With 15 years of experience as a clinic owner, Beth Winkler has dealt with her fair share of challenges – from the aftermath of Hurricane Katrina to multiple providers leaving at the same time. Through all of that, Beth and her partner Lisa Taglauer, PTA have built clinics that thrive and grow on policy, procedure, and a healthy dose of quirky, fun culture. Those foci have allowed Beth and Lisa to grow from one clinic to four and focus on solidifying their company culture to weather any future storm. Beth and Lisa own and run Magnolia Physical Therapy in New Orleans. You are going to learn a lot about culture building in this episode as Beth shares that story from her point of view with Nathan Shields.
Our guest is someone whom I've wanted to have since the beginning of my podcast, and I finally tracked her down and got her. Beth Winkler is a physical therapist, CEO and Cofounder of Magnolia Physical Therapy in New Orleans. Beth, thanks for finally coming on. I finally got you.
Thanks for having me. I'm glad to be here.
You've been in New Orleans for a long time and you've successfully built up four clinics. Will and I looked up to you and Lisa for the longest time during our ownership. We thought, “Here are two women who are great owners, they created a great culture and they are doing everything right.” That’s why I'm excited to finally tap into some of your wisdom and knowledge. You guys have always been someone that we've looked up to as owners.
Tell the rest of the audience a little bit about your professional path and what got you to where you are now.
Lisa and I met when I was a new grad, a couple of years out of school. She came to volunteer at the clinic that I was working at, and we became instant friends. We talked about not opening our own clinic as of yet but we work well together. She has gone in a PTA school, so I wanted to make sure that when she got out of PTA school, I'd love to have her come back and work here and work together in some capacity. While she was still a tech, I got offered a position at another clinic where they were going to pay for my manual therapy fellowship. I couldn't pass that up and that was when PTs were in great demand. It was like, “Name your price,” which was nice but there's one caveat. I said, “I don't come alone. I have a great tech that I want to come with me,” and the owner was happy to hire her. He was looking for someone, so we worked together through her. She went off PTA school and we hired her back as a PTA.
There were some changes in the company that we weren't too happy about. We had suggested a few different things on how to become more efficient and have Lisa go out and do some of the marketing while she could also see patients. It was like, “Thank you for your input but no thanks. This is the route we're going to go.” It felt like our voices weren't being heard, so I started talking about doing our own thing and we could be our own boss. It was never to grow to four clinics and see all these patients, it was just so we could have more freedom to do what we wanted to do. Lisa thought I was joking all along. When I finally said, “Let's do this.” She's like, “You're serious?” I'm like, “Yes.”
Honestly, we looked at our bosses that we worked for, and no offense to our former bosses, but we're like, “If they can do it, we can do it.” Let's go ahead and start this thing. We always have the default at home health, which as a PT, there's always the default of home health. I knew I didn't want to do that. That was the alternative, so the alternative was not an option. It's like, “We need to make this go or I'm doing home health.” That was not what I wanted to do. It wasn't my vision for future plans.
The irony was the day that we were going to put a deposit on a tiny space, I don't even know how Lisa and I would fit in this place. I was dropping off home health notes across the hall from where we used to work, I saw the owner in the hallway, and we were still on good terms. He's like, “What are you doing here?” I said, “I’m dropping off notes.” He had lived out of town and I said, “What are you doing here?” He goes, “My therapist quit. Do you want your old job back?” I was like, “No.” He goes, “Do you want a clinic?” I'm like, “Maybe.” It was the old text phones and I mentioned this at Will’s where I was texting Lisa like, “A, B, C.” I was like, “David is selling his clinic and he offered it to us.” We took over his lease, the patients, bought his equipment, had it owner-financed the equipment, and there we go.
You were all set up and ready to go. It was that easy. You opened up a clinic and you immediately had a room full of patients and everything went hunky-dory after that, right?
Not really. Three weeks later, a little storm called Hurricane Katrina hit New Orleans and that was a little insane. My friends would ask me, “How did the clinic do?” I said, “I don't know.” We didn't have that many patients to begin with. I was getting going and I was ready to go. Lisa and I were so driven to get back. We both lost our homes. Lisa's home completely went underwater. The water was all the way up into her attic, so her home was completely destroyed. I had 4 feet of water in my home, we had to gut it and completely renovate it. We didn't move back into it until a year later and that was considered as, “You're back in your house soon.” Everything is relative. We have the clinic, so we would take turns. She’s like, “I'm going to go.”
Our husbands were not there because they needed to be with our kids. There was no daycare in the city, so that's why most people were back, you couldn't bring kids back. My husband and I are not together anymore, but at the time he had got a temporary job up in DC, so he kept our daughter up there. We would alternate going to my house and Lisa would go to her house, gut it a little bit, and try to salvage some clothes. It’s the same thing with me. We were doing that and also seeing home health patients, which is the other irony of that.
That's what we’re trying to get away from but there was no one doing that. They didn't even have nurses going out to some of these people's homes. We were bringing people supplies. Lisa and I will go to our church and get toothbrushes, toilet paper and clothes, then bring them to these people. She got a puppy for a patient one time. This woman's dog drowned in the storm and it's awful. She's like a vigilante coming in with these hot pink colored scrubs that she had donated, “Would you buy some new scrubs?” It was funny. It was an interesting time but it was one of those things that if we were starting off that way, there's nowhere to go but up.
I was going to say the same thing. Everything had to be easy after that.
When was Hurricane Katrina? That was how long ago?
That was August of 2005.You're always learning. When you stop, that's when you have a problem. Click To Tweet
You've been a longtime clinic owner and you've run the gamut. You've done many things opening up new clinics and you started by purchasing a clinic. You've got a ton of experience. What were some of the biggest challenges that you had in developing your clinic over the past couple of years?
We were talking a little bit about it before. It’s finding that sweet spot. When you have therapists that are working for you, it's like, “When do you hire that first new therapist? When do you hire the second one?” In the beginning, we thought we had a formula. What was happening is we would get to a certain percentage, hire too quickly, and we would be inefficient for a while. It was nice because you can sit back a little bit as far as a treating schedule but the profits on the other end suffered for that because you're not having efficiency. You have the other end where you don't have enough therapists. We've had two waves of 3 to 5 therapists leaving at a time. It was like, “How do you rehire?” Us going back into patient care where you have a ringleader that doesn't agree with something that you're doing and takes everybody with them. That was challenging.
You have the therapists that are there with you who are overloaded and overworked. That's no fun either. Still to this day, I'm still struggling with that. What is that perfect balance because we were growing so quickly and we were hiring people, but if you're hiring that quickly, do you have time to get people on board and hone down on your culture, your core values and that kind of thing? That's what we're going to focus on in 2021. Let's do a slow growth so we can get people connected to our core values and what our culture is like so they don't go and leave and work for the big hospitals.
It’s focusing on the training and not sending them out into patient care immediately. They may do start seeing patients but you're going to focus on what it means to be a part of Magnolia Physical Therapy, “This is how we do things, these are the expectations, and laying that stuff out upfront.” We wanted to talk a little bit about the culture that you have created in Magnolia over the years. It started with you guys and everything that you did to focus on making it survive after Hurricane Katrina. You guys are so much about service and you want to provide that service for your employees. You want them to work in a great environment, you want it to be a place where people enjoy working and will attract top talent. What are some other benefits that you might see in creating a culture in your clinic?
One of the best benefits is having fun. Work doesn't have to be about coming in, going with the grind and pushing through. I know that Lisa and I are goofy. We have different senses of humor. Bringing that into the clinic with our patients and our team, we have students that come in and they see how silly and goofy we are in the clinic, that’s one part of our culture, that's not all of our cultures, but it's a big part. We make fun of ourselves. It's opening up a sense of vulnerability when you can make fun of yourself and poke fun at things that the team might be like, “Here they are trying to push this policy in or whatever.” We go ahead make fun of it and it lightens it up a lot.
That was one of our values as well. We had our core values but we did have a cultural value that was about fun. There was so much about me and Will that was about humor and a shared sense of humor. That was one of our cultural values and we define it. We let our teams know that if it's not fun, that's not worth working like this. To be intentional about that, it’s important because it's a place where you want to work. You’re the owners, so you should be in a place that you want to be on a regular basis. You don't want to be in a place that you dread especially if you're the owner of that company. Maybe not specific to having fun, but what are some of the things that have worked culturally? Then we'll turn to the flip side with things that haven't worked.
It’s investing your time to spend in the clinics. There was a period in time, especially in the beginning of COVID when it was like, “If you can stay put, stay put.” I wasn't visiting the clinics a lot. Being in the clinics and having team members see me interact with patients. When we first open and we've hired our first therapist, it's like, “How am I going to make this person a mini-me?” Not an exact stamp or replica, but how am I going to get them to instill how I would treat a patient or how I would have fun with a patient?
It's important for them to see us immersed. It doesn't have to be necessarily treating patients, although that can help. Sometimes I'll go to a clinic, sit in the waiting room and talk to the patients. It’s like, “How long have you been working here?” “How long have you been coming here for therapy?” I’m like, “No. I’m one of the owners.” I'm talking to everybody and I love doing that. How nice is it when you go to a restaurant and a chef comes out and talks to you? That's how I look at it, not like, “You're the owner.” It gives a sense of that patient feeling special. It’s like, “I met the owner,” that kind of thing. It’s to create that feeling in them a little bit and show the team too that I'm interested in what the patients have to say.
I've come across owners who have got to a point where they've got some freedom. They're not treating patients and they could work from home remotely. I have to remind them sometimes you need to still be there because they get too comfortable working from home. They’re like, “They don't need me. They're doing fine.” I want to remind them, “It's important that your presence is there on occasion because you want to exhibit part of that culture and personality.” Honestly, you want to make sure things are going well and make sure everyone is following the policies that you would expect. It's nice to have your ear in on conversations, whether that's at the front desk or between provider and patient. That's part of maintaining culture and having that presence. You can still maintain that culture at larger clinic members like 15 to 20 clinic members. That means you simply have a lot of other people that already know the culture, how you do things and have bought into the purpose, values and all that stuff before you can feel comfortable with not physically being present in the clinics.
I've done it wrong the other way. At the beginning of the COVID crisis, I’m not going into the clinic and having team members get these videos for me. It’s not an order but it’s like, “Let's work on this,” and here I am sitting at my house. They don't know what else I'm doing and that didn't come across well. I remember our COO was like, “They don't see you as I see you.” They need to know the goofy Beth so you can create that mutual respect in that.
There was a clinic that Will and I had. It was always awkward when we visited. We weren't that present often. It was a little bit out of the way but it was successful, our guys are doing great numbers and they don't need us. When we'd show up, there was a weird vibe. Sometimes, you get that sense that something is off here. That's when we had like you where someone quit, another one will quit soon thereafter, and another one quit a little bit later after that. Being present and recognizing the feelings and atmosphere, you can get a lot of sense simply by observing and being present.
There are other times where I might not have been so invested. It’s not only going to clinics but even with a marketing team. I've been working closely with them and we had a couple of team members in that area that were not getting along. It’s like, “Let's dive in and figure this out.” Let’s get in, work on rebuilding trust, and spending a lot of time with them doing that. I can tell you that they've told me, “We would not be here if you would not have done that. If you wouldn't have taken the time to show that you care, you value both of us, and us getting along, that meant much to you.” That was a wow moment.
It's cool to hear that you share some of the issues that you're having even years across four clinics. I see you as a successful physical therapy business owner and Lisa as well. It's still a work in progress. Things aren't perfect. You have your own difficulties. Who could have guessed that the pandemic would come along and it presented its own set of difficulties? This is something that you're constantly working on. It's not a one and done. It's not like you can open up a McDonald's franchise and it's going to run as it would anywhere else in the world. You guys are still working hard at developing the culture that you want.
It's still a challenge. It ebbs and flows too. You have periods that I look back on where we were doing even better than we are now. For Lisa and I, we took off a whole summer and we came back to a mess. Our numbers looked good, we were doing well and the culture was good. To me, it's not always about how well are the numbers and how are our profits are. It has become more than that now. We have four clinics and instead of doubling or tripling, our purpose is let's get what we have and get it humming. Get everybody happy and engaged. I look back to the team, we had fun but it wasn't like this team approach where it's like, “I’ve got that, I’ve got your back.” Whereas now, I feel like we have that. It's more fun and inspiring to be here.
When things were running well or at times when the culture was good, what were some of the things that you recognized from that? What were some of the benefits of having a culture that people bought into?
We've been working a lot on trust and getting people to be more open and willing to say what they think and feel. We started with these anonymous surveys. Be careful what you ask for because you'll get it. We got back not so great feedback and I was like, “What's going on?” We started honing in first with the management team. Let's be open and vulnerable. It was hard work on my end because I had to sit back and say, “What am I doing that is creating this environment of people not wanting to speak up?” It took a while to recreate that trust.
We're so used to this top-down management approach, which got us far to a certain extent but that's not how I wanted to run my company anymore. I wanted it to be more of, “Let's get everybody's input, and let's come up with decisions together.” Number one, you've got more brains that are pitching in. People who are on the front lines know the systems better and can come up with better ideas than I can. It’s being open to that instead of, “I want things done yesterday.” I can sit here, write up a whole plan, have it done tomorrow, and try to shove it down everyone's throats but that I learned does not work. It's taken a lot on me to sit back and say, “Let them come up with a solution or whatever.” Most times, it's better than what I would come up with. Even if it wasn't something I would have done, it still gets the end result. It's like, “Why does it matter how you get there if you take Road A or the scenic route?”
Creating that and having everybody pitch in and not be like, “Why would that person say that?” One of our core values is giving everyone a chance to surprise you and me. Let them come up with it. I've noticed that they take more ownership that way. It's been a little more fun. Our management meetings and team meetings to be able to see they are pushing the core values instead of me, Lisa or Ron are on an island by ourselves.Give everyone a chance to surprise you. Click To Tweet
That's one of the keys to a functional team is the relationship of trust. Are there certain books that you've read that have helped you develop that team and that feeling of culture?
It's called Leading with Gratitude. That was a good one. The Five Dysfunctions of a Team takes you through the different steps. It's like a workbook and implementation on how to do it. That's been great getting people to open up a lot more. We also hired a coach using the Scaling Up Methods. What he helps us with is making sure everyone's voice is heard like the quarterly surveys, “What worked? What didn't? What are some of your barriers that help us create that safe environment for people to say what they need to?”
I immediately thought of Five Dysfunctions of a Team when he talked about open conversation and vulnerability because my mastermind group is reading that book. That’s first thing that came to mind. Our leadership team went through that book very much so to make sure that we were addressing things openly and people felt they could talk honestly. I don't know what it is but there's something about that lack of trust. When the team members can't feel like they can share their opinions and their voice isn't heard, that's when they start looking elsewhere. They're like, “I'm not being heard here so I'll go someplace that will.” That can sow a lot of discord. As you've been through this process when culture is good and culture is bad, what are you learning about your team in general? What do you learn about some of the people who have been with you for years at a time?
The ones we’ve been with us for a while, I think of resiliency because there are team members that come in that aren't a culture fit. The more we have those core values honed in, the more they stick out a sore thumb. It's that loyalty. You have someone who might be for whatever it is behind our back saying negative things about management and owners. Other team members are like, “We don't do that here.” It's the loyalty to the team and not loyalty to the complaining, that type of thing. When you do have team members leave, it's hard. You have to regroup again, revamp, get back in deep, and go over those core values because it can be a disruption. That's the biggest challenge. If a therapist leaves, they want something different, they think better or whatever. It's different when we're not a match and how that affects the team.
There are other things where people aren't a culture fit where other team members might not see that. They see what they see and they don't know what goes on or what has been done behind closed doors. That team member has lashed out at another person. That's something we're not going to share with the whole team, so that’s a struggle. It's like, “They let that guy go. If they let him go, my job must be in jeopardy.” That's been a real big setback that we've had. People are thinking that if someone is being let go, they may be speaking out of a meeting, and it so happen to happen after that but that wasn't it at all. It's trying to rebuild that trust again.
When you've had people leave, and it's such a blow to your company, you almost take it personally. I did and I'm like, “I’ve got to re-assess what I'm doing and I've created.” We’ve got to go back to the drawing board, “How can I make sure this never happens again?” It's not the type of environment that you want to create. It's not an experience that you want your employees to go through so what do I have to do to change it? As you said, that's the dirty work you have to get. Get back into it and decide, “What are we going to do to make this better? How are we going to hire? Who are we going to look for? How are we going to filter those people out that aren't good fits?” You have a little bit more determination as you go back to it but it's not easy work.
You want to be able to be safe for the people who are working their butts off and pushing, and not bring someone on who's going to gossip, argue or do whatever. If you want to let that person go because they're not a culture fit but you also don't want to create that feeling of fear like they're going to lose their job. That's one of our biggest struggles that we've had with our culture, especially since COVID. All our cups are empty and we're running on fumes. It’s the smallest thing. It's the frustration, so you’ve got to maintain that.
It's not all rosy and things don't always go swimmingly. Even at your size, you're still dealing with issues with the pandemic, and in your case, a mass exodus which doesn't help. At the same time, you're always going to be coming up with these problems as an owner. The strength that you have is the management team. You have a shared experience with Lisa, a commitment to each other and the clinic that you guys are going to get through this. It's like weathering another Hurricane Katrina, it's not as bad but you're in a completely different place as a company and you have some idea of where to start from at this point.
That has made us more resilient with things that happened. This has been the biggest blow since Katrina but almost everything else is like, “We can handle this.” I see the light at the end of the tunnel, so that’s good.
We're talking so much about the culture and it's something that you're working on. You've had these issues related to the pandemic come up, but owners should know that Beth and Lisa have policies and procedures in place. You've got many other things that are going well and you're doing swimmingly. You've got the admin in place, you're following your KPIs, so you know what to do. You have so much of that established, I assume that coming back around is going to be a little bit easier because you know which buttons to push and where to look. Your focus is on training. It should be simple because you do have many policies and procedures in place. It's a matter of, “How do we train people on this?”
It’s finding the right time to train them. One of the famous things that we say is, “It fell out.” It’s like, “I thought we had that in.” We joke that I'm the Chief Reminding Officer but it is. It’s like, “Let's get back to basics on what fell out that we need to get back in.” Our percent arrivals have been below 90% and I can't tell you the last time they were below 90%. I’m like, “We need to start from square one.” We have what works. We don't have to recreate that wheel, we just have to get it back in.
Congratulations on getting 90% on a regular basis because there are plenty of people who have never been to 90%. I’ve never talked to them before, so you guys are doing something right for sure.
Thank you.Work doesn't have to be about coming in, going with the grind and pushing through. It can also be fun. Click To Tweet
As you're looking at creating this training program to hopefully improve your culture and the people that you have come through the company, what are some of that looking like? If you had someone in front of you who is a newer owner and they said, “Tell me what does your training program look like.” What are some of the skeleton structures of something like that?
We started using an online system for our training. I forget the fancy term that they use for it but it's online. You can assign people lessons and we've created different lessons and paths for their receptionist. There might be 8 or 10 lessons for that receptionist. It's videos, it's interactive and we can ask questions. If it's a receptionist, we can have them talk about percent arrivals like, “What would you say if somebody cancels?” We'll show a video of us doing a drill pretending to be a patient and we'll have the new team member video themselves telling a patient why they shouldn't cancel. We can see what their reservations are if they are someone who might be a strong candidate and hone in on where they might need a little bit more work.
That’s been fun and cool to be able to set someone up on these training programs. We still have people do it. That's the second phase but it's not so much legwork on the front end because we already have it into a system and we can refer back to that. That’s been great. In doing in-person training, we have some of the key components that we do for our patient compliance. We'll revisit that every 3 to 4 months to refresh people. I’m sure you're familiar with some of the stuff we've learned with our previous consulting companies, the awareness characteristics, getting them to realize how this is affecting their lives, and how it could get worse.
It’s reminding people to use this and the eval, that helps with the percent arrivals and things like that. I’m also looking at leadership training, not just our own policies and procedures but let's pick a book. The chiefs, me, Mary, Ron and Lisa are reading Crucial Conversations. We're reading a chapter a week, we're discussing it and starting at the top there. We're going to help figure out how we can filter that out to the rest of the team. When you're ready to be vulnerable and say what you need to say, that helps you figure out how to do it. I’ve worked with many team members who have conflicts with each other using that strategy and that's been helpful. It's that model of constant learning. You never graduated from PT school. You're always learning and when you stop, that's when you have a problem. It’s the same thing with leadership.
When you do training with a front desk person, are you taking them off the front desk for 1 or 2 hours or once a week? How do you schedule your training?
We're revamping that especially now that we have this new program. They take the lesson and there's an observed period. We observe them for 1 or 2 weeks with an existing receptionist who does well. We have someone who's an essential scheduler and now in our HR department. We have two other people who are rockstar receptionists that are in different positions. We might have them observe them doing it. Have them watch you do it, have them do it and mastery. That's still in the baby phases. What we used to do is have them read the manual and two weeks shadow a receptionist that's doing well. We would do drills once or twice a week to try to hone in. We're working on doing a better job of getting that onboarding process more solidified. It's never just done. There are always ways to improve, hone in and make it better.
If you want to know an intense training program, go back to the episode with Blaine Stimac. For their training, they go out for six months. For the 1st and 2nd week, there's a little bit of training every day. It's weekly, monthly and quarterly. They've got it all lined out and I'm like, “That is involved.” The results speak for themselves. They're a plug and play company now. They've got 30 clinics, so when they want to open up a clinic, it’s plug and play, train the right people or move this guy over here to over there in the new clinic and it's successful. They've got this successful method and he ties a lot of it back to the training, which then cultivates a culture of this is how we do things. It's not necessarily the atmosphere culture that we might be thinking about, that's their business culture. This is how we train, do, interact, run policy procedures and run a meeting. It goes on and on. That, in itself, is also a culture.
I have to go back to that because organization is not my greatest attribute. That's why I have Lisa.
I wish I was more organized. As you were thinking about culture and coming into this interview, was there anything that came to mind that you thought was important that you might want to share with the audience or even younger PT owners, if you will?
The one thing that sticks out to me is you're never done. You talked about Blaine, you have these systems in place and you have these training so it's plug and play. It's a constant work in progress because things change and industry changes. We have lots of industry changes. I'm finding more with the team members that we hire, they are demanding to be more part of the process and to have more of a say, and they should. It's our business model of, “This is how we do it here. Here is the policy and you better do it this way.” It doesn't fly that much anymore. Try to create something where we can have the team's input and come up with ways to constantly improve and evolve. That’s what I've learned in 2020.
Thank you so much for sharing. I brought you on because I know you guys are successful and you've created something great in New Orleans. This goes to show that even the seasoned owner is going to come up against different hurdles. Some of these might be similar hurdles that you had when you were a younger owner, but you visit them now on a larger scale. I’m thankful that you're willing to be open and share that in that regard. There are still issues that people are dealing with. The pandemic is something that hit all of the owners in different ways. Even the larger practices suffered like you were talking about in one way or another. It's cool that you're willing to share as we're talking about culture and some of the benefits of it because you've seen the benefits of it. You know what it’s like, what it could be, you have to reset and get that mojo again. Thanks for your time, Beth. I appreciate it. I've finally got you in. It's been great to talk to you.
Thanks so much for having me. I appreciate it.
We'll talk to you later.
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For many owners making the transition out of (some) patient care and into more management/administration is a huge hurdle but one that, once they experience it, leads to more growth as a company. Jacob Pollard, PT has made that transition and has now taken the NEXT step. Now, instead of him being the go-to guy for all questions, the resolver of all problems he has developed a leadership team that follows policy and procedure. His team is able to follow policy and handle issues without his involvement! What is simply a dream for most owners Jacob is now experiencing because he spent the time developing his team and training them on the policy. Learn how this all came to be in this conversation with Nathan Shields.
I've got a friend, a coaching client, and also a business owner nearby me in Wasilla, Alaska. He also has a clinic in Anchorage. He's the Founder and CEO of Empower Physical Therapy. Jacob Pollard is joining me on the episode to talk about some of the growth that he’s had that I wanted to highlight and share with the audience.
Jacob, thanks for coming on. I appreciate it.
Thank you, Nathan. I appreciate you asking me to be on. I'm excited to talk to you.
Before we get into what we want to talk about, which is developing your leadership team and creating, implementing and utilizing policy procedures in your clinic, share with the audience a little bit about you and what you've done up until this point to get to where you are.
I live here in Wasilla, Alaska. We have a clinic out here in Wasilla but we also have a clinic about 40 miles south of here in Anchorage, Alaska. We started Empower at the end of 2016, the beginning of 2017. We're excited about having it and being around. Nathan talked to me and introduced me to a coach that helped me but as most practice owners, I’m working 45 to 50 hours a week of treating and then trying to fit in. In addition to that time, hours to try and do marketing, admin trainings, business management and grow the business, anything and everything else that most clinic owners do. It was right around that time in October, I had my second child with my wife and I was exhausted. You know how that is with a new baby. I thought, “There's got to be a better way. This can't keep going this way.” Nathan is the one who introduced me to a man named Jamey Schrier. Jamey's program is the Practice Freedom U. I got introduced to him first. I started down with some coaching and consulting. Nathan also reached out to me when he started coaching to become a coaching client of his.
I quickly jumped on board because I realized, through Jamey's program, that I had no idea what I was doing as far as running a business. I needed people who knew how to run a business to show me what to do. That's a big thing that prompted me to get started into taking control of my business and deciding I needed to do something different. Through a lot of that coaching, consulting and education, I started to turn around things with my business and say, “This is a business. It's not a job for me to come in and do every day.” It changed me and my family's life and where I am.
Before, I was still treating full-time. I had a couple of admin blocks here and there. We made the transition and I started carving out more time to work on the business. Now, I'm completely out of treatment and I've built a management team that helps me run all the day-to-day operations of the business. As Jamey said, we've implemented a lot of policies and standard operating procedures that helped guide who we are and what we do. I've been able to take a step away and focus on the business. That's where I've come from and what I've done. It's been years of a journey here.
First of all, congratulations. I remember when you first started opening up your clinic in town and I had met you and I thought, “Here's a guy who's opening a clinic like I did years ago. He probably doesn't have a lot of business training.” I remember I sent you a book or two because I'm like, “You're going to need some help.” I had Jamey Schrier on the podcast a couple of times and I was like, “I'll throw some contact information on Jacob’s way and see if he could use some help.” That seemed like a real turning point for you where you started getting a handle on how to run your business and what you needed to be doing.
When I started working with you some time ago, it's cool to see where you are from December of 2019 to 2020 and the changes that have evolved in your company. Part of it is like what you said that you developed some policy and procedure and standardized operating procedures. You've also started to build out a real leadership team, which is vital to take some of the burden off of every owner. I wanted to go down that path a little bit. When we first got started working together, you didn't have a designated office manager. If you follow the traction and rocket fuel organizational structures, there's the visionary at the top and the integrator. She was essentially your integrator but you didn't have well-established clinic directors of both places, it didn't seem like. You were the clinic director for both locations while you're also trying to treat patients. Am I right?
I want to talk a little bit about your successes and some of the things that you've done right, some of the things you've done wrong, or what you would have done differently. In talking about that, share with us a little bit about how you started working in developing a leadership team. At this time, they're doing a lot of stuff on their own. What was that transition looked like? What did your leadership development program look like per se?
The leadership team and the management team has been the biggest thing that's allowed me to step out of the business as far as working in the business and start to work on the business. It wasn't an overnight thing. One big thing was I was hoping I could turn to my office manager and say, “Now you're the practice manager, make it run.” It didn't work that way. Same with the clinic directors, I gave them the title. At first, this was talking about those mistakes, I said, “You're the clinic director.” I expected them to know what I meant when I said, “You're the clinic director.” Looking back, those were big mistakes on my part that I didn't provide any clarity for what I meant by that. I didn't provide direction and a clear outline of, “This is what I need you to do and expect.” I didn't set those outcomes for them from the beginning.
You didn't have a job description. That's essentially what you're talking about. A clinic director has these traits, these are their responsibilities, these are the product, or these are the KPIs that are measured by or are responsible for.
I didn't have that. I had written down a few things I wanted them to take over. It was, by no means, a clear job description. That was a huge mistake on my part. From your coaching and Jamey’s coaching, I knew I needed a management team. I started there. On one hand, it was good that I jumped in. I said, “We're going to build a management team.” I used to sit around and kept thinking about, “I’ve got to get it perfect before I do.” On the bad side of that, it did come with some headaches and a learning curve. That would be something I would have done differently. I would’ve got clear on what I expected from them and written it all out before I made them the clinic director or the practice manager.
When did you see some traction as far as their growth and taking on the responsibilities that you expected? When did you start seeing some of that? Did certain things start happening? Did you implement certain trainings or something like that?
To be honest, it was during COVID. When we got hit with COVID, I relied on them and leaned on them. At the same time, I had some more time to flush out a lot of these things. At that point, we had 4 or 5 months of struggling through like, “I expected you to run those reports and they didn't get done. Make sure you do it next time.” It's me telling them here and there instead of having it all written up to this and move on. I was realizing like, “I've got to get this all organized so they know what to expect.” It was during that time, end of March, beginning of April and May when COVID was at its worst up here as far as shutdowns and all that stuff. We banded together. We spent some more time training with each other. They got to see more of what I was doing because I was there with them more. On top of that, I had more time to sit down. It’s almost going through that trial together and build some managers. I’m not saying everybody needs a COVID to build their managers but it forced me. I realized, at that point, I need these things or I'm not going to have a business. In the future, I hope COVID never happens again. That drove me to say, “If I don't figure this out, in a couple more months we're not going to have a business.”
COVID might have forced it. If someone is not going through that stage of a pandemic, recognize you've got to dedicate and set aside training times. I'm assuming you sat shoulder-to-shoulder with them, looked at reports, talked to them across the table about how to handle things, “This is what we do and this is how we handle this.” If people are outside of the pandemic and they feel like they're too busy, I even told a client, “You've got to take time away from them being on the floor to train them or else you're going to be spinning your wheels.”
That was the scariest thing for me as a new business owner. Cutting my hours or cutting other therapists' hours to train them or to work on creating a job description. I couldn't see past like, “I'm going to make a couple of hundred dollars if I'm out there and my PTs are out there.” I couldn't see past that. By taking a few hundred dollars that we would make by being out there for these two hours, training, going through this and writing this up, it's going to pay huge dividends into $1,000 down the road. Out of everything you said, taking the time was the scariest thing for me.
I remember you and Jamey told me, “You've got to start blocking some time and working on the business.” That concept was hard. It took me a couple of months to do it. It took me a full year before I got out of treatment. I was working with you for over a year before I was like, “I’ve got to get out of treatment.” It was cutting hours back-and-back. It's still a scary thing to do once you've trained for it for so long in your life is to treat patients. That's what you want to jump back into doing because it's easy and you feel comfortable with it. I can step out there, treat these people and make some money. Taking time is vital. No question, that would be huge advice for someone down the road.
It's a mindset that every PT owner I work with has to get over. The first one is taking themselves off the floor. Even though they know that's what they need to do, there's some mental barrier in there or whatever it is that keeps them from doing that. To take another provider off the floor, I'm paying them for me to train them, how does that work? They can't flush that out psychologically. It's a hurdle they have to get over. Inevitably, every time they do it, there's a positive response. They're like, “Why didn't I do this earlier? Now, I can see that.” You have to go through that experience to figure it out.
I knew this was going on. The thing that stuck out to me in our mastermind meeting was when you talked about your wins. One of your wins is your management team was able to resolve a problem without your personal intervention. You might have discussed it, whatever the problem was, but they handled it without you. That's another level of ownership where they follow policy and procedure to resolve an issue without you. That's next level ownership and something to get excited about to try to replicate over and over again. Share with us a little bit about your win there.
The incident that we're talking about, in particular, we have a policy or a procedure in place on how to handle patients that are no show and patients that miss an evaluation or miss a follow-up visit. We have different ones for what they miss. This was an exception in their mind. Usually, those exceptions in the past would come to me like, “What do you think about this person? They did this, but then their dog got sick. They should give him leeway on this one.” Inevitably, they would come to me as what do I think? I was supposed to decide and tell them, “Go do this for this case. In this case, let's do this.” We got a lot clearer lately. We wrote up in a policy and procedure, “This is what we're going to do and this is the procedure.”
I had come back into the clinic the next day or later in the afternoon. They said, “We tried sending you an email or calling you and we didn't get ahold of you. Ignore it because we figured it out. We went back to the procedure and followed it. That patient is taken care of.” I don't even remember what happened honestly. They either booked out or they told them they're not coming back. That's the thing that was nice. When they told me that, I sat back like, “I didn't have to do anything with that. They took care of the issue and they resolved it.” I’m not even sure who the patient was or what happened. It’s exciting for me to say that.Look at your business as a business, not as a job for you to come in and do every day. Click To Tweet
That's a new experience for you.
It was, it's the next level. You can write up those SOPs but then the training and getting people to do them, that's next level. It was exciting to see.
Number one, you weren't necessarily involved. I was joking you need to turn off your email a little bit more often or not answering the phone. Number two, the policy worked. That's like, “Something that I wrote about worked. That's cool.” That being a new experience is what you're looking for. Back in the day, we got to a point with our leadership team and our clinic directors, if they came to us with a question like you had, our response was supposed to be, “What does the policy and procedure manual say about it?”
Even though we knew the answers in our heads, our job and our leaders’ job if they were talking to the clinic directors was, “What does the policy and procedure manual say?” It's too easy for them to send out an email or make a call and get the answer than it is for them to do some footwork, look through the paperwork and try to find it. If you're going to make that policy and procedure manual, live, breathe and have some meaning, you have to guide them back to that over and over again until they get a clear message and then say, “If the policy procedure manual doesn't give you the answer or you try it and it didn't work, then come talk to me. Don't come and talk to me until you’ve followed the procedure.”
Another cool story, I did an out-of- office visit at the surgery center. I went down and did an eval for a new patient. We document those a little differently and the way we get it to our biller is a little different. We updated the procedure of how we do these things. I wasn't even sure how we did it because I wasn't the one that updated the SOPs. Something cool was my practice manager was the one who updated and how we do it, “This is the system.”
You're telling me that people besides you are making policies?
Now, they are. That's another big thing that we've started doing. My practice manager has done several of these procedures.
I wanted to gloss over that. I want to make sure that stood out.
Another big thing for me in the beginning was I felt like I had to do all of these procedures and write down all the systems that we do. It was overwhelming. I can't even tell you everything we do. I couldn't write it all down, let alone the whole team. Once you had said it or someone is like, “There's no reason why my new patient coordinator and the practice manager can't write her own procedures and systems.” They've been writing them out.
Back to the story. I was the lazy one and I was looking around and saying, “Where are these supposed to go?” My practice manager pulled out the SOP binder and said, “Right here.” She's the one that pointed, “Here's what the system says.” I was laughing about it. They were all making fun of me. You can tell I was fish out of water in my own clinic. I went and put it where it needed to be. It was too easy to ask around than it was to go to the manual. It was good. She brought me back to it and said, “This is what we do.” It was a cool experience.
That's been their MO this entire time and not any fault of theirs. That's how they've been trained to get answers. As you start implementing these policies and procedures, it's going to take a learning curve and a redirection regularly before they get the message. If you have a question, figure it out through the manual first and then talk to your supervisor if that doesn't answer the question or if you don't get the result that you want. That's what is super exciting about it. I assume that all that grinding and hard work feels like it's paying off.
Not only is it paying off in the sense of my overall workload has dropped dramatically. I've been able to hand off a whole bunch of different things and tasks that I was doing. It's paying off in the stress level of my life and the time I get to spend with my family. I'm not working every night anymore like I was. I would get home and put my kids in bed. By 9:00, I was back on the computer. Every practice owner knows what I'm talking about. If I was doing notes or I was writing emails, I was on the computer from 9:00 until 12:00 or 11:00 PM. I'm not doing that anymore. My wife pointed that out and she said, “It's been awesome that we can be together, not have to worry about me being on the computer.” It's paid off in the overall profits of the company. Financially, it's paid off. We've had some huge growth. No way I could have done it without growing my management team and bringing on other people too.
We didn't even mention that. You were striving to hit 800 visits a month and now you're up to over 1,100 visits a month if I'm not mistaken.
We went over 1,300.
Over 50% increase in one year.
It was nuts.
We had some big growth. Thank you.
In a pandemic no less, right?
Yes, it was.
Your leadership team, new clinic directors and practice manager, how do you think they feel now that you've given them these responsibilities and they've made this progress?
They feel a lot more ownership of their position. Before, it was obscure and vague of what they were supposed to be doing in that role that they reverted to what they feel comfortable in, treating or running payroll. That was a big thing Bree did. Bree would go back into authorizations or something that she felt comfortable with like, “I know I can do this. I'm going to go do it.” Like we do when I don't know what to do but I know how to treat someone, so I'm going to jump back into treating. This has given them some clear direction and I know that they feel more comfortable with their abilities to lead and manage and their ability to own what they do in their positions.
I feel like you're now becoming a coach to them.
I have a quick half-hour sit down with each one of them once a week and we model a coaching call like, “What are some wins from the last week? Let's review it. What are some challenges we're working on? What are some things I could do to help?” We model a coaching call through that. It's been awesome and fun to do.
You've made this great progress, you've got the beginnings of a management team in place, your policy and procedures are starting to come together, and they're starting to gain some traction. What do you think the next steps are that you're going to be working on?
That's the role of the owner. It's always looking ahead, looking to the visionary of, “What's next? What's down the road?” Before, I was always like, “Let's look what's down the road.” Instead, I would put my head down and see what was right in front of me. I didn't want to trip over that tree branch and so I could never see what was coming up to the horizon. What this has allowed me to do is look to that and say, “This is what I see in our future.” A new building for example, bringing on a new service line. We did bring on massage therapy. We'll bring on occupational therapy. It’s allowed me to step into that role of, “How else can we empower our community?” That's a phrase we say and our clinic being Empower. How else can we do that? By me, working on the business, we can reach more people that way. That's exciting for us.If I want to get from A to B, it's a process, a road to go on. There's no secret sauce to make it happen overnight. Click To Tweet
Were there some books that were influential not just for you? Have you shared any books with your management team?
We read a book now. We try it once a month. It's been once every two months or so. I had them all read with me the E-Myth so they can understand what I was going to be doing. It’s like, “This is where I'm moving to and what I'm going to be spending a lot of my time on.” A lot of the Mike Michalowicz books were influential for me. Profit First was awesome. Clockwork was a great book. I've read most of them, The Pumpkin Plan and a couple of others. Those are influential. Jamey Schrier’s book, The Practice Freedom Method, that's a good book. My management team is reading that too because we're talking about marketing, active appreciation and a couple of things along that line.
If you can look at your leadership development program, if you will, some of it was shoulder-to-shoulder training and there were some books involved. Was there anything else that you did to help them learn and grow whether it was leading out on meetings or heading up other programs and stuff like that?
There are a couple of things. One is I did end up giving them some responsibilities and said, “I want you to do it.” They took it over even if it was rocky to start. Bree runs our team meeting now. Before, I always did it all. She took that over. Even if it was rocky in the beginning, she's run with it and does a great job with it. The other big thing, we also sit down all together once a week for 30 minutes. When I say all together, I mean the management team, the four of us. That helped a lot because there was no real coordination between us. I would be going one way, Bree would be trying to do something else, the other two clinic directors had no idea what we were doing, and that didn't help them. This at least got us coordinated and said, “This is what we're going to work on and this is how we're going to get these things done.”
It's simple things like that. When I talk to clients about developing leaders in their clinics, they have a deer in the headlights looking and understandably so. It simply goes back to having opportunities for communication and a meeting rhythm works. What did you learn to make you a leader? What books did you read to make you a leader? What is your agenda for leading out on a team meeting? How do you remind them of the values? It's little things like that. If you took 30 minutes and wrote down what you did as a “clinic director,” then that's what you would train the other guys on and that becomes your development program.
I've had a couple of PT owners that we've talked to that have asked, “What did you guys do that last a little bit?” Honestly, I've told everyone, “Nothing complicated, out of the box, obscure or crazy things.” Mainly, it’s been a lot of simple processes and they've started to get traction to where they're finally taking off. Part of it was the fact that we kept doing it during that time when they weren't getting traction. We could have turned back and said, “This isn't working. Let's scrap this whole procedure thing. Let's scrap the management team. I'm going to take back over.” It’s like he says in the E-Myth like, “Fire everyone and I'm going to do it again myself. This is a headache.” I knew that I didn't want to do that. Sticking with it, eventually it paid off. A big thing for people to think about is it's not going to change overnight. It’s been years for me to get here. Even then, I don't feel like I'm there. It's not like, “I'm done.” At the same time, I'm in a way better place now than I was years ago. It’s important for people to look at that and say, “If I want to get from A to B, it's a process and it's a road to go on. There's no secret sauce that tomorrow or next month, I'm going to now be all of a sudden done with treating and out of all this.”
It's great to hear your experience and you can share some of the details about it. That's why I was excited about having you on to show owners that it can happen. It can happen within a couple of years. You’ve got to start doing some of the hard work, start putting some intention and development behind it, and it starts coming around.
In Jamey's group, we talk about something we call the deep work. The deep work that the owner needs to do and that's vision planning, value building and culture creation. It's all those things that, a lot of times, you don't do because you're busy treating or managing the fires. Taking the time and doing that deep work pays off huge in the end.
Thanks for spending a little bit of time with me and sharing your experience. It's great to have that experience and see that happening in real-time. Number one, congratulations. Number two, keep it up. You're doing great things.
Thank you. I wouldn't be anywhere now if it wasn't for Nathan and Jamey's group. You've helped me a ton to get where I am. It's a huge difference from where I was before. I'll put a shameless plugin for Nathan's coaching. He's helped me a ton and it's been awesome. You may have even talked about some coaching when we first met and I blew it off because I was like, “I'm too busy for coaching.” It's one of those things I would now say, “I would never start a business without a coach and without this type of training.” For anybody out there that's considering, “Should I pay for a coach? Should I pay for some extra education or training?” It’s more than worth your money to do that. I would have never got to where I am without that.
It's the formula. I don't think I've interviewed an owner yet, a successful owner at least, that hasn't stepped out of treating full-time, got some coaching or consulting and continues to network. Whether that's in a mastermind, PPS or small business organizations, they're doing all three of those things on a routine basis. It's a formula that hasn't been proven wrong so far. If you want the stuff that you're talking about growth, freedom and the ability to develop what you want in a business, then that's the formula right there. Thanks for sharing your experience.
Thanks for having me. I'm happy to be on.
Thanks for your time. Thanks for coming. I look forward to hearing more about your growth in the future.
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Whether you’re an owner or employee, you’ve probably experienced burnout in your job – that state of emotional exhaustion, depersonalization, lack of accomplishment or growth that hits even the best among us. In this episode, Nathan Shields is joined by Professional Rebellion cofounder, Phil Plisky to discuss why we tend to feel that way and what can be done if and when we're at that point. Phil is also physical therapist himself. His passion for solving the problem of burnout in the PT industry is part of the reason for developing the company. This discussion is important for PT owners, but it is also important for owners to recognize when their team members are at that point and how they can help them get through it. Listen in and learn, among a lot of other things, how burnout can be a good thing even though it sucks.
In this episode, I've got Phil Plisky. Phil Plisky is a Physical Therapist and Cofounder of Professional Rebellion. He's also a faculty at the University of Evansville in Indiana. He is a consultant for professional athletes and the military. He has a cash-based private practice in Indiana as well. He's run the gamut. He's doing a ton of great stuff. We want to talk a little bit about something that he's been passionate about and one of the reasons behind developing Professional Rebellion and that is burnout in the physical therapy industry. Before I get too far into that, Phil, thanks for coming on.
Thanks. It's great to be here. I'm excited to talk to you.
I'm looking forward to the conversation. I first learned about you because you co-authored an article in Impact Magazine in August of 2020 with Jenna Gourlay. I plan on having her on the podcast later on. You guys talked about navigating difficult conversations and I thought, “What a great article because many PT owners have to have these difficult conversations. They don't know how to where to start.” We didn't have that training. I recommend owners to go back and read the article because there's a lot of great information on there. I'm also going to do an episode with Jenna specific to that article at another time. Phil, we're going to talk a little about something different. Before we get into that, do you mind sharing with us a little bit about your professional history and what got you to this point?
I always tell people I graduated from PT school in the last century. It provides a little bit of context there. I've gone through the standard gamut of being a staff PT, going back to get my Doctor of Science degree, changing jobs every eighteen months to three years. I would love a job for a year and then start to hate a job. I’m always trying to get something new. I opened clinics for hospitals. I've been Vice President of different private practices. I did a lot of different things in search of that great career. I can't tell you how many times I was burnt out. I didn't like what I was doing.
You're not talking about the patient care aspect. You're talking about the responsibilities that were peripheral to them.
The amazing thing is it didn't matter what it was. If I were in patient care, I would get tired of the patients and I'd go, “I want to do management.” If I got into management, I would get tired of approving time-off requests and dealing with the paperwork and the staff training and all stuff. I'm like, “I'll go back to be a staff therapist again.” I did that and I loved it for 12 to 18 months and then I got bored. I developed the Y balance test and did research and did a lot of different things that way. Every single time, no matter what it was, I would get tired of what I was doing. Being in my ideal career, I recognize that people don't have a lot of help and I wish I would have had that help to know what I should be doing and how to get there.
You and I sound like we're about the same age. I graduated from PT school in ‘99. Maybe we still have a little bit of that mentality of growing up and you join on with the corporation and you build and grow within it. We're on that cusp where people are not doing that as much. Our parents have that mentality. It was awkward to get into a job and be switching it after eighteen months, like in my personal career, and not be with them for a long time and not envision myself going up the ladder in leadership and stuff like that. I'm assuming that you found that what you were experiencing wasn't unique to you. Maybe you came across other physical therapists that were having the same issues.
I did. What was interesting about it is I looked at some of my mentors and one of them is still practicing and doing patient care 8:00 to 5:00 every single day, Monday through Friday, and that wasn't me. I felt guilty about it. I felt like I was a bad physical therapist, a bad person. 8:00 to 5:00 patient care got old. I never had anybody tell me that was okay. Not all are cut out for that. It's probably rarer that we're cut out for patient care for 40 years, 8:00 to 5:00 only.
You don't see a physical therapist doing that.
They don't. It's an emotionally and physically taxing job. It can start to feel like factory work after a while.
Consider some of the geographical issues that you have when reimbursement rates are low in some cases. It's hard to provide that one-on-one dedicated care for 30, 45, 60 minutes. You’ve got to do what you’ve got to do. You’ve got to be profitable to sustain.
That was one of my favorite jobs. I was the Vice President of Clinical Excellence. I had always said my role in that position was to uphold the two pillars of the practice. One pillar was clinical excellence, which means delivering that outstanding care that's scientifically-based, research-based, and has great outcomes. The other pillar is making a profit. If you don't have a natural tension between those two pillars, then your practice will not succeed as well as it can. An ideal patient care, without looking at profit, is not going to be as effective or efficient. If you look solely at profit, that's not going to be ideal patient care. There should be this natural tension and that was my responsibility. I enjoyed that role for about eighteen months.
Was this the genesis as you're recognizing that you don't want to be this guy that's treating patients 8:00 to 5:00? Did you start looking outside of your network for a mentor that could guide you on your professional path? What brought along the genesis of Professional Rebellion?If you can't lead the person, if you can only give them answers, then you’re not being the best coach. Click To Tweet
It was the absence of that mentor that brought it about. It was not until about 12 to 14 years into my career that I truly figured out what I wanted to do. I had no one along the way. I could have easily ended up quitting physical therapy altogether probably anywhere from 3 to 5 years in. Fortunately, I was driven to get my Doctor of Science and do all these other different things and research. Through that, a lot of different doors opened for me and that kept me engaged.
There wasn't anybody there for me. I had great clinical mentors, absolutely amazing. There wasn't anyone to describe the path, describe these feelings of discontentment and what to do with them, and what's the next thing. Even as private practice owners, we get into starting the practice and that's exciting. We start to see some success and that's exciting. Somehow, we start feeling like a rat on a wheel again. It’s like, “This is what I was trying to escape practice before. Now, I suddenly feel the same way.” What is that cause?
As part of the Professional Rebellion, what are you telling? You work not just with PT owners. You're working with what you call staff Physical Therapists as well in helping guide and mentor and help them create the professions that they want to live in. What do you tell them at the beginning? Can you share maybe a couple of nuggets? Where do people start when they're burned out?
My mentor, Gray Cook, who I eventually stumbled on, helped me professionally and clinically. When we're working on projects together, when we're developing the fundamental capacity screen or whatever thing we're developing, we always say, “Let's define what's going on.” I like to start defining burnout. That label was thrown around so much these days and it doesn't matter the profession. We see this in teachers. We see this in police officers. Everybody is talking about burnout, which is also perpetuating it as well.
When you look at burnout, the clinical definition of it is emotional exhaustion, depersonalization and lack of sense of personal or professional accomplishment. That's a pretty severe definition that we say there. Many of us can suffer from that and that becomes a big problem. When we use the word burnout, we're saying, “I don't like what I'm currently doing. I hate going to work. I hate my job. I can't stand X or Y.” We almost then have made burnout synonymous with being overworked. Sometimes it is being overworked, but sometimes it's being underworked or under-challenged. There are a lot of different things that go into that.
If you think about your career or my career, how is it that we can have a job that we love for 12 to 18 months and then suddenly, it becomes the worst job in the world? How does that make any sense? How can we open up our private practice and love it and it's exhilarating and exhausting all at the same time and then start to hate it? That doesn't make a lot of sense. Quite frankly, your duties haven't changed. There's probably no harder time than the first eighteen months of starting a private practice. Every owner will tell you, “There's no other time than five years into practice. There's no other time than ten years into practice.”
I love that you add underchallenged into that definition. As I'm working with some of my PT honors as coaching clients, they've been PTs from 2 to 15 years. The ones that have been around a while, their concern isn't so much necessarily finances as much as it is, “I'm done with this.” They'll use the word burnout. There are a couple of things that come into play. I like the idea that there's a lack of challenge at that point. You've seen a lot of the diagnoses. You have a toolkit in your repertoire of treatment and care. You've made some financial gains. You're pretty safe there. You're seeing a lot of the same people. You'll get a lot of returning patients. You've got a team that's been with you for probably a few years. You have some of the emotional ups and downs with HR. At that stage, more than likely, the burnout is coming from what they call burnout from being under-challenged.
Beyond severe, clinically defined burnout, it comes from either having lack of clarity, challenge, or community. Those are the defining things that I would dare to say might hit 80%, 90% of the root causes of burnout.
Delve into that for me. I have an idea of what you mean by lack of clarity. Tell me what you're talking about there.
Lack of clarity can come in a couple of different ways. One is having a bigger purpose for your life and your career. As private practice owners, you all are familiar with purpose statements, mission, vision, Simon Sinek’s Start with Why, the whole nine yards. We're all aware of that. It's important to have that. If you don't have that, that's going to be a big problem. The second part of clarity is where a lot of private practice owners and physical therapists struggle is, what does actual success in what I'm doing day in and day out look like?
Here's an example of that. There's a manager of a PT practice that I know. He's truly a manager. He’s been doing it forever. I looked at him and I said, “How can you do that? You're approving time-off requests, dealing with front desk staff, turnover, and all this miserable stuff.” He's been doing it forever. The reason is he's defined what success looks like for him. Success looks like, “I want to be home and emotionally detached at 5:00 PM. I want to be with my kids. I could climb higher, but I don't want to.” We forget what success looks like or what that definition is. What data are we going to use to know that we're being successful?
As entrepreneurs, we're great at moving the goalpost. It's a constant movement. It's like, “If I have my own practice, doing my own thing, I have that freedom and flexibility.” Suddenly, you get it and you're like, “This isn't freedom and flexibility. What the heck happened? When I add staff, then I'll be able to get freedom and flexibility because they'll be doing all this stuff I don't want.” You're like, “Maybe once I have an office manager, someone who's responsible for all those things,” suddenly you've complicated your life and you're like, “I still have less freedom and flexibility than I had before.”
It's funny that you bring this up because these are the first things that I talk about when I'm with a client. Even before I get a client, I'm asking them, “What are your goals? What do you want to achieve? What's your ideal scene with coaching, with me in the next year or two?” That's a hard question for a lot of them to answer.
Here's the thing. A lot of times, once you're seeking help, you're already drowning. When you start asking goals and stuff like that, and this is what I've done and I continue to make this mistake, I talk about asking the goals which is like shouting at the drowning person like, “Thumb goes into the water first. It’s the proper swim stroke and then it's bobbing up and down.” That’s the wrong thing. Let me show you a life preserver first and then we'll talk about how do we swim better.
A lot of it goes back to clarity on purpose. Many clients will come to me and say, “What's my next step? I've got some freedom. You've coached me to a point where maybe I'm not treating as much or not at all.” They'll say, “What's next?” You tell me. Where do you want to go? What's your purpose for this business? Now that you have some time and freedom, what do you want to do with that time and freedom? That can be a hard question to ask.
It's not only hard. It's scary. We tend to bury ourselves in busyness, which gets us to our second concept of challenge. Private practice owners are particularly susceptible to it, “Once I, fill in the blank, I will be able to and fill in the blank.” You get there and it's not what you thought it would be. It is about that purpose and that challenge. You can't look at your day and go, “I'm not being challenged.” Every private practice owner has way more challenges than they need. It’s like, “Am I growing intentionally?” That's why we seek that new thing and why we're tired of where we're currently at. What skills and abilities am I working on intentionally to do that new next thing? If you can't articulate that, then that is probably also beyond clarity. That's another source of this feeling of burnout.
The way that they articulate it is to use the word burnout. From what I'm gathering from my experience is that when they're getting to the point of burnout, they're like, “Something's got to change.” They can't articulate it. Maybe they'll use the word burnout. To me, from an outside perspective, they're not living their purpose, but they don't know that because they're not clear on that purpose.
To sit down and get some clarity is going to require a lot of attention, soul searching, time and effort. It's not easy. I'd rather go do something and check that off my to-do list than to sit and think about what I want to get out of this life and find a purpose for myself because then I've got to be intentional with my actions. Personally, I might hold myself accountable. What I'm doing now might not be in line with my purpose. That conversation, they can't necessarily articulate it. What it says to me, in no uncertain terms, is they're not living what their ideal scene was in their head even though they can articulate it.The best times in your life are often the ones when you are the busiest and most challenged. Click To Tweet
Moses has these Ten Commandments written in stone. Your purpose is written in stone. We're taught that in business. When you make your company's why statement and your mission statement, no matter what happens, it should never change. It shouldn't be a moving target on a monthly basis or maybe even an annual basis. Sit back and reflect and go, “What is that?” Fortunately, one of the ways that I did it in my career and it was pure happenstance is every position I took, I always said, “What do I hate about what I'm currently doing? What do I love?” The only way I'm going to move positions is if it has more that I love and less that I hate. I kept iterating that process over and over again to finally start to develop my ideal career.
It would have been way easier if I connected it to that clarity of mission, my not-to-do list. You ask for goals and you can diagnose a lot. One of the things that I love doing, particularly entrepreneurs, is what's on your not-to-do list? They're like, “My to-do list? Did I mishear you?” I'm like, “No. What do you intentionally not do and are okay with it?” If they can't articulate that, that also tells me where they are in their clarity.
It's funny that you brought that up. I had that experience. I was setting some goals and I did a number of personality tests. The Kolbe test that I took for personality came back and told me that I should not work with small engines. It specifically said that.
I like that. That sounds like a great test, something that gets that specifically. When I grew up, I can fix about any engine, but I hate every minute of it.
It bled over into my family life. I would spend a Saturday working on something and trying to figure it out, watch all the YouTube videos. I'd come in and I'd kick the dog and throw some pans and my wife is like, “Steer clear of dad today, kids.” My goal was to hire out every repair. It's been such a blessing in my life.
We do a lot of coaching and consulting on, “Am I ready to start my private practice?” One of the Litmus tests if you're ready to start your private practice or not is how many professional services besides medical do you pay for? Whether that be the guy that fixes a toilet or a lawnmower, if you don't value the skills of those professionals, you're going to have a hard time convincing your patients to pay you for your professional skill because you have said, “I don't value the skill of that.” If you can get into that idea like, “I value that. I need an assistant.” There's always something in me like, “I don't need it. I could do it myself.” It’s like, “Why?” I hate it. There are people who love it. Why don't we create this great symbiosis that you'll take what I hate off my plate and I'll pay you? That's the whole goal.
There was so much of that in Tim Ferriss’ The 4-Hour Workweek where he talked about virtual assistants. I've got a number of clients that use virtual assistants. In the past, I've used Fiverr to farm out marketing projects and stuff like that. It can make life much easier, opening your mind to the fact that there are people in this world who love doing the stuff that you hate. They're good at it too, so much so that it's worth you not wasting your time and energy and saving your time, energy, emotion, and all the psychological baggage that might come with it. Letting other people do that can be freeing.
We'll give a caution with that. I've got a friend who works a white-collar job. He's in the office in a suit every day. He loves going home and working on his landscaping and building a retaining wall and remodeling his basement and stuff like that. I did that growing up and that sounds like poke-your-eye-out fun to me. He enjoys that. He finds that relaxing. It's not that you have to pay a professional for everything. You have to pay a professional for what you're not good at and don't like.
That can also be tough as small business owners because initially, we wear all the hats. Even if you have the time to do it, it's hard to pay somebody to do it because you're mining your expenses or bootstrapping things. What could you be doing better with that time, even if it was thinking during that time? Your time is that much more valuable to consider the path that you want to take your business, maybe a marketing strategy that could net you more patients, goals for the upcoming year that could stretch you and help you grow further. Even an accountability meeting with a team member could get you so much further than going in there and calling the vendor and telling not to come.
“You're going to buy this or do that.” One of the practice owners that I work with, this was before he started working with me, he takes his Tuesdays and Thursdays off “to work” on the practice back to that work in the business versus on the business type of thing. He takes Tuesdays and Thursdays off and he could be doing patient care. He's a great therapist and does well. Yes, sometimes it is doing the duties of a private practice owner that he does on those Tuesdays and Thursdays. He also has specifically slated time for thinking. We don't do that anymore. That's considered taboo.
That would be considered unproductive time. You can't bill for that.
I don't even know what code that goes under. Medicare is certainly not going to pay for that.
There is that hurdle I have to get over with owners because their thought process is, “I'm exchanging my time in treating this patient because I know I can exchange my time for money with an insurance company by treating this patient.” To get them to the point where they're spending their time working on the business, they don't understand the exchange at that point. I don’t recognize that.
That's exactly right. I found that time and time again. Along with that is a lot of private practice owners are great leaders, which means they feel that they should be in the trenches with everybody. Otherwise, they're not being a good leader, which I love that heart and I love that spirit. That does make an excellent leader. At a certain point in time, you've got to pull out of the trenches and you can't feel guilty about it. Getting over that guilt is probably one of the hardest things. I can almost better make the argument for the finances of it than I can about the guilt of it.
It comes up time and time again. I want to know what you would say to those owners because they feel guilty and they worry that their team members are going to resent them because they're not on the floor with them anymore.
It's about being a good example. We're talking about burnout with private practice owners. Private practice owners have team members that are also burnt out and they burn out quickly and crazily. It's about being a great example for your team members and going, “What do you love to do in your day?” “I love wound care.” “You want wound care? Who loves wound care?” “I do.” “I love working in women's health.” “Whatever it is, let's get you doing more of that. Tell me what you don't like.” Do that with your team members and then be explicit with your team members.
What I love to do is provide an environment that you can thrive and grow in, in such a way that we're paying the bills. We can survive pandemics and still be able to pay you. That's what I think about on Tuesdays and Thursdays. If we let our team know how much we care about providing stability for them and providing growth for them, they'd be like, “Of course, he needs Tuesdays and Thursdays. Maybe he needs Mondays, Wednesdays and Fridays too.” The focus is making sure that I have the opportunity to grow and the opportunity to be paid. I want that guy on that wall the whole time.
That's been my experience. As these owners make that transition, they feel that way initially but that's not the reality that they go through. People don't express resentment. They're looking for them to answer questions but that doesn't mean they necessarily have to be treated on the floor. When they do take the time to improve the business and improve the working environment and have those conversations with team members that they didn't have in the past, that's when the team comes back to them and says, “You need to be doing more of this stuff. Whatever you're doing on Tuesdays and Thursdays, whatever you're doing with your coach, whatever you're learning at the consultant, you need to be doing more of that. How did we ever get by with you treating full-time to begin with?” Those are more of the comments that are coming back to them when they start working on their business and having those conversations and focusing on their team.
If we said that lack of challenge is a responsibility for feelings of burnout, whether you're burnt out or not as we said is a question, but if lack of challenge is there, modeling for our team members that we have a coach and a community is the third secret to combating the feelings of burnout. We need to be challenged. I'm an introvert by nature. I like to sit and think by myself and not talk to others. This pandemic has taught me that I am not. I thrive on working with people.
One of my values is collaborative creation. It's being in a community of people who are challenging me, who are making me better. We’re working on something together to get better. Being a private practice owner is lonely. You can't talk to your staff about the problems you're having because you don't want to burden them with it. It's your responsibility as an owner. You also don't want to share your successes like, “We had a great Q4. This is awesome.” You got to have that community that's causing you to grow and that's asking you the tough questions like you do with your coaching folks saying, “What are your goals? What are you looking for? What does success look like? What does a win look like for you?” If you don't have someone in your life doing that, it's like being the lazy, out-of-shape PT, and trying to get someone else off the couch.
People look at you and go, “Why would I listen to you? You don't have it in order.” It's also about modeling that investment for your teams, like, “What kind of community do we have in our system? What kind of community do I have as a practice owner that people are thriving?” I've had some of the worst jobs. What we did was bad, but I loved every minute of it because I love the people I was with. They were like-minded. Private practice owners, they're running around solitary and it's lonely.
One of my mantras that I talk about on the podcast quite often is to step out, reach out, and network. It goes in line with what you're talking about. For PT owners, specifically, step out of treating full-time so they can spend time working on the business. Reach out and get some support. Get some business acumen, training, consulting, coaching, you name it, and network because it is solitary. Honestly, who is holding you accountable? I work with a number of owners that have been owners for over a decade and they say, “I've got all these goals. If I achieve them or not, no one's asking me. I'm not accountable to anybody.”Being a private practice owner is lonely. You can't burden your staff with your problems. That is why you need help. Click To Tweet
It goes back to what we were talking about earlier. Are you willing to pay for professional advice and help? I’ve got a financial planner. I love finances, it's a passion of mine. I can't read enough financial information. I could do everything he's doing. When I started working with him, I told him, “You are my personal trainer for finance.” It's not that I don't even have my own abilities to do my own personal training. That's not the case. It's accountability and clarity on data because we're our own worst judge of how we're doing. Think about working with patients, “How are you doing?” “I’m no better.” “When you came into me, you were not walking. You walked in, so you're a little better.” It’s not their fault. It's how we naturally are. We're looking at our current circumstance where we've always been and not where we came from and what we're doing. Having a coach and having a community around you goes such a long way to that satisfaction to avoiding that burnout.
There's so much to be said for being part of an accountability group, a mastermind, an organization of small business owners. It wasn't until I did that, that I recognize a lot of my weaknesses are commonly placed throughout all industries. I can learn from these other guys. I can get questioned by these other guys on maybe some false postulates that I have about, “I can't do this.” They're like, “Why can't you do that?” I give them my answer and they're like, “What?”
Don't you hate when you get that answer? It’s like, “That was obvious. I can't believe I didn't think of that myself.”
If you don't have that network, if you're not collaborating, you don't get pushed. You don't get stretched. You don't get invited. You don't get challenged. That’s where you can get some burnout because you're not getting challenged.
I'm going to say it's okay to say burnout because it's almost like the word love. It means different things to everyone else. Burnout could be actual clinical burnout or it could be, “I'm dissatisfied with where I'm currently at.” Sometimes, that dissatisfaction comes with a huge lack of hope. Nothing can change from that so I stay there. Use that dissatisfaction, use that frustration, as an agent to change something. If you're feeling frustration and dissatisfaction as an owner, you're doing it right because that means you have an area of growth that you need to work on. Go get some help working on that.
The problem is when you get that frustration and then you bury your head in the sand and keep treating patients and keep pushing forward, the frustration, the emotional exhaustion comes into play and, honestly, a lack of accomplishment. You know something's wrong and you're not taking the energy to fix it, “I got these distractions. These patients want to see me and I've got to see them.”
“I'm the only person that can see them.” That was a hard point in my career. I was like, “They want to see me.” Once I found out that they sometimes did better with other people, that bite of humility launched my career.
I have to broach the subject and it's hard for people to swallow it because I had to overcome it myself. It sounds like you did as well. There's an element of pride that keeps us from growing when it comes to pulling away from patient treatment to address the things that need to be treated. We get to that point where I've built this practice because of the way I've treated and interacted with patients. I can't trust someone else to do this job like I can.
The thing that we've got to keep in mind is if you love patient care and 100% can't see yourself doing it 40 hours a week, then you should be in patient care and you should be hiring a great chief operating officer to do the business stuff that you don't like. I don't think that's who we're talking about. We're talking about people who are hiding inpatient care. Business stuff is hard sometimes. It's awkward. We don't want to look at it. We don't want to deal with it. We don't want to deal with staff development and knowing that staff development is the secret sauce to their happiness. Remember, it's about your staff having clarity, challenge and community. It doesn't matter whether it’s your staff or not. Having those three C's there are critical.
You're talking about owners reaching out and getting some coaching. I've talked to a client to help him recognize that as you start moving up the leadership ladder and handing off some of your responsibilities and hats to other people, you are becoming their coach. You're helping them gain clarity. Help them feel fulfilled and accomplished. This helps them then avoid burnout, if you will, and also buy in to your culture. You're starting to develop a culture because you're becoming a coach to them and guiding them. It happens on different levels. We might reach out to the coach because where we're at is owners. We can be then seen as coaches to those who we are working with, especially our leadership teams.
Who’s coaching the owners on how to be coaches? One of the things I love that you do is like, “This is what staff development looks like. This is what handoff looks like.” When you're looking at what you're doing, you need to be spending a lot of time in coaching the people who are now your coaches and then approaching the people downstream from you. That's important.
Summarize for us your three things that you focused on. I remember community at the end. Remind us of the first two.
We're looking at clarity and that clarity is, do we have clarity of overall purpose, business purpose, and things like that? Also, do we have clarity on what winning looks like in our private practice or as a staff therapist or whatever? What is that clarity? Otherwise, we're going to keep moving the goal line. We're going to keep moving the goalposts. We're looking for clarity there. We're looking for challenge. How am I being challenged intentionally by other people to grow? What does that look like? It feels a little awkward but yet exhilarating. Think about all the different and hard things. This is why burnout isn't about being overworked. If you look at the best times in your life and go back and look at them, a lot of times, they were when you were the busiest and most challenged. It's not about doing too much. It's about not doing the right things.
We have clarity, challenge and then community. Who are you doing this with? Who are you gaining your clarity with? Who are you being challenged by so that you're enjoying the process of that? That may be your team that you're with in your private practice or it may be a combination of both, your team and your private practice and the group that challenges you, the people that challenge you, your coach that challenges you. If I look back at my career, my favorite thing was when I was working on a team with people doing something that no one ever thought we could do. That's been the most fun part. It was fun because we accomplished it. When we accomplished it, we're like, “What's next?” I sold the business and my partner said, “I know we've sold and you're disbanding people. We've enjoyed our time together. Whatever the next thing is, let me know. I'm on board.” Did you hear that? It doesn't even matter what the thing is. We had so much fun together.
I experienced the same thing with my partner. We work well together and we sold our practices. There are plenty of reasons why we communicate now because we've collaborated and we enjoy each other's company and we are aligned in our values and many of our purposes are similar. That makes it a lot more fun to work in that environment. I'll ask you a quick question and then we'll see if you have any more that you want to share. What would you recommend an owner say when a provider, maybe not even a provider but a front office person, a biller and they come to you and they say, “I feel like I'm overworked, I'm too stressed out?” Would you have any advice for an owner in that situation on how to deal with that conversation?
I can tell you what not to do because I've made these mistakes and it does not go well. Remember our analogy of the person drowning and then you're going to tell them about the swimming strokes that they need to do and how they’re whipping their legs exactly right and the breaststroke that they're trying to do. It's a horrible idea. Our natural tendency as entrepreneurs, as learners, and things like that is to throw information at the person and be like, “You’ve got to read this book. You’ve got to do this thing.” Those are important.
Don't get me wrong. There are a lot of books that I have that I recommend, but that's the worst thing to do when someone comes to you and has that burnout. The first thing to do is to be compassionate and to talk to them about the time that you were burnt out too and how bad it sucks. We tend to offer solutions way too early. We do this in relationships a lot too. It’s like, “This is my problem.” You're like, “This is how you fix it.” “Let me know that you're okay with me being burnt out.” That's the first message. It’s like, “It's okay. It's normal. It's common. Let's explore together how we can help that.” You have to be committed as a practice owner to truly doing that.
If you've developed a system that the only person that can thrive is the person that works 8:00 to 5:00, seeing X number of patients and billing X number of units, you might as well accept burnout and consider it like, “I know the guys at Toyota are going to develop lateral epicondylitis. We're going to have our lateral epicondylitis program. There's nothing to do about it because their freaking job sucks.” If you're not committed to being truly open to like, “What do you love? What do you want to do?” If you can do that and also either keep your minimums like, “I'm transparent with you in our books. This is what I pay you. This is what we make.”
If you want to decrease your hours, that's great. This is what it looks like. When you decrease your hours, I know that your margin goes down. While it may seem a one-to-one ratio to you, it's not a one-to-one ratio to the practice. If we're both okay with that, let's go down that road. This is the margin we need to make. Do you think you can make that margin in that specialty area that you want to go to? If you think you can, I'm going to give you some free time. We said that free time as an owner sucks. What about the free time as a staff therapist to go develop and go, “I'm going to give you this free time?” Like in my coaching group, they hold me accountable. I'm going to hold you accountable to that too.
If you're going to be given that 20% time to go develop, at three months and six months, I’d better see what has developed. We're going to make a decision every 3 to 6 months whether we're going to continue developing. The solution is helping the person gain clarity, help the person gain challenge, and help the person in the community. If you're not willing to do that, you pat them on the back and shove a book down their throat and it’s fine. Go buy them lunch because that's going to solve this problem.
We go to the solution partially because we are males. As you and I are talking, the first thing our wives don't want to hear is the solution to their problem because that's where we tend to come from. I agree, some of those solutions come best even though you might have the answer in your head like, “I know what you got to do.” It comes from them. If you can have that communication, “What do you need and how can I help you at this point?” your job as a leader is to create a foundation for them to succeed.
You've described the ideal coach which you have to be as a practice owner. The answer to burnout and all that, there are books on that. You don't even need me. You don't need Professional Rebellion. You don't need you. I hate to downplay your consulting service. You don't need it if it's all about knowledge. It's not all about knowledge. It's about relationships, community, and discovery. If you can't lead the person, if you can only give the answers, that's not the best coach.
They're not going to grow. Also, they're not going to gain from inner wisdom and experience. Sometimes you have to let them, “Go ahead and do that. Tell me how it turns out.” They might fall flat on their face.We tend to think of burnout as synonymous to being overworked, but it can also mean being underworked or under-challenged. Click To Tweet
If you know the idea is bad, it's going to be a little shorter leash. It's like, “We're going to follow up in a month with how that's going. If it's not going, then let’s maybe explore. Here's the deal. Let's look at that in a month. Where do you think you can be?” Gain that clarity, “I can be here.” “Let's follow up in a month and see where you're at.”
People can set up their own challenges. They know where their weaknesses are, most of the time. Even though they might not be able to iterate them, they can come to a conclusion pretty quickly. It’s like, “This is where my challenges are and this is what I need to focus on.” If they have that willing leader to sit down and talk to them and ask them those hard questions, that's when they can start seeing growth and then that leader holds them accountable. They're being challenged. They're getting some clarity like you're talking about. They’re collaborating and have a community in which to grow and accomplish and get all the fulfillment that they need.
I’ve seen some great practices built on the concept of community because community begets passion, begets expertise. People like being asked for. If you become the running guy or the running gal in the runners' community and you're a runner yourself, that's an awesome place to be.
You're serving and you're living out your purpose at that point and that's cool. Anything else you want to share with us? Anything that popped into your mind and you’re like, “I’ve got to get this off my chest.”
The key thing is to understand that the feelings of burnout are completely normal and you should look at them as a positive thing even though it sucks. That positive thing means that if you do it right, you're about to grow and get on to the other side of it and you'll be thankful. If you grow in the right process, getting that clarity, getting that challenge and getting that community, everything will go well. If you don't, rather rinse and repeat, you're going to be putting Band-aids on burnout as I did.
I love our conversation. I loved your definition of burnout, which was emotional exhaustion, depersonalization, and lack of accomplishment. You wrapped it up well. Once you're feeling those sensations, those struggles, you name it, if you look at them as opportunities for growth, then you got a cool future ahead of you because you're willing to take on that challenge.
This has been a lot of fun. I've enjoyed it. This is great.
If people want to get in touch with you, how would they do that?
The best thing is probably at PhysioRebellion.com. The Professional Rebellion is a parent company. There's the Physio Rebellion, which works with physical therapists. There's Private Practice Rebellion, which works with private practice owners. We're adding in the fitness or personal training around. My goal is that we would have both a teacher rebellion, a student rebellion. What we're teaching at the DPT program, I feel bad for these students. They are beyond burnt out and they are beyond hopeless.
Part of my goal as a faculty member is to re-instill that hope. I feel somewhat badly for maybe some other universities that don't have classes with dealing with this and developing more than your specialization. It’s like, “What is your career path look like?” It's okay to talk about how that involves your life and your vacations and your significant other and your dog. I love doing that. PhysioRebellion.com is specific for physical therapists. You contact me through there. You're going to have Jenna on. She's one of the cofounders as well. You can get ahold of her. One thing we look at as far as the coaching community is like with physical therapists, there's a right fit for certain people. I'm not the right fit for certain people. I'm willing to admit that there's sometimes way better people that can be your coach, can be your mentor.
I've had the same thing. I've had people come to me and I'm like, “You might want to try this other coach over here.” At least talk to 2 or 3 different ones before you land on someone. If someone was interested in doing what you're doing and talking to students and wanted to be adjunct professors at a local university because they have some time on their hands and maybe that fulfills something for them and their purpose, how do you go about doing that? Do you talk to someone in the local PT program?
First of all, that is a huge common fulfillment. I’ve always said that I never wanted to be a teacher growing up. The irony that I'm a full-time faculty member is not lost on me. That does fulfill a lot of different aspects of that challenge, of that community, and that type of thing for people. Here's the advice on that. You've got to reach out. You have to reach out multiple times and in multiple different ways and multiple venues. Most faculty are interested in having guest speakers, adjunct faculty, because it does bring variety, it brings interest. Quite frankly, sometimes it can lighten the load a little bit.
You have to realize that faculty, like a private practice owner, might get 75, 100-plus emails in a day. If you happen to email at the wrong time of day, a wrong time of the semester, they're either engaged in and immersed and it's like, “That's a great idea. I can't deal with that now.” It's then off the radar or they're like, “This is my two-week break here. I'm shutting down. These emails are going to accumulate and I may or may not get back to them.” I would be persistent in it and keep asking because a lot of times that one ask doesn't get heard. Sometimes it may take five, ten asks of different people.
What I found in my coaching too is the emails that people send are not good because it's not clear. Think about it. You say, “I'm interested in teaching and helping out. Do you have anything?” It’s like, “If I have to think of what problem you're solving for me, I'm not going to think long and hard about that because I don't know what your skillset or expertise is.” If I were to go to a PT program, “I'm passionate about student burnout and student anxiety and things like that. I was wondering if there's a place in your program that I can give a 45-minute presentation to help them with that and that can either be part of a course or not. Let me know if I can help out in any way.” We should know that from business. That's Sales 101. Be clear on what you're offering.
Come with a product.
It’s like, “Do you like me? That's great. Let's go a little more than that.”
Thank you so much for sharing that. I'm sure there are plenty out there that have gotten to a point where they want to give back and they want to do more.
Being called a Professional Rebellion was not a light name choice. It was not something we came up with within a day. That’s the whole goal. I teach the leadership and practice administration course at the university. My goal is for us to have this revolution in physical therapy where private practice is something you go into. It's a plan and this is how I do it. There are many practice owners that could help university faculty who have never owned a practice who are teaching these courses that are laying and don't have any real world.
Don't get me wrong. My students might say, “Dr. Plisky is the lamest professor there is.” Go out there and share what advice you have for students. What is cool is it also develops your business because if you're sincerely giving back and you're likable, those students are going to want to do clinical with you. Those students are going to want to work for you. When you're making choices on staff hires, you're choosing from the best of the best who already matched your culture because they already know you and you already know them. It's a win-win. Your personnel problems go down, your attrition goes down.
Thanks so much for sharing your expertise, your wisdom and your knowledge. It was awesome to have you on the podcast.
It's been a lot of fun. I look forward to doing it again.
We will do it again. Thanks, Phil.
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Much has been said about the importance of maintaining engagement with your patients in order to avoid drop-offs and comebacks after discharge. However, how to run an extensive program like that could be a difficult hurdle for owners to overcome. Thus they either don't make the effort or the program they start loses steam. That's where an automated engagement platform like Swell can minimize the time and effort in order to maximize the results (consider the 80/20 principle - this is the 20). Plus it helps you improve Google status by obtaining more, recent Google reviews. In this episode Baylee Jensen of Swell joins Nathan Shields to share the key things to note when obtaining Google reviews and how Swell can help you stay more engaged with your patients with less effort.
I have Baylee Jensen from Swell, which is a company that can help physical therapists in their in-patient engagement retention and also help them get more online reviews. Thanks for joining me, Baylee.
Thanks so much for having me, Nathan.
Baylee is Business Development and Partnership Manager for Swell. Her job especially is to work in this physical therapy space as we're talking about. She works with other healthcare industries, but we're talking specifically about physical therapy because she does have some experience specific to physical therapy. We wanted to help PT owners do a little bit better with that patient engagement side, the patient retention side, minimizes drop-offs, you name it, we're going to talk a lot about that. Before we get into that, Baylee, do you mind sharing with us a little bit about your professional path and what got you to where you are now and your experience with physical therapy?
I’ll take us back to college. I studied Communications in college. I loved it but I didn't know how that would apply to the real world. I found this space within tech that was communications. I’ve been working in the healthcare industry for years now. I was in dental for a while. I switched over into the medical rehab, podiatry, physical therapy, chiropractic. I do love physical therapy. Part of the reason is no injury is the same. You go into dental and there are a few things. It's like a plug and play but I like how different PT is and I love working with that. I work with our key opinion leaders, different organizations and companies within the PT space, of course, one-offs with my offices there.
What are you working on now and how are you focused on helping physical therapy and physical therapy owners at this time to improve that patient engagement side?
There are a few ways that we can take this. What this whole platform does and what we're trying to do is help automate but personalize that communication with those patients. We're all busy and we're living in such a very changing world. It's hard to get into that flow or have your schedule down. What we're trying to do is make it easy for the office to use but also easy for those patients to engage with.
What are some of the benefits to a program like yours? I had an interview with Heather Chavin of GoGoDone and she had written an article in Impact Magazine about how to better utilize our patient emails and social media and focus on retention. She outlined even in the article seven days straight of email campaigns from when that patient first starts to help them understand, “This is what we're expecting of you but there are also these hurdles that we're willing to work through you with. Expect these things work through these things,” but we're not talking those first seven days. We're talking email campaigns for post-discharge and then follow up stuff and maybe monthly or quarterly newsletters. There's a lot that owners could put out there but how do they do that? I assume it's a platform like Swell that could help them out.
Any business but especially a physical therapy clinic, it's a very dynamic process. You’ve got to get them in, then you treat them and then there's going to be a patient care plan. There are many steps. I’ve talked to a lot of physical therapy clinics and they'll spend a lot of money going to these marketing bootcamps or they're spending time and money marketing and spending all these campaigns. Without follow up and without that next step, you're not actually going to get that business into your practice. What we want to do is come in and automate that for you so that yes, you have those things running in the background but then you have a system that's going to take care of that and follow up. Yes, there's going to be a small piece to it but there's so much to worry about that we want to take a burden off of you and take that sales piece away from you and help you engage with those patients. Whether it's getting them in the door the first time or continuing to get them in as a customer for life.
Tell us a little bit about what you recommend physical therapy owners do. Whether they use Swell or something else, what are some of the recommendations that you offer?
Let's dive into the online platform space and reviews because that's going to be vital to any business, no matter what platform they're using. It's an interesting time and it's been coming for a while, but 93% of customers will read online reviews before making a purchase. Even if somebody is like, “I have the most amazing physical therapist, you’ve got to check them out,” they're still going to go check that online review. I love the saying, “Your business is only good as Google says it is.” Whether or not that's the case, to the people that haven't been in, that's all they see.
It's a perfect example of social proofing. Making sure that your online presence is in a good spot is vital, especially in these day and ages where a lot of these are telematter. Sometimes they're not coming in the office or they're checking things out online before then. It's important. A couple of other facts that I like is 97% of consumers use online media. Rather than trying to look elsewhere, they're going to look online. It's easier for them, easier for the business. Another 31% of them are willing to spend more money if it has better reviews. Even if you're not in the most price-effective option, if you have good service and good reviews, they're willing to come to you.
If someone were to say, “Get a referral from a physician, whether that's in-person or Telemed,” I can imagine one of the first things they're going to do is check out, “Where is this place? What is it? What does their website look like?” Inevitably, they're going to punch in maybe physical therapy. Nowadays, many physician referrals are like, “Here's a prescription. Go find it. I'm sure there's a physical therapist near you.” I know many physician offices are doing that nowadays. They're leaving it up to the patient to find. They’re going to punch in physical therapy near me and you want to have good reviews and get yourself moving up that SEO ladder. It's vital that we spend a little bit of energy on making sure those reviews are good. That's not just Google. I'm assuming you're also talking about Yelp and stuff like that too.
There are a few things in Google's algorithm that they look at and one of them is diversifying. They want to make sure that you are across a lot of different websites. It’s not just your Google website that helps with boosting your search rankings there.
What are some other websites that you could be on?
Your website is going to be important. A lot of times, this can happen there. If you get reviews on Google, you can repost them to your website. It's coming from two different sources. Facebook is good. If you have a blog, sometimes people will use those, Yelp, Healthgrades, whatever they want to there. There are services like Swell. We'll be able to push review invitations to any of those different platforms or multiple if they want. That is something to be aware of, having that across a couple of different platforms. Google is king and most people look there but you have people that maybe are from a different area.
I’ve talked to people in the Midwest and apparently Yelp is their go-to, not Google. Maybe they grew up there and they're coming here. They're still comfortable going to Yelp. We want to make sure that company is keeping aware of all of their platforms there. The other thing is that people get a little bit confused with SEO, paid ads and then Google reviews. Those get confusing or PPC. PPC is a paid ad. It's pay-per-click. I worked in 2019 in the marketing department. It was still my role is under marketing. I learned a lot. I don't know how people do marketing, but I applaud each and every one of you because it's a hard job. There's a lot to manage. PPC campaigns are good because you can reach a broader audience and you can target.
If you are looking to do a certain area or if you want to start targeting certain keywords like a sports injury, maybe you're starting to do a sports injury clinic or something along those lines, you can target those searches. You and I were talking about this. Anytime I go do a Google search, I see the little ad, I usually skip and then I want to go to those organic ones because you can pay for that. With your organic searches on Google, you can't pay for an increase in rankings. Obviously, it's supposed to be organic. There’s nothing that you can do to get that to move up. PPC is good. Most of Google's platform recommends that you do a little bit of both. Keep in mind, you're paying per click. You're not paying per customer. If they click on the ad or on your website, you're paying for that even if they don't convert. You want to make sure that you have a system in place to help get them converted. That can get complicated. You want to do like a retargeting campaign with an email based off of those clicks if you have a system reading that. That’s smart.
I haven't met a lot of physical therapists that do the PPC campaigns. Have you talked to anybody that's done much of that?
I have. Usually, it's through a marketing agency and I find where they get frustrating is the marketing agency is there to run the campaigns. The physical therapy clinic will provide the money and then they'll run the campaigns. It goes back to the physical therapist and their business to convert those patients. The problem is, is a lot of times they don't have the training or the know-how to do it. It gets tricky. It's good. More benefits will come from organic. The nice thing about organic reviews is that will also boost your SEO. Search Engine Optimization is what it stands for. There are a few things. If people are leaving comments in it, you want to make sure that you're responding to those. When they say certain words in there, it's based off of a keyword. If you're looking for back injury physical therapist or something like that, the more times that's mentioned, that will help you boost to the top.
The actual words that are in the reviews can improve your organic SEO.
It gets a little bit tricky too because when you're responding to that, we want to make sure we're HIPAA compliant. Most of those responses are going to be very general but what they say or if they say like a certain doctor's name or something that can typically help as well. When Google is looking at your local search rankings, it looks at five different things. It's going to be relevance, distance, prominence, quality and quantity. They're never going to release all of their algorithms but that's been standard. Those things are going to be ones that we want to look at. Pretty easy, quick takeaways. Relevance is how well does this match up for what people are looking for.
With that said, in your business profile, there's a spot that you can say like physical therapists in Ogden, Utah or whatever you want to say. If you're starting to treat different types of injuries or like I said, maybe sports therapy, put that in there physical therapy and sports therapy. That way, if someone's researching sports therapists, that's going to pop up under you, not just physical therapy. Make sure that you're using words that you would think that they would be searching for. That's going to help with relevance.
Where do you put that again?
In your Google My Business profile, there's a description area. Some people leave it blank. I wouldn't recommend it. You don't have to make it extra long but put it in a good description of what you guys do there.
Especially if you've got some niches or if you specialize in something, you want to make sure that's in there. As people are looking for let’s say physical therapy for runners, then you might want to add something, some descriptor like that in your Google profile.
What I would recommend for that, let's say the clinic is we target runners but maybe not a ton of runners are looking for that. Maybe like athletes because that's going to be more general and you're going to be able to get more. If you want to target runners, you can. When you're putting those things, in their thinking mind like, “What is the average person going to look for?” They're not as targeted necessarily, even though it might be. They're going to be broader. Think in a buyer's mind or some of those things. The next one is distance. You're going to want to make sure that your address is correct in there because that's one of the things that it'll look at. What does ‘near me’ look like? You want to make sure that's accurate. If you have a couple of different locations, make sure that they each have their own Google My Business page so it’s pulling in.
I’ve had that before where it's used an old address from a previous business that I was in and we had to update that or sometimes if your business is linked to your home address for some reason or other, it's going to bring up your home. You want to make sure it is the right address for sure.
I was talking to one of my physical therapy offices. They were like, “We were at our house and did physical therapy near me and our location didn't even pull up.” It's because it's using all five of these things. If it thinks that, “Even though this one is closest to you, I still found a better one. That's a little bit further away but it will fit your match better,” that's what it's going to pull. Google is built for the user's experience, not necessarily the business experience. Pretend like you're a buyer as you're getting some of these set up because that will help. The next one is prominence. This one is how well they're known online, like what I was saying.
Diversifying that SEO is going to help. What I recommend, if you have a Facebook page, you don't necessarily need to direct people there. With our Swell platform, if someone leaves you a Google review, you can repost it to Facebook. You don't have to do double the work but it's helping that SEO. You'll pop up a little bit quicker as well. Next one, these ones are very self-explanatory, but quality. What we like to recommend is we want 4.7 or above stars. Typically, people don't go below that. The other thing to keep in mind and maybe this is me, but a lot of people feel like this is there's the first page. You can go to the second page and then you can go to the third page.
Majority, 90% of people will make a decision based off that first page. Even if you're like, “I have way more reviews than these top guys,” it's like, “Let's still get you to the top of the list because then you're going to be that much more seen because people don't take the time to move forward.” The last one is quantity. The way that Google looks at it is going to be the number of reviews fresh and then frequent. Even if you had 500 reviews but you didn't get a review in the last four months, it's going to be like, “We don't know if their service is still that great.” What it's going to look for is to make sure that those are coming in frequently and that those are being responded to.
You see that with a lot of physical therapists. They think, “Our goal is to get blank number of Google reviews.” They push out this program and they get a bunch of reviews. Maybe they got 40, 50 reviews in a one-month period and then it falls off. They don't come back around to it for another year or two years. You're saying that might help you for that month, but the effectiveness is lost after that.
Think about it if it was you. For instance, a couple of years ago, I went to Hawaii. I was the only single in there. I got the short end of the stick and I was sleeping on the pullout couch. I don't know if it was that or surfing or what, but I did something to my back and I had never been to a physical therapist before, but I was like, “I got to find one.” All that I could do was go online and search. Even if I saw one that had great reviews, but it had been a long time, as a consumer, I'm like, “I don't know. Maybe let's look for somebody that got a review last week that they had a great experience.”
I feel the same way. Even in product searches and Amazon or something like that, I want to see something that's a little bit fresher, not something from 2017. The more you can keep that relevant and up-to-date, that lends more credence to you for one reason or another. I don't know what it is but that recency means something to me as a consumer.
It will help within those rankings there. The other thing is to make sure you're responding to those. It doesn't have to be anything that's super detailed. It'll be HIPAA compliant. The Swell platform will let you respond right in Swell so you don't have to go check like Facebook, Google, Yelp, whatever. You can do it there. You can have templated responses. If it's a five-star, “Awesome, thanks so much for coming in. I’m glad you had a good experience,” or something. Even if the patient doesn't see it, the algorithm likes that because it will help boost.
A lot of what you're talking about has to become then like a system or an ongoing process that is built into the physical therapy experience from the administrative end. There's got to be a process to that. I'm sure you walk owners through this in developing a system to make this an ongoing thing and not a one and done project.
I was talking to someone and they invested in a new laser worth $60,000 or something like that. They were stoked on it but it's like, “That's awesome. You have a great plan in place of how to upsell that. If you don't get patients in the door, what are your opportunities to do that?” It is that full cycle of like, “Got to get them in the door. We can give him the treatment, then let's get them a review so that other people can see that.” It is that loop. We understand there's so much going on. As a physical therapist, your number one priority is patient care. You're not as worried about some of these things. That's where we want to come in as a platform and say like, “We know you have other focuses. Let us take over and automate a lot of this so you don't have to worry about it. While it's important, we can help lift some of that for you.”
That platform is definitely needed because a lot of people in my audience, they're like, “I'm treating full-time and then I'm trying to run my business on the weekends. I don't know how you expect me to do all this stuff.” The reason I bring people like you on is I'm trying to say, “There are resources out there, maybe I’ll have to look. Here's Baylee sitting here that can help you and give you an idea of let's automate these things for you.” It's part of the new patient process or discharge process, you name it. That being, “Put them into this email system. Our process means we need to get a review or at least get them an email or text that day or the following day to, “Please write a review. Here's the link.” It makes it as easy as possible for the patient to do it as well. If we're putting through them through a lot of hoops to give us a review, then it's more than likely not going to happen. That's where a program and a platform like yours are so vital to a physical therapy owner’s success and retention engagement and all these things that we're talking about.
We talked about this as well, but I got back from a trip and had great experiences and was asked to leave a review. I didn't have the link and I couldn't remember what it was. It's not even that I wasn't willing to. It was, it just wasn't easy for me. We're all very lazy and we're busy and we have a lot going on as a patient. Making it very simple for the patients but also simple for your office is going to be huge for both ends to maximize that. Anything with a system or a software, it's only as good as your training is and as your office is going to use it. That's where we want to come in. Even if you were using only 10%, so much of this as automated that you should still see a good increase even if you didn't have time to touch it.
If we can go in there and look at some things and some metrics, there's a lot that you can learn. If you’ve got a review and you want it to go down by practitioner, if you want to look at, “Who treated them or who checked them in or what was the service that they got,” you can filter that down. It’s like, “This is getting a lot of great reviews. Maybe we should do a marketing push for this. It's the end of the year. Let's run a promotion for the holidays,” or something like that. You can get as creative as you want but having that platform there to make it easy, like you said, for the patient is going to be huge.
Do you guys recommend more texts? Do you recommend more email? Which has been better responded to in the past?
Text is going to be best. Think about it. If it was you, how quickly are you to respond to an email versus a text? As a human being, we're in there a little bit more, especially as the generations are getting younger and younger, it's a quicker response. The other nice thing too is we can have it go out from their actual business member if they want. Those patients will recognize it. If not, we can do a local area code, but it will never be a short code. It's a little bit easier and quicker for them. The other thing that we recommend and we can have set up automatically is a lot of offices or systems will send it out right after or right when the patient's in the office.
Maybe you have to run back to work or you're taking your kids to soccer practice or you have things going on. You want to do it, but you don't have the time. We'll usually send it out in that evening, say between 6:30 and 7:30 PM when they're home and settled and be like, “Now I have two seconds to do this.” With that, if they don't, we can send a reminder the next day or in seven days a sequence like you were talking about. It captured that patient.
Do you find that the 6:30 to 7:30 PM timeframe is a magical hour?
It's been nuts. One thing that's nice too with our platform is we're Google-sponsored. We're powered by Google, which helps. That was going to be something that helps respond with that. Also, we find that hour has increased it. The number that we say, “Keep in mind, this is going to sound low,” but for reviews and for engagement, we see about 10% of those reviews that are being sent out responded to. That seems low but keep in mind if you were at zero. If you're seeing twelve patients a day and we can get one a day, that's going to be massive for the business.
First of all, do you have to get permission to send out regular texts to a patient like that?
We're HIPAA compliant, CAN-SPAM compliant, all those things. The only thing is if they want to unsubscribe, they can click stop to subscribe to them. If they don't want to receive that, they don't have to but that's typically why we want to do some value with it like, “Thanks so much for coming in. Here's next steps for your treatment. Could you also leave us a review?” If that patient is saying like, “This has benefited my treatment plan. I don't want to unsubscribe from this thing.”
There could be a lot of value if that 1st, 2nd or 3rd text is, “Thank you for coming in. Here's a link to your home exercise program if you have that thing set up. If you don't mind, if you've had a good experience, please share your review online. Here's the link for that.” That makes it very simple and easy for them in all three phases.
We can even do more specific ones. Depending on the EMR system that you're using, if we're integrated with them, we can even pull based off of the person that was seen with them. If you want to have a certain doctor's picture or we can do the logo and then we can even pull in dynamic fields. Of course, it’s their name and a certain treatment that they were seen for. Based off of the code, it looks more personalized to them and people respond better to that. The office doesn't have to do anything with it. It's set up and good to go.
Are there some EMRs that you do work seamlessly with and others that you don't?
We have 90% of the market. The ones that don't, we can still work with what we do as a CSV upload of the patients. It's not a problem. Most of them we work with.
What are some of the other things that you might recommend owners, either email out or texts and requests? I know a lot of owners might work off of NPS scores or they might work off wanting other feedback. What are some other things that owners might be looking for with these texts and emails?
It depends on the office. Some people love data and so they want to get that feedback. We offer NPS. We can send those out as well. That's going to be like, “How highly would you recommend this thumbs up, thumbs down thing?” NPS stands for Net Promoter Score. We also have a system that's going to be like a ten-question survey. If you want to drill down a little bit more, you can do that. Keep in mind, you're going to see a higher drop-off per click that patient will do. That's why our reviews area one-click to the site thing.
If they're doing a survey, do you recommend a certain number of questions considering it does take more clicks? Is it better to have a 3 or 4 question survey versus a ten-question survey or have you found that matters?
It depends on what they're looking to find out. If it's about a certain new laser or a treatment that they got or if it's a new person in there, maybe you only need a few questions. If you're like, “I feel like we have a whole within our system, when you get some more information on it.” I probably wouldn't send that out to every patient that you see. That conversation usually is a little bit better of like in the office like, “We're learning or working on how to better our system here. Would you mind filling out a short survey?” That goes a long way. The other thing that is big as well is think about this if you were a consumer. With mine, when I booked it, I didn't even know if they accepted my insurance.
I was like, “They have great reviews. Their website looks awesome. I need help now.” On their website, if you have a webchat feature that they can communicate with you before having to make that call, as a patient, sometimes we're either at work when we don't have time to do that or don't want to be up-sold. We're just trying to do some due diligence. Having a system that they can communicate with the office without having to make that actual connection is big. We can do a web chat feature. It's nice because it goes right to the message board. You can manage any web chat feature or web chats, Facebook messages or text messages all at one place that makes it easy for the office
Does it come up into the Swell app that's on your computer or phone?
Is there anything else that you want to share in regards to value that you could provide for the audience or any other gadgets or cool things about Swell that you want to share?
There are a few other systems within there but what we want to do is not take away a front desk person per se but if we can save time so that they can focus on other things. We want to be like another person in the office but it's a lot cheaper.
That's the last thing I want to do for my front desk person because I know I was very sheepish about adding more to their plate because they're answering the phones and they're scheduling patients. They're trying to engage the person that's coming in. They might be verifying insurances, which takes forever and is a headache or dealing with a patient that's trying to reschedule. The last thing you want to do is come in and say, “Can you add this and do this more?” If this is something that is pushed over to them, they get some push notifications like, “Someone has got a question about that.” Maybe it's easier for them to type an answer because now on top of that, trying to ask them to get the review from the patient could be hard. If that's an automated process that doesn't necessarily have to go through the front desk, if instead they maybe click on that patient and it starts that campaign, that made things a lot easier
You don’t even have to click on the patient. It can be scheduled. If you're like, “I want to go the day of,” great. It starts. It's nice. It's ironic that I work for a tech company and I'm not super technical myself, but it is very simple to use. We've designed it for that because I’ve talked with tons of offices over the years and they're like, “I'm so comfortable with what I have but it scares me to switch platforms,” or, “I don't know how to use that.” Maybe they graduated from high school or whatever it is. We want it to be easy for anyone to use. The Swell system is self-explanatory that way.
Especially with the pandemic of 2020, the way we were engaging with patients in 2019 is completely different in 2020. It needs to be. It forced owners to recognize that they need to be a little bit more socially engaged and not rely on the in-person physician referrals or the community events, if you will. Let's admit it, physical therapists are usually a couple of decades behind technologically and so we got to get away from the paper. It forced us into the 21st century and that's where a platform like yours can be helpful.
You can look at it 1 of 2 ways. It's either a blessing or a curse but usually, people don't have a physical therapist on hand. It's not like they're dentists that they're seeing every six months. If they get an injury, then they're going to go look for that. If your house was flooding and you're in a panic, you're going to quickly go online to find somebody. It’s the same thing with this. They don't necessarily have time to be doing all this due diligence to ask around, to go to a normal physician and ask for referrals. Their online platform is the number one place that they're going to get business these days.
What I like about your platform is it can be text, email or both because as you've got a current patient, maybe text is more appropriate. If you're sending out information to a patient from two years ago, I don't know if text is necessarily appropriate, but you can still do the email thing and keep them engaged so that you do become their physical therapist. It’s like you have your own dentist that you go to. When you have an injury that crops up, you want to make sure that you are that physical therapist that they go to on a regular basis. I liked that you guys can use texts and email to your advantage and you can also maintain that engagement forever, especially at post-discharge to make sure you stay in their mindset when friends or family members do get injured.
It depends on their injury but you can have a system set up of like, “I treated you. We had our three-week treatment series but I want to check on you in 3 and 6 months to see how you're healing or how things are going.” A lot of times, offices don't have time for that. They're swamped and they don't have time to do that follow-up and a lot of times patients don't remember that. If we can have something set up where we're reactivating those patients and getting them back into the practice, that's going to be huge for them.
If you could share your contact information if people are interested in the program, go ahead. How can we get in touch with you?
I will share my email, Baylee@SwellCX.com. You can email me there. I’ll even give you my cell phone number, (801) 708-9215 or you want to go around and peek at the website before you're communicating with someone. It's SwellCX.com. You can even schedule a demo from there if you want or you can text me. If you want to see more of the product and how it works, let me know and we can get that hooked up for you.
Thank you for taking the time to be on and sharing some information for PT owners. Hopefully, they take advantage of it and utilize something technological to get those reviews and also stay engaged with their patients.
Thanks for having me, Nathan. I had a blast.
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Steve Line, PT has spent plenty of time and $$ on all of the different marketing tactics over the years, and has made his share of mistakes along the way. Based on his experiences he shares his insight on the basics of marketing and the need to understand the different audiences and messages that are needed for a successful marketing strategy. What worked five years ago doesn't work now. In fact, the marketing strategy that worked in 2019 definitely isn't as successful in 2020. Thus, it's important to get back to basics and reassess our audiences and message. Join in as he discusses all of these on the show with Nathan Shields.
I have Steve Line, a physical therapist, owner and President of Columbus Physical Therapy out of Nebraska. I got Steve on because he wrote an article in Impact Magazine about marketing and covered some basics that are important to visit and revisit over and over again. I've done so with my clients after reading his article and discussing some of the basics that he mentioned. Steve, I appreciate you coming on. Thank you.
I appreciate the opportunity, Nathan. This is a great show. I've enjoyed your previous episodes.
Tell the audience a little bit about you, where you come from, what brought you to where you are, a little bit of your professional experience and where you're at now.
I have been a therapist and an owner for many years. I wasn't a staff therapist very long and then I was thrown into the fire. I grew up in Kansas as a kid and went to Nebraska to PT school and everything. I've been in Columbus, Nebraska since 1998. What brought me to this point was I've always wanted to be an owner. I had the first love of Biology and the part of Physical Therapy that the patient care part that drew us all to it but there was always part of you that wanted to be an owner to lead the operation. I had a particular interest in customer service. A lot of that was grounded in some of the part-time jobs I had as a child. Through high school, I worked at a grocery store then I got to college and got more jobs that were customer service oriented. I was in a grocery store bartending, various things that had to do with dealing with the public. I could see the parallels and the weaving of this thread of, “We're all the same,” but it doesn't matter if it's a patient or if it's any consumer, we need to reach them at that level.
You've been a business owner for many years now so congratulations. Do you have one clinic or have you grown to multiple clinics by this time?
We've got three locations.
In your article, you talked about some of the basics. I was intrigued by the title itself, it's called Marketing Like an Engineer. I know where you're going with that after reading the article but let's start with some of the basics. You talked about marketing buckets to start off with. I think when PT owners look at marketing, they look at everything. Marketing is marketing but it's important to recognize that there are some distinct areas that you want to focus on and allocate monies and have completely different action items in those different buckets than you would with the other buckets. Lay it out to us. What did you define as the four buckets there?
It's reverse engineering. At the end of the day, we want to have patients. What makes up the new patients that come into our practice? Time and time again, I measured it over a lot of years and kept coming up with these same four general areas. This isn't anything that I created on my own because now that I've talked with other clinic owners, they're coming up with the same stuff. It's common knowledge to some degree but we haven't talked about it. The four buckets starting out former patients or your patients in general. Those are the people that you're working with. Those should be your most loyal fans, the people that return to you, that is the most valuable of all of them.
I know I'm speaking to any therapist that is big into quality care and those issues certainly are patient bucket is number one. You want to put as much emphasis on energy. A lot of it is an investment of emotion and relationship into these people. You don't have to necessarily spend a lot of money to invest in that level of marketing. It's probably the cheapest of all the marketing buckets. You do a great job whether you build a relationship with them, give them great service and send them out the door with a great taste in their mouth or the experience that they had with you. It doesn't take a whole lot to get them back into your doors if they had a problem again. We got to stay in touch with them. That's one of the things we do there.
You're talking about not current patients but also past patients. That is huge. That's outside of the local community. That's your largest pool of potential there. As you said, it doesn't take as much money. There are other things that cost significantly more but it could get you more bang for the buck as you spend more time fully. With the current patients that are in your clinic, there are ways that you can improve engagement and their experience like you alluded to win them over. There's a huge pool of multiples that have been to you in the past that know, like and trust you that can put some added energy into them as well that can repeat returns.
Get on the reactivation but that's the first main bucket. I tend to count the next three as patient referrals being a branch off of patients. If you can have your loyal, raving fans then if you can get them to send friends and family, not only bring themselves back in but bring someone with them. Now, you've expanded the ROI of that particular bucket and then moving on to physician referrals or professional referrals. Not necessarily be physicians alone but any professional that can send you a referral like, “I know this group. They do a great job. I recommend you go there.” The final bucket is your general public. Now, you're casting the net out into capturing people with different messages across all of those buckets.
Correct me if I'm wrong but from my experience, the amount of money you have to allocate to those different buckets increases with the way we've progressed thus far. Patients and past patients are relatively cheap. Getting patient referrals again shouldn't cost you a lot. Maybe a little bit of incentive might be in play for patients and past patients to bring family and friends over. Maybe spend a little bit more to get in front of the physicians. Maybe it's a newsletter, an occasional gift, lunch or something like that. You have to be mindful but it does take a little bit more and to reach out to the community, you got to spend a lot of money to net out.
A lot of that money comes into the various avenues and platforms you have to use to reach them. You have to do every door direct mail, however, you're putting on an event some of these things can get costly and in a hurry. Not to deter anybody from like, “I don't want to mess with that bucket.” I'm going to leave that bucket alone. The general public bucket can expand and explode your clinic but you have to do it correctly. I've learned a lot from Chad Madden, Shaun Kirk and a lot of different people that train in marketing systems. Having that specific message and knowing who you're targeting particularly is critical.
I want to get into that but before we do, since we're talking about budgets, I love the story that you shared about the marketing budget that got out of whack in your early years. If you want, you can go ahead and share that but let's talk a little bit about budgets and what people might need to allocate for marketing because as I'm talking to some of my coaching clients, they'll ask, “I want to do this thing or the other. What do you think?” I said, “How much money do you have to spend?” That's what everyone is going to ask you. A marketing expert is going to say, “How much are you spending?” That is a deer in the headlight question for every PT owner I've come across. They're like, “I don't know, how much should I spend?” They don't know. Talk to us a little bit about some marketing budgets.
It isn't just marketing budgets. The same question could be posed if I wanted to get into a new location and I have a new lease, I want to build a building or whatever, it's like, “How much do you have to spend? How much is the clinic going to cost you? Is it going to be beyond what is feasible within your operation?” I've stood on the shoulders of many great mentors like all of us have and learned how to allocate it on a formulated basis so that no matter what, every dollar that comes in or X amount of cents, gets given out to labor, payroll cost, benefits, marketing, rent and utilities.
After a while, you start seeing some similarities on that to how much percent is appropriate. Give or take, in some regions, you're going to have to pay a little more to get a therapist so your labor cost goes up a little bit. Marketing in general, we always try to keep it generally around that 10%. We have gone in our start-up clinics when we're trying to get out there and push it off the ground and get it to launch 14% to 15% but it doesn't stay there. Once we start growing, you'd get those patients within, as long as you've got a good customer service and a reactivation system in place, you're staying in touch and keep a relationship there. You then can start lowering those costs overall and get it down to 10% and start reactivating the cheaper but the lower hanging fruit in marketing and that's your form of patients.
That's a surprise to some physical therapists because if they were to do the calculations, they'd find their marketing spend in the past has been somewhere in the 1% to 3% or less range but if they want to achieve the goals that they want to achieve, they got to recognize that they should allocate somewhere in the 5% to 10% range and more if they're starting up something new. That can be a hard pill to swallow for some physical therapists thinking, “I need to spend that much.” Maybe you don't. If you're happy where you're at and you're not necessarily focused on growth, maybe you need to be closer to the 2% to 5% range to maintain and continue going forward. If you have any illusions for growth, you're going to need to expect to pay more in marketing and that's where you start. How much do you have to spend? A lot of times, it depends on how you're going to spend it.
I try to look at all of it. It's an investment. I use the term ROI a lot around the clinic and everybody on the leadership team knows what I'm talking about but it's like, “I would like to do X, Y and Z program or campaign. I want to try this. What do you think?” I'm like, “I don't know. What's it going to get you? I don't know. I just want to try it.” I’m like, “We need to spend a little time and project out and think about, not, ‘We don't know,’ none of us have a crystal ball but we should have a pretty close estimation of where we're going to land, what we're targeting to understand how to get that.” When we're talking costs, 10% is an investment not only to grow your practice but keep your practice stable and keep it where it is because competition never stops and costs never stop growing and reimbursement never stops decreasing. You get caught between those three and you're squeezed. You need to always be pushing funds and energy, look at money and resources as energy, push it toward the things that are going to continue you and keep your venture going. That's probably another way of how to look at it if they're freaked out about the growth part.
That goes to like, “After I know what my budget is, how do I allocate that money?” That's where you were leading the discussion. Let's come back to that. It's like, “Who's your demographic?” If you don't know who your target audience is then you're not going to know where to allocate your marketing monies because you want to be where they're living.
You want to know your community and that takes time. Nobody pops into a town and knows everything about it but you want to learn what's your median range of ages? What is the household income level? What type of community is this? Is it white-collar or blue-collar? Is it farming, agriculture or manufacturing? Is it all tech? It could be all of it mixed into one. You need to know if you're targeting particular people of influence. Have they been well-educated? It's the same thing that political pollsters use. They are trying to identify who is that avatar within the community, that individual, that face, that nameless person because that generally reaches across to all of them.
We have a manufacturing, a heavy community in our first location. Our second is all agrarian, an agriculture is driven which is a smaller community. The third community that we have is a practice in is a combination of all. It is manufacturing, it got some retail, it got some white-collar related people there and it got a little bit of a mix. On the physicians, we have to target them differently too. We keep going. It's a piecemealing of all these buckets figuring out.
In each bucket, the message is going to be completely different but when you're looking at your avatar in the community bucket, what comes to mind for me is a podcast that I listened to is Paul Gough’s earlier podcasts. He's in England and people have the choice to go to the state-sponsored clinics but he's not part of that program. People have to pay cash to come to see him. His target market when it comes to marketing is the 55-year-old female kids or older. They have a little bit more income because they're upper-middle-class. Simply that alone can influence your marketing message. You're talking to females. How are you going to talk to females? How are you going to talk to older women who have a bit more money that can pay cash out of pocket versus going to the state-sponsored clinic?
That alone is we'll generate a different message than the message that you're going to create for your past patients. There's a different message if you're going to focus on orthopedic physicians versus internal medicine. Honing that message to your target audience doesn't exclude the rest of the audience that you're reaching out to but it will capture their attention more so and bring you the type of patients that you want to see.
It's as simple as this. When you are talking to a friend or a family member, you've known them your whole life, your level of understanding of that person is so much greater. You can talk pretty generically and more loosely and then hone in on specifically what they're interested in. Case in point, you have patients that are into baking, crocheting, hunting, fishing, football or welding or whatever it is and you learn those things. You can't keep records on everything but you do need to have some sort of semblance of, “This is what this guy or this girl was into,” then when you're sending out some personal related messages or the phone call systems that we do, “How are your grandkids doing? The last time we talked X, Y and Z.”
There is no better way to connect. You can't do that when you're talking to somebody you've never met before. Right in there are the basics of the message change. You're trying to target, what is important to them and what means something to them? In our particular case and a lot of cases, we're looking at middle-aged females, like you said and they're the family, consumer decision-makers. They decide when grocery day is and what they're going to buy for groceries. They decide where their kids are going to go to school. They're going to decide for certain where their health care is going to be done. That is who you're targeting.
That's good to know because although your interest might be in high school athletes, you got to recognize that they don't carry the purse strings. It's the parents that they got that. The majority of the time, it's the mother that you've got to influence.
Always target the decision-maker.
I interviewed Angie McGilvrey down in Florida. They've got a number of practices and we were talking about social media advertising. She's been very successful with that. She posts regularly on the different social media channels but her target audience is going to be the female athlete who’s probably in CrossFit and their 20s or 30s. She's got it mapped out. She knows who her avatar is down exactly. She tailors that social media message to those people and thus, has been successful with her social media campaigns. Know that message and know who you want to work with. Angie used to take all comers and the majority of it is in Florida and Medicare. Since they had a reset, which happened to be a hurricane a number of years ago, they decided to change their message to focus on the patients that they wanted to see. Now, the demographics of their patients are completely different because they tailor the message.
We've never felt that we could wholesale, go and choose one group like the 30 to 40 female athlete or what have you. We still target all comers. We do it differently through different strategies to try to get them all. We're in a low populated area so we have to squeeze as much as we can out of what's available though.
Are you a little bit more rural?
You got to be the country doctor, essentially. They're not bringing you their animals.
Haven't yet anyway.
That can be some of the more difficult marketing that you do when you're reaching out to the public.
It is. In that article I wrote, I used some references from Dan Kennedy in marketing and they get the Marketing Results Triangle, taking, targeting and tying in together the message, the market and the media for the group that you're going after. Once upon a time, you could say social media, internet, email, all those things and don't work for Medicare people but that's not true anymore. As grandmas are all on Facebook now, you can now open up some of those avenues that once were viewed as well, you can only reach them with newspaper ads and mail. What worked many years ago now is moving and evolving and you have to keep moving with that.
We're at the end of 2020 and what worked at the end of 2019, now post-pandemic is different. You've got to recognize, if you don't have any energy, time and money put into the direct to community marketing bucket then you're going to be in a lot of trouble because that physician bucket is shrinking because maybe not in your community but I know in some of the larger metropolises they can't go in and see doctors anymore.
I don't want to say it's completely gone, but the only way we can ever reach those guys is we tried to do everything systematically so it isn't just licking and sticking. We try it once and see how it goes but making sure that our notes always read a certain way, particularly to the doctor because we know what they all generally want. They don't want three-page notes sent to them on progress. They want them as simple and short as possible. I still see at times therapists on the bigger ones. We are already missing them if you want to try to influence them. That's one piece but then always making sure that we do a quick phone call, “So-and-so is coming over to see you. We want to make sure that there's a note that's already been faxed. Have a great day.” It's trying to provide customer service to them as well. The last thing is we do an in-between progress call having our therapist make a call to the doc's office saying, “I want to touch base to let you know how so-and-so is doing. That is all. Thank you.” That's all the way you can make those touches when you can't see them face to face. They don’t want you in there and I don't want to be in there.
When you consider the direct to community type of marketing, that's new territory for many owners. Either they haven't used social media, don't know how to use social media or they haven't used mass market mailers, media posts, the radio, TV or anything like that. The post-pandemic forced their hands if they want to make some connections and growth. They might say, “I don't know what to do.” Start with, who are you marketing to? If you're thinking about the decision-maker is being the housewife, the majority of the time then where are they living? That might guide you to where you need to be in social media.
That's an easy one from a mailing standpoint. You can do a target grid search on every door, direct mail, if you want to hit X amount people in certain age groups and so on and so forth, you can get that down to a fine point. Our mailers, once upon a time, wasn't an effective marketing campaign but it dropped off a lot as far as our effectiveness with it. Particularly if you're marketing the same old, “Come in for a free consult,” some sort of a new tripwire that connects them. That works well with us still but if you're sending something that says, “Do you have back pain? Call us today,” you're better off using some other strategy than that. It's going to be costly.
The one thing that therapists always make the mistake with is we assume everybody knows what we do. Everybody's thinking of physical therapy every day of their life. Nobody is thinking about physical therapy ever. Let me break everyone's bubble now with that. I learned that early on and that was probably a saving grace for me. I focused on, “These are consumers, these aren't patients.” That may ruffle some feathers with some PTs but if you start changing that mindset and knowing that that individual is being competed with by General Motors, by their utility bill, by their kid's college tuition, by all these other things that are drawing their time and money and energy, you're going to go in there and say, “If you've got back pain, call us today because we give great quality care,” you're not going to reach them. You have to do something more targeted to get them to reach out and call. One of the things that Chad Madden did is using a digital product, eBooks, things of that nature like, “If you have a low back pain, come and get your free low back pain workbook, learn how to treat yourself.” That speaks to some people. Things that bring them out and get them reaching to you. You're trying to attract people to you.
The important thing to recognize and you've alluded to it essentially, is that you do something and then you've got to assess the effectiveness of it. That's why you're changing the message on your direct mailers every so often. Recognizing that, “We sent out these three mailers. We've spent three months on social media,” which seems to be about the time it takes to gain some traction on some of these. Maybe you can share your experience.
It takes time.
People think that if I send out the social media posts, things should be ringing off the hook like, “I've increased my Google Ad spend for the past three weeks. Why aren’t we getting more new patients?” It takes time. At that point, that’s important to figure out exactly what was the ROI or the Return On Investment.
Whatever you do, if you're doing social media for three months, make sure that we're measuring. Is it working? Make some adjustments as necessary. Marketing is conversational. You're talking with someone and you keep saying the same thing over and over to them. They're going to be like, “Something's wrong with this guy. I'm not reaching them. They're not connecting with me.” Your conversation has to adjust to whoever you're talking to in-person. Marketing is going to change in whoever you're talking to out there. The things that they want to hear is what you want to try to reach them with. As you know, there are only many things, what are the results and the benefits and then try to overcome those barriers of, “How much time is it going to take? How hard is it going to be? How much is it going to cost?” Those are the pieces of sales that you'll have to work on to overcome when people do finally reach for you.
It's interesting, as more people have been doing social media posts and some of my clients have noted so much of the focus of the content can be like, “Here are some stretches for low back pain. Here's the anatomy of a shoulder that you need to consider,” and I'm not convinced that's what gets people engaged. Honestly, one of my patients said, “I get more engagement from posting a beautiful sunset than I do from any of that other how-to stuff in social media.” I'm like, “I probably wouldn't click on any of those things either and might give a thumbs up to a nice sunset too.” We got to consider that not everyone wants to know your how-tos and what- fors.
They don't want to know that. They want to know, “I have a problem. What are you going to do for it?” If they have shoulder pain or back pain that’s been bothering them for a long time, at some point, you send the right message out, “Are you sick and tired of this back pain?” That's different than we treat back pain as not emotional. It's factual. There's no feeling from it. Marketing has to derive a feeling. It has to create any emotion because that’s what motivates us to move, to go do something. You have to target that. Knowing where most individuals are at in their feelings about their problem, makes a big difference in how you tailor your message to them.
If you're in a running community and those are the people that you want to see are the roles, you're not talking to them about sitting at a desk and how that causes neck pain. You got to target the message appropriately and give it some time to take traction. I'm not convinced that it’s a home run out there to get new patients in the door but it's a repetitive single in the baseball analogy that usually gets some tractions.
It's always a small ball. It is the things of how much marketing have I done over the years and all the while, my marketing was great, my front desk personnel was terrible? You got people ringing in but unless you're taking the phone call, you're trusting that individual to hook them and say, “Come on in. Are you having pain? You need to go see your doctor first.” That is what we know. That works against your general public marketing. When you want the general public to reach to you and then when they do, you say, “Go somewhere else.” That’s wrong. It isn't just marketing. It's knowing how to handle all the other components that come with it.
It's customer service, at that point. That's what you were talking to at the beginning. I remember talking to one of the founders of Keet Health. If you can focus and improve the customer experience, that will triple your marketing efforts because those people will think about that, especially in the different buckets. It's going to improve the patient compliance and they're coming back if you can improve the customer experience. It's going to more likely help them refer family and friends to come to as well so it's going to help that bucket. If you focus on the customer experience, patients are going to go back to the physicians in that bucket and say, “I love this place and you ought to send all your patients there.” On the backend, if you're reaching out to the community and they have a poor experience on that initial call, you just wasted your marketing dollar at that point. It is so much that it comes back to customer service and the effectiveness of our marketing can be submarined if the customer service isn't there.
It's got to be credible. If you say that you deliver the feel-good experience, which is what our brand name is. Our tagline on everything is the feel-good experience. Meaning, we do focus on not only making them feel good physically but emotionally, spiritually, making that connection with them, giving them a great experience all the way through. When they do call in and say, “You got to go somewhere else first,” and treat them like, “You've been here before,” we related to whatever then you've blown it. You got to make sure that that is incredible all the way through that you perform and behave as your marketing is.
Trusting somebody to do that naturally is a fault.
You got to train it in.
They don't say whatever comes off the top of their head that they think sounds good, you have a script for them like, “This is what you say when a new patient comes in. This is what you say if they walk in the door versus if they say, ‘I heard about you on the radio or I got this flyer in the mail,’ and then you say, ‘Great,’ then you say this.” That's trained over and over and its role played. That training can be taken into many different sections of the customer experience. It's not just front desk training, that's training that can occur at any point in the customer service experience, providers, technicians and billers. You name it.
You're leading off into my last project here. I've been working on a book. I created a system many years ago and I'm getting around to putting together an actual book for it. It’s called the Feel-Good Experience: How to Grow Your Practice with Five-Star Customer Service. It covers all of the psychology of the human being, our needs, wants, the certainties and the things that we're looking for, all of us. It doesn't matter who you are, where you come from, what gender, nationality or any of it. There are certain commonalities that we all are seeking. Ultimately, it's respect and communication and that level of professionalism to lead them through the process. One of the worst things that I can see over the years and I've had it happen to me personally is when I go in seeking a service or an item and someone says, “It's over there,” and they point me toward it.
To me, the difference is when that person says, “Let me go take you there and show you where it is. Let me get it for you.” That's the difference. We always want our clinics to run within that model. We have five stations or so. Front desk, we use the aids, therapists, hosts and hostesses because their first action is to bring them back. There's a whole set of steps there on how you body language that action to show them respect, honor and appreciation for them being there and bringing them back with them, being cognizant of those things. Things that they tell you, things that they maybe don't tell you, the subtle tells. If you're sitting at the poker table, you got to be able to read people. Going through clear to the end again, the front desk individuals are the last ones to get them again. They got two important parts, in and out. That's all within the book soon to be released.
Do you have a title for it?
The Feel-Good Experience: How to Grow Your Practice with Five-Star Customer Service.
When is this coming out? If someone read this episode in the future, what do you think?
It'll be out in February or March 2021.
Congratulations on that. It all goes back to the topic of how we can improve our marketing and much of that can be fortified and even multiplied by having a good customer experience.
You'll find out quickly if you’re not, particularly if you're at an executive level of management in your company where you're managing a lot of different sites and you're not right there watching everything. When your former patient bucket starts tanking out and you're still doing all the ingredients that you've always done that work to bring people back in and you're dropping off quickly, there's a reason they're not coming back. You definitely want to target some of those things.
You're saying that a lot of people will measure the return patient percentage of their new patients. What percentage of your patients are returning patients that have been there before? You're finding a correlation between that statistic, that number dropping and maybe a worsening of the patients.
It's usually two different things. The first thing I'm targeting is I'm going to my marketing going, “What's fallen out? What are we not reaching out to them with?”
We're not sending emails and calls to the patients.
We're doing it all and it's all because everything is well documented in our system. I'm like, “They're not coming back then on the phone calls. What are they saying?” “They didn't want to come back or they went somewhere else.” You then start taking note of all that. They started going to other places and that's when bad things are happening. You want us to fortify former patients and get them served.
I love that you brought that up because that can be key for some people who are seeing numbers dip and give them something to look into because they might be saying, “This circumstance led to not coming back,” but you are not looking internally and saying, “Maybe they're having some poor customer experiences that they didn't have in the past or something's fallen out.”
Particularly if it's a lifelong person that keeps coming back and they've been back for ten years and we've had this happen, it's the most painful thing ever as an owner, when you treated that patient. When I was a therapist and you had this such tight connection that they would text you, they will call you at home and you took care of them. All of a sudden, the next time you see them, they're standoffish and then they say things like, “I went somewhere else.” It's like, “What happened? Something's not right.”
That's such valuable feedback that maybe you get that from physicians occasionally if they're honest and you have that relationship with them, or the one person in the community that came through and then decides to go back on Google and give you a one-star rating or something like that. You can simply trust and get much more out of those past patients if you stay in communication with them regarding how things are going in your clinic. That's something that you have to do as you personally step away from treating everybody, which is the most PT owners. There's so much value there, for sure.
They're a wealth of survey knowledge, instead of hiring a survey group to do surveys, survey your past patients. That is the simplest and most cost-effective way to find out how you're doing. You've got to make sure that they're being honest. You allow them to be honest, you give them a safe place to be honest. If they say something bad, you can't lose your cool with them. You have to say, “I appreciate that,” then you can mark it and make your changes off of that.
You covered a ton of great stuff and shared a ton of wisdom. Steve, is there anything else you want to share before we start wrapping things up?
Thanks for having me. I appreciate it. This is an absolute, tremendous opportunity. If anybody would like to contact me, they can contact my clinic number at work (402) 564-5456 or reach me by email, which is CPTSL@ColumbusPhysicalTherapy.com.
We'll look forward to your book here. Thanks for your time and sharing. Hopefully, everyone gets a ton out of it but I appreciate your time.
I appreciate it, Nathan. Thank you.
Thank you, Steve.
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Over the past three months, Dr. Avi Zinn, PT, the owner of Druid Hills Physical Therapy, has made some big moves. He’s hired a new PT, signed on for another year of consulting, and switched his coach. He also continued to refine his processes with a new Prompt EMR and a new billing company. Thus, he has continued to grow his practice and has not had to step back into treating or be physically present in his clinic for a full day since March. Much of his hard work to establish systems and work on his business for the past couple of years is paying off for him, basically setting him to be a top-ranked PT in Atlanta, Georgia. Listen in as he shares these improvements with Nathan Shields.
This is Reality Episode 4 with Avi Zinn. We've followed Avi here in 2019. We followed you because you are a newer owner. We first got in touch because you were looking for some consulting help. If you want to hear about his story and whatnot, you can go back to the first episode. You decided to go with a consulting company. You've been with them since 2019. You have seen great growth in yourself as an owner and also in your clinic. We want to come up to speed.
In the last episode, we talked about how you got through COVID and how you're coming out. You’re optimistic about how things were going in general. Atlanta had opened up from lockdowns. You were projecting to continue to grow and bring on another PT. I’m excited for you in that regard. Bring us up to speed. What's been happening? We can talk about some of the trials that you might've had and some successes you've had as an owner over this period of time?
A lot of stuff has been going on since the last time. The biggest thing I listened back to our previous episode and I was talking about hiring on a new PT. The majority of what I was focusing on around that time was trying to figure out when the right time was to bring the new PT on because it was during COVID. It was hard to decide when things were going to feel like we're back to normal and clearly, we're not back to normal. We decided to go ahead and make the decision. Finding the right person is always challenging. It took a while, but I was able to find the right fit and we were able to get her started in the middle of September 2020.
Let’s talk about a few of the details if you don't mind. You were trying to figure out when was the “right time” to bring them on. What were some of the numbers you were looking at? What were some of the thoughts that were going through your head to make you decide to finally do it?
As a coach, you would not necessarily think I went in the perfect way. I didn't fully look at all my numbers to see that we were at a good utilization percentage or this and that. I got a sense by looking at the schedule and feeling that we were full. The world started opening up, we were getting more people wanting to come in, so it felt like we were busy and we need to hire on.
I assume you were seeing a jump up to a different level of new patient numbers or a consistent high total visit numbers.
It’s more total visits and new patients have always been about the same and that's also an indication of needing a new PT. When you get new patients but you're not getting more total visits. It’s because the PTs are discharging or too early. Some patients are falling off because we're too busy trying to get the new people when we can be focusing on the ones we have.
You got a sense that with the new number of new patients that you had, you weren't being as efficient as you could and getting them in for the 2 to 3 times per week or giving them a level of attention to the patients. Sometimes patients don't feel comfortable when the clinic is completely full. There is no table to do your exercises or they have to wait for that. You lose a little bit of patient engagement. You got some of those senses.
It was a few of those. Because of COVID, we've spaced out our clinics. We only do one patient at a time and there's not a space issue with that, but the therapist schedules were getting full. The patient engagement was more like we were letting people drop off and not having room for people and retaining them.
What were your concerns financially about bringing on someone? That's always an issue when I'm talking to newer owners. It’s like, “I've got to bring on this salary and the benefits for this PT. How is that going to impact me?” Had you worked that out or were you feeling uncomfortable?
I was feeling comfortable basing it on what it seemed like the influx of new patients and we were getting full. There were concerns with any time bringing on someone new. You’ve got to fill their schedule, spend a month or two trying to fill them up and you're still paying them. Luckily, I was able to find someone who agreed to start at part-time for the first month and then at the end of the first month, we transitioned her to full-time. What happened was even after the 1st or 2nd week, I had already asked her to increase her hours because we had enough patients. She was interested and she was happy to increase her hours.
That’s one of the benefits considering the situation that our industry is in. There are a number of PTs that are looking. I don't think that was the case in 2019. I don't know how many PTs would have been okay with starting part-time and then ramping up as they go. There’s an opportunity now for owners to bring on people slowly to build up their caseload that wasn't quite there a few years ago.
It allowed me to choose someone who I felt was a good candidate because there are a lot more people out there looking for jobs. I was able to find someone. I knew I had a little time so I didn't hire because I needed to fill a spot right away. We did get a little busy waiting to bring that person on, but I knew that I wanted to find the right person. That was what a lot of the work I was doing with the coaches. I've got my original coaching group, the Lighthouse Leaders, which is what we've been talking about most of the episodes.
Additionally, we talked about in the last episode where I hired Will Humphreys’ billing team. He also does coaching with me as well. I've got two coaches. I’ve got the coaching group and Will. A lot of what we've been focusing on is the mission, purpose, vision and values. Bringing on this new PT, I was able to make sure that she was aligned with our purpose and our vision. Making sure that she was the right fit for our team and not hiring someone because I need someone to be a PT in the clinic.
Was that a different process for you than what you've used in the past?
It was. Will helped me write some of the ads. He’s good. What did we write in the ad was about joining a team that is committed to values and purpose. Do you want to be a part of a team? Phrasing it that way. It gets better candidates because they are attracted to those specific things. I hadn't done it that way in the past.
Did you find that you got better candidates and people that were more engaged?
What’s interesting is that in March 2020, I was about to hire someone on. It didn't end up happening because of COVID and everything. Even with that candidate, she seemed like a good candidate. I was about to hire her, but it was something different when we spoke about the vision, purpose, future, growth and goals whether or not the other one wasn't the right person or not. It's hard to say it didn't happen anyways but this time, it felt different.
As you went through the hiring process, could you tell the candidates that weren't aligned or not engaged when you talked about values and whatnot? Did it help the filter system a little bit?
It made sense why I was doing that. There was one guy who clearly needed a job, which is fine. I don't blame him but all he was focusing on was specifics of like, “I want to work and I want to get paid.” Not anything more than that. That’s not what you want to say in your interview. Even though I was prompting him to talk about some of these things, he didn't align with or didn't buy into it.
If people are uncomfortable in that position when you talk about values, if their body language changes or they pay some lip service to it but you see something different in their job shadow, that tells a lot. When you put them up against the values, hold them to it and have them verbalize things related to your values, then it's almost like they self-select because they can't use the words if they're not aligned with the values. It comes across junky. You can always tell they're not comfortable. That helps a lot when you're going through that hiring phase being clear about those values and having those discussions.
You get a sense that they're authentic, sincere and it's someone that will be a good fit for your team because you can tell that they want to be a part of a team.
Not to spend too much time on this section, but it's awesome that you went through that experience. The part-time part of it is cool as well that she was coming on part-time for a couple of weeks. If it didn't work out over a 2 to 3-week period, you got some support but you're not fully committed so you have an easy out if they're not living up to what you expected.
For the reason of allowing me to ramp up with a lot less pressure.
Congratulations on the hire. Did you simply post something on Indeed and work through that?
You’ve got the benefit of being in Atlanta, but you also have the benefit right now of so many PTs looking for work compared to past years. I'm sure you had so many to choose from.
The PT I hired moved from Houston. She's making a change. She and her sister wanted to both move to Atlanta.
There are a lot of PTs out there doing that.
People are moving from what's going on. You hear about a mass exodus from New York and people moving out of there. People are changing their lifestyles now because of what's going on.
I've heard about it with a client in Cheyenne. I've heard about it with some friends in Ketchikan, Alaska. People are uprooting from Chicago, New York, New Jersey, you name it, to give themselves an opportunity to reset so it's a good time to find those people.
With her moving from Houston, it was super helpful to have Will and his team as our billing company because not only has it been great having them as the billing company. The first main reason is I'm not doing the billing anymore. They do a great job. They have all their systems for keeping track of the billing, claims, deposits, EOB and all the stuff that they should be doing. They also do verification and credentialing. Since she came from out-of-state and she had only worked in a hospital system, her credentialing and all that stuff was way more robust. It was a bigger process to have to completely get her credentialed with Medicare and then all the other insurances. It was a lot of work that I’m glad that I did not have to do.
It's so beneficial to have someone do all that credentialing stuff for you because if you fill out the form wrong or check the wrong box then it can delay that credentialing process so much longer. You'd rather pay somebody to deal with those headaches. Tell us a little bit about also the consulting. You’re still with the same consulting company. You signed up again after being with them, but you're changing individual coaches. Talk to us a little bit about that.
I signed up for group membership or whatever you call it to be part of the consulting group. The year came up and it was time to decide how to move forward. The group has a new lead coach that is not a PT. He’s got a much different background. He’s a CPA and has a lot of experience with business consulting but not specifically in the PT arena. It was appealing to me to get a different perspective from someone outside of the PT realm to see what it could be like.
There's an opportunity there to get a different perspective and not work with someone who might be simply accepting of your reasonings, your thought processes and you haven't worked with him yet. Going forward, he's able to challenge you a little bit on some of those fixed ideas that you have.
It could be. The coach I had in 2019 was great, valuable and we got a lot accomplished. Having this new one to challenge me is exactly what I am looking for. To challenge me, dive into some of the financials and look at our numbers a little differently. In the first year of coaching, I had a lot to focus on other things whereas all the numbers are important. There was a lot of focus on our systems and a lot of things that were not so data-driven. This could be a cool switch with the new one.
That’s not uncommon. Will and I had at least 4 or 5 different coaches over the course of the number of years that we worked together especially if you delve into it a little bit. The CEOs that are out there that have coaches, they'll change coaches every few years to get a different voice and a different perspective. They also have strengths in different areas that you can build off of. Not to say that they're necessarily improving in the coach that they're using each time, but they're simply getting a different voice. Something that speaks to the owners or the CEO’s weaknesses a little bit more. I can see the benefit of that.
I can relate to that in two instances with the previous coach. Chris and Will in two separate occasions both talked about mission and purpose. Even though we're talking about the same thing, the way Will talks about it versus the way Chris talks about it is different. You disattach onto the language that they use differently and relate it to an experience or a construct that you have in your head. It allows you to think and approach it differently. It could be as simple as that. Hearing the same thing but hearing it differently.
As long as people are getting some coaching, that's my greatest concern. I've had coaches that were PTs and most of my coaches were not PTs or in the industry. There are people that have reached out to me to get some input and advice and some of them work with PTs and some of them don't. That’s fine, as long as you're getting some support, guidance and business training, stuff that we didn't get in physical therapy school.
As long as you're simply getting it, that's the first step and then moving on from there to make sure you have the proper systems in place. You're working on the right things at that stage in your business. We’ll have to keep track with you on how the new coach goes going forward. Tell us a little bit about what you've been working on outside of the hiring process. You've got the coach. You switched over to billing with Will as of last time we spoke. It sounds like things are going well in that regard and the other things that you've been working on.
Outside of hiring on the new PT, the billing company and we switched over to EMR so we’re still working with Prompt and they're getting better. They're developing their software and they're coming up with cool things. Every update, they have cool new features. One of the big pushes that we've been doing since Corona is social media presence. We had a little extra time but we didn't have a social media presence.
We’re posting more on Facebook, Instagram, creating blogs, video content and sending out MailChimp newsletter. One thing that we did was have the PTs make videos of introducing themselves talking about their philosophies to be put on the website and use as promotional stuff. To also send out to people so when they sign up for an appointment, schedule their first visit, it includes a video or a link to their webpage and say, “Meet your PT.” They can meet them before even getting into the clinic.
That was an idea that Jerry Durham talks about in some of his podcasts. I didn't exactly come up with that on myself. Including it in the email to introduce before people coming in. Along that same lines of social media is something that we've been talking a lot about in the coaching group, the Lighthouse Leaders, is relationship marketing. It's not the same thing as social media but in a way, a lot of our referrals have been from Google Ads and we do a lot of paid advertising.
I haven't focused so much on making relationships with people in the community. Not just doctors but also trainers, massage therapists, athletic trainers, running groups, or yoga instructor, whatever. I put that in the same category as our social media because we're reaching out to people and we're trying to be connected with more people in our community. We’re trying to widen our audience, try to figure out who our target audience is. We're a generalist orthopedic outpatient clinic. It's hard to say who our target audience is. That’s also one of the things that we have been working on. It’s the social media and trying to reach out to our community a lot more.
How often are you posting social media content? How often are you sending out newsletters via MailChimp?
We’re doing monthly newsletters. We’re posting only once a week. We should be doing more. We’re getting it off the ground. We’re trying to broaden our audience and try to figure out how to get more people to either like our page or follow us so that we can reach out to more people when we post stuff. I don't know too much about the social media stuff as far as using it for not personal stuff but as a business, how to get out there and reach your audience. We're trying to do it and see what happens.
I did a podcast with Angie McGilvrey. She's a master at it. They had a hurricane in Florida, which shut them down and it gave them an opportunity to say, “How do we want to reset our business?” Coming from someone who was not on Facebook at all, no social media presence or whatsoever decided to focus on a certain target audience and do more consistent social media posting, engagement and that stuff. They started like you. Once a week, they'd post something to a particular audience that they wanted to attract. A few years later, they've got a part-time videographer that comes in and they're spending a few hours each week. Three of them are doing different social media things. They’re posting 1 to 2 items a day. It starts where you're at. Putting someone in charge of that so it’s not you all the time and then focusing on, “Who are we speaking to? What do we want to say?”
The interesting thing is, and I don't know if you've seen this as well, but as I talked to my clients, they say, “Sometimes I post stuff on how to do certain exercises, muscles they need to be concerned about, and activities they need to avoid. I'll post something about a dog and the level of engagement goes up to 200%.” Sometimes, it's not always about them wanting to know what you know and you espousing all of your wisdom. Sometimes, it's about staying engaged and posting a picture of a nice sunset once in a while.
We haven't tried it yet but we will.
The cool thing about social media is you throw stuff out there, see what sticks, see what starts connecting, and simply start doing more of that because you find out quickly who's engaged and who's not.
You can see if there are 20 likes or 100 likes and go from there.
Have you had any HR hiccups that you've had to deal with? Not that you have to get into details but that things seem to be running smoothly for you.
Things have been smooth. No real issues or HR stuff. We've done HR stuff as far as developing a better employee handbook and some of the SOPs. In regards to the SOPs, our front desk has been with us since 2019. She got accepted to OT school, which she's most likely starting her program in January 2021. Before COVID, one of my PTs were transitioning to the clinical director. We put that on hold, but we're still talking about it and doing some of that stuff. Not officially but me, the front desk and the PT have been trying to develop a strong, solid SOP for the front desk so when we do get someone to fill her position, our systems are going to be much more developed and more efficient.
It should be seamless if we can hire in time that we can have her come in and even sit with the front desk for a few weeks before she leaves, that would be even better. We're working on that type of HR stuff but nothing like disciplinary things like, “Thank God, my team is great.” Part of it is luck and following the advice of the coaches and all this stuff. It’s working on your team, setting up everything in a way, meeting with your team, and making sure that everything is running smoothly and not being a micromanaging boss but also letting the team run the place and all the stuff.
The smart thing that you've done since you started was to recognize that you needed to spend time writing up systems and how things were done. That’s a grind and you're still working that at higher levels but now is when it starts bearing fruit. As you said, the team can run things and you don't have to micromanage. This is where you're working through that hiring process with your coach and Will, and establishing your mission, vision, values. It's the same filtration system for those candidates at the front desk as it was for the PT. You can have the same conversations, you can get into a flow of how that interview process goes, and also gain some experience in being able to quickly weed out those that won't be a good fit.
This is all working in your favor. The fact that you were working on SOPs for a long time. Your systems are getting into place. You've got someone who's at the front desk who thankfully gave you plenty of time, and notice as to knowing when she's going to take off so that you can start preparing well ahead of time. If the next person can come in and shadow your person to be successful and you have two people there working at the front desk for a short period or as long as you like, you're going to be set up well in that transition and hardly see a drop-off.
I hope it works as smoothly as you said. That would be great.
It all goes back to the work that you started doing a couple of years ago in putting together your systems and processes. It’s starting to bear fruit. I'm assuming where you're at, are you treating it all now? What does your weekly schedule look like?
I haven't treated since COVID, since March 15th, 2020 or whatever. I've been out of treating and I've been out billing since April or May 2020 or whatever. It’s been great because it has allowed me to focus on all these things and get some of these systems in place. Before that, I was always working on them here and there, but I've had time to sit down, write them up, get things going, get feedback from the team. Even get their advice on how we should do things and get things set in stone so we can use them efficiently.
You've been an owner for a few years. It took me 12 or 13 years to get to where you are to finally step aside and work on my business, so congratulations on that. What are the next steps for you, Avi? You've been through the process considering the mission-vision values. Part of the vision portion is setting up some goals, longer-term or even shorter-term. What are some of the things you're looking forward to in the next year or two?
I've still got plenty of work to do on the systems and everything. What I do acknowledge is that even in the year of having the coaching, I'm still not dialed into all my numbers. That's also one of the hopes of this other coach, he's got a CPA background and he might have a better sense of financials and stuff. I want to focus more on our numbers, be more data-driven. It goes back to the SOPs, but it goes almost to some of the stuff we were talking about in the last episode as far as leadership team. I've been in the process of implementing where the team reports their stats to me or to the clinic director and then the clinic director reports it to me so that we're all taking responsibility for our own numbers.
Looking at the numbers and being able to project and grow from those. I do have numbers and look at them, it’s just I don't have a strong grasp on them. Looking at the numbers of September and October 2020, October was our biggest month ever, which has 100 more visits than last month or at least. We hired our new PT. You would hope that at some point, but her schedule filled up quickly which was cool. In addition to it being the biggest month, our utilization was good for her first month.
It was at 75% utilization too. That’s a big accomplishment and that goes back to having all these systems in place so we’re not losing our patients. We’re aware of their plan of cares, cancellations, and making sure that the front desk sets them up for success by setting up their expectations before they're coming in and dialing in on all those things. Moving forward, now that those systems are at least in place, they could be refined and improved. It allows me to start looking at the numbers, projecting, and using that for some continued growth.
How many providers do you have at this time?
We've got three providers.
You’re starting to get into that phase where you start developing a leadership team. You’ve already started that process by pointing out who your next clinic director is. Considering what that leadership training process looks like in your clinic and start developing those leaders to do exactly what you said to start looking at statistics, numbers, working off of the numbers as to what to do going forward, and also tracking those numbers to see if they're meeting your goals and expectations. Developing a leadership team, getting a handle on the numbers are great things to focus on in a little bit for you as a leader. Are you considering further expansion in the course of 2021?
Yes, but it all depends on the pandemic thing. It’s hard because we have a space for more people if we didn't have to distance. In our clinic, we rearranged it so we could fit three PTs comfortably. They're all in separate areas of the clinic. That’s how we want to do it. I'm sure there are clinics that are not as distant and we can squeeze another one in, but that's how we feel comfortable with our clinics. As far as expanding, we could get another provider and fill the other hours. We're open from 7:00 to 7:00 or something like that.
For me, it's hard to make any real plans for that until some of this stuff calms down. I can see that if all of these systems continued to function and not only function how they are now but even better and improve, that growth will only be a matter of having the space, hiring the people, and getting the patients as far as growth goes big. I can't imagine it's that simple but if we have all these systems in place which we're developing, I can see how it's going to be easier each time we grow because there's going to be a process for everything that comes up and it's not going to be like, “I'm going to have to deal with everything.” We don't have to figure it out every single time. There will already be a process and it will be smooth when something comes up.
Congratulations on the new hire. Congratulations on the successful EMR and billing transition. You've gone through some great stuff and coming out of the pandemic well. We spoke about the last time, to gain more patients for this new provider, you do a lot of work with Google Ads. I assume you simply increase your Google Ad spend, revamped a couple of things and you're continuing to grow.
I will say that we are seeing more and more referrals, not necessarily from more doctors, but internal return patients, word of mouth, so that’s been cool to see also. We are playing around with the ads, boosting the budget, and all that stuff, but we are noticing that the longer we've been around, the more reviews we have. People are starting to notice us and know that we're here. People are referring their friends and family. At some point, we won't have to rely on the paid advertising and we can get patients by word of mouth and by being a part of the community.
I don't know exactly what year of ownership that is, but there is a point where your return patients start making up a significant portion of your clientele. You still have to market and get fresh blood coming in. Once you focus on starting that internal referral program and pushing patients to refer family and friends who are injured or need some help, that can be a huge boom to your new patients. It takes a few years to build up that base level, but you're starting to engage with them as well with the newsletters and the social media postings. These are people that already know, like, and love you. It’s best to tap into that number of people which could be in the hundreds and thousands over time. Tap into them and it could bear fruit.
That’s the hope. That’s what we're doing with the social media. We're trying to engage with the newsletter, people that have been into our clinical before so they've all been here. We're trying to keep in touch with them, let them know what's going on, introducing them to the new PT. We've been also creating some eBooks which have been fun. Giving out links to the eBooks. Providing value to the community and not necessarily looking for anything in return. The goal isn’t to get people to make an appointment from that newsletter, which would be great, but it's more of keeping in touch with the community. Hopefully, that will keep us on their minds. If they know someone, they'll remember to tell them that they had a good experience with us and that could create another referral.
Congratulations on the growth thus far. You're doing great especially at ownership. You’re making progress and to be where you're at is enviable for a lot of owners. Congratulations, you're making steps in the right direction.
Thanks, Nathan. It's definitely fun.
Dr. Avi Zinn has practiced physical therapy in many settings prior to opening his own clinic in Atlanta: outpatient orthopedic clinics, hospitals, rehabilitation centers, and in people’s homes. He is an expert in treating all different types of pain and injury, and in developing treatment plans that bring people back to their most functional selves as quickly as possible. Avi’s main mission in opening Druid Hills PT is to utilize the experience he has gained in the field to provide high-quality, personalized care to each and every one of his patients.
Avi has his doctorate in physical therapy from Touro College, and is a Certified Orthopedic Clinical Specialist. He lives with his wife and three children in the Toco Hills area.
There are many statistics that an owner COULD track, but which are more important than others? In this episode, Nathan Shields’ guest, Craig Ferreira of Survival Strategies, Inc., answers that question based on his greater than 35 years in the physical therapy industry. Not only does he share the key stats to track, but he has also developed software to track, graph, and project. The power of tracking stats is based on the objectivity of the data, which tells you exactly what needs to occur to improve the status of your company and achieve your goals. Every successful PT owner that Nathan has interviewed and met is tracking and acting based on the key statistics they regularly assess.
I've got a returning guest to Craig Ferreira. He is the CEO and Owner of Survival Strategies, which has been helping physical therapy owners for many years. He is also the CEO of Hands-On Diagnostics. I wanted to bring him on because not only does he have a wealth of information, experience and expertise in relation to helping PT owners. If you want to learn his story, you can refer to our past episode. I want to talk a little bit because you've developed a software program to help us gather the most important statistics, especially those related to growth and where you can capture losses quickly that might be a detriment to your business. I'm trying to summarize it there, but first of all, thanks for coming on.
How are you?
I'm doing good. Let's jump into it. You've developed this program and I'm sure it's because of the decades in which you've worked with PT owners and its key statistics related to your business ownership. Talk to us a little bit about the statistics that are involved and some of the key components to it. In my conversation with Will Humphreys, and I'm sure you would agree, one of the key aspects of being a successful PT owner is to lead by statistics to measure those stats and see which trends are happening over time and work off of those statistics to improve your business. I'm getting my head of myself, but that's the importance of it. Tell us a little bit about what you're seeing and why you decided to develop this.
First of all, this came from my years of experience working in clinics. I worked in about 200 clinics myself onsite as a consultant in the ‘80s and the ‘90s and before the computers. There was one of a few items that I realized that people didn't have and to this day, they still don't have, which is you can keep a statistic. Let's call it new patients. That's good, but how many of these do you need to pay your expenses and to make some profits? People sit down with Excel and this and that and you can figure it out, but my software does all that automatically. You can say, “I want 20% profits and I have this expense and so on.” The system I designed automatically creates what is that bottom line, which is an important thing to know.
The other side of the coin is people don't know what could they do? What's my potential production with my existing staff? I made the software do that too. You not only get what are we doing? You also get, what could we do, what do we get to do or what must we do? With those parameters, you can also educate your staff as to, “Do you see this graph we've got here? Here's a red line. We got to be above this all the time. We could do this. This is what we're doing.” The owner has to include in that red line though, reserves and profits. If they don't put that in, they're not running their business as we know. They're just running it to pay themselves and hope that they can make some profits.
I find that with a lot of the clients, the people that I talk to and I saw it in myself back in the day, but we simply run along. As long as the bank account shows us that we have some extra money, then we would assume that we were doing well because we had none of this financial and formal business training. One of the first things I have to get some of my coaching clients to do is say, “How many visits do you need to break even?” Sometimes they don't know or, “What's that dollar amount? What do you got to make every month to not only cover all your expenses but also to provide you a little bit to put away in reserves and that 10% minimum profit margin?”
What are those numbers? Not to have those numbers is simply flying blind. As I said, you're hoping and wishing that the money shows up. If it doesn't show up, then you're scrambling with your head cut off. It's better to not be in that position but to be working from a place of certainty. I love that you said you have to share that with your team. Not only is important for the owner to know that, but the team should know that. They need to know when they're producing well, when the clinic is going well, and when the clinic's not going well. They should know that so they can do something about it.
I remember I had a PT once. It was in Arizona in the middle summer and it's a slow season for us. I said, “I don't know if we'll hit 150 visits this week.” She stared at me like, “I don't know what that means.” She had no clue. This was an experienced PT and it was no fault of hers. It was all my fault. I thought, “I'm not teaching my team the importance of the members and when things are good and when things are bad.” That was a learning experience for me. I'm glad that you said that.
Most of the people that come aboard with you are not trained in economics so they don't understand it. The point is that whole subject by its own definition would indicate that you need to understand the business, what could it do and what does it have to do? What are the areas of loss that eventually ended up to you losing money? I can guarantee you that I can look at any clinic. I don’t care who's it is and show at least a 10% loss at the front desk and another 10% loss in the billing and collection area. I've never found one I couldn't do that with. It's easy to say that you need to know how many new patients come in to make your bottom line. What's even more important is, what are the sub-things you see that make that happen like?
One statistic that you must track or referrals that don't arrive and some people just don't do it, the front desk doesn't do it, or they don't even know that anybody that contacts that clinic for any reason is a referral. That has to be the concept. There is a phone call, an email, fax, a friend, a family member like, “I heard about your services. I want to come in. The doctor sent me.” Consider that to be a self-referral. Do they get in the door? If you don't track referrals versus evals, you can't see that you're losing about $1,000 every time you don't get that patient in the door. Nationally, I think that's about the average these days. Your front desk needs to know that. That's a $1,000 loss.
I don't think they understand that when people call and say, “Where are you located? What are your hours? Do you take this insurance?” That's not what they're calling about. They’re simply fishing and those are potential referral sources. If your front desk isn't trained to be the salesman that they need to be, they're going to simply answer the question and hang up.
The clarification I'd make there, if it's a patient calling, that's not the referral source to follow, but that is a self-referral. Those things have to be tracked. It then comes in and now they start canceling. That's the other area of loss. What do they do? They don't get it made up. They don't control the schedule. They take excuses. That front desk has got to be trained and good at communication and skilled. One thing I found out is that people don't track dropouts. I asked, “Do you get dropouts?” They answered, “Yes.” I asked, “What is it?” A dropout is self discharged patients. That's the way to think about it. They don't track it by the therapist so you don't see whose patients are dropping out more than others and all that other stuff.
Here's something you can do. This is a suggestion that I have for the whole profession. At intake, you should have a form that says, “It's a medical necessity that at the time of completing your services here, we need to see you in person.” It has to be done in person. That is a procedure that will help at least with the front desk and the patient. When they say, “I don't want to come back, I feel better, it hurts too much,” or whatever they're saying, “I understand, Joe. Remember in the intake stuff, you got to come back in. We got to complete the paperwork,” or whatever you want to say, the reason is you get the patient back in.
I've said it a million times on the show. I share it with my clients, but we both know the average number of patients who complete their full plans of care in most outpatient physical therapy clinics across the country is something 15% or 20%. If that stat alone is measured and improved, that can do wonders for your revenues and your bottom line.
There is no doubt about it. That's another area of loss. Those statistics you see need to be tracked to point dropouts, cancellations and no shows. That's a whole other thing, which has to be tracked. In my software, I track all this by therapists and then it automatically makes it by the percentage of arrivals. It does it mathematically so you can see the percentage of arrivals of each therapist and the clinic as a whole. You can also do this in Excel.
It's important to track that by provider because your clinic on average could be doing well. If you don't track provider, it could be a situation where 3 out of the 4 providers are doing above expectations, then the one provider is below expectations, bringing the average down to where you want it to be. When you go by provider, you're able to have the one-on-one conversations that need to be had and people need to be held accountable. Otherwise, you're going based on feeling. It seems like their interactions are going well with the patients, with the other team members and they're seeing the right number of people. If you don't get down to by providers statistics in terms of their billing and their dropouts, then you get a feel for exactly how well they're doing in your clinic.
The other thing you want to keep advance schedule, “What's scheduled next week?” That’s an important statistic. If you've got the advanced schedule, you can see what's coming up and you can also go, “This person normally does 60 visits a week. Next week he only has scheduled 40, what happened here?” For therapists, it's evals. The other thing that happens is discharges go out of crazy. If you don't track the evals against the discharge, it gets to be nuts. The advance schedule, the percentage of arrivals, which is calculated by the no shows, the cancels, and the dropouts. You've got the average treatment charge, which we haven't talked about. That's a whole other area where you're losing money. There's a thing called percentage capacity.
This guy should be doing 100%. He did 60% this week. What did he do for the other 40% of the time? Those are the statistics. What I did with the software is I've made it so that each therapist, the clinics that have been using this, the staff gets to the point where they fill in their own numbers. They sit there and they fill in their own numbers and graphs are automatically generated. It also shows their bottom line and their individual bottom line of potential. Personally, how many of these do they have to do? It doesn't show them anything about finances unless the owner wants them to because the software has four access levels. It's done extremely fast. As a matter of fact, I timed it. If you gather the numbers and you put it in a spreadsheet and you press enter, each therapist takes about three minutes a week.
It's the gathering of the data that could be theoretically the “problem.” They don't have the data. They don't keep the data. They don't know where the data is. That's a whole of the situation. The last thing that I realized and created was a thing called profit. This is the thing that we will love. It was the profit projection sheet, where you can take your expenses and a few other parameters and you say, “I'm going to hire somebody.” I plugged them in. I plugged in your salary, your taxes and they're going to add X more visits per week. What does this do to how many more visits do I have to do? What kind of money can I make on that projected income?
Here's the other thing that I've never, ever seen to be untrue. I have done hundreds upon hundreds of these profit projection sheets with clinics random from all over the place. When people sit down and tell me that they are not making any money, and then I sit down and show them, “What are you talking about? Let's take a look at this. With your existing resources, you could be making an extra $200,000 a year.” They go, “What do you mean?” I was like, “You can be. The reason you're not, we need to find that out.” Normally, it’s that they didn’t get enough new patients. They don't know how to control that. That's a whole other thing. In some cases, they have enough new patients. In pediatrics, for instance, we're working a lot with pediatric practices. Most or all of them have waiting lists, but that's not where they lose their money. They lose their money from inefficiencies internally, scheduling, charging, billing, no planning and no goal setting.
The software is made to do that, but with all this said, that's all nice we can talk about this. The last thing, the break-even point and the viable practice, there's only one. It’s when that owner recognizes that they cannot be in the treatment room all the time. There's no leadership. There's nobody looking at the numbers. There's nobody even designing the numbers. What I try to do is make it for a business where other people could be involved in the stat tracking so it's not all on the owner, which helps the owner out.
I love the financial projection portion of your program. I talked to clients when they're talking about growth, bringing on another PT and adding that salary. They say, “I don't see how it's going to work.” I say, “This is where you need to get your CPA and your bookkeeper involved and start adding some of those numbers and projecting and seeing what new patients or total visits you'll have to hit in order to make the numbers you want to make.” If you can do it on your own, that takes a step out of the process because you and I both know that you're going to have to set up an appointment with the CPA. That's a month out and it's going to take an hour on top of the other stuff. It's going to cost you something to do that. If you can start plugging and playing some of those numbers, knowing your reimbursement rates, you're going to be able to create that financial outlook on your own, which can be super powerful.
The other part of it and I made it a little section. It's like a, what if, “I'm going to open up a new income source or I'm going to open up a new clinic.” “You can do a projected budget.” You don't need to go to your CPA. You can sit there and put the numbers in. I've already done that work. It's fun. It also tracks the referral sources to see who is referring, what their specialty is, what part of town they're in, and the demographics of the referrals. It creates pie charts, graphs and all that other stuff.
You've been doing this for many years. You've been preaching the importance of key statistics, tracking, graphing and watching them. What do you find in most clinics that happen to the owner and the clinic itself when they sit down and take the time to measure their statistics on a regular basis? What transformations do you typically see?
I believe and know that anyone has a high intelligence level. That's my own thing. What I have found is most people can make decisions and do something, but the step that's missing is the observation of enough information to make the decision. What you see when an owner starts to see, “This affects that and that affects this. This is the bottom line. That's my potential.” I've been listening to people tell me that they can't produce, but I go and look and see that they're not producing. It starts to get rid of all the confusion. They get unconfused. The confusion starts to become a way and now they have stable things to view and understand their business from. It calms them down. The stress level comes down.
It's emotional at that point and it's completely objective. I love that it's analogous to a dashboard because when you see the stats, they tell you what you need to do next. You don't have to sit there and think, “What's going on? Why aren't I doing this? Why aren't I profit? What's happening to all my new patients?” You look at the stats and it tells you the story. You simply have to follow those stats and take action.
I'm going to give you an example I am seeing with every clinic we've ever seen. When the new patients go crazy, the discharges all of a sudden, go crazy. The therapist starts discharging.
They get busy and they start discharging patients or letting them fall off or whatever.
We then go and interview them. We put in what we call a chart review. The owner, somebody sits down with the chart and says, “Can we take a look? I noticed you discharge Joe here at the end of four patients. There are a few of the discharges, what's happening?” “I got too many new ones.” “Did we establish the goals with this patient? How come? What are we doing here? Aren't we supposed to be treating and helping people achieve their goals? Did we discharge him because we're too busy? That's a management problem. You've got to let us know we need more therapists. Don't just start discharging the patients.” It happens all the time.
My point is this, if you don't objectively measure, Joe, has new patients on an uptrend and all of a sudden, the discharges are above the evals or they spike. What do you do? You go and look interview Joe. The way we found it is chart reviews because the therapist will agree that, “I could have done some more. I didn't have enough time.” “We've got to get that fixed not financially, but because we're not getting the patients what they need.”
Now, you have a patient that hasn't fulfilled their goals and they're going around town telling family and friends that the physical therapy doesn't do anything for you. They're not telling everybody that they only went to four visits and they expected miracles. They're saying that, “The physical therapist didn't work for me so I'm not going back.” That comes down to the responsibility of that particular provider, not getting full buy-in and engagement with the patient and following them through to the full plan of care.
A long-term client of mine, Paul Salkovskis mentioned to me many times he's been treating for as long as I've been consulting, “The most important aspect of the whole therapy thing is the first interview with that patient, where I bring them to an understanding. Not only am I their therapist, but our job as a team is we're going to go the whole later and I need your agreement to stick with me. We're going to make that happen.” That’s key.
On top of what you already said, it seems like the owners that look at their stats on a regular basis and act accordingly are simply in greater control. They're in a more powerful position to do what the clinic needs. If they're in the treatment room full-time, then they're not seeing, observing, and not taking the actions that are necessary. What can help those providers who are treating full-time is if they number one, take control of their schedule and set aside at least a half-day a week initially, to gather the data, measure the statistics, break it down by clinic and provider and then act accordingly. Start from there.
Over time, you'll team members start reporting their own data up to you and you'll see changes in their behaviors as they see the data for themselves because that's their scorecard. It shows how they're doing. They tend to start taking control of their own areas and that provides them a powerful base off of which they can work, improve, set goals, and show progress. Once it starts with the owner and works its way down to the team members individually reporting those statistics, that's when you can start gaining some traction.
We have some long-term clients who I can think of one, in particular, has about 50 staff. All her staff is in my program and they play games. They'll go, “How many did you do this week? You did that minimum visit? I'm going to beat you this week.” This fun and they also get rewarded.
If people wanted to find out where they can get your software program, how can they find it, whether it's online or in contacting you? How can we get in touch with you?
The easiest thing to do at this point is I'm going to give you my personal email. The reason I'm doing that is because of COVID. I'm all over the place. We do have an office still, but everybody's working from home, at least in my profession. It's CraigLuisF@yahoo.com. If you have an interest, shoot me an email. Somebody can shoot me an email and I will ensure that either my assistant or myself sets up a demo if you want to see what am I talking about here? That would be the easiest thing to do.
I'm excited to hear about the part of your software that projects things. I think that's missing with our PT owners because they go off of feel. They might see numbers in terms of new patients, the total visits, and their bank account and they're like, “It's time. Let's grow,” but they don't know exactly what it's going to take? How that's going to affect things? What the financial implications are going to be when they do expand, and what they can expect? Having this software available to them can provide them some opportunities to look forward appropriately and know exactly what to expect and what needs to be done in order to be profitable.
It gives them a great tool. It's a fast tool as well. It provides the data quite fast and then it makes it a lot more fun, frankly, because you can see what's going on.
If you got a numbers nerd or something like that in front of a spreadsheet, you start throwing numbers up there and see, “What does that do?” Can it also reverse if I want a 20% profit margin, will it tell me the number of new patients I would mean once you have all the data?
You can automatically change the percentage of profits to anything and they'll tell you the new patients, the visits, the charges you need after your write-offs in the account. It does everything like that so you could see it. It's not just a spreadsheet of numbers. It's in a graph. You can look at it and it's got color to it. It's got an aesthetic.
I love this stuff, especially for PT owners. More resources are coming available to us, but there needs to be more of this and you don't find it available in the EMR. I'm glad that you created something like this.
Thanks for your time, Craig. I appreciate it. Do you want to share anything else with the audience?
I hope and know that everyone is pushing through what we all have to push through the stuff that's been going on. It seems to be getting better. One thing I would like to communicate that I noticed, because of COVID, the communication level has greatly increased between people. What I'm hoping is that when it's done, you don't decrease the communication level. Keep it up there because that's, what's keeping everybody's hope factor. I call it alive and creating, and what are you doing? Who's helping who? If somebody is in trouble, they can talk to somebody.
I agree because as we were going through the middle of it March, April and May 2020, there were more webinars, free consultations, and that stuff that I don't think that's necessarily fallen off. It's important. You stressed for owners to know that the consultants at Survival Strategies are more than able to do a free consult with you. I'm willing to do the same for people at Hands-On Diagnostics. If people are still trying to push through, the resources are still there. We haven't backed off of our willingness to work with you.
You might not hear from us as much because there's not as much coming through the pipes day-after-day from Medicare and everyone else. They're still available. They're still there to help. They want to help people through and the resources there, the communication on the owners has to continue as well. They need to maintain a high level of communication with our teams. They need to maintain a higher level of marketing and promotions that they did to the doctors back then. They make sure they keep it up and don't let it back off.
It should be doubled or tripled. We have many clients now in the training company that are doing better than they've ever done. The reason is that their communication level to their community has been quadrupled. That's an important factor. It's a pleasure. If you ever want anything again, I'm always available to help.
As always, it's great to have you on and learn from your wisdom. I appreciate your time, Craig.
Thank you very much.
Have a good day.
Craig Ferreira has been around the PT block thousands of times. He knows the inner workings better than almost anybody and can break down any situation into easily digestible nuggets. Thus, I had to have him on when I found out that he's about to give a talk on how to improve productivity and, specifically, sales in the PT setting. Most PTs hate "sales" as we know them, but doing it in the right way isn't "sales" at all. How we present that to our teams can be super easy. Craig knows how to do it. If you simply do a little footwork, have some conversations, practice the art of "selling," create and hold expectations firmly, then just wind it up and let it go, you can see results quickly! Follow Craig as he'll walk you through it.
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My guest is Greg Todd out of Florida. You might have seen Greg around. He's got a ton of stuff going on. He's the owner of multiple PT clinics. He is the Creator of coach and consultant companies called PT Builder and Smart Success PT. He's a mentor. He's a fellow podcaster. He's got a great event coming up. Look out for that. I'm excited to bring Greg to you because in his story, he came to recognize early on in his career, and that was even prior to owning his PT practices, that it wasn't the traditional PT skill set that was going to get him where he wanted to be in terms of success, significance, the effect on his community that he wanted and the wealth that he wanted to achieve, and even the freedom that he wanted to have in his life. He turned to recognize that he needed more non-traditional skill sets and the build-up of those skills. Whether that was learning how to lead others, doing better in marketing and sales or at least having the ability to communicate better with other people and becoming the visionary of his own life and the visionary of the companies that he wanted.
I'm excited to bring Greg to you because it harkens back to the same message that came upon with my interview with John Woolf where we recognized that it requires a change of mindset, that it is not the traditional skill set that's going to get us further as PT clinic owners to achieve the goals that we want to achieve. Read into Greg's value stages that he brings up for any member of a company, whether you're an employee or the owner, and how that correlates to the amount of money and freedom that you have in your life. That's invaluable. He also talks about four different types of people that exist in the world. I'm sure you can relate to all four of them, whether that's yourself or others that you've come across. I will let Greg put his own words to it. Read his story. You will get a lot out of it because he brings a lot of energy and a lot of wisdom to the story and to the message that he's carrying forth.
I’ve got Greg Todd, a physical therapist out of Florida. He is the Creator of Smart Success Physical Therapy and also the Co-owner of three physical therapy clinics and soon to be four. Todd, first of all, thanks for coming on. I appreciate it.
It's my pleasure. Thank you for having me. I appreciate it.
Tell me a little bit about you, Greg, where you started from, what got you to where you are and what you're doing nowadays.
I've been a physical therapist since late 2000 and got into the field because my mom told me to. My mom was a medical transcriptionist for an orthopedic surgeon. She told me and indoctrinated me that, “Greg, you need to have a skill.” She loves her husband but, “Don't be like your dad.” My dad was an entrepreneur and he used to work for a company called Primerica. She says, “You want to have a stable job. You want to have a skill so that you can get a job when you get out of college.” Initially, she wanted me to be an orthopedic surgeon. The orthopedic surgeon that she worked for, the day that I went to go meet him and shadow him, he was in a pissy mood that day. He said, “Don't do what I do. I'm on my third wife. My kids don't know me. Do what they do,” and he had physical therapists that worked in his office.
That is the story of why I decided to go into physical therapy. I knew that I needed to get a stable job because my mom told me to. I knew that physical therapy was in demand. It was between physical therapy and pharmacy. I've always wanted to do physical therapy because I love sports, but I was leaning towards pharmacy because I had a speech impediment and I stutter a lot. I was very afraid that I wouldn't be able to communicate with clients because of my stuttering that I struggled with all my life.
I ended up deciding on PT and that's how I got into it. I was not planning on being an entrepreneur. I just wanted to work 9 to 5, come home and have a good living. I always knew I wanted to have a family. Within four months of me being a physical therapist, I was married to my college sweetheart. I quickly realized into the profession that there was a hard ceiling and it wasn't necessarily the money, but it was the time that I wasn't able to get back with the hard ceiling that I was experiencing. We had our first child and then that turned into two, three, four and I realized that this is not going to work. It's such a hard salary cap and more importantly, it was such a hard time cap. I realized that I was not going to be able to ever win the time game if I was just a staff physical therapist.
I thought that I was going to reach my ideal pay by year ten. My first job, I make $39,500 a year. My plan was to make a 4% increase every year. That wasn't bad back then because I was coming out in 2000, 1997 is when the Balanced Budget Act came. You are lucky to have a job. $39,500 and I had a full-time job. I was like, “We're good.” I was making $7 at the most. I'm like, “This is great. No problem.” The issue was that I was under the assumption that you're going to get a 4% increase every year and I had a plan to make $50,000 by ten years. I know it sounds crazy now, but back then that was like, “$50,000, I'm going to get a 4% increase every year. I'm going to hit the corporate numbers. I'm going to hit the company numbers. I'm going to take care of patients. I love physical therapy.”
On my first year, the company that I was working for was a big corporation. They had continuing education courses every single weekend that were company funded and that was within the company because it's such a big company. I did 180 CEUs in my first fifteen to sixteen months. I thought that was the way to achieve the 4%. I had done over 100 continuing education units by month twelve and I've got a 1.5% increase in pay. That was the first a-ha. When I went to my boss, I was pissed. I'm like, “Why did I only get a 1.5% increase in pay?” He was like, “You didn't do anything wrong. That's what we give for staff PTs.” I was like, “How do I get an increase in pay?” She says, “You’ve got to be a clinic director.” Now, I understand how the whole levels of earnings work. It was the first time that I realized you don't get rewarded for being a better clinician in the real world. You get rewarded for moving up in management and you get rewarded for other things, but you don't get rewarded for clinical excellence, which is sad but it's the reality of the situation.
That's no different than being a PT owner. You don't get rewarded for your skill set.
You get rewarded for running the business right, but I didn't understand that and most people don't understand that. If you think about it, it doesn't make sense because we put so much effort into CEUs, into this and that. You've got to get this. You’ve got to do this. You’ve got to become a CSCS. You’ve got to become an OCS. You've got to become an SES. You've got all these different things but nobody talks about that does not get you any closer to having financial freedom and any closer to having time freedom. I went through this journey for about three and a half to four years. My wife and I started to have marital problems. It’s nothing crazy. She was frustrated that I was working so much and that I was on this quest to do every single CEU course there was out there. At that time, I also got the opportunity to work with professional tennis players. I was working on the WTA and ATP tour. I was trying to become an OCS. I was trying to get every single manual therapy certification there was on planet Earth. At the end of the day, I was getting nowhere in terms of earning more and getting more time freedom.
Where it culminated for me was when I asked my boss where I was a clinic director at a brand-new clinic. I had achieved the numbers that they wanted after a year of working in that clinic and gone beyond 50%. I said, “All I want is one day off a week. I want to work four twelves. You are paying me a salary for 40 hours anyway. Let me work four twelves and let me get that one day back so my wife and I can start to spend more time with one another,” because that's where the frustration is coming, that I'm never there. He said no. That was the day that I knew that it didn't matter. I had to become an entrepreneur. I had to go and open up my own thing so that I could be in charge of my schedule. I did not want to do this, but they forced my hand and that's it then.
It wasn't tragic but in a sense, it's a challenge. It’s not even failure but something took you to the point where, “I've got to do something different.”
I’ve got no choice. It was either that or the marriage. They made it very clear. Just to give you an idea of my schedule. People may go like, “What was your schedule like? Was your wife being a brat?” No, she wasn't. Here is my schedule. I started seeing patients at 7:00 AM at the clinic I was working at. This is a company called CORA. I was seeing patients until 8:00 PM. When my tennis players were in town and they weren't out of the country for tournaments or whatever, I was going to their houses or their condos in a place called Saddlebrook after work. It’s about five to ten minutes from my clinic. I was going there and I was working with each person an hour to an hour and a half at a time. I was sometimes leaving Saddlebrook at 11:00 PM.
I’m getting home by midnight to 1:00 AM, eating, then staying up until 1:00 AM and she's asleep. She's waking up to take our daughter to her mom so she can go to work. This was the normal day. Then the weekends were going to Continuing Education Courses. At that time, I was trying to get my Manual Therapy certification to the University of Saint Augustine. That was Monday through Friday for us, then Saturday and Sunday, I was in Saint Augustine trying to become this better clinician. It was a rat race to the bottom. That's all it was.
I love having you on because I'm all about stability and freedom. My story is similar. I wanted stability and freedom, unlike my father. Something that could give me the opportunity to be like my uncles who were in the healthcare profession. They had time and money, and I wanted that. I love having you on because that's what I'm all about on this show. Was it at that time that it finally clicked for you that your clinical skill set made no difference or did that come up a little bit later?
At that time, I started to get it but I didn’t still fully get it. I've started to realize that I was blaming the companies. I was like, “I think they're trying to screw me over. What I'm going to do is I'm going to leave and I'm going to open up my own thing.” I had a non-compete so I had to leave the area for one year and then I came back. During that time, I ended up with this guy who saw that I was working with all these tennis players because the tennis players followed me. He had a very small clinic called Renewal Rehab. He's like, “Let's team up. You will have all the insurances if you work with me.” We decided to become partners. We’ve been partners for fourteen years.
At that point, I still think clinical didn't mean anything and it does mean something. What I did realize at that time was that the corporate system wasn't set up for me to be autonomous, for me to make decisions, for me to do things that I feel were in the best interests of the patient. I knew that at the time. I knew that enough to say, “I’ve got to get out of their system.” I thought that if I went on my own, all these awesome things that I had: OCS, CSCS, all the Manual Therapy courses that I did, and all these different things were going to flood all these people to me. At one point, I was working with three either current or former number one players in the world. I truly thought everybody was going to come to me but it didn't work like that.
You had to come to the realization after stepping aside, working with this other guy and partnering up with him that patients didn't show up, I assume.
There are a couple of things that happen. At that point, I was still working a lot with physicians. I had verbal agreements that, “When I come back to this area, will you send me patients?” They’re like, “Yeah.” Until you come back in the area and you say, “I'm open,” they don't give a crap. There are a lot of things that I had to come to terms with. A lot of PTs think, “If I know this person, if I have this certification, if I do this, if I know dry needling and if I know that, all of these people are going to want to come to me because they are going to want the best.” That's not how it works. That's not how the game works.
What are you telling owners nowadays? What's cool is you're also working with physical therapy students and telling them what the game is like. What are you telling them to focus on? What are you telling them about the system? What do you encourage them to do?
I'm explaining to anyone that wants to get clients into their door, “No one gives a crap about you. They just care about themselves.” That's the main thing you have to understand. The big thing that I'm telling them is everything that's in life or the way that things are with your clients is they don't give a crap about you. They don't give a crap about your certifications. You have to learn how to communicate with them at a very high level. When I say at a high level, I'm talking at a low level. That means we have been trained to communicate the way that we communicate with our colleagues. That's not how it works in the real world.
In the real world, you have to treat everything like an advertisement. You have to talk to people in a way that they're interested in. You have to be able to do things that are going to connect with them for their needs. That's not something that we are trained on. You have to hook people. People are interested in stories. They're not interested in facts. I was trained that the way you need to do it is you need to bring out your JOSPT or the journal article but nobody gives a crap about that. I had to train myself that the higher level of communication is communicating at a third to fifth-grade level with people. That's the big thing that I tell owners. That's what I'm having to do for my clinics and make it very simple for people to understand what it is that we do.
A lot of your focus then is on what people might call soft skill set. It's sales, marketing and patient engagement. It's interacting with people and building relationships.
I'm going to tell you what one of my coaches trained me on. I don't think most people understand this. At my conference, I have him speaking three times because I know that people's minds will be blown once they understand how this works. What he trained me on is that there are four levels of value. We have been trained for our entire life pretty much at the lowest level of earnings, which is implementation. Let's talk about the four levels of value. Implementation is the lowest level. The next level is managerial and unification. That third level is communication and the fourth level is imagination/vision.
Let's break it down. If you take the lowest level, which is implementation. Implementation is somewhat like if you go to a hotel and you want your room cleaned. You want to make sure that your room is clean day-after-day that you're in it. If you check into a hotel and the room wasn't clean, you'd be pissed. You'd be like, “Can somebody clean the room?” That's not a good experience for you. That's a low level of implementation. Someone that's like a maid or a cashier at Walmart. As physical therapists, we are also at the implementation level as well. It is the lowest level of earnings there is. The next level and I didn't realize this when my boss was telling me this in 2001. She was saying, “If you want to get higher than 1.5% increase of pay, you need to become a clinic director.” What she didn't even realize is that the next level is managerial. That is someone that's overseeing all the implementers. You get paid more to make sure that the implementers don't kill themselves, don't kill each other and that they give a good service to your customers. That's a higher level of earnings. Not a lot but it is a higher level of earnings.
In the corporate structure, that brings more value.
When I look back now on my journey in 2004, that was what my boss was telling me. My boss was saying, “If you want to go up in this company, you need to go into regional management.” That's the only level to go. There's no 97110-OCS code. It's 97110. It doesn't matter who does it. It doesn't matter if there's a 97110-eighteen years of experience. It doesn't matter if there's a 97110-36 years. There's a 97110 code. It's just for implementation. There is no way that it's going to pay you any more. What I realized is that if I can go up more in management/unification, which is the second level of value, you can get paid more but it's still a hard cap. There's only so much you can get up the corporate ladder. Here's what I've come to understand. The third level is communication. Meaning that if I can learn how to communicate, if I can learn how to market, if I can learn how to do the hardest thing for any business, which is to get clients and keep clients, it is the highest level skill that you can have.
Think about the people that make the most amount of money in this country. It is the best people that are in sales and entrepreneurs. Entrepreneurs are salespeople. They're selling you on their vision. It is the high-level authors. The first job I ever had was a sales job when I was fifteen years old. I sold newspapers for a company called the Sun-Sentinel. I made $11.50 over two weeks. I sucked in sales. Now, I'm good at sales. I did a webinar and I made $138,000 in two days. It's a skill that if you get good at, you can make a lot more money. I was watching Kevin Hart's Irresponsible tour on Netflix. That guy makes gazillions of dollars by doing a stand-up act for an hour. It's something he's got good at. The best singers make a ton of money. It's all communication. It all falls under the communication umbrella.
They’ve got a robust sales program in social media, you name it, it’s all about sales. You build a brand.
It's all communication. Best actors, best singers, best authors, salespeople are all great communicators. Communication is an amazing skill to have. That's why it's the second highest level of value. Then the top level is the visionaries. It's like this. When you think of Apple, who's the first person that comes to your mind?
It's interesting that you didn't say Steve Wozniak, because Steve Wozniak was the person that actually built the machine. You said Steve Jobs because he's the visionary. At the end of the day, the visionary is the one that’s like me having the vision of this program called SSPT. I make the most because I was the one that envisioned it. I was the one that was able to sell the program. I was the one that was able to build a mission and turn it into what it is now. I get paid the most. That's what people don't understand. They don't understand that throughout your entire educational system from pre-K to grad school, you've only been taught at the lowest level. It sucks but it's also optimistic because it's like, “If I go and learn these things, I could accelerate my income and my earnings to astronomical levels.” That’s what I try to teach people.
You had to go down this path yourself to figure it out that you were losing money or at least you weren't tapping into your potential as long as you stayed an implementer. To those physical therapists, I know you've come across them, that are still working on patients, what are you telling them? How are you getting them into increasing their value and getting out of that?
I don't have a problem with people working on patients. The big thing that I need people to understand is that you want to make it a goal to do more things at the higher levels of value than just stay at the implementation level. I'm not saying for people to go from, “I've been treating patients for the last one to twenty years that I've been a clinician and just go cold turkey away.” I'm saying to respect the other things and start to work your way up to those other levels of value so that you can now burst through the ceiling. The reality is most people aren't even paying any attention to it. They're frustrated. They're like, “Why does my career suck? Why am I burning out? Why is this happening? Why is that happening?”
They don't understand those four levels. They don't understand this is how it works. They don't understand that every single CEU course that you go to, what does it teach you? How to implement more. There's no CEU course out there that is saying, “We're going to teach you for a day and a half how to implement, but then we're going to take the other day and a half and we're going to teach you how to communicate what we taught you.” Nobody does that. They don't even know it. I figured it out and it was my coach who put the pieces together for me. He was like, “This is because it's the four levels of value.” I'm like, “That makes so much sense.” That's how my whole career has gone.
Tell me about that a little bit because I'm a big proponent of coaches. You've got to step out and recognize that you're not creating more value by simply treating patients all the time. You've got to be a visionary if you're going to own a practice, make more money and have more stability and freedom. I highly believe that coaches and networking are integral to making those steps. Tell me about your journey towards getting a coach and working with a coach. Did you start right off the bat or did you get to a point where you’re like, “I need some help.”
Let me bring it back to maybe 2004 or 2003. My older brother has always been the entrepreneurial type. I've always been the anti-entrepreneur. That's how it was in the family. I just wanted a stable job. He was always the one coming up with ideas and this and that. He's always been telling me about Tony Robbins, about this person and about that person. I’m like, “Whatever.” I always thought that personal development meant that something was wrong with you like you needed to see someone. I didn't understand the whole thing. It wasn't until I experienced pain as in the way that I thought things were going to work out is not working out, that I started seeking out direction. My older brother was probably one of the first people that I'm like, “Maybe you are right. Maybe I should go open up my own thing.”
From there, I never got my first coach until 2012. I started realizing the power of having how much people knew that I didn't know. I always thought that coaches were CEU like continuing ed people. I realized that there was another world out there that I had not even tapped into. It was in 2011 or something like that when I went to my first real event. I started realizing that there is so much crap I don't know. I started looking, “Is there anybody in physical therapy that does this?” Nope. There's no one in physical therapy that does this stuff. I had to take coaches from outside of my profession, learning and then how can I implement and incorporate this into what I do? That's what I did.
I realized that there was definitely a need to have people that thought the way that my coach has thought and be able to apply it in a field like physical therapy where people have no concept to any of these things. Now, I have many coaches. I have one person that I've employed as more of my mentor and then I have coaches for different things, those different levels. I pay a lot of money to have coaches because I'm realizing that you tell me one or two things and it can be the difference of doubling my businesses. It could be the difference with allowing my missions, all the things that I'm doing to take it to another level. I believe in self-education and I believe it has catapulted my career infinitely more than traditional education. I'm willing to pay for it.
I love that you shared your insight on that and especially what you pay for it. You didn't share dollar amounts.
I pay over $100,000 a year.
I've done the same in the past. What it turned out to be the following year was easily double that in increased revenues. It's funny because I will talk to friends who are like, “I'm thinking about getting a coach, but this guy wants $10,000 for a year and they're hemming and hawing.” I'm like, “You don't even know that $10,000 investment could triple, quadrupled or do more in the next six months to twelve years that you don't even realize.”
Nathan, I want to tell you something that's important about this. I was Facebook Messaging a guy that's like, “I've been listening to your podcast. I've been doing this and doing that. I'm ready to take this one course that you have. Tell me something to get me over the edge.” I was like, “Here's the deal. I don't convince people. I'm not into that.” I do persuade, but I don't believe in convincing. Convincing is getting you to do it for my reasons. Persuasion is getting you to do it for your own reasons. I need to have you come to the conclusion that this is in your best interest. I'm going to say the reason why people are like, “Yeah, but I don't want to get screwed over by a coach.” I was like, “This is why every single coach I've had, whether it's been a great experience or not a great experience has been beneficial for me.”
We are in a profession where everything that we've done, for the most part, I'm assuming the majority of your audience have only done traditional education. People are like, “How is it that you're able to do all these things?” I have a $30,000 coaching program that people work with me for a year and people are like, “How can you get to the point where you charge that?” I was like, “It's when I started paying for it myself that I realized that my worth has gone up.” I can tell the person like the one you’re talking that's like, “$10,000 or $15,000 or $20,000.”
What I've learned is that there are four different types of people out there. This is something that my coach taught me as well and I will share it with you. There are feeple people, there are freeple people, there are cheaple people and there are premiumple people. This is how it works, but it makes perfect sense. I can say for me, it has changed everything in my businesses when I understood that I've been all four of those people. The first person is freeple people. These are the people that want everything for free. What ends up happening is that when it's time for them to sell anything, they have a hard time selling anything. They're so used to getting everything for free that they feel like a hypocrite for charging. The problem is nobody gets results in them because if you give me free stuff, you don't take it seriously. It's the way it is.
Then you have cheaple people where everything they want are discounts. The thing is when it's time for them to get people to buy into their stuff, they're discounting everything. What happens for them is they're like, “I give so much and I'm not getting anything for it.” Those people end up quitting because they're not charging their appropriate fees. Then you have feeple people. They are people that are comfortable with paying a fee. They don't want to pay for the best, but they're comfortable with paying a fee. What happens is in return, you get people that don't want to treat you as the best. They just want to treat you as, “Okay, you're decent, whatever.” Then you have premiumple people. Premiumple people is where I finally got myself as somebody that used to be a feeple person and now I'm a premiumple person. I’m willing to pay premium for the best.
I have my event and I'm paying someone $25,000 to speak at my event because I want the best. I've looked at my bill so far for that event and I've racked up over $100,000 of bills because I want to have the best of it. I will make a ton of money because I'm willing to accept it. I know that I only give the best so I don't have any hiccups with, “First, he was going to pay me $2,500 a month or $30,000 for the year.” I have no problem with it because I know that I give the best of my people. I don't even know how to not give the best. I've had to train myself to get to that level. I think most people don't understand that and they have this hang-up with selling, “I don't want to sell.” You don't want to sell because you're a feeple person. You probably get everything for free. You should feel awkward. It's like me cheating on my wife and asking her to be faithful to me. It doesn't make sense. That's not how it works. If you're faithful to me, I'm faithful to you. If you love me, I love you. If you don't love me, it's hard for me to love you. That's the way it works and most people don't get that.
It comes back to mindset. You hear about the mindset of abundance and making sure that, “There's plenty of it throughout the world,” instead of a mindset of scarcity, “There's only so much of it out there. Whatever you got, you’ve got to keep it. Someone's out there to screw you over.” Instead of thinking, “There's an abundance of money to be made out there. There's an abundance of love to provide to people. There's an abundance of knowledge to provide to people. We can all share in this boat together.” Switching from that scarcity mindset to an abundance mindset is hard for some people to get over.
I've been there. It's very difficult for people to get over. I'm at a point in my career where I have four kids. My wife's love language is time. I don't have to work anymore. I have an exit plan where I don't have to work if I don't want to. I want to do this but what I have come to understand is my wife would prefer that I hang it up. She's made it very clear. She says, “I would rather you hang it up because you're giving so much to people.” What I've noticed is this. I started Smart Success PT on May 29, 2016. It was for one year that I was coaching and educating people for free.
Do you want to know what my show up rate was for the calls that I did? At this point, I'm only working two days a week in my clinics. I only do evals, everybody else does all the other stuff. I had all this time for myself and my wife, but I told my wife I want to help out this new generation of physical therapists and teach them the things that I've learned. I would block off six to eight hours a week for complimentary coaching calls with me. My show up rate was 30% because I was giving free stuff. I was attracting freeple people and they didn't respect it. What I did was instead of me hitting the dream at 38 years old back then when I started this whole SSPT thing, I was creating another nightmare in my marriage. My wife's like, “Here you are taking time away from me to give to these people that don't even value your time.” Now, I have to charge $30,000 a year because now my show up rates are 100%. It actually saved my marriage. We don't need the money. I don't want people wasting my time.
You have to recognize that you provide value and you’re worth something. There's something to that. There has to be a monetary obligation. Otherwise, people do exactly what you're talking about. They keep in the value of the service that you provide if you're not willing to charge a premium for it. That's a constant battle for physical therapists because at our core we feel we should give away even our services for free. We feel bad asking for a co-pay. We feel bad for asking for a deductible. It hurts to our core to ask people for money. We've got to get over it.
We've never been trained on any of this stuff. That's why everybody struggles with it. They've never been trained on value, personal development, how money works and that you not collecting the money from people is hurting them with regards to getting them to commit. There's so much stuff. Trust me, I struggled with that as well. I struggled with it mightily. Then people are shocked when they get canned. It's like, “They cut my hours. How did this happen?” It happened because nobody paid attention to money. Nobody paid attention to value. “I don't know why patients are canceling. Maybe it's the weather.” No, it's not the weather. The value's not there.
Here's the interesting thing. I give the most amount of free content out. I have 900 videos on YouTube. I've been doing this four to five days a week for four years. You could see that I go on Facebook Live pretty much every single morning and I turn it into a podcast as well. I'm on episode 500 of my podcast. Here's the deal. I give out free stuff because I have made a commitment that I'm going to dedicate six hours of my week to serve my healthcare profession. I'm going to give out but everything else is paid. This right here is one of the six hours. When I and you talked, I knew that I had one more hour this week of my six hours that I give away. I was like, “No problem.” This is one hour but after that, if you want to work with me, you have to pay.
What has happened though is that people have seen, “This guy gives so much value for free. What does his paid stuff like?” It's not a problem for people to pay me money and they pay me a lot of money. It's no problem. When they pay, they realized, “This is worth it.” I've had 475 people take my course. It's the only online course that I've never had a full refund. It's never happened before. It's a $3,000 course. That's the entry level to work with me. The deal is that we have to get over this whole money work that we have. You've been taught that money's evil. You've been taught rich people are stingy, this and that. There's so much crap you've been trained on. You've been indoctrinated on that so that you would stay at the lowest level of earnings, which is the implementation level. What people don't want you to know is that anyone could get to the other higher levels, but then it screws up all the people that are at higher levels. Now they don't have implementers and they're panicking. That's why I'm getting so much flak from different establishments because they're like, “This guy's turning all these people into entrepreneurs.” Now they're all waiting, “Who's going to work for us?” It’s freaking people out. I'm having fun with it. I'm loving it. I love watching all this happen.
You're doing great and I love the energy that you bring in. I know that you have a conference coming up. Is your conference a lot of this like how to market, how to sell, how to change the mindset or am I off base? Tell me what is your purpose.
That's what it is. It's called SSPT Live, which is my flagship course, Smart Success PT. The conference is three days. It's based on how I have my method set up for SSPT. The first thing that I believe everybody has to do is they have to calibrate themselves. We have to change their mindset. They've had a worker bee mindset, “This is all I can do,” and we need to help to calibrate people. It's like having a compass. We need to know where we're going first. The first day of the conference what I do is I'm going to show everyone there's not one way to do it. There are many different ways to do it. The people that I've been coaching that are now at a level to where they're at the top 1% in earnings in physical therapy, I've been able to do it for our practice owner, for mobile concierges, for people that are doing online coaching, strictly online, canine physical therapists. I've been able to get all of them, at least one person beyond the 1% in PT.
The first day is about giving you the belief that you can do it in any way that you want. The second day of the conference is about teaching you those higher dollar value skills: the communication, how to be a leader and how to have a vision. That's what the second day is about. If we can focus you on the first day and then we can start to teach you those skills, the third day is about giving you the ability to have a legacy. It's showing you. My whole thing is calibrate, care, create. Calibrate you and getting you focused. Care is showing you the high dollar value skills. They are true care skills that you're going to need in order to win and then create. Create wealth, time, financial freedom. Until you create those things, you cannot create a legacy. You don't have the time to do it.
People say like, “It's such a nice ride.” There are many nice physical therapists out there, but they've never created time and financial freedom. They can't do the things that I'm doing. They are good people but they can't do it because they have never focused on creating time and financial freedom. They can't give back, which sucks. Overall, if you think about it, our profession typically attracts people that are good at the core, but they suck with making money and with knowing how to create time for themselves. They can't do anything impactful.
That's where you see a lot of burnout. You don't see a lot of 40-year-old practicing in physical therapy out there. You get to the 40-year-old mark and you're looking at you can't be a staff physical therapist anymore if you've been a manager for a period of time. There's a hard ceiling there. They're not fulfilling their potential. They're looking for other things. They will get a realtor license or something like that.
Do you want to know what the sad thing about it? When you think about it, the entrepreneur is always telling the implementers what to do. The problem is that in our profession, you don't have enough entrepreneurs. I'm an entrepreneur and I have clinics. Why is it that my employees are happy? They're happy because I am an entrepreneur, but I'm a physical therapist at heart. I want to set it up so that my people are happy day-in and day-out. I have a very unique set up at my office to where the culture is amazing at all three of my clinics. Here's where the problem is in physical therapy. The problem is that most entrepreneurs that are running physical therapy locations are not physical therapists.
They don't have that, “We need to do what's right for the patient, but we need to also do what's right for the physical therapists.” They don't have that pull. What's happening is they're like, “Blue Cross Blue Shield has decreased by 10% in pay, add more patients in the schedule.” Easy fix, go work harder. What's happened is that the entrepreneurs never had that moral code entrenched in them on what it's like the moral code that we have as healthcare practitioners. This is the reason why I'm trying to create many entrepreneurs in healthcare so that when they grow, expand and scale their businesses, they now have already indoctrinated them the moral code of a healthcare practitioner. Whereas if you think about it, most of the people that are running these big organizations are not healthcare professionals. They don’t care. They only care less.
I know you've got to get going. You shared a ton of content. I'm sure we could go down another road with another topic, especially that one in particular. Unless you have something more to share, make sure people get your content or at least your contact information.
You can find me @GregToddPT. That is my handle on Instagram and YouTube. If you want to opt-in to my mentorship list, I send out an email every single Monday called Mentor with Greg. It's something that is on my mind that I feel I can help people. I've been doing it for two and a half years. That's MentorWithGreg.com and you can opt-in to that. My event is SSPT Live. We’re nearing in 500 people for the event. That's pretty awesome. On Facebook, it's www.Facebook.com/ThePTBuilder. I go live at about 7:30 every morning. I usually do a 20 to 25-minute talk of whatever I feel can help people. I also turn it into a podcast and the podcast is called The Hunt for Greatness. I'm everywhere. If you want to binge on my stuff, you can binge on it as much as possible. You will be bingeing for months.
The stuff that you're sharing on your Facebook webinars and also your podcast, is that stuff specific to PT or is it more business in general?
It's for everyone but I have an affinity towards physical therapists. My program has taken in the first five or ten OTs, we have dieticians, chiropractors and we have people that are not even in healthcare. It's going beyond because at the end of the day, if you think about it, no one's learned any of this stuff.
A lot of it is basic business principles or entrepreneurial principles that are beyond just the PT.
It's funny, 10% to 15% of my people aren't even in physical therapy school yet. They're learning the stuff and they understand, “I'm taking this information. I could become a consultant.” They're making money to pay off their entire physical therapy education. I teach people how to create money. That's what I want to teach you. If you can learn how to create it, that money is just exchange. I'm teaching people to be more valuable so that you can make whatever you want.
Thanks for your time. I appreciate it. I wish you the best with everything. I appreciate it.
Thank you so much, Nathan. I appreciate it.
For the past 18 years, Greg has dedicated his life to helping people with the skills that he has learned in his physical therapy career.
In the last eight years, he has helped thousands of people in physical therapy (and now other allied health professions) because of the skills that he learned beyond traditional physical therapy schooling.
This has led him to live the life of his dreams for himself and his family, and now helping others, just like you, create the life of their dreams for their families as well.