a video that works and uses music that connects with the audience that would match that video.

Are most of your campaigns then diagnosis-based or body part-based?

We're all in communities. We all need only to be good neighbors and collaborate. Click To Tweet

I would say body part-based, not diagnosis-based.

Do you find more certain body parts attract more patients than others? I would assume that your back or neck pain patients or those ads might bring you more patients than others.

It's surprising, back can do okay. What we find is that there are many people treating backs in our communities. There are chiropractors, goodness knows how many guys would like to inject backs whether they be surgeons or guys that usually are surgeons. There are many disciplines that are trying to get onto backs. That's the toughest space to compete in. It's worth doing but shoulders do great. Knees do great. Surprisingly, we've always had a positive return on ad spend but we would think they'd be right up there with backs, but not as much.

Are you also doing Google reviews, Yelp or anything like that? One of my previous episodes was with Roy Rivera and he doesn't do any physician marketing. The one thing he stresses is that with every discharged patient, he sits them down and says, "Did you like your therapy? Did you meet your goals? Will you write a Google review for us?" He gives them the link card and then follows up a few days later with an email that says, “Here's the link to Google. Would you please rate us and write a review?" Do you do something like that as well to improve your reviews online?

We started a couple of years ago where we said, "Let's take this seriously." We did an intensive 60-day campaign to get a bunch of Google reviews done. It was a face-to-face process where we were intentional about doing it. It's not something we wanted to keep up because for us, it didn't quite gel for our PTs long-term. The way I feel about our PTs is these guys work hard and they are good at one of the most important jobs in the world. I want to be great at that. Enjoy yourself. I don't want to load them up with an ongoing Google responsibility. We use bot ware and there are a few of these companies out there now where patients are sent emails asking them to do reviews. That's an automated fashion and that works well. We may only get one review a week per clinic or something, but that's all you need. I'm not an SEO master, but it does seem that as long as you're getting consistent reviews, it doesn't need to be a bunch. Get a bunch to start with because you don't want to see that there are 30 people or something that like you. As long as you're continuously updating that, that's what matters.

If you can get some ongoing consistent up-to-date ones, you don't want to see a review that's from a few years ago. You want to see something that's happened in the last month. That can always be positive. It sounds like you're also cultivating some of your past patients via email. Is that right?

As part of our online process, we do an email campaign to all our past patients we have emails for every month. It's not a one-off email. It's normally in a funnel mindset. It might be saying, "This is the first exercise we usually give for shoulder pain. This might help you if you have shoulder pain." You want to see okay. You don't want to be harassing people with emails that don't apply to them. You only want to re-email people that opened that email. For those people that opened that email, then you can send the follow-up email. It might be an article or it might be a web resource that you've developed or something else. Maybe after the next email, you give them a chance to opt-in for a free consultation or an operation. It's funnel-wise.

Are you using something like Infusionsoft to do that for you or another program to help you do that so it's automated?

I use two email software. We worked with Infusionsoft initially. It was complex. We work with Campaign Monitor and Drip, two different email platforms that work for us.

That works for you. Is that something that you're on top of? Do you have someone that manages those campaigns?

PTO 76 | Direct To Consumer Marketing
Direct To Consumer Marketing: One of the nicer things about direct access and being successful in online marketing is that we can now refer to physicians so much better.

 

I'm on top of that. I enjoy the content. Building that content and I'm deferring a lot of the responses to other people to manage. I don't need to go through and I don't go through and respond to every email. They go to other people that can respond. I will send emails from our other PTs. All our clinic directors, I'll send an email to their past patient list from them so that when they read that patient response, it's going to that clinic director who can then answer questions and so on.

Anything else you want to share with us about some of your successful online marketing strategies?

A key is to think outside the box. Workshops have been great over the years and they've been effective and they remain effective. What we all should be striving for is if you've done workshops, you know who generally goes to those workshops. It's folks over 55. You might get a few younger folks in there, but generally it's the over 50, 55 group which is great. We want to serve them and they're our bread and butter. For most of us, most PTs reading, if someone offered them a workshop on any topic, they would probably never go out. Who has time? Nathan, you might have a couple of kids.

We've got a couple. I'm a little busy. 

If someone were to say, "Nathan, why don't you come to sit down for an hour and listen to something about investing?" you have to say, "Will you give me the first $100 to invest?" You're not going to go. How do we reach people that wouldn't go to our workshop? Think outside the box. Think about what would get their attention. One thing we did that was effective was we created a full risk assessment page online. You could go to this page and you could answer some questions and it would give you a lot of great information. There’s video work on there too that tells people how bad their fall risk is. We had ads on Facebook and Google the directed people to, "If you want to find out your fall risk, here it is."

The great thing about that is that the CDC and Medicare are behind us. They desperately want us to stop people from falling down and breaking their hips. You can feel good about that educational program where people are learning, "I'm at risk for this. I didn't realize that many people fall every year and when you break your hip, it’s that much chance that you won't make it for another year." It's striking for people. That's been effective for us in educating the community. Those folks that need it, they're coming to the clinic to get their balance right again. They don't have time to come in there and sit around an hour for a workshop one evening, but they do have time to go through some emails, some texts, some phone calls, and then they're like, "I need you guys. Let's do some therapy."

It's a good exercise to go through before you start any of these campaigns is to think about who's your target audience. What do they need to hear? What are they thinking? What are some of their fears? What do they want to do? How is this inhibiting themself? If you have a good idea of what that avatar looks like, then it helps you write the content that's directed to them and it's going to get their attention. 

It's certainly helped to have true patients for a few years. It'd be tough for someone doing this. We know those marketing groups out there that aren't in this therapy space but they're trying to sell you stuff. If they don't know patients at this intimate level that we know them, it’s hard for those guys to know what they want to hear.

If people wanted to pick your brain and maybe see what you're doing on your end, is there any way they can get in contact with you? Would you share your information?

I'd love to chat with folks. What we all need as PT owners are lots of other great PT owners being successful. That's what we need most because if that happens, then people know they need to seek out good physical therapy as opposed to the other specialists. I'd love to answer questions and help and guide people for sure. I love doing that. My email is probably the best. It's Matt@StarPTClinics.com.

Are you willing to help people on this journey towards online marketing?

Absolutely, Nathan. I chatted with one lady in North Carolina and gave her some direction of where she could go. I enjoy doing that. We're going to be working with a small group of PT owners and taking on some of their online marketing responsibilities for them and building out some campaigns. The other thing is not only is the content time-consuming to develop but managing the funnel. Responding to the replies, the emails, the text, the phone calls can be pretty involved. Most PTs haven't got time for that. We'd like to handle that for them as well.

That could be huge. It could be a good resource because if you're not a content creator and you don't want to do it, you don't have the time to develop the funnels. Most importantly, follow through on the metrics and see what's working, what's not working in any particular area. You’ve got enough stuff on your plate already as a PT owner and I'm assuming my audience would love to have someone help them with that.

I'd love to. It's a blast. We enjoy it. If we can help, that's a win.

Thank you so much for your time, Matt. I appreciate it.

You're welcome, Nathan. It's been a pleasure. It was nice chatting with you.

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About Matt Slimming, PT

PTO 76 | Direct To Consumer MarketingMatt has had extensive training and specializes in treating the spine, lower extremity and vestibular rehabilitation. He is certified in the Fishbain DOT-RFC Functional Capacity Battery, Golf Fitness, and Essentials of Musculoskeletal Imaging.

He completed Barefoot Running, Surgical conditions for the athlete, Tennis Rehab, Running Rehab, BEST Exercise Program for Osteoporosis Prevention, Rehabilitation for the Postsurgical Orthopedic Patient, Modules 1 and 2, Physical Therapies in Sport and Exercise, Modules 1, 2 and 3, Muscle Energy Techniques, Evaluation Manual Correction and Treatment of the Sacroiliac Joint, and Direct Access Medical Screening.

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