PTO 148 | PT Recruiting

Recruiting has changed over the past two years. How you find your next PT now is much different than it was prior to the pandemic. The show’s guest today is Brian Weidner, the President of Career Tree Network, is a recruitment advertising and human resources firm that helps physical therapists connect with career opportunities. Brain discusses with Nathan Shields in this episode how PTs are now making employment decisions with a greater focus on personal dynamics and lifestyle. That’s why we need to show PTs how the job can fulfill their lifestyle goals and their own needs. If you want more on how to find your next PT, tune in!


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Recruiting - New Methods To Find Your Next PT, With Brian Weidner Of Career Tree Network

I’ve got a frequent guest, Brian Weidner, President of Career Tree Network which is a human resource company and a recruiter for PT employers. Brian was letting me know that he does 95% of his business with physical therapy employers and physical therapy owners. Brian, thanks for joining the show. I appreciate it.

Thank you. It’s nice to be back.

We’ve talked in a couple of episodes in the past about recruiting physical therapists and what we need to do to procure and acquire physical therapists. Once they’re on the hook, how do we get them in the door? Those have been some valuable episodes. Over the past years of doing the show, the recruiting environment has been essentially the same as it has been most of the time. Sometimes it’s hard to find physical therapists, especially on your geography. It’s cool to bring you on to talk about what you’ve noticed. We’ve noticed a lot of changes since the pandemic started and what it takes now to get physical therapists in the door. I’m excited to bring you on. Let us know about what you’re seeing in the environment right now, what owners need to know, and what they need to do to start finding talent.

During COVID, the height of it was an interesting time to be a recruiter as all of our clients stopped hiring and started laying off people. It’s not great days to be recruiting talent when all of your clients are letting people go and furloughing. There was a period of time when we have a lot of active projects and then all of a sudden, our clients no longer had needs. Since October of 2020, I’ve started seeing our clients coming back. As the vaccine is rolled out and continued to have more people adopt that, we’re seeing pretty much everybody and their brother is hiring a PT. The market is the strongest that I’ve seen.

We started the company in 2007 and it’s the strongest demand for PTs that I’ve seen in our time. Not only is the demand strong now, but we also have a few other factors that are interesting to where we are. One of those is that during COVID, the employment has been like musical chairs where PTs are in a position but it’s maybe not full-time. They might get furloughed or their employer closed. There are all these factors. Even new grads from May of 2020, a lot of them are still without their first full-time position. It has been an interesting time where a lot of times we look at people that are changing positions frequently. We use different indicators based on the resume to make decisions and evaluations of people.

With COVID, we would have to be more lenient to be more understanding of that short-term employment or that PT that hasn’t been comfortable seeing patients at all. They haven’t worked since the pandemic began. We’re seeing some interesting trends around that. It’s easy for me to recommend flexibility. It’s easy to say, “Be more empathetic to PTs,” but it’s trickier when you’re the clinic owner and you have someone that hasn’t seen a patient since April of 2020 and now their resume is on your desk. Due to the fact that everybody is hiring PTs, we’re seeing that speed of the hiring process is important. It’s always been a factor but now with such high demand and the job market is incredibly strong, if you’re not acting quickly on candidates, they’re moving on to other opportunities.

If we’re looking back on what it was like immediately during the pandemic and for the first six months or so, either people were letting people go or scaling back their hours for a period of time. As they started ramping up 2 to 3 months after the big hit, they had their pick. It was an odd time to be a PT owner because rarely, if ever, has it been such that there were PTs available to hire like there were at that time. Some of my clients had an easy time finding some physical therapists and bringing them on and preparing ahead of time for the ramp-up. Now that we're back into the full swing of things in most places, it's June of 2021. It has been hard for my clients to find PTs. They're having some success with the new grads but it's getting harder. It's getting back to the way things were or even tougher than they were prior to the pandemic.

New grads are like a unicorn in a certain sense. They’re always very attractive for clinic owners to hire but signing a new grad to your team is sometimes a difficult task. Even when you do have the new grad signed, a lot of times, they make another employment decision without telling you after they’ve signed. The clinic owner thinks they have the new grad lined up. Everything is in place and they’ve done credentialing. All of a sudden, on the first day, they say, “My parents decided to go to Hawaii,” or “I move to my girlfriend.” You couldn’t even predict and now, they’re gone. It’s a tough scenario.

If you’re not acting quickly on candidates, they’re moving on to other opportunities. Click To Tweet

What are some of the things that you’re noticing now compared to pre-pandemic? What does an owner need to be aware of in order to secure some of these available PTs? What are you advising PTs to do compared to what you might have recommended before the pandemic?

What we’re seeing now is that PTs are making employment decisions with a greater focus on personal dynamics and lifestyle. COVID has woken a lot of people up to say, “Do I want to work in this setting? Do I want to drive this distance from my house? Do I want to live in my current town? Should I move back to be closer to my family?” When they look for positions, they’re looking for jobs that are going to better meet their lifestyle. This is something that might be a generational thing as well. We’re seeing it clear now with COVID where they care more about the work schedule than they do about your mission statement.

As a practice owner, a lot of our clients have to buy into our values and believe in our mission statement. That’s important to a certain extent. However, PTs are more concerned about their own work schedule than they are in your mission statement. We need to ensure that we’re showing PTs how the job can fulfill their lifestyle goals and their own needs. Always being clear about the logistics of the job is something that is important. Oftentimes, those logistics are not used within the recruitment process by a lot of private practice owners where the practice owner leads in more with, “Come and join the team. We offer a great work environment.” They’re using loose marketing phrases when the candidate is more concerned about the logistics of the job.

What you’re recommending then is making sure that your ads are more focused on what you can provide in terms of the lifestyle that they want, whether that’s in the community that your clinic is in or in the schedule that you’re able to provide a greater focus on in terms of lifestyle.

It’s being clear around the flexibility of work schedule, the hours that the clinic is open, any weekend requirements, mentioning the number of holidays that you give off per year, compensation and all those logistics of the job. Especially now, because of the fact that there’s such a high demand for PTs, we need to be more upfront about the salary and benefits which is also uncomfortable for a lot of organizations. I had a PT that I was talking with. He’s relatively happy in his position. He’s in an outpatient setting. He said, “I could get another part-time position or I could leave my current role and go somewhere else.” I said, “What would it take for you to leave your current position?” He was like, “Honestly, the salary.”

There are a lot of PTs that are sitting on the sidelines that are willing to explore and change positions but they don't want to jump through all the garbage of the recruitment process. They don't want to apply online or do multiple phone screens. All they want to know is, "My kid has a soccer game every week at 5:00. Can I go to my kid's soccer game? My current job pays me $68,000 a year. Is this new job going to pay me more?" There are all these logistical things that people are factoring in.

Being more upfront with some of those things, would you recommend they put all that in the ad? Is that something they would simply introduce earlier in the conversation than they normally would?

Putting it all in the ad is a good thing. What we’re seeing is that PTs especially are not coming forward until they’ve done a good level of research. When we contact someone via text message about one of our clients, they don’t respond to the text right away and say, “Tell me more.” They want to know who’s the employer and what’s the address of the clinic. They’re researching. In recruitment for some areas, you have more of a chance to play with the candidate back and forth. You can, “How are you? What are you interested in?” There’s this conversation that unfolds. Unfortunately, with the PT market and the high demand for their skills, they are able to be blunt in terms of what they want. A lot of times, that bluntness is uncomfortable.

PT Recruiting: Putting it all in the ad is a good thing. PTs are not coming forward until they’ve done a good level of research.

It can be uncomfortable for an owner that’s not sure of what they would offer somebody. It’s important as the owners go into this knowing, “What is your salary range?” Don’t start talking about what you’re going to offer that person with that many years of experience after the interview. It’s important to have your salary ranges determined ahead of time, salary and/or hourly. If it’s a new grad, I’m going to offer them this. If they’re out 2 to 3 years and they have a couple of certifications, I’m going to offer them this. If they’re ten-plus years of experience and productivity in the outpatient clinic, I’m going to offer them this. Would you recommend they be more sure about what they’re going to offer ahead of time?

You have it worded correctly as well especially if the pay for new grads is set in stone. For example, you could share in the advertisement that, “If you’re a brand-new grad, we start our new grads at whatever it is per year or per hour. We go up from there based on experience and qualifications.” That way, you’re not sharing everything with the candidate because you want a little bit of wiggle room. You don’t want someone to say, “They don’t pay what I’m making. I’m not going to come forward.” At least, they have that data point, “This pay for this position starts at whatever it is and then it goes up from there.”

Maybe this is hard to say across the entire country. What is a general range you’re seeing for new grads as they’re coming out in 2021?

I would refer people to APTA. They have salary data within the workforce development section of the website. They have robust salary data that I referenced as well. The only downside is it hasn’t been updated. The last time it was updated was in 2016. You can do some cost-of-living adjustment to bring it up. They have it broken down by practice setting, years of experience and geographic area. That will be the best because it’s all member-driven.

The last time I spoke with Will Humphreys about recruiting and he recruited our company, Empower Physical Therapy in Arizona. His range is somewhere in the low $70,000-ish for outpatient ortho staff. Maybe that’s higher nowadays because the demand is so great. I don’t want to say it got into the high $60,000, but it was at least in the low $70,000-ish from what I recall.

When you have a candidate surfacing, we need to be competitive with the salary and benefits. We also need to realize that the PTs are not just concerned about the money. If they ask about salary, that doesn't mean that that's the only thing on their mind. They are often looking at salary as a component of it. Some of our clients get scared or turned off from the candidate if they even ask about salary during the interview process. They would say, "That PT asked me about salary. He's only concerned with money and we can't pay as the other guys pay." We have to be competitive. Maybe salary, in particular, is not your strongest suit, but then how are you compensating for that in other ways? Can you be more flexible with the work schedule? Can you offer more continuing education? Can you do different things outside the box that are nonfinancial that would still differentiate you as an employer?

Maybe when they ask that question, it’s not necessarily their prime motivation asking about salary but it’s just checking a box, “Did you meet a minimum standard?” If you can meet that minimum standard and check that box. Now, I can move on and say, "Do I have the flexibility that I want? Am I able to have a lifestyle that I want? What are some of the other expectations? What is the clientele?" It might just be one of many questions that they're asking to cover all their bases. What are some other things that you're noticing that are different from how things were, pre-pandemic?

One additional area, we've seen PTs are physically moving and relocating to new areas which are somewhat new. In the past, we haven't seen these many experienced PTs that are willing to move somewhere. All of the moving that we're seeing is for personal reasons. They're looking to relocate to a certain area because their family is there or whatever reason is personal to them. The days of a PT relocating specifically for a job are likely behind us. We have travel PTs who travel around on the temporary assignments but it's very rare that I've seen a PT tell me like, "I'll go anywhere in the state of California. What do you have in California?" It would be great if people were more flexible, but there’s not that level of flexibility.

PTs are making employment decisions with a greater focus on personal dynamics and lifestyle. Click To Tweet

Now, we see it more on the PTA side, the physical therapist assistant side. Maybe if a clinic was looking for a physical therapist assistant, you could find someone that would relocate for the job, but on the PT side, we’re not seeing PTs relocate for a specific job. That means then, the best candidates for your job already live in your geographic area or have some personal connection to your community. We often have clients in more remote areas and they’re like, “How do we get a PT to move here for the job?” It’s a very difficult scenario because PTs don’t move just for jobs, at least what I’ve seen.

The recommendation around that is those PTs that are in your geographic area, that’s a prime audience for your talent pool as you’re looking to hire. Finding a PT outside of your geographic area to relocate to where your clinic is, is a very difficult and costly challenge. The strategy is since those local candidates are the best candidates and are the ones that we need to pay attention to, A) We can’t discount people without fully considering them for the jobs and B) We also need to look at making direct contact with that pool of candidates. We can’t just post the job on Indeed and hope that the small audience of PTs see it.

One action that we did in the past was emailing out the list of licensed physical therapists in the state and getting their attention in that regard. Is that something that you do quite often?

Yes. Email is still a good source. We’ve been doing a lot with text messaging. First, I was nervous to do text messaging but over the years, we’ve found that it’s even more successful than email. We send multiple emails to the licensure list and then we do additional research to identify email addresses for people. What’s interesting is within those multiple emails, we send at least three email messages about one job to people. Usually, it’s the 2nd or 3rd email that gets the person to reply. If you’re sending out emails, I would recommend sending at least 2 or 3 email messages to the same person.

Interestingly, you’re using texts more and understandably so because people typically respond or at least they read their texts. Whereas you might not have that open and read rate with emails like you do with texts. I can see how you might use that more often to your advantage.

The texting is great. Originally, we were texting people individually. We would individually research phone numbers and we don’t know which phone numbers are correct. If we were trying to find your phone number, Nathan, we use an online people search-type software website to find possible phone numbers. The websites give us multiple phone numbers. We would send a text to every phone number that we would find for the person. Later, we came across different ways to automate that process and make it easier. It’s still very time-consuming because when you send out the text, that’s just half of the process and then you have to respond to the texts. If you send out 500 text messages, you have a lot of replies coming back in, questions and updates but that’s what we’re paid to do.

Have you used any social media ads whether it’s Facebook Ads or other social media avenues to access people and promote?

Yes. The easiest way would be to post the job on those social platforms. LinkedIn and Facebook would both have ways to post jobs. Otherwise, you can do a lot of cool targeting ads on Facebook. There's a lead generation ad that we've used in the past where we're posting it and we can narrow it based on job title or people that have an affinity to certain organizations. The targeting function is good there. You are getting leads coming in. The downside is sometimes the people don't realize what they're clicking on. It's not like they're applying for the jobs which is a good thing for us to talk about. There's a difference between the candidate on Indeed who hits submit after uploading their resume versus the guy on Facebook or Instagram who just happens to click. All of a sudden, you get access to his email address. That second guy on Instagram is not applying for your job. He's maybe interested. He's open to talking to you.

PTO 148 | PT Recruiting
PT Recruiting: Instead of blasting all the content at once, go back and forth and drop little marketing elements within the conversation that you’re having because then people will feel more invested in the conversation.

There’s still a lot of work to do after that.

It's asking questions like, "Why do you want to come work for us? Why should I hire you?" That's way too early to ask those kinds of questions. It's more of developing those relationships, nurturing the candidate and answering questions. In that aspect of recruitment, it's an important aspect right now with where we are because a lot of candidates are interested passively and open to exploring where we like it when a person uploads their resume and sends it to us.

That’s the easy part.

Unfortunately, we’re not quite in that same spot anymore. Being willing to engage with talent, talk with them and have some dialogue back and forth are important.

What do you find the success rates are with these different channels to access potential candidates? Whether it’s social media versus text, email, posting on Indeed, ZipRecruiter or any of the other sites, is there one that’s far and away the most effective or least effective?

The least effective and the most costly is direct mail. It used to be that my wife is a PT. We get letters and multiple postcards every week. I’m sure you’ve gotten them over the years. Companies are realizing that direct mail is very costly and the response rate is low. When you’re doing proactive recruitment, you need multiple follow-ups. When we’re sending out the text messaging, we’re not just sending out one text. We’re sending out 2 or 3 texts to the same people.

It’s the same with the email address. We’re sending at least three emails to the same person. Direct mail would be the one to avoid. It’s tempting because we have the licensure data and there are a lot of mailing addresses on there. Instead of using those mailing addresses for direct mail, I would recommend using those to develop a list of the candidates that live closest to your clinic and then trying to research those people, sending them emails, texts and calling them rather than sending the direct mail piece.

Has social media worked very well for you in the past?

When you have a candidate surfacing, we need to be competitive with the salary and benefits. Click To Tweet

Not really, for the cost of it. When we first started doing Facebook Ads, they were pretty good in terms of generating people that are willing to talk but over time, it got more expensive and fewer quality results. The targeting was not great. It's good to try it and see how it goes, but what we find in terms of the most successful would be emailing, text messaging and posting it on Indeed.

If you were going to recommend a plan of action or a recruiting strategy for a PT owner it would start with the obvious. Place the ads where there are supposed to be the state boards, local colleges, Indeed and ZipRecruiter. Make sure the ad is out there where it needs to be. If you’re going to do some active recruiting, then it’s going to start with getting that list of state-licensed providers, especially the ones that are near you and start honing in on their email addresses and texts. That’s how you’ll be more active.

You want to do a geo-targeted list based on the people that live closest to your clinic. We found that you need at least 300 people on the list in order to get a slate of candidates to surface. You may have to play around with the zip codes to get more of a closer radius if you’re in a larger geographic area. Once you have the 300 people on the list at a minimum, then you would go out to online search websites to try and find phone numbers and email addresses. Usually, the state licensure data does not provide that. You’re manually researching each and every person on that targeted list. You’re getting multiple email addresses and phone numbers, then you’re able to do the direct contact via email and text. You could also cold call people too but we found that cold calling has become less effective as well. A lot of the recruiting tools that we started with and that historically, direct mail and cold calling shifted into more email and text messaging. In some ways, it has become easier to recruit because when you’re sitting and cold calling people all day, it’s draining. Sending out mass emails is easier in some ways.

Even then, dealing with the geotracking, finding emails and cell numbers, at point, I would think most owners would say, “Who else could do that for me?” I don’t know if I have a lot of time. Maybe I have a couple of hours a week if I’m set up in such a way that I have some admin time that I could focus on that. Even touching it just a couple of hours a week means that the rest of the week, nothing is getting done to recruit that next PT.

That’s why we’re in business to a certain extent. Even if you get the licensure data, and then you do all the research or you have someone on your team do it, then you have to start thinking about, “How am I going to email these people? Do I just put them in the BCC line? Do I subscribe to email software? What’s that going to cost me? What do I put in the message? How do we ensure that they get a quick reply to it?” On the texting side, “Who on my team is going to send out these texts? How are they going to reply to them? Do I have to buy them a cell phone? How long is it going to take to send out these individual texts? What do I say in the message?” There are all these factors. It’s easier said than done. That’s why when a practice has a position open. There’s a lot of stress and anxiety around it because they don’t know what to do. They have the job posted and are like, “I have the job posted and we’re not getting people coming in.” They know that there’s something else they could be doing but the barrier to perform those step is pretty rigorous.

If they were to take that step and try to send out emails and texts, are there any particular topics or subjects that get a better response rate? I’m sure you don’t want to be all about how amazing you are or maybe you do. What kind of content should an email or a text consist of to get a response? You have to do it multiple times. One email or text might not do the trick. Is there a certain topic or a thread that is followed through with each of those?

Conceptually, we have two different hurdles to jump over. The first is, "Are you even open to exploring a new position?" That's the first one, yes or no. "Are you open to exploring any job out there?" A lot of people are retired or happy in their current position. Once you have that dialogue going, then you lead in with the logistics of the job where you're trying to show people like, "This clinic is close to your home. It's located down the road. We offer flexible work schedules. We're utilizing these technologies. We're doing a continuing education annually of $2,000. Would you be open to exploring further?"

The first is, “Are you even open to explore any jobs?” The second is, “Are you open to explore the job that I have?” I try and keep the messages short as possible. I like to do more back and forth with candidates. It’s more time-consuming. It might be called drip marketing where instead of blasting all the content all at once, you go back and forth and drop little marketing elements within the conversation that you’re having because then people feel more invested in the conversation. They’re more engaged to continue talking to you versus if you just send them like, “Here’s a link to the whole job advertisement.” I feel like you’re giving them too much information.

PTO 148 | PT Recruiting
PT Recruiting: We want to give everybody a retention bonus for sticking around and staying with us through COVID.

I like how you address it because it’s not, “We’ve got this position open at this great facility. Come check it out,” and promoting you. It’s rather, “What do you need? How can we help?” and more focused on the potential candidate.

It needs to be around their needs and the logistics. The other thing that I would say is that you should sell first and screen later. My wife got something from a private practice owner, trying to recruit her for the job. It said something like, “Come and see if you have what we need for our position.” It was like, “Come forward, send me your resume and see if you are what we want.” It was like, “You’re contacting me about this job. I don’t want your job. You can screen me later but first I need to raise my hand and say, ‘I’m interested.’”

You don’t want to start being competitive around like, “We only hire the best. If you’re not going to work hard and be passionate about our practice, you don’t even need to come forward.” It feels fun to say that kind of stuff. It feels powerful to be like, “I’m the employer. I’m building a great team here. Do you have what it takes to become part of our growing team?” To me, that’s like nails on a chalkboard. Thinking about it from the PT perspective and for me talking to PTs all day, most of the PTs I’ve talked to are relatively happy in their current position. They don’t need to leave. They’re fine staying where they are but at the same time there, they want a job closer to home, better benefits or schedule.

That's where you want to focus on those things. Maybe you also have to know your audience. These people are in demand. If you're going to someone who's in demand and say, "Are you good enough to come work for me?" You're out of touch.

It’s a matter of building that interest first and then screening later. Screening is always important. Everybody wants to hire the best people. We need to do a thorough screening and interview process but we don’t need to start interviewing someone until they’ve been excited about the job and we know that they’re interested. If I’m contacting someone through a resume database, my first thought process is, “How do I share details with them about the job? How do I learn more about what they’re looking for?” I’m not worried about screening them at all until the very end of the conversation after I’ve confirmed that they’re interested. Once you start asking, “Are you willing to work until 6:00 PM? Are you willing to do all these logistical things that the job requires?” They feel almost threatened sometimes if you’re asking those screening questions too soon.

There’s a lot of the stuff that you shared in recognizing how things have changed away from direct mailers and more towards engaging through electronic devices. Is there anything else you would like to share about how things have changed since the pandemic?

I have one more area. We’re seeing some hesitancy from PTs to leave their current employer, maybe with some feelings of loyalty where that employer was good to them during the pandemic. Maybe they did extra hours, kept their pay going or survived the pandemic at their current employer. There’s a question mark of, “Is this future employer going to be stable? I’ve already built my seniority at my current employer. If another wave of COVID comes, will my new job be secure? I know what I’m getting with my current employer and I feel safe but what about this new opportunity?”

There are some themes in there. You can play that up for your current staff who might be looking to leave where you can start playing into like, “We were good to you guys during the pandemic. Here’s a list of the things that we did. We want to try and keep you. Now that things are more stabilized, we want to build and retain our team here.” That’s one area because we’re hearing a lot of our clients saying that their current staff is leaving and that’s why they’re hiring. It’s not all due to growth. It’s, “I could have had a growth hire but then my person gave notice and now I’m scrambling.”

You should sell first and screen later. Click To Tweet

The first step in recruiting is the retention of your current team, but then also thinking about that hesitancy and trying to reinforce the stability of your organization within the interview process. It’s talking about how long you’ve been in business, the stability of what happened during the pandemic and how you took care of your employees during the pandemic. Also, showing to the PTs that are maybe interested to come and work for you like, “We have an employer here. We are an employer that’s stable with a solid foundation."

It’s not only highlighting and promoting that to potential recruits but also highlighting that for the PTs that are on board.

That’s important. It has only happened a couple of times where the private practice owner realizes that the person leaving is due to their own fault. It’s always that the PTs are leaving the team due to outside circumstances. You wonder if that’s true or not like, “Is there something else that you could be doing now to maintain and build your current team so that the person thinking about leaving or the person that has their resume posted online stays and sticks around with you?” Maybe it’s time for the person to leave. There are all different circumstances why people leave jobs. When you have good people on your team, it’s not specifically tied to recruitment but more on human resources.

You want to try and retain your current staff and think about that. It’s some of the stuff like the stability piece, reinforcing of the benefits, doing a salary adjustment, offering a retention bonus or other factors like, “We’ve been through COVID together. We want to give everybody a retention bonus for sticking around and staying on with us through COVID. We’re having a celebration now that COVID is behind us.” Trying to retain that current team is important because as you grow, we can’t always be replacing people. We have to be adding to the team as well.

The last thing you need when you’re ramping back up is for the current team members to step aside or step out of practice altogether. That’s a double whammy. You’re not only looking to hire for growth. Now, you have to hire to replace and you don’t want to be in that position. Thanks for your time, Brian. It’s awesome you shared so much great information, especially noticing the difference in how recruiting has evolved over the past years. If people are in that situation where, “It’s time to grow. I’m ramping up. I’m in that place. I need to replace somebody,” how do they get in touch with you and get your help?

Our website is We have all the information about our company and services on there. There’s also a link where people can book a time to chat with me on the phone. I’m always happy to talk and help. Even if it doesn’t turn into a client relationship, if I can help out, I’m always happy to do so.

Thanks for your time. I appreciate it.

Thank you, Nathan. This was a lot of fun.

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About Brian Weidner

PTO 148 | PT RecruitingBrian Weidner is the President of Career Tree Network, a recruitment advertising and human resources firm based in Milwaukee Wisconsin that helps Physical Therapists connect with career opportunities.

Since 2007, Brian and his team have helped thousands of Physical Therapists achieve their career goals within a new position.

Outside of the office, you might find Brian playing princess with his daughters, watching heist movies, or eating sushi.

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PTO 147 | Care Plan


Treating patients isn’t just about getting them through the doorYou and your team also need to make sure their plan of care is completed. Our host, Nathan Shields, flies solo today as he talks all about making sure no patient falls through the cracks. Nathan discusses how to plan and execute a weekly walkthrough to make sure all active patients are attended to. We also hear about the benefits this brings, not just to the patients, but to your health care providers as well.  


Listen to the podcast here:

Nathan's Coaching Moment: The One Meeting That Has To Be Done Weekly 

I want to share with you something that Ive been working on quite a bit with my coaching clients. Something that we use to address issues regarding retention, situations in which maybe theres a busy season or youre expecting a busy season, but youre not as busy as you think you should be or just those situations when you might be thinking, “Whatever happened to that guy? Whatever happened to that girl? She came in a couple of weeks ago for her knee and now shes not here anymore. Worst of all“We had a ton of new patients and our total visits arent going up significantly this week. It seems like people have dropped off. 

That issue came up routinely for us in our clinics. There was one thing in particular that we did that helped it out and that was called the weekly walkthrough. You might be doing your version. You might even call it something different and thats great. Id love for you to share with the other owners what youre doing. Share with me and Ill let other people knowespecially if its a good idea. The issue generally comes up that patients are falling through the cracks. Youve got poor retention effortsor were not doing anything retention-wise to keep patients in the books. Theyre canceling, not rescheduling, and going on vacation and then not returning for physical therapy, you name it. 

The statistic that we want to improve with this particular action is increasing our percentage of completed plans of care. Click To Tweet

Ultimately, that leads to poor outcomes for the patients, lost patients, and revenue. That poor outcome for the patient eventually leads to a poor reputation for you because now theyre not getting the results that they want. Hopefully, but routinely, it gets back to the physician, That physical therapy clinic didnt work for me. We need to move on. That ends up being a loss of referrals for you, not in terms of the physicians, but also, theyre not going to refer to their family and friends. What is one thing at least that we did on a routine basis to help with these issues? That was called the weekly walkthrough. This is where it was simple. We got an Excel spreadsheetlisted all of the active patients and their future appointments with notes available to list any communication efforts that weve made. First onlist of active patients, next few columns the appointments that they had scheduled coming forward, and then lastly, any communication efforts that were made. 

Each patient on the list was addressed, whether theyre scheduled or not. What is their status? What are the communication efforts? If you can take it to the next level, the frequency in which they are scheduled at an appropriate level for their appropriate plan of care. Lastlywe would talk about who was formally discharged and informally discharged from that list. Formal discharge was obviously who agreed with the physical therapist that theyre not coming anymore. They popped the champagnegot the coffee mug and t-shirts, they high-fivecelebrity walkthrough, and lead them out the door. They were formally discharged versus those who simply arent returning your calls. Those are the informal discharges. Well talk about the important statistic to track that. 

Ultimately this walkthrough is focused on patient retention and that patient retention leading to happy and engaged patients meeting their goalsThe statistic that were going to try to improve with this is the percentage of completed plans of care. Thats the statistic I was talking about with the discharges. That percentage of completed plans of care is notoriously poor for our profession. Depending on who you listen tothat could be 10% to 20% of all patients that come through our doors are actually completing their full plans of care and meeting their goals, which is horrific. Its lost money, lost revenue, and poor reputations, you name it. Itall that stuff. 

The statistic that we want to improve with this particular action is increasing our percentage of completed plans of care. Another byproduct of it could be increasing the frequency per week that we see those patients. Inherently, if were only seeing them one time a week in a typical orthopedic clinic, theyre probably not getting well and not meeting their goals. Theyve got to come 2 to times a weekso you want to address that as well. What can the results be from the weekly walkthrough? The results are increased total visits, which leads to increased revenue, increased bottom lineprofits, and the patients ultimately are getting better. Theyre following through with their plans of care. The weekly walkthrough is a must and we called it the weekly walkthrough because we literally walk through each chart back in the day of each patient in our file folder in the file cabinet. Were old school. That was how it was back in the day. Now your EMRs can print out some of those sheets. Some of them arent very trustworthydepending on your EMR. It might be better for the front desk person to literally print all of the active patients and keep that active patient list going. Thatthe kicker. 

Heres the secret. This is the front desks responsibility. This is not your responsibility. Your responsibility is to make sure that this meeting happenssame day, same timeevery week. Ensure that it happens and that all the active patients are addressed. The responsibility to keep that active patient list up-to-date and fully communicated is the front deskresponsibility. They should be living in that form throughout the week, knowing where all the active patients are and exactly what efforts have been made to get those patients on the schedules. 

Ultimately in an ideal situation, I, as the leader, would come into the meeting. The front desk would hand me the Excel spreadsheet with all the patients listedall their scheduled appointments. If they dont have any scheduled appointments in the near future, especially the next weeknotes are made as to what their communication efforts have been and where that patient is. Maybe theyre on vacation or something thats happened that they cant come in. Everything is listed and they report to me exactly what is happening with all of our active patients. 

PTO 147 | Care Plan
Care Plan: The responsibility to keep that active patient list up-to-date and fully communicated is the front desk’s responsibility. They should be living in that form throughout the week, knowing where all the active patients are and exactly what efforts have been made to get those patients on the schedules.


Recognize this is the front desk responsibility and it needs to be reported up to you. That is their job to ensure that all the patients are on the schedule and make sure all their patients who are scheduled come in. That’s why one of their main products is arrival rate, but make sure that all the patients who are on the schedule to actually come in for their visits and ultimatelyfill the schedules of the providers. That’s their job. Make sure that this one meeting happens and what will you benefit from it? You’ll see an increase in total visits. Youll see an increase in revenues, increase in patients plans of care being completed. Happy patients that are engaged in referring friends and family and doctors who are happy that the patients are getting better and thuswilling to send you more patients. This one thing can help you with all of those byproducts and increase all of those statistics, making you a happier owner. Recognize that the secret to it all is that youre not in charge of it. 

Yes, initially youll have to do some training. Youll have to show them what to do and how to do it, but then eventuallythey have to take ownership. This is their responsibility. They are supposed to lead out in this meeting and show you exactly whats happening with all the active patients that are coming through your doors, so they are not falling through the cracks and not getting better. The weekly walkthrough, I highly recommend it. It has to be done on a routine basis and if you do so, things will improve in your clinic. Thats my moment for the day. 

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PTO 146 | Cash Flow


Businesses can’t survive if their cash flow is not consistent. You want to make sure you always have a good amount of money coming in. Nathan Shields sits down with top financial adviser Eric Miller from Econologics as they discuss what you need to do to ensure and increase in cash flow. They discuss seven tips that will help create a better cashflow for your business. A must-listen, especially when you need to learn how to increase profitability.


Listen to the podcast here:

The Simple Things That Increase Cash Flow With Eric Miller Of Econologics

A long-time frequent flyer, Eric Miller of Econologics is our guest. Eric, how are you doing? Thanks for joining me.

It’s always a pleasure. What are we talking about?

We’ll be talking about cashflow.

That’s good.

We’ll talk about cash. We want to talk about how we can increase cashflow in our PT clinics. I’m going to give you a minute to talk about where you’re coming from so people know. If they haven’t heard from you before and why you can talk into this subject. As PT owners, we think we’re limited to the cashflows that we simply see with the patients that are coming through and don’t know how to necessarily increase that per se. We want to talk about what we can do to fill up our buckets a little bit more. Increase that profit margin and some of the cushions that we have in our clinics. Before we get into it, let’s share with the group quickly about you and where you’re coming from.

PTO 146 | Cash Flow
Cash Flow: Remember you have three roles in your business: your practitioner role, your executive role, and then your owner role.


I’m a financial advisor by trade, so I learned how to be a financial advisor over the years. Years ago, I had the first realization that if I was going to help practice owners become better in their personal finances, then I had to understand a little bit about how their practice work. Let’s face it. That is the main generator of wealth for most practice owners for their household. Most of them were very dependent upon the cashflow of their business for their household’s financial survival. If I was going to teach people, I had to learn how to be better with money. I wanted them to have more income sources, less debts, pay less taxes and all the things that they want. I had to know where it was coming from and show them how to improve the income-producing ability from that source. That’s where our whole niche of working with private practice owners, specifically physical therapists, came from.

Your whole business model is around helping private practice owners. That’s in physical therapy to become more financially viable and successful.

We make your business more valuable and make sure that that translates into personal financial success. As many practice owners, you can have a great big practice that’s producing a lot of money, but if it’s not translating to the benefit of the household, what’s the point?

Talking about increasing cashflow, where do you want to start?

One: Know The Golden Rules Of Revenue And Expenses

We can talk about the number one thing in increasing cashflow. It all starts with having the correct numbers. Many times, you hear people say, “My cashflow is low,” or “It’s not where it needs to be.” I’m like, ”Where does it need to be?“ I’ve said this before, “You got to make sure you understand the two golden rules of income and expenses.” Those golden rules are your business. Just face it. It’s good to try to spend everything that it makes and then some. Don’t fight that it will, but it’ll also make what it needs to make to be able to function and survive. There’s a natural demand for money. If you want money, you practice and needed money, you needed to pay a bill or your kid needed surgery, that was going to cost X amount of dollars. You would do whatever you needed to get that money together and pay it. Why? Because there’s a demand for that money.

Make your business more valuable, and then make sure that translates into personal financial success. Click To Tweet

It’s the same thing in a business. You have to have this almost obsession with, “I need this much money for us to be able to be solvent, expanding and profitable so I can have business reserves, pay off my debt and pay myself as an owner.” It comes down to making sure you know exactly what that number is. Whenever I talk with private practice owners, the first question I asked is, “What is your make and break number? Are you including all of your profits in that number?” Nine out of ten of them said, “No, I wasn’t.” You’re operating on the wrong number. Once you get that number, at least you know what your target is. That’s where you start. That’s the first thing. You have the right target.

I can think back to my experience that things started changing in my business when I did a few things. One of those fundamental things was sitting down with my CPA monthly. I told him, “You need to teach me how to read a profit and loss statement and show me.” This is many years into ownership. “Show me my cashflow and all that stuff. Help me figure out what my break-even number is, then I could translate that into visits per month.” I just knew that baseline standard for every clinic after that going forward because I did that on a routine basis. I knew my numbers, but the one thing that I know you guys push hard for, that I didn’t do. I wish I had. I would have much more money in the bank if I set aside that 10% of gross revenues to owners as an expense line. It’s one thing that I know what you didn’t cover right there, but part of knowing your numbers is putting that expense line in there.

I think you have to include that. Remember, you have three roles in your business. You have your practitioner role, your executive role, and then your owner role. Most private practice physical therapist pays themselves a salary through W-2 wage. You may take some distributions out of the business at certain times. Maybe you call that your executive compensation, but most people don't compensate themselves as owners. You need to because it’s vital that you do that. Number one, it increases the demand for more money in the practice. It also handles the financial issues at your household because if you’re doing $1 million, $2 million or $3 million in revenue, 10% is an awful lot of money. It builds up and then uses that to create other income sources. Remember that the factor in your payments to each other when you're coming up with that make or break number.

Two: Inspect Your Finance Lines

Know your numbers, that would be your number one. Number two, if you're having difficulties with cashflow or you feel like it could be better and it's just not, you have to inspect your finance lines. I worked with other types of practice owners, but in a PT organization that relies heavily on collections and reimbursements, who's doing that? It's not automatic. There are people who are doing that. They are responsible for your finances. Whether you like it or not, their emotional viewpoint or attitude towards money does have something to do with it. I'm sure you've met those people who if you gave them money, would be out the door the next day.

When you’re looking at the people who are responsible for your collections and billing, you got to have someone that has a bulldog mentality. I’ve seen so many PTs who have so many difficulties wasting money and money that was never built that should have. You've heard the stories. I had one guy who said, “I found $20,000 of unreimbursed treatment sitting in a desk drawer,” and stuff like that. If you’re having difficulties with cashflow, you’ve got to go inspect that line. What’s going on here? Are there good systems in place? Do we need to create more? That’s where your eyes should be especially on your finance lines.

I think so much money in talking to Will Humphreys, my business partner and now the owner of In The Black, a billing company for physical therapists. He onsistently loses money at the front desk because those people at the front desk are scared to ask for the copay. As you said, the bulldog mentality has to be there. My best front desk people and my best billers were the people who said, “We’re not emotional about it at all.” It was simply, “This is the transaction that needs to take place. This is the agreement that you made with your insurance company, not with us, regarding your copay. Your insurance plan says blank is owed when you come to physical therapy. I need to collect that $20 copay. I need to collect $100 to go towards your deductible. How would you like to pay?” The best one is, “Why don’t we just get your credit card on file so we don’t have to go through this each time? You don’t have to remember it. We’ll have it on file. I’ll give you the receipt as you’re walking out the door.”

That was the other thing I was going to say. You got to make it’s super simple for people to pay you.

That can be tough for owners as well because we might own the company, but that doesn't necessarily mean we know how to manage the front desk personnel. We could run it ourselves but we don't know how to manage somebody per se. The same thing can be said for billing people. Even if we have billing in-house or outsource it, we don't know how to hold them accountable. That's where you can look at previous episodes. You can talk to my business partner. We talked about how to hold your billing people accountable. You need to know your numbers on the billing side as well, and not rely on them saying, “Here are the reports. We’re doing a great job. Hopefully, your cash and your bank account are still going in the right direction.” As physical therapists, we know how to manage that. We have the ability to do so. We just have to talk to the right people. As I said, I’ve done an episode on it.

I have the right numbers of what those collection ratios should be. All those things that are going to result in money need to be addressed. Have a stat on them so you can inspect that. We've all had these people in our companies at some point in time who are doing pretty well for a period of time, and then they have massive problems. They're like a yo-yo. They go up and they go down. Find another place in the organization for that person other than the finance lines.

Don’t let them touch your money.

Do not get them anywhere near the money lines because the result is awful when that happens.

It’s when I turned a blind eye and trusted people to get the job done where a lot of money got pilfered away. I assumed things were happening and I wasn’t inspecting it. I didn’t have my pulse on it. I just assumed things were happening and they weren’t. Money’s got taken away from my clinic.

It will spread everywhere if it’s not channeled correctly. That is for sure.

I remember in my consulting that you can take your hands off of almost every position in your company, but CFO is the one that you rarely step away from.

I want to make sure that you’re getting very heavy and accurate reports in that area constantly. There are some other areas that may not have as much attention on, especially if the results are good. Going forward here, that is an area that’s a little bit more difficult in a physical therapy office because it’s not like there’s a lot of cash. That’s just the transaction-wise that are changing hands. Employee theft is a big deal for small companies. It’s becoming more and more rampant that we are seeing embezzlements occurring. Criminals can get very creative when it comes to this. That's why you have to make sure you have your attention in this area.

Much of it can be that simple transaction at the front desk. That $20, $25, $10 or $50 here and there adds up over time.

It’s a simple thing. I have four more. Do you want to keep going?

Of course.

Here’s a good one that everyone can do. All of these things we’re going over. I know it seems sometimes that there are outside forces but when you start looking at it, it’s always an inside job. There are always things you can do inside of your practice.

We might not necessarily be breaking new ground here, just put more attention on these things.

PTO 146 | Cash Flow
Cash Flow: Get rid of clutter, things that you don’t need, things that you don’t use.


Increasing the speed at which everyone does their jobs. Time gets a lot in the way of production. What I’ve seen, especially in practices that have a lot of patients coming in the door, you need to work on speed of service. Wherever you look in your organization and say, “Where can I increase the speed of this service getting done what I wanted to do?” Even when you’re doing the therapy, it doesn’t take away from the care. Some of the best practitioners I’ve seen work really fast. Not just so much in the healthcare areas but also in any other areas of your organization where things need to get done very quickly. When you start doing that, you take time out of the equation and you will see income go up. It's one of those things. You're like, "What would a speed have to do with it?" Think about it. When you complete something, it's done and now it opens you to do more things. If you can get people to increase the speed at which they get their products, you'll see your income go up quite a bit.

A lot of that depends on the clarity that they have regarding their position. If they know that their main product is to get patients in the door, then they'll probably be going to focus on getting patients in the door. If you add the elements of time to it, we not only get patients in the door but we get the patients in the door within 24 hours of receiving the first phone call, fax or how we receive it first. We’re not going to sit on it for a week and then call them, and see if they call us. Our job is not only to get them in but get them in now. If they’re going to reschedule, we’re going to push for a reschedule later this afternoon versus two days away.

Three: Get Things Done Faster

Any area in your business, whether it’s scheduling, collecting money or whatever it would be, how can I increase the speed of this? How can I get that done faster? That’s where you’ll see the production increased because of that.

In the billing sense, Will has recommended that when you’re looking at your AR, aging report, you want that aging report front-loaded with cash. The money that you’re expecting to see should be within that first 0 to 60-day accounts receivable aging timeframe. Maybe only 5% in the $60 to $90, 5% in the $90 to $20, 10% in the $90 and above because you have worker’s comp or liens out there that take longer naturally. Your insurance stuff should all be front-loaded up into that 0 to 60-day timeframe if you’re doing things well in the collection spaces.

It’s a missing element that a lot of people don’t think about. If they looked at their organization and they found out ways where, “This has taken too long. It doesn’t need to take this long. We can increase the delivery of this,” they would find that it would have a dramatic impact on their cashflow.

Not to belabor the point but I know there are studies out there that if you don’t collect that copay at the time of service and they walk out the door, the percentage that you receive on that dollar immediately goes down to $0.65 on the dollar. If it goes out 30 to 60 days, it gets down to 50%. Twenty-five cents of every dollar that’s out there is going to get collected if it’s not collected as soon as possible.

When time enters the equation, it stops. It slows things down. You want to make sure you try to do everything as instantaneous as possible. I’m lazy by nature. There are certain things I’m lazy about and there are certain things I know I have to do it now. If I don’t do it now, it will cost me down the line. Number four, this one is off the wall but I will tell you this. I’ve seen this happen. Have you ever walked into a place like a facility that’s full of clutter, it’s not very kept and it looks like crap?

Make it super simple for people to pay you. Click To Tweet

There are magazines all over the place and lots of stuff on the walls.

Do you think their cashflow is good or bad in an office like that?

You’d question it. You’re considering that lack of organization.

Four: Make Sure Everything Is Organized

It’s bad. Make sure everything is very neat and orderly. Get rid of clutter, things that you don’t need and things that you don’t use. Make sure that the appearance of the people is nice. A lot of people wear, not necessarily a uniform, but they have the name of the company. It makes a difference when people see that. The cleanliness of the place matters right now to people as far as how safe people feel when they’re in that particular practice. Make sure that the facility is clean and not cluttered. Nobody likes clutter.

You can see that not just in the front desk area. That's where we initially go when we think about clutter in the healthcare setting. In a PT setting, it’s also in your gym. Make sure you have plenty of space between tables, especially during this time. Anytime that you can declutter the area and make it look less busy, it lends toward our mutual friend, Sean Kirk's theory, "If you want to increase the number of patients in your clinic, add more tables." If you add more treatment tables, then it seems like there's a space for that person to be. The last thing you want for the patient is to come out of a treatment room or come from the front area at the front desk to start their visit, and there’s no place for them to lay down on the table and get the treatment that they need. When you go to church, the last thing you want is to not have a seat.

You want to go in there and you want to feel comfortable. You want to feel like, “This place is clean and I can sit down and I’m not going to feel dirty.” It does make a difference. When you ever went to a restaurant or someplace and it was nice. It was a good environment. Everything was presented and then you want to go back and you pass. It’s the same thing with your practice. Make it spic and span and aesthetic. If you do that and get rid of a lot of the stuff, then open up new space so you can deliver more services, it’s going to improve your cashflow.

One thing to consider also, and I didn’t think about this until after I opened up my first clinic, I used an interior designer to design some of the front waiting room and treatment rooms. I got a lot of compliments on that. I didn’t think much of it until I had another experienced physical therapy owner come by my practice. He’s like, “Smart move on the design stuff,” because who makes the decisions in healthcare? It’s the moms. The moms are making the decisions for their parents, for their kids, for their spouses so if you can make it nice and presentable for the females, then more than likely, you’re going to gain their trust.

Did you take credit for that when he said that? You’re like, “I meant to do that the whole time.”

I was thinking so far ahead. That’s me as a new owner thinking it awfully.

Five: Hire The Right People

Number five, make sure you don’t have people that should be out there doing your marketing trying to get you more referrals. Don’t stick them in the organization with stuff that is going to clutter what they’re supposed to be doing. You want to make sure that the people who are supposed to do your promotion or marketing are allowed to do that. A lot of times, it’s hard to expand an organization if you’re doing all the functions especially when you first start. You want to make sure that you have marketing people or whatever.

Those people are internal. They’re there to deliver. People who are going out there, doing the promotion and marketing, talking to the doctors, trying to get referrals, trying to manage the social media and all that, don't bog them down with other stuff that's going to not allow them to do their job, which is going out there and trying to find new patients. That would be one of them and that also goes for the CEO. Don't bog the CEO down with things that are going to not allow them to strategize and make sure that things are getting done in the organization. They're getting drawn back down in the organization instead of being able to look at, “How do I expand? I want to buy this new practice.” You keep that person outward. Let them be them.

A couple of things come to mind. In my mastermind group, one of my clients talked about this because he’s growing, expanding and hitting some great numbers. What he recognized on the marketing side is he was doing all the marketing, going out and visiting the doctors. He would make the marketing pushes, especially when the holidays come around and stuff like that. That means he’s only getting out once a week or twice a week for a few hours at a time. By hiring someone part-time to solely focus on marketing, that marketing strategy went crazy and their numbers increased because now there’s someone who is consistently hitting the doctors. It’s not dependent upon the owner who’s got plenty of other things to think about and do to get out and market when he has time.

That happened to me as well as I hated marketing, to begin with. I was happy when I found a physical therapy assistant that wanted to do the marketing and blocking out time in her schedule to go out and market on a routine basis. Number one, I was happy because I didn’t have to do that crap. Number two, someone was excited and doing it routinely instead of me and not just when I had time. As owners, numbers go up a lot of times so we don’t have marketing time to get out and visit. Inherently, the numbers go down. Now it’s time to market again. We go out marketing and we ride that roller coaster, whereas if there was some consistency to our marketing efforts with someone who is dedicated to marketing, then you wouldn’t have to worry about that so much. You’ll have a consistent increase.

To that person’s point, that CEO that hired that person part-time, I wonder how much that increased their cashflow by having that person do that. It’s a huge number.

The hit to their expense line was simply the part-time salary of someone who’s going out and doing marketing, whereas all their other expenses are saying the same that essentially goes right down to the bottom line until they have to hire the next person.

Six: Focus On The Right Things

I got one more. When is the last time you've looked at all of your income sources inside of your business and made sure that you are focusing your marketing efforts or whatever your efforts are on those that are providing not only the highest profit margin but have the highest demand and the easiest to deliver? If you’re going to form a business and you have a product or a service, you want it to be profitable. You want a lot of people to want it and it should be fairly easy to deliver that service optimally. In a PT practice, what are some of the income sources that you have? You have reimbursed patient care and non-reimbursed patient care. You have supplements performance marketing and cash pay line.

Even within reimbursements, there could be commercial payers versus workers’ comp versus motor vehicle accident/leaning patients. There could be different avenues that way.

PTO 146 | Cash Flow
Cash Flow: If you get everybody motivated, coordinated, and behind you and the purpose of the organization as a team, that will show more rewards and results than anything else.


I would break all those down. We have an exercise that I can make available that people can download. It would allow them to look at their income sources and all the different services that they’re providing. Making sure that they’re pushing or marketing those services that provide a reasonably good profit margin. That they are in good demand and fairly easy to deliver because that’s what you would want to push. If you’re not pushing those, what can help increase your cashflow is finding some of those things that would be able to do those. You always want to look at your services. Where can you expand? What can you add? What are some things that you can introduce that you’ve always wanted to that could increase your bottom line? Adding HODs or services like that, you can increase your profit margin by doing those things. That is what I would do. Inspect, review my income sources and market those that are going to give me those three things.

I know it's helpful for some of the clinicians here in Alaska to have massage therapists on staff because there are insurance companies that will reimburse patients for a massage therapy as long as it’s directed by a healthcare professional. They’ll have massage therapy onsite. That adds to the benefit and it’s another cashflow. That’s pretty easy to implement. You don’t have to have any additional equipment necessarily. You just have to give them space to do it.

It’s not that hard. You just have to look at it and say, “What would it take to get this thing going right now,” and just execute and do it. That’s a pretty good list right there. If people did those things, it certainly wouldn’t hurt them. It’s the little things. It’s that 1%. You can look across an organization. If you could prove to every area of your organization, that 1% or 2% will have a big impact on the organization somewhere. I think that’s going through these things of what you can do. It may not seem much. I don’t think any one of these is going to change your life right away, but a combination of doing all these things would improve your cashflow tremendously over time.

Seven: Motivate And Coordinate Your People

I remember you did a presentation once about what to do when someone is in a cashflow crunch. They're having issues and they're bleeding money. One of the things that I recall and always stuck with me is to focus on your purpose again. Make sure the employees are focused on that purpose again. As you start pushing some of these, some resistance might come up like, "You're all about the numbers,” or “You’re all about the money.” Number one, if it hasn’t been clarified and solidified amongst the team, then it’s going to look like that but when you can say, “No, our purpose is to serve people. Here’s our purpose blank.” It’s to do some kind of service to help empower, get people out of pain, you name it. If we can do it faster and we can see more people, that means we're doing a better job and having a greater impact on our community. Tying some of that stuff back to the purpose helps people look past the superficial complaint that you’re just about the numbers or money.

You are a genius because that's the number one thing to help improve your cashflow. Everything you just said was correct. All these other mechanical things you can do in an organization, you can look at the numbers, you can expect your finance lines, you can increase the speed of service, clean the place up and all these other things. If you get everybody motivated and coordinated behind you and the purpose of the organization as a unit or a team, that’ll show more fruits of labor than anything else. That will show more rewards and results than anything else if you could do that. That was beautiful. I’m glad you remembered that.

You brought it up in times of cashflow crunches. We were talking about people who might go in. If you want to get a huge return on your investment, spend the time and energy to focus on clarifying your purpose. Make sure it's somewhat inspirational and get people out of bed to work for you. That generates culture, and now this culture wants to see itself improve, grow and greater expand our purpose to affect more people. That’s when you start seeing some serious cashflow changes for the positive and an increase to the net value of the company. It’s when people are looking for opportunities to organize, increase the speed, and know their numbers as it pertains to how they fit in the company. It all works together and starts creating a better organization. Thanks for joining me. If people want to get in touch with Eric Miller of Econologics, how do they do that?

If you could improve every area of your organization by one or 2%, that will have a big impact on the organization. Click To Tweet

They simply go to When you get to the homepage, it’ll say who we serve. You can go to Physical Therapists because you’ll be right there. We have Financial Success Guides and plenty of downloads that you can utilize to help you on your journey, assessments and all kinds of things.

If they want to inspect their income streams as you mentioned in number six, is that where they’d find that as well? Is that readily available on the website?

I do believe that there is an exercise on there. If it’s not, we can put it on there or they can email me directly. It’s

Thanks for sharing. It’s awesome. It’s all about the money and all about the Benjamins. Thanks for your time.

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About Eric Miller

Eric Miller has been in the financial planning industry for over 20 years. He’s a co-owner of Econologics Financial Advisors – awarded an Inc. 5000 honoree for 2019. As the Chief Financial Advisor for the firm, Eric has had the good fortune to have over 10,000 financial conversations with private practice owners in various healthcare industry and helped guide them into a more optimum financial condition using a proven system.

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PTO 131 | Improving Culture


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.


Listen to the podcast here:

Strategies And Challenges To Improving Culture With Beth Winkler, PT

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.

Thank you.

Tell the rest of the audience a little bit about your professional path and what got you to where you are now.

PTO 131 | Improving Culture
Improving Culture: A bit of slow growth can help you get your people connected to your core values and culture so that they don’t leave and work for the big hospitals.

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.

Pretty much.

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?

PTO 131 | Improving Culture
Improving Culture: When you do have team members leave, it's hard. You have to regroup, revamp, get back in deep and go over your core values.

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.

PTO 131 | Improving Culture
Improving Culture: Try to create something where you can have the team's input and come up with ways to constantly improve and evolve.

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.

Thanks. Bye.


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About Beth Winkler

PTO 131 | Improving CultureBeth received her Bachelor of Science degree in physical therapy from Northeastern University in Boston in 1995. She specializes in treating various types of spinal and pelvic disorders and completed a three-year residency program with the Manual Therapy Institute. Through this training, Beth earned “fellowship” status in the American Academy of Orthopedic Manual Physical Therapists and is practiced in advanced clinical, analytical, and hands-on skills in the treatment of musculoskeletal disorders.

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PTO 130 | Leadership Team

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.


Listen to the podcast here:

Next Level Leadership: The Benefits Of Developing A Leadership Team And Creating Policy With Jacob Pollard, PT

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.

PTO 130 | Leadership Team
Leadership Team: You've got to start blocking some time and working on the business.

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.

PTO 130 | Leadership Team
Leadership Team: The owner’s role is to always look ahead and say, “What's next? What's down the road?”

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.

PTO 130 | Leadership Team
Leadership Team:

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.

Thanks, Nathan.


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About Jacob Pollard

PTO 130 | Leadership TeamJacob Pollard is the founder of Empower Physical Therapy in Alaska. He attended Brigham Young University where he took an anatomy course and became fascinated with the complexities and systems of the human body. This, along with his experience as an athlete, drove Jacob to pursue a Doctorate in Physical Therapy at Idaho State University. Jacob is a member of the American Physical Therapy Association. His ongoing love of sports led him to coach girl’s high school basketball following his graduation.
Jacob loves working with patients, finding the root of their problems and improving their lives! He strives to become the physical therapist you trust to return to time and time again for the different injuries that happen throughout life. He began his Physical Therapy career in Wisconsin working as a traveling Physical Therapist. He then worked at an outpatient orthopedic clinic in Idaho before deciding to come north to Alaska and open Empower Physical Therapy.
Jacob is married to his wife Kiley and they have two boys that keep them active and happy! Their appreciation for adventure and community make for a perfect fit with the Alaska life! When not working, Jacob loves to spend his time playing sports, being outside with his family, traveling, hiking and camping. He loves Alaska and the amazing opportunity he gets to live in such a beautiful place.
Jacob began Empower in 2016 with an idea to create a company that truly cared about their patients like family. He began as a one-man show and has since helped to grow the business to include 10 providers and a staff of 20 total. He has not done it alone and owes so much of the team's growth to the amazing all-star members of the Empower Family! He now spends the majority of his time looking ahead at the possibilities to help and Empower Alaskans.

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PTO 129 | Professional Rebellion


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.


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Achieving Fulfillment And Avoiding Burnout With Phil Plisky, PT

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.

PTO 129 | Professional Rebellion
Professional Rebellion: Physical therapy is an emotionally and physically taxing job. It can start to feel like factory work after a while.

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.

PTO 129 | Professional Rebellion
Professional Rebellion: 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.

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.

PTO 129 | Professional Rebellion
Professional Rebellion: 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.

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 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. 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.

PTO 129 | Professional Rebellion
Professional Rebellion: The first thing to do to help someone who is experiencing burnout is to be compassionate and talk to them about the time you were burnt out too and how bad it was.

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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About Phil Plisky

PTO 129 | Professional RebellionPhil Plisky, PT, DSc, OCS, ATC, CSCS, is the co-founder of the Professional Rebellion, a community dedicated to helping physical therapists create the career of their dreams. His mission is to advance the profession by inspiring those with the power to change it. He does this as an Associate Professor at the University of Evansville, Director of Residency Programs, co-developer in Functional Movement Systems, entrepreneur, and consultant in professional sports. He believes that everyone can design their ideal career and part of his is helping others create theirs.

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PTO 128 | Patient Engagement

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.


Listen to the podcast here:

How To Automate Your Patient Retention, Reactivation, And Reviews Programs With Baylee Jensen Of Swell

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?

Even if you're not in the most price-effective option, if you have good service and good reviews, patients will be willing to come to you. Click To Tweet

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.

PTO 128 | Patient Engagement
Patient Engagement: The nice thing about organic reviews is that will also boost your SEO. If people are leaving comments, you want to make sure that you're responding to them.

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.

As a physical therapist, your number one priority is patient care. The other things, you can automate. Click To Tweet

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?

PTO 128 | Patient Engagement
Patient Engagement: People don't have time to ask around or to go to a physician and ask for referrals. Their online platform is the number one place that they're going to get business these days.


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, 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 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.

Thank you.

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About Baylee Jensen

PTO 128 | Patient EngagementWith a degree in Communications, Baylee Jensen has always been passionate about the power of communication, and the technology that drives our interactions today. Over the last several years, her focus in the medical and PT space has been helping offices navigate through the ever-changing landscape of today’s communication trends and technologies, especially regarding the millennial disruption taking place in our digital world. She is passionate about enabling the improvement of efficiencies in practices, thus making day to day operations flow smoother. Over the last few years, she has developed a passion for speaking and educating the healthcare industry across the country, and is currently a business development executive, overseeing partnerships and professional relationships.

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PTO 125 | PT Marketing Basics

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.


Listen to the podcast here:

The Basics Of Marketing - The Buckets, Budgets And More With Steve Line, PT

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.

Look at money as energy and push it toward the things that are going to keep your venture going. Click To Tweet

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?

PTO 125 | PT Marketing Basics
PT Marketing Basics: If you want to achieve your goals, they should allocate 5-10% on marketing and even more if you're starting up something new.

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?  

We are.

You got to be the country doctor, essentially. They're not bringing you their animals.

Haven't yet anyway.

Never assume that everybody knows what you do. Nobody thinks about physical therapy, ever. Click To Tweet

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.

PTO 125 | PT Marketing Basics
PT Marketing Basics: Start with identifying who you are marketing to. It will guide you to where you need to be in social media.

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.

Marketing has to drive a feeling. It has to create an emotion. Click To Tweet

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.”  

PTO 125 | PT Marketing Basics
PT Marketing Basics: If you focus on improving your customer experience, it will triple your marketing efforts.

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

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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About Steve Line

Steve Line, PT,OCS,ATC is President/CEO of Columbus Physical Therapy, P.C. He founded the company in 1999, leasing office space in a strip mall in Columbus, Nebraska. Since that time, he has expanded the company to 3 locations across Northeast Nebraska, going from 1 employee to 25 and boasting a nearly 14x growth in a underpopulated rural area.
Before starting CPT, he worked as a new grad PT for another PT practice that highlighted the importance of production volume, expansion and customer service. Prior to working as a PT, he attended UNMC PT program in Omaha, NE and UNL for undergraduate studies.
Throughout high school and college years, he worked at various customer service - oriented part time occupations to help pay for schooling. It was throughout those formative years of dealing directly with the consumer in grocery and bartending that developed his intuition for “anticipating consumer needs” and eventually developed a proprietary customer service model, “The Feel Good Experience” that is used primarily in all of the company clinics.
Although, a physical therapist by training, Steve identifies more with the mindset of an entrepreneur, a leader and a teacher. He has published several articles with Impact magazine, a publication of the APTA PPS, and is currently finishing a book entitled, The Feel Good Experience: Grow Your Physical Therapy Practice With Five Star Customer Service.
Steve, married to Kristine for 21 years have 2 sons Evan and Derek, in highschool and twin daughters Alexis and Brianna in middle school.
In Steve’s spare time, he enjoys being outdoors; hunting, fishing and working on his several farms he owns in Kansas and Nebraska. He enjoys reading, and talking about “anything business, real estate or property management related.”
Steve is available for questions and consultations regarding business coaching and operations and can be reached at

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