PTO 68 | Team Buy-In Secrets

 

Team buy-in means a significant number of people become greatly involved in making your company or organization perform well. If you tried to implement this change without success, then Arlan Alburo, PT, DPT, MTC has you covered with his thirteen-step process. As the CEO, Chief Content Officer, and Co-Founder of Orthopedic and Balance Therapy Specialists, he saw to it that he is leading the company in the right direction. In this episode, he explains each of the steps one by one, and intricately shares how he convinces his team members to buy-in the new programs and procedures. He teaches us how we can align everyone on the same page and optimize plan implementation. Arlan’s thirteen-step secret incorporates objective data, proper planning, tracking, and (maybe most important) team input. Following the process will surely increase your rate of success.

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Listen to the podcast here:

Getting Team Buy-In: The 13-Step Process For Successful Change With Arlan Alburo, DPT

I've got Dr. Arlan Alburo out of Indiana. He will be sharing with us the thirteen-step process to implement change and new programs in our companies. You may have experienced it in the past, I know I have, where you present changes that might be coming, new policies, procedures, new programs, new ideas and treatment techniques. Maybe it falls flat during the meeting. Maybe you get some head bobs, but you're not convinced that there are a lot of buy-ins and you’re questioning the success of the program going forward. Many times, there's some resistance to that change. You get feedback after the fact that there are some disgruntled employees, people who haven't fully bought into the changes that were presented. Sometimes those programs aren't altogether too successful.

If there was a way that you could increase your success rate in implementing those changes, you would want to know, I would assume. That's what Dr. Arlan Alburo was going to talk with us about is how to be more successful and get buy-in from the team when we implement changes in our company? I'm excited to present to you the thirteen-step process. I'm excited to use it on myself and my teenage boys. I could always use more buy-in with the family. As we implement this thirteen-step process, we'll see a significant increase in the success rate and buy-in from our company teammates as we follow the process.

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I've got Dr. Arlan Alburo out of Indiana. He is the Cofounder of Next Level Physical Therapy, which is a mastermind coaching group for PT business owners. I've interviewed another cofounder and member of Next Level Physical Therapy both Travis Robbins and Kevin Kostka. Arlan is a part of that group. He is also the CEO and Cofounder of multiple physical therapy clinics in Indiana called Orthopedic and Balance Therapy. Thanks for coming on, Arlan. I appreciate you doing so.

Nathan, thank you. I'm honored that you've invited me to be a guest on your show.

I'm excited to know about your story because I know a little bit about it having talked to you, but would you mind sharing with us your story to become a successful physical therapist and what got you to where you are?

I'm originally from the Philippines. I was 22 years old when I immigrated to this great country of ours. I like to tell my story and start off by saying, “I got off that airplane in Chicago with a $150 in my pocket in fives and the ones.” I am so thankful for the profession of physical therapy who brought me to realize my American dream with my family here in Indiana. We have four locations for our practice here. We’re considered as a suburb of Chicago. I am also the Cofounder of NLPT to help our fellow private practice owners out there realize their dream of running a profitable practice, achieving time choice and financial freedom. I started my practice in 2003 in Valparaiso, Indiana, with my cofounder.

Back in those days, we did everything like most private practice owners when you're starting out. You do your own marketing, went out to visit physicians, you type your own reports and your vacuum. You do everything. My practice went up fairly quickly to about a 100 to 120 visits between the two of us, but then you realize, “For this thing to grow, I'm going to need more help.” We plateaued by 2007. By 2011, we were thinking, “This is not what we thought it would be.” We were paying ourselves but we would have made more by working for somebody else.

For the longest time, that was the question at the end of 2010, “Should we keep our practice open?” At that point we realized, we need something. We need some help. We need to study a little bit more about business, about entrepreneurship. That's when our practice started turning. That's when we started realizing, “We can grow, we can scale this thing, but we're going to need more help.” By 2013, we were growing pretty well. My practice went through quite a bit in 2013. Our main location was involved in a fire. We closed our practice for seven months, but we actually came back from that pretty strong. From a team of three, by the end of 2013, we were probably eight to nine people, which to us was already a lot of growth.

Working together with your team in framing your plan increases its likelihood of being carried out. Click To Tweet

Now, we're a team of 30 in four locations. We're opening our fifth one shortly. My fellow cofounders from NLPT had been a great help in doing that and in scaling the practice. I'm a full-time CEO and visionary for our practice. I don't see patients anymore. That's what has helped us put systems in place, putting our leadership team in place and make this thing run smoothly with the help of our leadership team without the owner or the cofounder having to carry the burden of running the business. It's exciting times and I’m hoping to share that with fellow private practice owners out there.

You’ve got to rewind for us. What did you do between 2010 and 2013? I have an idea in my head and I have a formula that I reiterate on the show for successful business owners. I wonder if you followed the same path to success between 2010 to 2013.

What we did was we searched, “How can we get help? Is there coaching out there?” During those times, there was not a whole lot of coaching. I'm a natural fact-finder, so I read the lot but we decided to go with a consulting company out of Florida. I don't know if they run anymore. We got some leadership training and how to organize our practice. I believe Kevin Kostka went through the same thing. That's what got us started is putting systems in place. To put systems in place, you start with your organization. You’re organizing the board and being a good executive, like what Kevin Kostka talked about with you. That's how it got us started. We attended marketing conferences. Most of all, conferences on entrepreneurship and business development has been helpful.

It's the same formula. I always reiterate to reach out, step out and network. Reach out to find a coach, consultant or mentor, someone that can guide you. You’ve got to step out. As you got that consulting, you had to take portions of your treatment day instead of the sign for the business. You probably started at a half-day, maybe a full day a week or starting simply work on the business since you’re not seeing patients. You started networking or joining accountability groups, masterminds or collaborating with other PTs or simply business professionals to establish your network and start working on some of these business aspects that you're trying to move through. Almost all my episodes have followed that same pattern. It's one that I consistently preach and harp on.

It’s crazy because when you're working in your business and seeing patients, there’s nothing wrong with that. The longer you're there and spending most of your energy just seeing patients, by the end of the day, you don't have the energy to work on your business. Without that energy and without that dedicated time to work on your business, your business will never grow beyond the line of patients you or your partner can see.

I started doing half days of working on the business. Transitioning from that patient treatment energy to working on my business was energy draining. It was hard to switch mindsets during the days. I tried to move people towards taking a full day and simply focused on the business from the outset. Did you have the same issues?

That’s exactly the same issue I went through. I started out by blocking four hours. I would stay in the office. I will just close the door. If you stay in the office, you block four hours before you know it, someone's knocking on your door. That's also telling you that you don't have systems in place. I thought, “This is not working.” I decided I'm going to go to the local library for four hours. I would tell my teammates, our teammates in advance and tell them I'm going to be off the grid four hours. My phone is going to be off. I'm not going to be checking email. They know that even if they tried to reach out to me, they wouldn't be able to reach me. That four hours became eight hours and then I said, “This is working.” Eight hours became two days. It became three days. By May of 2017, I was gone from treatment full-time. I have not been seeing patients for many years now. It is fun running practice when you have help and you have a leadership team in place.

I'm assuming that you are opening up your fifth practice, but you're probably not doing a whole lot about it. Are you pretty busy yourself?

I'm not going to be seeing any patients. My job there is laying the vision of how that location's going to be, setting the pro forma for that with my CFO and then envisioning how many we need to staff that place. We have our leadership teams and VP of operations to make sure that things are running smoothly right off the bat on the first day.

PTO 68 | Team Buy-In Secrets
Team Buy-In Secrets: It is fun running a practice when you have help and you have a leadership team in place.

 

That's great. Congratulations.

Thank you. I refer back to my leadership team. Without them, it would be tough because when I opened my second office, I did all the work.

From 2010 to 2013, you're getting some consulting and training. This is what we're going to talk about. You're getting all this consulting and training and you're getting all these ideas. You're like, “We need to do this. We need to do that. I need to structure it this way. My employees are going to do this thing.” Was that well-received right off the bat? How did you start implementing things?

It's probably happened to most private practice owners. You learn a lot of stuff from the consulting that you're going to or maybe go out of state for three to five days and learn business concepts and then you go back and instantly try to implement it. It's easy to do when it's just you and your partner and maybe be a couple of people. When you have a big team and you're trying to implement new concepts all the time, you might not always get the best buy-in from your team. Sometimes you're going to get blowback. A lot of owners out there were seeing that in our consulting with NLPT too. Our first mastermind group was a group of twenty. When they first joined, we were throwing a lot at them to help their practices out, but they would go back to their teams and tried to implement them right away. They were getting a ton of blowback.

We then realized, “We need to introduce the thirteen-step of change through persuasion to our mastermind climbers.” That way they can introduce any program, any change that they're trying to implement in their practice and ensure maximum buy-in because it happened to me. From that period from 2010 to 2013, I would go back and tried to implement. It was a little easier at that time because we had a smaller team. If I did that now with my team of 30, let's say I attend a conference in San Diego and come back on a Monday and decide we're going to do this thing for the whole company. That’s not going to go well. There are specific steps that you need to take as a private practice owner when you're introducing change through your practice or implementing a program or trying to tweak a certain process. You have to go through these thirteen steps to make sure that you'll ensure maximum buy-in. The problem is most owners jump to step seven. Step seven is implementing the plan. They skip steps one through six.

It's not any different than going to a ConEd course that you alone go to and then you come back and say, “Every other therapist needs to introduce this into their treatment protocols.” They're going to be like, “Why? What? Who?” They didn't get all that prep that you got during the course of your ConEd course. It's not necessarily different than implementing some new treatment procedure when you're trying to change structures and procedures and something is as fundamental as their jobs. I can imagine, it takes some cozying up to them and preparing them for that change. I'm excited to know what the thirteen steps.

There are four major stages of change through persuasion. Stage one has three steps in it. Stage two has four steps in it. Stage three has three steps in it and stage four has three steps in it. All in all thirteen steps. Let's talk about stage one. Stage one is called Setting the Stage. You have to set the stage. What I mean by that is the three main steps in setting the stage is facing the facts. What are the facts behind this change that you're trying to implement? The more objective data you have, the better. Even graphs or trends. Let's say, what's a common thing that you've heard from your podcast guests as far as may be something that they've helped introduce or change in their practices? Let's say the arrival rate or something.

It’s simple things like that. Arrival rates or recruiting PTs are hard. Trying to figure out an appropriate salary to offer.

The common thing that we would hear is that the owners would like to improve on the plan of care utilization. Maybe the patients of their PTs are not utilizing the plan of care properly or fully well. There's something that PT owners wanting their team members to improve the plan of care utilization. Making sure that patients are graduating and making sure that patients are completing their plan of care. The common thing that would be facing the facts would be, what is the present plan of care utilization percentage? What is the arrival rate? What's the drop off rate? What is the graduation rate? What is the trend? How does that look like on a graph? Has it been down-trending for quite some time?

To implement changes, make sure that you as the leader would be walking the walk and talking the talk. Click To Tweet

Another combination maybe for some practices that sell cash services. Let's say, they have a laser or dry needling that they're selling as cash services and their team is not selling it. The owner can sell it, but when it comes to their teammates trying to sell cash services, they can't do it or hardly doing it. Again, you lay out the fact, “This is the fact. Our plan of care utilization is at this level or our sales are at this level.” Even units per visit is another thing. Maybe PTs have some locations or some practice may be seeing patients for an hour and maybe only charging three units.

Anything that you're trying to change, you’ve got to face the facts as far as that particular situation and issue goes. After you think about the facts, the next step would be you got to establish a sense of urgency. By the way, the most powerful way to face the facts in my view, and we've been doing this for years now, is open-book management. My practice is open-book management to all our teammates, not just our leadership team. Our whole team of 30 people from the front desk, techs to PTAs, PTs, clinic directors or marketing people, they see our financials every month. That's a steep gradient for most owners to get to that point where you're showing your financials.

There's a whole lot of obstacles for some people to do that or a lot of reservations to do that. Face it, it can get any more factual than that. When you show your financials, the team sees whether you're doing well or you're not doing well. It's good to see that this is what's happening. How are you impacting the top line of the business? How are you impacting the expenses? A lot of lines on that P&L, they don't have control of, but the one thing that most teammates have control of is their impact on gross revenue through visits and through appropriate utilization of charges. That's one of the most powerful things that we've seen in this step number one facing the fact.

Number two, you establish a sense of urgency. If this trend keeps going, what's most likely going to happen and when you present this to your team, you have to get this out of them. You have to ask the same question, “If we continue in this pattern, this trend, let's say for a plan of care utilization, how would that impact our graduation rate?” If patients are not graduating and not getting the results, how will that impact our marketing? How would that impact our image with our referring physicians? How would that impact you as a PT or as a teammate? At the end of the day, that sense of urgency has to resonate with them. Most of our teammates are interested in the number one radio station, which is WIIFM, What's In It For Me? That sense of urgency has to ring true to them.

I love that you're asking the questions and you're bringing it back to them.

It has to resonate personally with them because otherwise, they would say, “Why do I care?” If we have the right teammates, they would be concerned. This is a way of making sure that they relate to the issue at hand. The third step would be creating that ideal scene. If this issue is addressed properly or if this program is implemented well, how does that ideal scene look like? What does it look like for you as a teammate? What does it look like for the practice? What does it look like for everyone who's working here? How does that look like for our patients? How does that look like for our referral sources? Creating that ideal scene is step number three. Those are the three steps in stage one, setting the stage and make sure you face the facts, show the facts and be as objective as possible. Establish a sense of urgency but to establish a sense of urgency, you have to help your teammates realize that there is a sense of urgency. You have to ask them questions, you have to relate it to them personally. It has to resonate with them that it impacts them. Finally, as a team, you have to create that idea of seeing what would that look like.

Once you've done that preliminary part, then we move on to stage two. Stage two has four steps in it. Stage two is essentially developing and implementing the plan. The first step, which would be step number four, in this case. The first step under stage two, which would be overall step number four would be framing a preliminary plan. If you have a leadership team, you start framing a preliminary plan of how are we going to address this issue? Who would be involved in implementing the steps that we were going to layout? What would be the timeline? Who's going to be impacted? How are we going to measure the results based on this plan? You frame that preliminary plan. Why is it a preliminary plan? It has to be preliminary because you have to involve the input of your team. If the plan is just from you, the owner or the founder, that plan is not going to be very powerful. You're not going to get complete buy-in.

If you frame that preliminary plan together with the help of your team, initially with your leadership teammates and you all work together on framing that plan, the likelihood of that plan getting carried out and implemented well shoots up very high. The next step, which would be number five is gathering feedback. You present your preliminary plan for your team, then you gather feedback. How do you gather feedback though? At NLPT, we love seven questions typically when we're gathering feedback from our teammates. The number one question we ask, let's say you present your preliminary plan. Whatever plan it is, maybe it's on the plan of care or improving cash services or maybe hitting our profit and loss targets and profit-sharing plan. People would have questions when you present a preliminary plan. The first question for gathering feedback, there are seven questions for gathering feedback that we love to use. This is based on the book, The Coaching Habit.

PTO 68 | Team Buy-In Secrets
The Coaching Habit: Say Less, Ask More & Change the Way You Lead Forever

Those seven questions, not that we wanted to memorize it, but understand how those questions flow. Let's say you present your plan, the first question that you need to be asking your team is, let's say, someone raises an objection, an issue or a concern about the preliminary plan. Your first question as the leader, the founder or the CEO would be, “What's on your mind?” You asked your teammate and you just shut up wait for their answer. Let them talk. After they talk, you follow up with the second question which would be, “And what else? Can you tell me more?” Let them dive deeper into it. Question number three would be, “What's the real challenge here for you?” Let's say they raise an objection or they're thinking this plan is not going to work, then you ask question number three.

Question number four would be, “What do you want out of this? The number five would be, “How can I help?” Showing them that you're concerned with their success as much as they would be. “How can I help make this a reality?” Maybe this is the preliminary plan. Maybe it ends up not being the actual final plan. By going through these questions, then you're able to gather feedback from your team and maybe you realize, “They would have a point. Maybe this is not the direction that we need to go.” Which leads us to question number six, “If you are saying no to this, what are you saying yes to?”

Essentially, you're asking your teammates, “I realized this plan may not be the best plan, but do you have another alternative for us that you would like to suggest?” Let them give you an option. Finally, number seven is, “What did you learn about this? What was most helpful here for you?” In number seven, you'd want to take notes on what you learned about that process because the next time you introduce another change or plan to your team, that number seven questions are important for you to remember. “This is how we did it the first time or this is what worked the last time,” and maybe this is the same way we go about it. Question number seven is, “What was most helpful? What did you learn about this process?”

That's the gathering feedback step, which would be number five and number six is finally just rolling out and finalizing the plan with your leadership team. What does a final plan look like? There's a goal, there's an objective, there are action steps and there will be people assigned to each action step. There'll be milestones and timelines for each action step. You also want to make sure that there is an actual deadline for when it's going to be done. As far as setting deadlines, deadlines should be agreed upon by the whole team instead of the founder just setting a deadline. Let everyone agree on a deadline and you’d get a great buy-in that way. They know, “He's not just mandating that we get this done on this particular date.” That was a mistake I've done.

There are so many times where I delegate something or ask somebody to do something without a deadline. I'd follow up a week later, “How are you coming on that?” He said, “I didn't even start working on it. When do you want that?” “I wanted it a week ago.” It's all my fault. I didn't set a deadline.

It can swing in the other direction too, where you said a pretty aggressive deadline and then you have teammates thinking, “What does he think? I'm not doing it right. I've got a ton of work that I need to do and here we go. He's putting a deadline.” That's why it's good to agree on a deadline for both ways. No deadline is not good. A super aggressive deadline that the owners set for the teammates are not very well-received either. It should be something in the middle, a happy medium. That's stage three. Most owners jumped to step seven is implementing the plan. Step six, finalizing the plan. It doesn't end there though, after implementing the plan. Stage three is you got to manage the results and morale of your team.

There are three steps here that are super important. Step number eight would be planning for and celebrating short-term wins. Let's say you have a huge goal or a big thing to implement or a specific metric. Let's say for example your plan of care utilization is 80% and you wanted to jump to 95%. A jump from 80% to 95% is such a huge jump. It's cool if you would set, “Team, if we get to 85%, how should we celebrate it as a team?” We love doing mini-games. I got this from Travis Robbins. We do mini-games in our practice as far as if there's one particular metric that we would like to influence, we'll do a mini-game around it. Then we'll decide on what the prize of the mini-game is.

In a month or in a quarter, it's something to look forward to making it more fun. Plan for and celebrate short-term wins. It is so important for our morale. Step number nine would be you need to track and report results on that particular plan that you're trying to implement. It has to be included in your scorecard. Typically, tracking and reporting usually happen during weekly team meetings. I would highly recommend if you're introducing a plan to change something, it’s something that you monitor, you track and report results on a weekly basis as a team. That way you know it's getting implemented correctly and you can debug it even more. Step number ten would be continuing to engage your team. You track and record results. The next step, engage the team, continue to debug, continue to tweak. If the plan needs to be tweaked out a little bit, change there a little bit and that's where the feedback from your team. You continue to get feedback at this step.

If the plan is just from the owner or the founder, that plan is not going to be very powerful and would not get complete buy-in. Click To Tweet

I haven't said a lot because I'm learning a ton and I'm writing down notes as you go into this, but continuing to engage the team. If you're one of those personalities that jump to the next thing often, this can drop out. That's where your teams can get desensitized to the changes that you present. They might look at it and say, “There's another idea. This will go by the wayside in another month.” He comes up with the next bright idea and then that'll go by the wayside. You're a little desensitized to the changes where I love how you're talking about continuing to engage the team and recognizing like, “This is part of our practice and I'm going to continue to talk about it. We're going to continue to push.” I love this step.

This leads us to stage four, which is preventing backslide. Change is difficult for most people. We’re all human beings. We are typically resistant to change and change is so personal. Especially, if our teammates have been doing things a certain way and then we are introducing a change. There might be some initial changes. They get desensitized to it. Maybe the first two or three weeks they might be doing it or implementing the plan and before you know it, they might backslide back to their old ways of doing things and back to the same issue. All that work results in nothing if you don't particularly plan out stage four which is preventing backslide. How do you prevent backslide? Step number eleven would be you need to discuss with your team right off the bat when you frame that preliminary plan and finalize that plan, disruptive versus desired behavior as far as that as the new plan or new change that you're trying to implement. List out at least three disruptive behaviors and three desired behaviors as far as the new plan that you're trying to pursue or a new change that you're trying to implement.

Is it part of the plan or is it something that you do on the fly?

I would do this right off the bat. You can include this in the plan. We just put this at step number eleven, but I think it's a great idea to put it in the plan right off the bat so that way people are aware. This is in stage four preventing backslide. It was put there to remind people to create this step and you can add this step to finalizing the plan in step number six. List disruptive and desired behaviors so that way your team is already aware, “These are the actions that we want to see from our teammates.” If there are five or six, perfect. These are the actions we don't want to see in regards to this particular plan or change that we're trying to pursue.

Finally, step number twelve would be to make sure, you as the leader would be walking the walk and walking the talk. You need to be the first model of an example. This is an easy example. Maybe the change would be a new employee handbook. In the employee handbook, it talks about coming to work early, like five minutes or maybe ten minutes. If you as the founder, the owner or the leader come late all the time, then it would not be great for implementing and following the plan when they could see you yourself following and creating one of those disruptive actions you've actually listed.

Finally, number thirteen is systemizing the process. Now that you've gone through this new plan, the first stage is you set the stage. In stage two, you've developed it and implemented it. In stage three, you've managed results and morale, you've track results and it is working. In stage four, the final step, want to systemize it using a process map. This is the thirteen steps of change through persuasion. We coach our mastermind groups for a whole day on this. How we dive deep into it including the process mapping at the end. You've got to learn how to process map. Once you know that the plan works, you got to put that as a system. You got to write that down. How do you write that down though? There's a great way to process map that. That's something that we coach our mastermind climbers on. I believe this change through persuasion thing is something that's a little bit underrated for most owners. It seems like it's something easy to implement, but the tendencies are to jump to step number seven. It seems like the first six steps, they're just a hassle. If you skip those first six, you will not get the maximum buy-in that you're looking for.

Maybe our readers are already doing a couple of the steps, but I love how you're talking about and presenting the facts, “Here's where we are and this is where we need to get.” They don't take the time to involve the team by establishing a sense of urgency and asking them questions. They also might not totally be open to gathering feedback from the employees or team members. They also might not be willing to engage the team members by celebrating the wins. I love the thirteen steps because it incorporates the team members throughout the process where some people might just say, “Here's the issue, here's what we need to do, get it up to that level. If you do so, great. We'll move onto the next thing.” I love the engagement that's brought out through the process.

At the end of the day, engaging with this is the key. When you look at the thirteen steps, it is the heart of this, engaging your team so they know they're part of forming a plan. When it comes time to implement it, they'll be fully vested.

I can see how this could be a good filtering mechanism or a vetting mechanism in and of itself. Even though you go through this process, some people are not going to be bought in. Some people are simply resistant to change. I see this as a great opportunity to use the process to filter out those people that simply won't get on the bus or fall into alignment with what their company is doing and where it's going. This goes every step of it. It allows for engagement and invites them to change it if they're not willing to do so along that path. It's easy to move people out in this regard.

PTO 68 | Team Buy-In Secrets
Team Buy-In Secrets: Once you started adding coaches to help you out, then the practice grows.

 

If you go through this process and you have a teammate who's still not buying in, then you might have to be looking at that teammate and maybe letting them off the bus.

I love that you broke it down into thirteen steps. I love that you brought in the The Coaching Habit. I read that and I saw a friend of mine reading as well. I loved it and how it can be influential as a leader because we are essentially coaching for the team members that we work with. As the leader, we're there to help them through any issues and problems. Sometimes we need to see ourselves as that coach.

That's actually written in my home office at work. My three hats. To our readers, when you think about it, you have three main hats for your practice. Whatever stage you're in, you may still be seeing patients, but still your top three hats and treating patients is not in the top three. Number one is you're the visionary, number two is strategist and number three is head coach. The neat thing is those three hats, you need to somehow incorporate that into your week and find times here and there to wear your visionary hat.

You have to work on something related to visionary and strategy every week and then work on coaching. In our practice, I've dedicated Tuesdays to coaching our teammates. Tuesdays are also our leadership team meetings, but it's also our one on one meetings. It is also our coaching meetings. That's the most powerful thing because that's one thing that I needed when I was starting out. I did not seek out right away and no wonder we didn’t progress as well. Once you started adding coaches to help you out, then the practice grows. It's the same thing for our teammates. If you want to be our teammate, we’ve got to coach them.

They want that. They want someone who's as concerned about their future as they are and maybe provide a little perspective along the way.

Do you follow football?

Of course.

Who's your favorite team?

I'm from Arizona, so it's the Cardinals.

There's a huge gap between knowledge and understanding, but there's an even wider gap between understanding and implementation. Click To Tweet

I'm a Chicago Bears fan. Our head coach is an amazing leader. When you look at it, we are like a sports team head coach. Running our practice is like being a sports team head coach. Trying to encourage and motivate your team. Matt Nagy is great at that. He is a great head coach when it comes to motivating his teammates, his team, being a great and encouraging leader and engaging his team.

Arlan, you've shared a ton with us. Is there anything else you want to share?

I want to end with something that I read. You've probably read this book, Executive Toughness by Jason Selk.

I haven't read that one.

I love that book. In that book, he mentioned specifically that there's a huge gap between knowledge and understanding, but there's an even wider gap between understanding and implementation. I already discussed the thirteen steps and maybe you've memorized it, but it's one thing to know and understand it and it's another thing to implement it. I would strongly recommend you implement it in your practice. If you have any more questions, feel free to reach out to me or reach out to NLPT and we can help you implement change through persuasion in your practice.

How do people get in touch with you, Arlan?

The best way would be through our Facebook group, NLPT Basecamp. It's a free Facebook group. They could join there and they could also add me as friend personally. You can message me on Messenger and we can correspond that way. If you have any questions, I'd be more than happy to help you.

Thank you so much for your time. You shared a ton of great insights. This is a huge step for any successful business owner who wants to make changes. You have to change in order to grow and scale. In order to do that, you have to implement these changes and this is the way to do it. I appreciate the wisdom that you shared with us. It was great.

Thank you, Nathan, for having me on.

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About Dr. Arlan Alburo

PTO 68 | Team Buy-In SecretsDr. Arlan Alburo, PT, DPT, MTC founded Orthopedic and Balance Therapy Specialists (OBTS), a physical therapy practice, in 2003. With 4 locations in Northwest Indiana in Valparaiso, Crown Point, and LaPorte, OBTS strives to liberate Hoosiers from relying on pain pills, getting them active and mobile without fear of slowing down, well into their retirement years.

Arlan is also a co-founder of Next Level PT, a Mastermind company focused on helping private practice owners achieve time, choice, and financial freedom. He speaks during Mastermind conferences on change management and how to achieve true team buy-in. He is also NLPT's head of strategy and leads strategic planning meetings.

He obtained his Bachelor degree in PT from the University of the East in Manila, Philippines and his DPT from Evidence in Motion. He is married to his wife Jane of 23 years, and they have 2 children, their daughter Alex and their son AJ. They live in Valparaiso IN.

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PTO 67 | PT Hiring Process

 

Going through the interview or hiring process is much like courtship. When you are really smitten by the right person, you can become a nervous wreck and bumble the job offer process. Brian Weidner of Career Tree Network is back on the podcast to share even more wisdom on successfully recruiting and hiring your next PT. He shares some successful actions that you can take to increase your odds of getting a "Yes!" when you put an offer out there. You've moved the ball this far down the field, be sure you get it across the goal line!

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Listen to the podcast here:

Seal The Deal: Tactics To Get The Next PT Candidate To Say "Yes!" With Brian Weidner

I've got Brian Weidner from Career Tree Network back in the show in order to talk about that last step in the hiring process, the offering of the job letter. Sometimes that can be a nerve-wracking experience to send it out, not knowing exactly if they'll accept it or not. You're putting yourself out there and you want to seal the deal and sometimes we can lose people if we don't handle that correctly. We want to talk about that last step in the process and how to successfully offer and present a job offer to an applicant that we're excited to bring on. If you have read the past episode with Brian, we talked about recruiting physical therapists and some tactics you can use to successfully recruit more physical therapists on your team, but we niche down a little bit more on this interview. Let's get to it and see what we can do to make that last part of the recruiting and hiring process as successful one.

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I've got Brian Weidner of Career Tree Network on with me. Brian was a past guest. If you want to know little bit about his story and where he came from, I recommend you look back. We talked about some tips and tools as to recruiting physical therapists and what he does at Career Tree Network to help physical therapy owners and staff their companies with physical therapists. He reached out to me because he's recognizing that there are some holes in our abilities to actually get candidates to accept our offers. We want to talk a little bit about best practices in terms of extending job offers and getting those people that we want, those physical therapists that we want to join our teams. First of all, thanks for joining me, Brian. I appreciate it.

Thank you so much for having me. It's great to be back. I appreciate the service that you provide here.

This is something that you've been noticing with the people that you're working with. What are some of the things you're recognizing? Maybe there are some tips you can give us on how to get that person that we want, that physical therapist that we think aligns with us and taking them through the application process, whatever that is. There's still that nervousness that maybe they won't say yes when I present them the ring on one knee. You’re going into this marriage and not sure what they're going to do. You worry about numbers. You worry about if they're going to accept it or not and how the negotiation processes go. What are some of the things we can do to make sure that goes to our advantage?

I like that example of a courtship process. You are building a relationship with this candidate and especially at a smaller practice, if they are hired onto your team, you're going to potentially see them more often than you'd see your own spouse or family. In a lot of ways, the people that you work with are your relationship, or at least they're part of your interactions with other people for sure. We've all had that time when we extended a job offer and then that candidate that we thought we liked and we wanted to hire, they would not accept our offer and they would go and work for one of our competitors. Losing that good candidate is very painful. It's also sometimes preventable in terms of the process that we're using. In general, we're at a point here where PTs are in very short supply. Whether we like it or not, they hold the control and they're driving the relationship often. That's because they have so many different options not only within private practice, but also in the other practice settings. When a PT is looking for positions, they're often interviewing at multiple organizations and it's important that in on their side that they find the best fit. Through those multiple interviews, they're also receiving multiple job offers. This is a topic that offers process, if you're doing it in a way, you can increase your response rate and you can actually get more candidates to accept that offer.

It does actually go back to like the relationship. What's needed is important. Candidates often lose interest quickly if they don't hear anything back. If you're able to extend that job offer quickly, that's the most important factor. We had one client who had a candidate who they liked, but the candidate was interviewing multiple places and they had multiple interviews scheduled down the road. Our client was waiting to potentially extend the job offer until that candidate had finished all of their interviews. In other words, the candidate was the best person for the job. The intention was to extend the offer, but they wanted to almost wait until they got permission from the candidate to extend that offer.

Like the candidate is going to say, “Now I'm open for offers.”

That's the first piece of advice that I would give is that you don't need to wait until the candidate is ready to receive the offer if you know that the candidate is a good person for the job. If they can do the job well based on your evaluation, go ahead and extend the offer.

We talked about this last time and how speed is so important. I don't know why we want to slow things down. Maybe that's a procrastination technique or maybe there's a fear that we're trying to avoid but think about it from the candidate’s point of view. If they think, “That interview process went well with that particular PT owner, I wonder what they think about me. I wonder if they're going to extend something to me,” and then I don't hear from them for a week. Going back to the courtship idea, usually if you want to go out with somebody, you want to let them know rather quickly and not wait a week and see if they come around to still wanting to go out with you. You want to jump on and as soon as you can. You don't want to let them linger out there waiting if you're actually interested and you're excited about that person. It's okay to show that excitement and extend the offer and say, “I was impressed with you. I'd love to bring you on to our company. Here's our offer. Hopefully you can talk more.”

Showing them the emotions and doing that heart to heart type scenario with the candidate is great. You never know, the PT might accept your offer and cancel the other pending interviews. There's no benefit to waiting. The only downside risk on that, which a person might ask is, “We can't have the job offer open forever. How do we make sure that the candidate gets back to us quickly?” The piece of advice with that would be to have an expiration date on your job offer. You could say something like, “We see you as a great candidate for our opening. We'd love to get this wrapped up as soon as possible. When do you think can you get back to me on the offer?”

Is it too much to say, “This is our offer for the next week?” If you know that they're going to do some interviews over the next two weeks, should you jump the gun and say, “We need to know within the next week,” even though you know that they're going to be interviewing for a little bit longer?

That depends. You might phrase it as, “I know you have a few extra interviews scheduled. Is there anything else that we could do now to enable you to accept our offer at this point?” Maybe there is something else, like a specialty area or a certification they were looking for or something simple that you could go ahead and do and that the candidate might cancel their other interviews. It's more of a case by case basis where you want to be respectful of the person doing their due diligence and making sure that they're exploring all the options on the table. At the same time, if you're open with the person and like, “We want this to work out. What can we do to make it happen?” that's a good approach. You never know what the candidate might say. It might be something we all fear, like if they're going to ask for a sign on bonus or they're going to ask for a corporate jet or a briefcase full of diamonds or something. We don't know what they're going to ask. They might ask for Friday afternoon off at 4:00 PM and you're like, “Let's do that.”

PTO 67 | PT Hiring Process
PT Hiring Process: Candidates often lose interest quickly if they don't hear anything back. That is why it is important that you're able to extend that job offer quickly.

 

I like what you said about things that you can add because there are some things that maybe as smaller practices that we can add to the pot, if you will, if you're trying to woo a candidate that maybe other larger entities can't provide. That is maybe the ability to pursue a particular niche or treat a certain demographic of patients. Maybe provide time off to work at certain places within the community that you could leverage to then increase the patient volume on their schedule, something like that. Those are things that we can leverage as small practice owners, and you talked about this before we started the interview. It's important for us to play to those strengths, especially going up against larger chain practices or corporate settings that might be offering other things, even larger salaries. Maybe we have to stick within our realm and offer other things that maybe those companies can't provide.

A lot of our private practice clients are quite concerned on the salary side. How am I supposed to compete with the larger hospital systems? They have deeper pockets, they have higher reimbursements, better benefits, things like that. Playing to your strengths is the best approach. Private practices offer a great mentorship opportunity where you can play into that card. We want to be the best physical therapists in this community, and we will work with you and mentor you and you will exponentially grow in your skills here. That's one angle, that professional development piece. Another card would be flexibility as well. Like our company here at Career Tree, we're quite small but we offer a great flexibility. If you want time off any day, any time, go ahead, take it off. That's perfectly fine. A larger company would have policies and hoops to jump through and that is annoying for folks. That’s one other thing on the strength side. Some of the smaller clients that we have, they don't offer like health insurance, for example.

My recommendation on that would be to have a stipend earmarked on the paycheck that has a wellness stipend that can be used for a wellness benefit or health insurance where your employee might be able to purchase health insurance on their own via the exchange. If you don't offer health insurance, I feel like in order to compete apples for apples, you should still do la certain amount of money earmarked for that wellness stipend so that the employee can compare. “They're not offering me health insurance, but they do have this wellness stipend.” It helps equate the two offers. Some clients will say, “We don't offer health insurance, but we try and pay our people a premium rate.” That's fine but that money should be separated out in that separate bucket so that the candidate can see it clearly as a benefit to them.

They recognize the full value of their compensation. Maybe I can get your two cents on this since you're talking about benefits and that can be a huge issue whether or not someone joins you. I've sat in a presentation by the guys from Paychex. They provide payroll but they also provide HR support and they can help you with all your onboarding and your contracts that are reviewed by lawyers. You can also enroll in what they provide health insurance-wise. Because they have a large network of small business owners, their premiums can be lesser. Have you had any experience with a company like ADP or something like that where they provide benefits? I wonder if you've seen anything from your angle.

I know some of our clients are enrolled in similar programs where it's more of like a group plan. My personal preference and maybe from employing people here and maybe from a candidate perspective would be it's a lot cleaner to offer a candidate that money earmarked for the wellness benefit and then they can do whatever they want with it. If they get insurance through their spouse or maybe they're younger and they're still on their parents' plan. Because when you do those interesting health benefits, I don't want to name names, but there are some that they're not that great where the candidate would say, “The health insurance that you're offering me is very low quality versus what the larger hospitals are offering me.” Rather than comparing health insurance plans, it's better to give them money and then they can use that money for whatever they want.

I wasn't planning on going into this too much. If we didn't offer full health benefits, we would also offer what is called Teladoc benefits. We got ours through redirect health and that gives you 24/7 access for a phone call to any physician at any time. You talk to them about your issues and they can also prescribe medications and send the prescription directly to the pharmacy for you to pick up and offer $100 or $150 or something like that per employee per month. You can provide those types of benefits and I believe it falls underneath the Obamacare guidelines if you're greater than 50 full-time employees. It’s something also that's out there that you can utilize and not have to buy a full-blown healthcare plan for each employee that could cost you $500 a person. It’s good to recognize that there's a telehealth option out there. I actually love it because then I don't have to make an appointment with my doctor and take my kids in and all that stuff. I can call them anytime day or night and Facetime me if they need to see, I don't know, a rash or a cut. Nonetheless, we're getting a little bit off topic. Sorry about that. I like what you're talking about as far as working with that person and making sure speed is a part of the process. Would you ever recommend someone have an offer ready to give to the candidate in person?

You don't need to wait until the candidate is ready to receive the offer if you know that the candidate is a good person for the job. Click To Tweet

Yes. That's a great option to do it when they're on site at the interview. If you have the interview scheduled and the candidate is coming in, you can have the offer ready to go and give it to them at the end of the interview day while they're there. That impresses a candidate that this practice is interested in me. You're covering the speed basis. They might accept it on the spot based on their positive experience from the interview and the job shadow. The only other piece of advice with that is some organizations will do reference checks or background checks and the fear would be, “If I extend the offer, how am I supposed to do reference checks and background checks?” You can have the offer contingent upon successful completion of the reference checks and background checks. We're extending you this job offer. It is contingent upon your licensure in the state that's contingent on your graduation from PT school. It’s contingent upon whatever else you need, but you're still offering them that position or giving them all the details at that point.

More than likely, extending them an offer in person isn't at the first interview unless you've done a ton of maybe conference calls, video conference calls or multiple calls on the phone. I'm glad you said after their onsite job interview because maybe you want them to work within your facility amongst the other providers and patients for a couple of hours so you get a feel for how they work in the environment and how and what the other people think of them. I could see where this might be completely appropriate after you've had a couple of those types of phases that they've been through in the interview process.

We do recommend doing the onsite interview in one day because it's very difficult to get the PT back and do a second day and oftentimes a candidate will drop out of the process if you say, “I want you to take another half day off of work and come in again next week.” That's not feasible for some candidates where if they're already there, I would say, “Let's do the job shadow,” or do whatever you need to do on the day when the candidate is visiting. You might not fully be interested in a certain candidate, but they can still do the job shadow. You might as well have them do everything on the same day. That way they don't have to try and come back. You don’t have to schedule it.

On the delay side, there will be less delays between the steps because every time that there is a delay, that candidate is considering other employment opportunities. Those delays are very important to minimize in terms of the sending the job offer in person. If that's not possible, the next best option would be doing it over the phone. I would not recommend sending it as a blind email. “Thanks for your time. We'd like to extend you the offer,” because you want to be there either in person or on the phone when the person first learns that they're going to be receiving that offer. Because then you can answer their questions and you can clear some things up right away and maybe get the process through to closure.

A lot of our clients would email the job offer, “We decided to offer the position to the candidate. We didn't call them or bring them back in person. We let them know via email that we were going to offer it to them.” That causes some delays because did the candidate receive your email? Did they open it? Did the attachment work? The candidate can wait and they can reply back at their convenience. Also, candidates are more likely to negotiate. They're more likely to feel empowered to negotiate job offers via email or text message, which could wind up costing a lot more in terms of wages and benefits if you negotiate via email because the candidate is more empowered to ask for things.

I can understand that. If I recall our process, we usually call and say, “We want to offer you this position. Look for an email from us.” You're saying you take it a little bit further and say, “We'd like to offer you the position.” Would you get into the details during the course of that call or would it be sufficient to say, “We're going to send you an offer. If you look in your email right now, it's there.” How quickly do you want that to happen, so we minimize that time distance between the interaction?

PTO 67 | PT Hiring Process
PT Hiring Process: You can have the offer contingent upon successful completion of the reference checks and background checks.

 

I would say the best practice is to extend the offer via the phone and actually go into the details, go into the most important details. “We enjoyed meeting you. I'm calling to offer you our position here. We're excited for the opportunity to work together. For a start date, we're flexible on that based on your preferences. For the hourly rate, we were looking at XX per hour. The benefits would include three weeks of PTO. How does that sound?” and go from there. You can say, “I'm going to follow up with the offer letter via email. It sounds like you need a couple of days to look at it. That's great. let me know as soon as you can because we'd love to work out with you.” Trying to get those questions answered as well right away is important because a candidate might not feel comfortable or might delay the process if there's emails going back and forth on questions and stuff.

If you can knock it out during the course of a phone conversation, then that could save you days of emails.

We’ve seen a lot of candidates that accept the offer right there on the phone. They don't negotiate. They accept. On the negotiation side, I may have talked about this last time, but a lot of newer grads are uncomfortable negotiating. They basically take what offer is given, which is from a business perspective, that's a good thing in some ways. Because PTs are in such high demand, they're not going to necessarily go back and negotiate with you. They're going to accept whatever else is out there that's better fit for their needs. We always recommend to aim high with the offer process rather than trying to low ball and say, “We're open to negotiate. Let's offer what the wages to as much as you can on the initial offer and leave it from there.” We can't risk the candidate not wanting to play ball and do any fancy negotiations. Because then we're going to maybe miss out on that person.

You imagine what you might gain in offering a lower salary. You could potentially lose out on them finding out that they could have gotten $5,000 more if they went over here and that being an issue down the road. What does that cost you to replace that person? If you low-balled and they're more than likely going to get a higher offer somewhere else, you might as well add onto your offer in the first place and thus avoid the possibility of losing that person, especially if they're aligned with you and you see a future with them in your company.

The wage from the employee perspective needs to be competitive. You can certainly play to your strengths like we talked about before, adding in some fun benefits that a larger company might not be able to offer.

That's part of the interview process. I talked about it a little bit with Kim Rondina. You want to find out where they want to go on the future, what do they want to do with their PT? If they're looking at particular things that they want to do specifically, that's maybe also during the course of that job offer where you highlight, “This is what we can do for you. We can provide mentorship via this channel. We can provide continuing education specific to this specialty that you're wanting to do. We can provide some bonuses that can be tied to student loan repayments.” That sounds like a big thing nowadays because every student’s coming out with hundreds of thousands of dollars in debt. As you not only explained the benefits, you also might want to take advantage of taking the time to explain the value add that you provide as a small business owner compared to other facilities they might go to.

The people that you work with are your relationship. Click To Tweet

Just one other point that I had on the offers and related to the business owner side is when you're extending the offer, try and remove the emotion from it. We don't know what's going to happen in the future in terms of will that PT stick around? Will they leave and go and work for somewhere else? There's a lot of fear and emotion around that job offer process and that often leads to the hesitation. Should I offer this candidate position? A larger organization, they're able to oftentimes move quickly because they don't have that emotional side. We often see it as well in terms of maybe holding out. We've had a few clients that we've had a lot of people interested in their position, but they're holding out for a rock star unicorn person coming forward. Not every candidate is going to be the next award-winning physical therapist. Not to say that you shouldn't hire a quality person, but if you have a job that's open, you need to evaluate candidates. Can this person do the job? Will they do it well to a certain extent? Will they meet the needs of what we have? That emotional piece sometimes comes into play.

The best way to get around that is to have other input within the hiring process so it's not you as the owner making the decision. You have your administrator or you have other PTs on your staff that are helping you like a panel discussion where the quality of the hire would increase if you have more data points and more people giving their perspective. You remove yourself a little bit. You obviously still make the final decision as the owner but to have more data points. It helps to remove that emotion in the process.

Maybe stepping back and saying, “What I need is a staff physical therapist.” If that person can perform that job and maybe you don't see a higher trajectory for them and you don't project them to be leaders, then maybe that's okay. Not everyone has to be leadership quality. I surprisingly had therapists who I didn't think would do much leadership-wise become clinic directors and killed it. Because not everyone has the personality where they're going to come out and shine and show a ton of charisma and be flamboyant and confident and know exactly what they want to do and how they're going to do it. “This is how I'm going to rule a team.” Not everyone's like that. If you're simply looking to add PTs on staff, you don't have to have the unicorn out there. Maybe you can suffice with a very solid rock star. Maybe not even a rock star. A very solid person who simply aligns with your values and that's okay too. Those people can have places within your company.

As your clinic grows and you're looking to add additional people, there's a business need to have additional staff. That business need, if you need to hire someone at a certain point in time, there's only a certain group of candidates that are potentially interested to join you at that time. When you're recruiting for a position and a given window of time, you're seeing the interest in candidates at this moment who can join your team, fill your position, help with your utilization and etc.

Is it only in that given period of time?

Down the road. If you wait six months, you'll have a different pool of candidates at that point. We need to be more business minded with the hiring process.

PTO 67 | PT Hiring Process
PT Hiring Process: When you're extending the job offer, try and remove the emotion from it.

 

That goes back to what was successful for my business partner, Will Humphreys, and I especially as he was doing the recruiting, is that we're always recruiting. We're not going to limit our scope to this period of time. We're always taking candidates. We always have an ad out. We're always open to take resumes for physical therapists. That way, when someone does come along that is the unicorn, it's not only when we have a position available, but it's at any time we're open for that person to come into our clinic.

Not having that networking mentality and being willing to talk to candidates even when you're not actively looking. Are you still willing to you have a PT contact you? Are you still willing to talk to that candidate and maybe help them get connected with another practice area or to save their resume for your future hiring? Maybe they want to come in. Maybe they're a newer grad and they want to come in and do a job shadow. Would you be open to support that student or that recent grad and have them come in and network with you?

That puts you at least in a position of power where we actually had people on the bench waiting to get into our company. People who would tell us, “When you have an opening and a position in your company, I'd like to be considered please.” That puts you in a position of power so that when someone does leave, and inevitably someone does do so with short notice, we have a pool of candidates that we could pull from that had already been vetted. That changes the dynamic and it puts you in a different position altogether to find the next great person to join your company.

Some candidates are not in extreme hurry. We have a situation right now with a client where they do have a candidate waiting to go in basically. The candidate is continuing their current employment, and everything is fine. Once the situation opens and the clinic becomes available, it's intended that they're going to join the team. You never know what's going to happen. At least have a few people on the sidelines. It's great.

It makes a big difference. Thanks for your insight on that. We talked last time a little bit about recruiting the PT. I don't remember us taking it all the way through to how do you get them to accept that offer. These are some important tools and tips to make sure you carry that ball all the way across the goal line.

It's important. Obviously, we know once you have that candidate, you've interviewed them, you see them as being great and how do we seal the deal and actually get it going. Especially when you have larger organizations with more sophisticated HR and recruitment procedures, the PT is going to have multiple job offers as well. Getting out there and getting there first would be ideal.

Thanks for your time again. If people wanted to get in touch with you, Brian, how would they do that especially if they're looking to get some help for hiring PTs?

We still have our website, CareerTreeNetwork.com. We also added HireAPhysicalTherapist.com as our second website, which is more employer-focused. There are blog posts with strategies, information about our service as well. People can actually book a call to chat with me right on the HireAPhysicalTherapist.com website. I'd be happy to talk. I know I'm not a salesman per se, so I'm happy to chat about this for free. Feel free to book a call and we can chat if anybody’s interested.

Thanks again for your time. I appreciate you coming for a second go around.

Thanks a lot. It's a lot of fun.

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About Brian Weidner

PTO 67 | PT Hiring ProcessBrian Weidner is the President of Career Tree Network, a recruitment advertising firm based in Milwaukee, Wisconsin that helps Physical Therapists connect with career opportunities.

Since 2007, Brian has helped thousands of Physical Therapists achieve their career goals within a new position.

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

 

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PTO 63 | PT Clinic Ownership

 

This week, Stephen Rapposelli, PT hijacks the show and turns the tables on the host! Stephen noted early on in his conversations with Nathan Shields that he hasn’t shared enough of his ownership journey with the audience, thus he pushed to take over the podcast and ask Nathan and Sean Miller exactly how they went from individual clinic owners to selling their clinics to Empower PT last year. Stephen asks some specific questions about the how's, why's, and what's that. Hopefully, in this episode, Stephen fills in some gaps and give you a little insight into the PT clinic sale experience. Sean shared all of his wisdom as well to add some great insight into the cycle of PT clinic ownership.

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Listen to the podcast here:

Step Out - Reach Out - Network: The Real Life Formula For Nathan Shields And Sean Miller with Stephen Rapposelli

This is Steve RapposelliI'm a fellow PT owner and I have hijacked Nathan's show because we have turned the tables on Nathan. Nathan needs to have the tables turned on him, so he does not know what I'm about to ask him, but here's a little bit of background. Nathan was nice enough to interview me for his show. You may or may not have read it. That's not important, but as I was talking with Nathan and as he was interviewing me in a very inquisitive, friendly way, I found out that he would not be the guy to say that to you directly. I'm taking it on myself to be the interviewer and to ask Nathan a little bit about his story because quite frankly, it's fascinating. It is a story that you are going to want to hear as a fellow PT owner. This is why think it's important.  

If you're a PT owner like myself, whether you have one clinic or five clinics or 100 clinics, you probably have the same questions in your mind that he did and that I do and that is where are we going here with all of it? What is the next step for me as an owner? Nathan has already walked that path and the story that we're about to reveal is going to be one that you're going to find entertaining, learn a lot from and help you on your journey. You may likely take a different journey than Nathan's and that's okay. Nathan has his own path, but it will help guide us as a way of comparing and contrasting where you may need to be. Without further ado, I'd like to introduce Mr. Nathan Shields. Nathan, are you there? 

Thanks for having me, Steve. I appreciate you having me come on my own show. 

We are glad to have you on your own show and I want to get right down into the end of the nitty-gritty. I know that your story is searchable in the wonderful digital land of Google, but we need to have it lying in your own show archives because it's very interesting and it's very instructive to your audience. With that said, you're a guy who got his training Northern Arizona and upon graduating back in the late ‘90s, you opened up a practice in the Phoenix area. Tell me about the path that you took when you first opened your office in Phoenix. 

I opened up my clinic in 2002 and that was in Chandler, Arizona. My whole goal was to get to two physical therapists, 150 visits a week and afford a TiVo. I thought if I could get two PTs, 150 visits a week and get a TiVo, then I know I've made it and that would be all. Lo and behold, I worked hard for a number of years and I opened up a satellite office in Florence. got a friend to manage that for me. That ended up being my business partner, Will Humphreys. Hmanaged that. He eventually bought that clinic from me. Together, we opened up another clinic in Maricopa, Arizona. We ran like that for a number of years. Each having our own success, we had his and our situation, but we shared common consultants. We knew that we needed help. We shared a similar networking group, a small business networking group. We found out, like most of us do that, I don't know what I'm doing business-wise. I can treat patients all day long and they're happy, they get results, but I hate doing the business stuff. 

You said, “We needed help. How did you know that you needed help? 

If you read my interview with Will, he knew he needed help because he had a breakdown. He had a stack of charts that he was going home with every night. He was driving in the middle of the summer in Arizona at 115 degrees in a little truck that didn't have AC. He was sweating through his clothes. For me, I was the guy that was staying up all night doing charts. I had employees that were upset with me and upset with the company, who didn't know who to talk to. I was upset with them and frustrated that they weren't simply doing what they were supposed to do, even though I didn't tell them what they were supposed to do. There were a lot of frustrations and I knew there's got to be something better. I also knew that if I continued down this path of working 60 hours a week and then trying to run the business on top of that, there was going to be a burnout. I couldn't keep doing that. It was at that point that we figured we needed some help. 

What help does a PT owner seek out when they reach that a-ha moment? 

They can do a number of different things. You can start reading books. You can start googling and looking up webinars and YouTube channels of other PTs that have been successful. You can reach out to a podcast. Nowadays, there are many more resources available to us at our fingertips as PT owners than there was back then I believe. Even the APTA has provided some good materials through PPS to help someone get started in a clinic, but there are many more consultants. There are many more companies. The internet is much more available so you don't have to feel as alone as I did back then in the early 2000s, starting at the clinic. There are many more resources now.  

My mantra is to reach out, step out and network. That's the common formula for success that I've found in not only in my experience, but also the people that I'm interviewing. You got to stop treating full-time. If you're going to be a business owner, you've got to put it on your business owner hat a couple of days a week and act as the leader of your company and that you own a business. Forget that you're a physical therapist almost anymore because more than a physical therapist or an owner, you've got to get some support, some outside perspective. You've got to network. 

Reach out, step out and network is a common formula for success. Click To Tweet

Did you seek out a PT-specific coach consultant? 

We had a personal/business coach, someone who helped us at different times as a parenting coach. When I say us, that's Will and myself. We found this person who was providing parenting seminars because we were new parents as well. That'll add to the stress. She also did some business consulting because a lot of it's about relationships, whether it's parenting or interpersonal relationships with the husband and wife or relationships that you have with your employees. It's about relationships. She did some coaching with us, but then we also reached out to a PT-specific consulting group, Measurable Solutions at the time and got some help in that regard as well to help us organize and establish structure and systems in our company. 

Are cutting-edge PT owners ever done seeking coaching/consulting? 

If you're me personally, I don't believe so. Consider the professional athlete, they're at the top of their game yet they still have coaches. I listened to podcast about The Trillion Dollar Coach or something like that, but Steve Jobs had a coach through most of his existence as the CEO of Apple. It’s the same thing with the guys at Google. They have coaches. They need another perspective. They need some insight. They need someone to hold them accountable if they're going off the rails and not heading towards their goals. I believe that everyone needs a coach. 

In your opinion, one consistent behavior of success of the PT owners that you've interviewed and interacted with is ongoing and regular coaching to help them grow personally and professionally. 

I believe so, yeah. 

That's good to know. Here you are back in the early 2000s. You're running and gunning with Will, everything is going well. For those of us who are not in Arizona, I assume that those cities that you identified are in that whole Phoenix Megalopolis area. Tell me more of your mindset at that time. Were you like, “I got the two PTs, 150 visits a week and the TiVo. Now we have two other offices. Let's just rinse, wash and repeat.” Where did you evolve from there and why? 

The ultimate decision is to get some consulting help. I don't know how to put my finger on it. We have another physical therapist on here with us, Sean Miller, who might've gotten through the same experience. My thinking at that time is, “We can't keep doing this.” When I think about what this is, it’s that I'm treating full time. I'm running my business. I don't have a lot of time with my kids. Maybe financially I'm doing all right, but I'm not able to enjoy it per se. I didn't feel like I had a lot of freedom. I felt like I was a slave to the company. The company didn't work for me, which is the ideal situation. I knew I needed help at that time. You and I both know, everyone knows who's reading this blog, we haven't had any business training, so I also didn't know what I didn't know. I knew I needed some outside help to do that. Did I answer your question? 

That statement you made of, I can't keep doing this,” resonates with a lot of your audience. That’s a very scary place to be because you're leaving a comfort zone of you treating people and making the donuts so to speak. To leave that to then work on your business is not an easy transition for most clinicians/owners. 

I believe a lot of us are high-achieving people. If we've gotten through physical therapy school, that's a common trait for all of us and we are very comfortable in being good physical therapists. Looking at it, if you were to say, “You're not going to do any physical therapy and you own a clinic, what are you going to do?” Most physical therapists might not know what to do to lead their company. They might go over and pay some bills or they might go market some doctors, but what are they going to do to achieve their company goals? That might be hard for us to accept, to set aside the physical therapy hat and put on a business owner's hat, one that we haven't been trained in. It can be an uncomfortable transition. 

PTO 63 | PT Clinic Ownership
PT Clinic Ownership: If you're going to be a business owner, you've got to put on your business owner hat and act like the leader of your company.

 

Once you had reached that point, Nathan, were you ready, willing and able to make that transition? Did you still have to be dragged into it by an outside person? 

There was definitely some trepidation because if you get down to some numbers, you're thinking, “If I'm not treating on the floor and I hire someone else to take my place, I'm losing money at that point. There's a decrease in profit margin because I'm taking on the extra salary.” I’m no longer “productive. I can't equate my time, which is time with a patient, to an outcome of money. It's hard to go from that to, “Now I need to set up a marketing plan.” You can't make the immediate correlation between my time and the results of that marketing plan.  

You went from considering yourself productive to being one giant expense for your business. 

Yeah, that's where it took a lot of mindset training. Maybe speak to this a little bit too, Sean, since you're on here. If any of you remember Sean Miller, he's one of my first episodes on the show and he went through some training as well. Maybe you can share your experience, Sean, in the same way, but I had to go through that mindset training that, “I'm not a physical therapist anymore. I'm a business owner who happens to provide physical therapy sometimes.” It’s to make that transition, to recognize that if I'm going to grow and make the company do what I want to do, I've got to work on the company to make it do what I want to do. Simply providing more patient care isn't going to get me there. You have to work yourself through that over and over again to wash that all out. 

I couldn't agree with you more, Nathan. I appreciate you guys having me on with you. That was a huge mindset shift for me as well. You're a full-time clinician treating patients. I remember working with a consultant and the first thing he told me was, “You need to block off five hours a week to work on your business.” I was like, I can't do that. There's no way I can do that.” When I did it though, I said, “I'm going to trust this process. I hired this guy to help me for a reason and I'm going to do what he says. Even if I ended up losing money, we're going to do it to see what happens.” As we all know, when you set aside that time and you start working on your business, you are automatically starting to see results and all of a sudden you realize, “That was a good idea.” It is a mind shift change because we're not used to that aspect of thinking we should block off time instead of being with our patients 

Sean, you bring up a very good point. I want to hammer it again. You said something that was key and that is you brought in a consultant who told you what to do. There are so many people out there who then will disregard that advice that they paid good money for. You happened to take the advice that you paid somebody to tell you. How difficult was that? 

I was telling a lot of people in our company this story and it was that when I first started with this consultant and they were recommending all these things that I needed to do in my business to improve it, I was super skeptical. I was like, “No way. This will not work. This is not going to help my business. I had to stop and check myself and be like, “What I've been doing is not working or has given me lots of more work and headaches and stuff.” I told myself, I'm going to go all in. If I totally disagree with what they're saying, I'm just going to do it.” Part of me was like, I'm going to do it to prove him wrong, to prove that what they have here doesn't work.” I've put it in and started doing everything and all of a sudden, my business started growing way more than I ever had done before with this. I've proven myself wrong with it. It's that mind shift change. I love the saying, “When the student's ready, the teacher will appear. There's so much out there that when we're ready, the teachers will be there for us. 

If you're not ready to learn the lesson, it will keep showing itself up on your front door. Nathan, I know that there's a lot of ground in between these two points, but at one point you said to yourself, for whatever reason, “I’m going to end this and I'm going to go to Alaska. I know there's a lot in between there. Here's a guy who is successful in Arizona. He's got Will working with him. He's got a number of clinics and now you have this idea of an exit strategy. 

Going to Alaska wasn't necessarily the exit strategy. There was a goal there that Will and I had that I was going to develop this diagnostics business. We did so in Arizona, we started some in Alaska and it started getting better. We had been doing diagnostics for a couple of years and it wasn't getting any traction. We recognized that we weren't putting that diagnostics business into its own structure. We considered it this small department within our current structure. No one really had any ownership of it and so it didn't go anywhere. We had some ideas around it but we never really focused on it. We decided, “If this is going to do something, one of us needs to take responsibility for it, make it its own business and set up its own entity.” I took over that. The agreement was that Will was going to focus on developing our leadership team so that he could free himself as well up from the day to day of the Rise Rehab at the time. 

If the owner actually owns the company and is not one of the laborers within it, then there's some value to that. Click To Tweet

How many offices did you have at that point? 

At that time, we had merged. We had that his, his and ours and we eventually merged. We had four clinics going. 

I believe it was close to twenty when you partnered with Empower PT? 

We didn't necessarily grow our clinics from four to twenty-plus. We simply gathered a bunch of people together to put ourselves on the market. 

That's the interesting part. Here you are as your own entity, Rise Rehab. You're in the Phoenix Valley, I guess you call it, the area and you say, “I can sell my four clinics to a national company or I can partner with these other independent practice owners and roll it all up and market that out and sell it as a bigger package.” Is that correct? 

Not totally. You make it sound like I was the brains of the operation. I definitely was not. This is why I'm glad we have Sean on, because he was in Arizona when a lot of this was happening. Will and I, we had a number of offers for our clinic over the years. People had approached us maybe three or four times and each time it was some variation of, “We'll give you 70% of what we consider the value of your company in cash. You guys maintain 30% and you become essentially clinic directors or middle management. Keep doing what you're doing.” That didn't sound exciting. We didn't get into it to become employees again per se. We'd said no a number of times. Like I said, this happened over the course of maybe five or six years. 

This is a conversation that a lot of PT owners have and it can be very disheartening after you've spent all your blood and sweat and tears building this baby of yours and somebody comes in and says, “We're going to give you amount,” when you thought it was going to be 3X. That might've been your feeling as well. What then gave somebody the idea to look around the area and say, “If we do this a little differently, it can be more than what the parts are?” 

For sure. We got some of those offers. We were a little bit disheartened. There were some that were better than others, but we're still relatively young. We'll focus on growing more. We're developing a leadership team to take off the day to day and we'll make it their job to grow the next clinic and open it up and that kind of stuff. A few years ago, a friend of ours, Jared in the Valley, he's someone that we talked to about selling our companies in the past. He came to us and said, “I work for a company that has some physical therapy clinics.” He was essentially the business manager, but he's a PT and they wanted to divest their physical therapy stuff. 

He said, I have an offer on the table.” I know I can get more if we essentially increase our value by increasing EBITDA, profit margins and revenues and that stuff. We can attract a bigger buyer who will pay more in multiples and that stuff. He called my partner Will and he was like, “That's a cool idea. Let me think about it. I'll talk to Nathan.” From what I recall, Will sat on it for a little bit and then Jared called him back a month later and said, “What'd you think about it?” He reached out to me. I said, “I think it's a great idea if we can do what he says he's doing. We could get more for our four clinics than we could on our own as the four clinics. 

We started making calls and that's where we reached out to Sean. I reached out to a couple of other people in the valley. Jared did some of his own footwork and reached out to some people. We started collecting some guys who were, and correct me if I'm wrong, Sean, in the mindset of, “If we can take advantage of the current market, it was a hot PT market a couple of years ago, we can get a higher multiple than what we can get on our own. It’s a buyer that we think is cool. We would consider it.” We didn't have any ties to it at the time. We had this loosely-held NDA between us. We formulated things together and got all got on the same page. 

PTO 63 | PT Clinic Ownership
PT Clinic Ownership: Everyone has to think about their legacy when they sell their practices.

 

Let's use Jared as an example. Your business did not have to have shared resources or procedures or processes as Jared per se. Is that true? 

Per se. Sean, how would you describe that? 

Essentially, we ended up with five different entities with different policies and procedures, but most physical therapy practices were very similarly aligned. We had some that were stronger than others in terms of being organized and structured. It wasn't a unique situation. I've never heard of it happening anywhere else before, but it wasn’t a unique situation for sure. 

Sean, to use a vernacular here, was it like herding cats? 

In the beginning, it was a lot of work. It was like herding cats, but to the point of why we did it as well helps in this discussion, for me anyway. It’s to paint the picture that the market was hot, the timing was good and it was the right concept that if we do come together as a bigger entity, there is more value there, which then increases the sale price of things. 26 clinics are worth more than my four clinics, essentially. For me, something that everyone has to think about when they go to sell their practices or whatever they want is I'm about my legacy. What's going to happen to what I built? Because I was proud of what I built and what I had and what we stood for in the communities and I had a great name in the communities. I didn't want to sell it to some big national entity who then comes in and changes all the paint colors and essentially rips out everything I put together. 

What this became was the opportunity to capture the market and get a great value for what I thought my business was worth, but then to also layout the fact that we could continue our legacy of what we had built. It’s not only to continue but grow it on a larger scale with more help and other people to help us do it essentially. That's what it was for me and how it worked out. With that in mind, we got five other owners and of the five, two of them exited and left out. The three of the other original owner stayed. The three of us then took our cultures, our processes and them all into place and are continuing them. At first it was herding cats to get everybody on the same page, but because we had the same vision of what we wanted to do, it wasn't hard to get the buy-in, if that makes sense. 

I understand. Using totally false numbers, let's say I'm a practice owner and I'm considering this and somebody offered me $100,000 on my own. I then think about making this arrangement, and I won't call it a partnership, but this arrangement. How is it that then I get back $200,000 instead of the $100,000? Should I be thinking of it like that? 

I think you can think about it like that. I want you to add on after I talk, Sean. I talked to a few brokers as we were going through this process and they shared some generalizations. They'd worked with many PT, mergers and acquisitions and they said, “Your typical practice is going to be maybe around $1 million, maybe $2 million if they're doing well.” That could generate maybe two times multiple of your EBITDA, maybe get a little bit more if the market is hot. If you don't know what EBITDA is, it's an acronym. It's essentially your net profits with some of the add-backs. You can get maybe two times a multiple for a small clinic like that. If your net profit is $100,000, maybe you get $100,000 to $200,000, but if you were to increase that EBITDA to a point where now you're talking to some larger buyers, not just some local dudes, but some national guys who want to plan a national scale, then you can get higher. You can get four times the EBITDA or five times maybe. 

I think that's an important distinction to make for your listeners and that is that it's not just gross revenue, but it's EBITDA. The higher it can go, the more there is latitude and a higher multiple for your sale.  

Do you want to add anything to that, Sean? What do you think? 

It's spot on. Now that I'm on the other side where we're trying to acquire people, you hit it on the head. You're a one or two clinic platform. The two, maybe three multiple off of your EBITDA, the bigger your platform, the more that EBITDA goes up, that valuation goes up. If you're a six, seven clinic, you're probably more four or five. Depending on where you're at and how strong your EBITDA is, that can even go above five. The typical PT practice is probably a three to five EBITDA. It’s what you typically see. 

To add a lot of value is to essentially work your way out of your business prior to the sale if your goal is to sell it and not work at anymore. Click To Tweet

Sean, I want to come back to something that you said and dig a little bit deeper in them. That is what you said the timing was right. How would a clinic owner figure out if the timing is right? 

There are a few factors there. One is where are you in your career with your business? I was taught by our consultants a few years ago that you need to start preparing your business for sale now. I was like, “I'm not selling my business for several years,” but I started to do it anyway because back to my point of listening to them. The stronger you are to position your business for sale and there are things you should do to do that, which maybe should be another podcast, there are some key things there. As far as the market side, what I noticed being in the profession for over fifteen years is the first probably eight years of owning my practice. Nobody was knocking on my door. Nobody was sending me any emails wanting to buy my practice. 

All of a sudden, like Nathan said, I started noticing, “We'd like to buy your practice,” or soft reaches, “Will you be interested in selling it?” That's when you started noticing things come around. Then you started getting more and more people hitting you up. It's like selling your house. What's the market doing? Where is the pricing at? We all know when the market is high for selling or house. The PT clinic side was the same thing for me. That was all of a sudden out of the wood where people were coming left and right trying to make offers to come in and made me pause and go, “What's going on here? What is happening?” We can all remember back in these days, but in the 90s, the same type of thing that I saw happening in our profession was happening in our profession in the ‘90s. It has its cycles as the housing market does. It was one of those things like, “Here's the cycle and now's an opportunity. If I'm ready to do this and go on and do different things with it, this would be the perfect timing to do it because the market is so hot.” I hope that helps. 

It certainly does. I think that your audience will have maybe one office or two. They could be a little bit heartbroken right now to think about that the value of their business is two to three times their net profits and, but what you're showing with your journey, Nathan, is that in partnering up with other local independence, your one to two office platform might permutate into a ten, twelve to fourteen-office platform and be much more attractive to a bigger fish. Is that accurate?  

For sure. A lot of the value comes off of the numbers. That's how they're going to value the company. You can add value to your company by not increasing the numbers, but they want to see general growth trends. I had done some episodes on this. I did one with Paul Martin. I did another one with Steve Stalzer of 8150 Advisors. One of my first episodes was with John Dearing who works with mergers and acquisitions. There are a number of things you can do to prepare, but they're going to look at the numbers. They want to see good policy and procedures in place. 

They want to see growth trends over the last few years. Not stagnation, but continued growth and a strategy for continued growth because they want to know that once you sell, you're not going to walk away. There's going to be a focus on increasing what they're buying so they can increase the value of their investment. Another strong aspect is if the owner's not treating. If the owner owns the company and is not one of the slave laborers within it, then there's some value to that. If they take him out, they're going to have to replace him with someone else. That goes back to structure, policy, procedures, organization and all these things that make a company more valuable without necessarily hitting the bottom line. When you do those things, your bottom line improves. 

Back to your question a little bit, maybe they're a little bit disheartened, but I've told a number of people across the country, what we did could be done in other places. If you know any of the other people in your community, some of the other owners, and you're looking at an exit strategy, we called a lot of people. I called a number of friends that weren't ready. They're like, I don't know what I would do if I would sell.” They're like, I'm happy with what I'm doing,” or “What is an EBIDTA?” They're across the board. They weren't interested in selling at the time, and that's fine. If you are looking at an exit strategy or if you want to take advantage of the market, start working your network. 

Talk to some local people, see if you can get some people who are on the same page and then there are opportunities out there. You reach out to some people who might represent you on the market. Yeah, you can get a little bit more for what you're doing. I know you didn't ask this question Steven, but I would say if you're looking to sell any time in the next few years, now's the time to do it because it's going to go through that cycle again. I don't think it's going to be as hot as it is now. I think we're at the tail end of that cycle, honestly. It's not going to come around for a little while. 

PTO 63 | PT Clinic Ownership
PT Clinic Ownership: As owners, we are the goodwill value of the clinic.

 

Sean, from your perspective, what Nathan did was he got a consortium of local practice owners, probably within 25 to 50 miles of him. Is there any advantage for him to have said, “I'm going to get my pal in Tucson and my pal in Albuquerque and my pal in Colorado Springs. Even though we're not going to have a map or a footprint that's every three to five miles in that geography, I’m placing some pins down in a very large area?” Is that an increased value, a decreased value or a wash from your perspective? 

I think it's an increased value from my perspective. When we did our deal, we ended up with clinics in California and one in Louisiana, which is the off beaten path one and kind of weird. The market share, getting it in multiple states is good. I will say some states are more attractive than other states are depending upon reimbursement rates. Is your market dominated by a hospital-based system? We're in the process of acquiring clinics that are states that we are not even looking at it based upon reimbursement rates and the hospital-based systems that we don't even go into. I do want to go back real quick as well and adjust something that Nathan said about selling your business. 

I think the key thing to learn is that as owners, we are the goodwill value of the clinic. If you look at selling your business down the road, if you're in the business, working it a lot like say 40, 50, 60 hours a week like we all did some times. You go to sell your business and you're telling the people you're selling it to, “I'm going to sell it to you and I'm walking away,” your business is now less valuable because you are a huge integral part of why the business is successful. Another way to add a lot of value is to essentially work your way out of your business prior to the sale if your goal is to sell it and not work at anymore. That's a key point. The way I got my business is it was running where I didn't have to work in the business unless they want it to where it didn't need me. If I wanted to exit, I could've left and left all the key people who were the key to making the business run. There's more value to that if you want to exit out, if that makes sense. 

It certainly makes sense to me and one way you can test your ability to do that is to take a month off. If the prospect of taking a month off makes you want to vomit, then it's likely that you have not put the systems and processes in place to allow you to do that. That's a good stress test. 

Yes, there's more value in a business where you can take a month off because you're no longer the goodwill value of that business. 

It makes total sense. Nathan, looking back on this process, what would you have done differently? 

I don't know. Sean might agree there was an element of timing there. We found a partner and this was something that Sean and Will were definitely a part of as far as they interviewed the interested parties that came through Phoenix. We found a partner that I would say is relatively ideal in allowing Sean and, Matt and Will to carry forth our company values, visions, policy and procedures that we all had some loosely held agreements too and not disrupt that. Empower physical therapy became something that's greater than ourselves and a greater expansive are divisions that we already have. I think I'm speaking for you Sean, but things came together in an opportune way for us to do this because we had a great footprint across Phoenix. We met up with a great partner. We have some great leaders in place. When you talk about Will and Sean and Matt and the CEO that we brought on, there's not a lot I can look at and say, “I would've done things differently. Things worked out well for us. 

You don't think that all the stars were aligned perfectly and it can never happen again. This situation can be repeatable across the country with other practice owners. 

I would think so. The benefit that we had was that Jared had been through this process before. The guy, Jared Bowman, who started this ball rolling, he knew the landscape well. He also knew the people to talk to. We did have that in our favor that other people might not have. Anyone that puts forth a little bit of effort and takes the banner and runs with it could do the same. 

I would agree. It does take a little work. Jared was a huge help because he understands the business acquisition side and understands the power of the equity world better than we did. That was where our strong play was. You would need someone like that, but that's what you definitely could do. What was different about us is that in the beginning, Nate mentioned it and I said it too, people were approaching us to buy our business. What we did that was different was we came together and then we started approaching the private equity firms and shopping them.  

What we realized is that there were people were approaching us whom I'll never sell my business to them. We're like, “Let's find somebody who understands our vision and what we want to do and is excited about it.” We went through that process, which was close to over 30 PT firms that we reached out to interview about ten of them in person. We ended up finding the group that we went with that loved our story and loved what we wanted to do as a profession and was totally on board, so it definitely can be done. 

When you do things that add value, your bottom line improves. Click To Tweet

You’ve brought up a good point there, that maybe we didn't iterate it, but we had an ideal partner in mind. If we're going to exit and we're going to sell our legacy to someone else, this is what they're going to look like and this is how they're going to be. It's not necessarily the best idea to take the highest bidder. It's valuable before you sell to number one, maybe have an idea of the number that you want, but also number two, who do you want to partner with? You want to vet that because that's going to affect your life significantly going forward. You want to make sure you've got the right person with shared alignments in values, vision, growth strategies and whatnot. You want to make sure that you're partnering up with the right person or group. 

There's a lot of due diligence that needs to be done. There’s no doubt about it. Sean, where can our audience contact you? Hopefully from this show, people have a lot more questions now than they did before work. Where do they contact you if they had additional questions for you? 

They could always reach out to me in my email. It’s SMiller@EmpowerPT.com. I love helping people and love showing people what to do and what I've learned from it. I'm a big believer that we're always growing and learning. I've always said, I'm the biggest rip off artist there is. I steal from other people what they've done and implemented it. If that works, I'm going to do that. It’s not to say, “Come steal from me,” but come steal from me. I'd love to share with things that people are interested in trying to do this or what we did and I’ll be more than happy to take time and talk to and discuss it with them about it. 

Going back to what you were asking me about me, Steve, if other owners can do that nowadays what we did, go ahead and try it. Reach out to Sean and say, “I'm thinking about doing this. What are some tips that you have?” Reach out to the guys at Empower PT that did it. We can guide you. If you're looking to sell, Empower PT’s a great place to go. I'll put in a plug right now. 

I've got to say the same thing. If you are looking to sell, we are still looking. We are trying to expand and grow and we have a huge vision belief behind therapists. Our core value is patients first. We’re a PT-centered company focused on the profession, trying to enhance the profession. We're looking for people with that same mindset that want to help us continue that vision out to the public. Come talk to us. We're always open to that as well. 

Sean, I want to thank you for your time and your expertise. Nathan, I want to thank you for being on your own show. That's very nice of you to show up. I'm sure it'll be an interesting listen for yourself and your family and all your friends. I encourage everybody to tune in for every episode because there is a lot to learn. Nathan is spouting out truth bombs left and right and we're all the better for it and everybody in the profession thanks you for it. Thanks again for your time. 

Thank you, Steve.  

Thanks for having me. 

I think it was great to do this little forum. A lot of people could learn from what we did and if they wanted to reach out to us personally and bounce some ideas off of us or ask for some insight or maybe you can help me with this, feel free to do that, whether it's Sean or me, it’s Nathan@PTOClub.com. By all means, reach out. Steve, thanks for offering to do this and I'm excited that we got the opportunity to sit down and do it. 

All good things happen when you shoot from the hip and have no script and let it rip. You guys are very good sports and, we came up with something good, don't you? 

Definitely, thank you so much, Steve. 

Enjoy the rest of your day and thanks.  

Thanks for your time.

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About Stephen Rapposelli

PTO 63 | PT Clinic OwnershipStephen Rapposelli, PT, OCS opened his private practice in 1992 at the tender age of 26, because he was told by his previous employer that he couldn't buy into the existing business. He has since grown into 3 clinics and has been voted best PT business in his state for numerous years. H

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

 

About Sean Miller

PTO 63 | PT Clinic OwnershipGrowing up Sean always felt the desire to make an impact in others life. It was in high school when a friend got hurt playing sports that Sean was introduced to the power of physical therapy and the impact it has on people’s lives. From that experience, Sean has set a course in his life to be a Physical Therapist and change lives. Receiving his Bachelors of Science from Brigham Young University in 1999, Sean then pursued his dream of getting his education in Physical Therapy. In 2001 Sean graduated from Texas Woman’s University in Dallas, Texas. Moving to Arizona in 2002 working for others Sean became very proficient as a Physical Therapist.

He now specializes in treating vertigo, balance, and orthopedic cases involving the shoulders, cervical (neck), and knees. After years of treating patients, full-time Sean realized that he was just 1 Physical Therapist and only had the ability to treat so many patients at one time; It was this realization that sparked the dream of owning his own practice. “What if we had multiple therapists all with the same skill and passion? The impact would be even bigger than just 1 therapist”. From this Sean along with his brothers opened Kinect Physical Therapy in 2012. “Opening Kinect Physical Therapy has been one of my greatest challenges, but to see the larger impact we have on the communities and in our patients is why I do this.”

Sean when not making an impact on others life’s enjoys spending his time with his wife and their 4 children. He is often found on the sporting fields coaching his boys teams, at the lake wake surfing or headed to the beach to enjoy the waves and surfing. His favorite quote that he lives by is: “We are what we repeatedly do, excellence therefore is not an act but a habit.” – Aristotle.

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PTO 07 | Growing A Business

 

A lot of physical therapists don’t consider what it takes to be great businessman or businesswoman and invest the time and energy into that like they did to become good physical therapists. Blaine Stimac is one of the more successful PT owners who has 23 practices across four states and is ranked #255 on the Inc. 5000 list. Blaine's success is closely related to the systematic way in which he hires and trains his team. Blaine shares that at a minimum, trainings can take up to six to eight weeks, with follow up trainings after that, to create amazing, productive employees right off the bat or weed people out really quickly who are not the right fit. Blaine says growing a business is about the willingness to learn from each one of those times you didn't do great. You’ve got to be willing to embrace every moment as a learning opportunity.

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20 Plus Clinics And Growing!

Thanks for joining me, Blaine. I’m interviewing Blaine Stimac with Health & Rehab Solutions based out of Montana. The reason I wanted to interview Blaine is because he’s super successful and every time I’ve talked to him or heard him speak, he's had a lot of great insight for me. As social proof, Blaine's company is number 255 in 2017’s Inc. 5,000 list. He's currently got 23 clinics that are spread out across four states and is looking to grow even more and even faster in the near future. Thanks again for joining with me, Blaine. I appreciate it.

Thanks for having me.

Blaine, tell me your story. How did you get into PT and specifically what led you into then physical therapy ownership?

Probably like a lot of people. I had an injury in high school athletics playing football. I got a bad ankle sprain my junior year and went down in physical therapy and got some physical therapy, which opened my eyes to that field. From there, I knew this was something I wanted to do. I was always in science. I was interested in medicine. When I got that opportunity to work with athletes, to work with people and their body, that's what I set my sights on from that point.

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I’m assuming like most of us, you’ve got excited about what you could do with athletes, what you could do to help people quickly, see the progress, and looked forward to that. Did you also recognize the possible benefits of wanting to become a physical therapy owner right off the bat?

I had that idea at the time since I was in a private practice when I got physical therapy. That idea strengthened more when I was finishing up my physical therapy school. I started reaching out when I was getting done with school and testing some different avenues of people I knew who had practices. An opportunity came up for me to jump into what was at the time a young practice only in existence for probably a couple years but wasn't doing great. It was an opportunity for me to jump in and take it over.

You can go into that a little bit. What was the biggest transition for you going from a normal staff PT to not having some leadership in that regard?

This was me making the move into that practice and taking it over and basically starting it from ground up. Any of the patients that were there had departed at the time that I came into it. Day one, I had zero patients on the books. That was my first PT job. I did that straight out of school.

What did you do to get patients in the door? What was number one?

I was in this relatively unimpressive office space over a card table, looking at a phone book and going through the Yellow Pages. That was my start to it. When I had the opportunity to do it, I was definitely excited to step into practice ownership predominantly because I always had the desire to do more, to test myself in a variety of ways. When that opportunity jumped, it was a no-brainer for me. I was pretty great. I was definitely naive with what was coming with regards to practice ownership. I jumped into it with the idea of being excited. I had a vision; I had an idea what I wanted to do. I wanted to definitely do things bigger, better than what I saw as the average out there. That's what led me down there. What I discovered when I did it was something a little bit different.

What were your biggest hurdles there?

Day one, I had to figure out how to get some patients. I went around and started meeting with doctors in town. I’ve got told multiple times that I wouldn't make it. The market that I went into was fairly competitive. It was viewed that you had to have a niche or you had to be part of the community to make it. For me, the first couple years were about trying to establish myself as a therapist. Being young, straight out of school, I was trying to make sure I was good PT. That's what I focused on in those first couple of years. I established myself in the community as a good therapist. I was getting excellent results. The medical community started to recognize me and I was proud of the practice. For the first couple of years, that's what I did. I grew enough in the first year to have to move offices, which was a pleasant surprise.

From that point, about year two is when I bumped up my size of my office. I started to need to hire staff. I started to realize I had a business to run. Before that it was me and my wife who's an OT. We find ourselves pretty easy to manage. Most people find themselves easy. That wasn't the problem. As I started to have a business and I committed to staff, I committed to a space, I started to experience a whole another element other than the care that I was providing. From about years two through year six, I went through this process of learning the business side of it. Not necessarily learning the business side of it, but learning what private practice was about.

It was a shocker to me that it wasn't about how good of a therapist I was. There were all these other factors that were playing into what was happening in my practice. I was starting to get a reality on that and this was becoming real to me. The things that bothered me had little to do with whether I knew what to do with my patients when I went to the office the next day. There were many other factors and what I experienced from years two through six, I experienced somewhat of a burnout, somewhat of being frustrated because I had worked hard and I had ideas of how it was going to go. It wasn't going that way. I had the idea that we’ve got a little bit bigger then I would have some balance back. I’ve got the idea that some things would happen. The irony of it was the bigger we got, the worst it got. The more business I had to run, the more what I didn't know got exposed. That led me to that route of, “This isn't what I thought it was going to be when I first started out.”

You're not alone. That's the common plight of the independent physical therapy practitioner. We assume that because we gained some level of expertise, we get some good feedback and we get some good results, we move on and we move forward assuming that owning a business isn't such a big deal and that we can learn it as we go. Other people have done it, so why can't we? Your story is the same as a lot of the other owners that I’m interviewing. In your case, what sticks out to you? You said you went through some burnout. Was there one area of your practice that was difficult for you to manage? Was it an accumulation of things that led to a point where, “I’ve got to do something different?”

It was an accumulation of things. At the time, I might have tried to peg it a little bit. It was a matter of me coming to this recognition, and that was about year six for me. I was proud of my practice. We had an excellent reputation providing great physical therapy, getting good results, but it wasn't a matter of what wasn't happening. You talk about a lot of therapists going down that route and that happens. There was a day in private practice when you could be a great clinician and you would make it because you're a great clinician. The margins were different. The ability to run a practice and not know a lot about running the practice works. The referral pattern control wasn't near as aggressive as it is. You could compete without being knowledgeable about marketing. There was a day when you could screw up a lot as an owner and still make it because you were a great PT.

PTO 07 | Growing A Business
Growing A Business: There was a day when you could screw up a lot as an owner and still make it because you were a great PT.

Those days have changed dramatically from ten, fifteen, twenty years ago depending on what part of the country you're in. Certain areas get hit with that change a little faster than others. About six years after trying a few different attempts to solve the things that I was up against and my challenges, I had this moment, a little bit of an epiphany with myself, where it was like, “Blaine, you're a darn good PT but you do not know how to run a business.” I got real with myself for a moment and I took a look at that. At this point in time, I’m only 30 years old. I’ve gotten a lot of career. I’m ready to start a family. I could get a picture of what the next 20, 25, 30 years are going to look if I didn't figure this thing out. If I’m going to keep doing this, I’m going to figure out how to run a business. That was the process of me making this move into realizing that I needed to become more knowledgeable and more skilled in that area as well.

Times are different and we've got to do more. We didn't get any PT training from our physical therapy schools. It sounds you were proud of your practice, you had a good reputation, and you were probably making fairly good money. In my situation, I lacked the stability and the freedom that I wanted. The stability and the money might have been good, but I knew that if anything happened to me, then that clinic was going down pretty quickly.

I lacked any freedom whatsoever because I was tied to that company and it depended on me. It was my baby. I thought about it 24/7. It was hard to get weekends off mentally and trying to pay the bills after work and stuff like that. I can totally relate to where you're coming from. Things are changing. You have to do something different. What were some of the things that you tried? What clicked? I’m assuming that essentially you decided that you had to reach out and do something different than what you were doing.

That's the moment that I decided I was going to do something more about the business side of my practice. That's one of the common errors that practice owners make when they want to make their practice better. It's interesting how they'll go get more trained in physical therapy, thinking, “If I become certified, if get my fellow, if I become OCS or I do something of the sort, it’s going to solve some of these problems,” but it wasn’t. That was my first reality with that. I reached out. At the time, there were a few different consulting firms that were around offering business advice. I researched three of them, picked one of them, and was happy with what I’ve got.

I got educated on the business side of it. I got trained as an executive which started to give me the tools and the knowhow that I needed to begin addressing my practice with the same level of skill and expertise that I address my patients. It's that same element. As I’ve talked to other practice owners in the past, I’ve gotten into that idea where I say, “We're going to have to become as good at running our practices as we are treating our patients.” We have all of this intention to become great clinicians and we short-suit ourselves on the physical therapy side of it. We don't get training in PT school.

Not only do we not get training, but the training we do get doesn't carry over to business. I always make the analogy that because you're good at football doesn't make you good at golf. It doesn't carry over the way that if you had some finance training or you had some other industries that might carry over. Generally speaking, because of that, we don't understand what's happening. With the industry as it is today and what it takes to even exist, thrive and succeed in private practice, you've got to be good in a lot of areas. There are a lot of different aspects that you’ve got to know something about and or be an expert.

It’s not always about a certain consulting firm that can do it for you. My whole purpose here is to help people understand that you need to do something. You researched three different consulting firms and you went with one. I would recommend to any physical therapy owner to do the same thing. See what's out there, see what's available, and see what can educate you on the business aspect.

There are many companies out there that will focus on marketing, but how do you structure your business? What should your meeting rhythms look like? How do you hire and fire people correctly so that you're getting the right people on the bus? There are a lot of different aspects to business ownership other than the marketing simply getting the patients in the door. When you're looking for a consulting group, company or person, you want to find that person that's going to help you in all those different aspects of physical therapy ownership.

That's excellent advice. I would give the same advice. The best move I made was deciding to get that business training and go down that route. It's also why as I progressed into becoming a multi-clinic company and starting to want to work with other private practice owners. It's exactly the purpose of my existing company or my senior company, which is to partner with other practice owners and or aspiring practice owners, fill that gap of what they don't have on the business side of it, a true strategic partnership that allows for two skill sets to come together and do more together than they would do on their own. Even if a strategic partnership isn't the right move for certain people, the necessity to get the education to get the training is critical. There are a few routes available to people like you're mentioning out there.

Tell me a little bit about that. Tell me a little bit more about what your purpose is and how you are a benefit to independent physical therapy clinic owners?

As I made that move, I got trained, I’ve got the tools, I started to have a lot more success in my practice. Not only did I have success and I was capable of doing certain things that I didn't understand before, it also gave me some of the freedoms you're talking about. I made an acquisition of another clinic in my community. I tripled overnight. I still was able to understand how to correctly manage what I had. This was a company that had an excellent clinical reputation in the community as the biggest private practice in the community, but again, struggling when it came to running the business.

It was a perfect for me because I’ve got the opportunity to go in and revamp an existing practice. It was an opportunity for me to utilize some of my new skill set. I had a lot of success in doing that. What also happened was it gave me the freedom and I began getting more involved in the APTA on both the statewide and the national level. This led me into recognition of what was happening across the state, some of the senior policy issues that our profession faced. In addition to at that point in time, I had met and had a network of colleagues across the country and many other private practice owners that I understood what was going on, and I saw that there was a bit of an epidemic.

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I saw that private practice owners, generally speaking, were struggling. I saw where things were going, the future. I thought it was only going to get harder. I had to face that myself with my practice being in Montana and went, “There are things here that I see coming that I considered still a threat.” I was at a Federal Affairs Forum in DC and I saw this future and I wanted to do something. There were two things I was trying to solve at that point in time. One, I wanted to do something that I thought would strengthen my chance of success into the future. I thought that growth was going to be necessary to do that. I thought strengthening beyond what I could do as an individual practice owner was going to be necessary to potentially handle what could be coming with healthcare reform and what could happen.

This was during Obama's first year in office, before he passed the Healthcare Law. Here we are nine years later and we still don't know what's going to happen with healthcare reform. I developed this passion to want to help private practice owners during that time of going through a certain process myself. Realizing the importance of the business training and realizing how much of a difference that made to me as a private practice owner, I wanted to work with private practice owners. I love that because most private practice owners that I know, Nathan, are in it for the right reasons. They're passionate, they care more, they don't want to work for the hospital, which I love. They're not willing to do it that way. They're out there because they really care. Typically speaking, these are the practices that offer the best physical therapy inside of their community.

I wanted to help them in an area that would strengthen their ability to serve their community. I wanted to partner with them. The consulting world is awesome too. You get a consultant, they can help you. If they train you in business, that's even better than giving you advice because that training you can use and keep. Short-term advice expires fast. It's not enough to deal with the ongoing challenges. What was nice about the company that I work with is you've got training, you had the education. It wasn't just advice, but at the same time there was an enormous amount of progression beyond that spot to take it to the level that I took it to.

That's where I thought a partnership would allow for a lot more where a lot of people don't have the time, the intention, and enthusiasm to go down the route that I did. I saw it as a good route for a potential partnership. I went down that route. I wanted to partner with private practice owners. I wanted to strengthen their chance to succeed. I’m a champion of private practice. I believe private practice has to make it for our profession to make it. If you look at the role private practice has played for when we were a secondary caregiver, we were clearly down the hierarchy in as far as healthcare providers to becoming an autonomous practitioner, direct access, capable of seeing people off the street, being recognized as the expert in musculoskeletal system.

That progression, in my opinion, has been driven by the private practice sector. I usually ask people, “Take a look at all the people that you'll pay money to go to their courses and either become certified in or look at all the people that we write today would let’s hear the big dogs out there.” The ones that we go to their courses got their name on everything, the leaders, the gurus. I’ll usually say, “Name one of them who didn't grow up in private practice. Name one of them who’s existing and living in a hospital system.” It doesn't work. These are the people that were driving the progression of our profession. I believe I want to help practice stay there. Private practice owners are the people who most motivate and inspire me because of what they're doing and why they're doing it. I wanted to strengthen that.

You've partnered with a number of physical therapists and opened up a number of your clinics. That first one you took over was a larger clinic than your own in Montana. With your experience, what are the two things that you see going wrong in private practice ownership that you're able to “fix” and what are some of your secrets to coming in and fixing those things?

Every practice has their own areas that they're strong in and not strong in. It can be the aspects of marketing. It can be the understanding of finance. Financing includes both, one, how to correctly use your money. As we know, we can't use and spend money if we also don't know how to make it. If we can't make it first, we’re in trouble. Number two, once we make it, we better know how to use it correctly in order to run a business. You see that error a lot in practices. All the practices that I’ve evaluated, most of them have a finance problem.

When you say finance, are you talking billing and collections? Are you talking expenses are out of whack and they're spending more than they should be? Is it a combination of both?

It’s a combination of both. What you bring up in the billing and collection side of it is definitely something that you have to know and understand. My general experience with third party billing companies is they do okay, but I don't think they're great at it. They improve if you're a bad situation, but I don't think that they do it as well as it could be done. That's why I decided to perfect it in my own practice. A lot of practice owners who have confronted that area and got good at it realize that side of it. In and of itself, it's a whole industry, hence the reason you have all these third party companies out there. That side of it has to be understood.

There's the side of knowing how to correctly spend your money, the expenses, and how to correctly manage it also from an understanding of how much volume you need your group to do. How do you manage this? There were many practice owners that I’ve looked at their practice that weren't even paying themselves or that were paying themselves less than their staff. They didn't know quite how to make it go and some of them weren't small. They had a decent size practice there. They didn't know quite what to do. It's not that they were way off in left field in any one area as much as it's a multitude of small little things not quite done right that add up to a chunk in there struggling with either low margins they're battling. They're wondering if they're going to make payroll this week. They're wondering what's going to happen.

Even when they're making decent money, when I asked them how many hours they're working, they're still making less than their staff. They're working 65 hours a week. When you break it out over per hour, it doesn't even sometimes come out to that. They recognize that they're not always getting that, but they keep going and they're driven because they have such a huge intention to help. They want to be great physical therapist, what is inspiring and what is great about it and what is to be admired. At the same time, we've got to have some skill on this to know what to do with that intention.

Number two, if I ask almost any business owner what's the hardest part about running a business, they're almost always telling me personnel, staff, people. Getting people to do what you would do. They'll say, “I’ve got to clone myself,” or they'll say, “If I could only hire more like this,” but the reality of it is those people are not going to do what you do. It requires that you have a skill set. It requires that you have some ability to learn to build a true team of people who can perform at a level that's above average.

PTO 07 | Growing A Business
Growing A Business: Short-term advice expires fast. It's not enough to deal with the ongoing challenges.

I had this realization after battling for a while when I first took that clinic, the first practice over that I was telling you about. I had the realization that I wasn't going to win with what was average. I needed to be able to do is to create a group that was above average. I realized I had to have a skillset and invest in the development of my group and their abilities. Probably one of the tougher parts of running a practice is learning how to work with your staff, learning how to take this group of people and expand their skill set upward and do it as a team.

Any secrets to what you do then to build that team or to filter the incoming people or filter out the wrong people? What secrets do you hold on there?

First off, you do have to be capable of hiring good people. There is a skill to that. There is a correct way to do that or a better way to do that. You definitely have to have a high standard for what you allow to stay on your team. If a person is distinctly not getting their job done, you have to be able to deal with that. It’s no different than if you're on an athletic team and one personnel on the field was distinctly not getting their job done, that person would be replaced. That has to happen. Once you get an improvement in the hiring side of things and the ability to know when a person should stay on your team and when they should not, the second piece is you’ve got to be good in your training. If you don't train people well, onboard them correctly, and give them the right training and expectations of coming onto your team, you're going to struggle. That's a key factor too.

You've shared your training with me in the past and there's quite a bit to it. You focused on defining the product that that position is supposed to obtain and how they go about getting that product have a clear definition as to the post. Am I saying it correctly?

Absolutely. We are definitely going to make it clear what the expectations of being part of our team. We let people know right away that we're trying to build a great team here. We're not trying to build an average team that will appeal to certain people, and certain people it won't appeal to. People who want to come in and punch the clock and do the bare minimum, it's going to be less appealing to them as the person who wants opportunity and wants to advance their career.

We make it known right away that expectation. We make the exact outcome or result of their job. Every position has a specific thing that it's there to do, which we might also call their product. It's the thing that, at the end of the day, we have to make sure is happening. It's the thing that we have to make sure we're capable of doing. If I’m a receiver, I have to catch the ball. I can't almost catch the ball. At some point in time, I have to actually catch the ball. When I’m learning, that's okay. When I’m growing and developing, that’s okay. I’ve got to eventually develop that ability to catch the ball and then I’ve got to have it right. We work on making sure people understand what that is, make sure that they want, that they're on board, that this matches their own personal goals and what they're trying to accomplish in their career. We start teaching them the knowhow, the technique, and what it takes to correctly do that.

My teaching isn't a matter of some two our little quickie training that I give them onsite or, “Here, read a couple things,” and then throw them insight. This is something that would involve reading, training, and mentorship. It involves some time. We deal with mistakes, we deal with misses, and we come back in and try to strengthen. No one learns their job in the first week that they're there. We want to think they do. Sometimes that's all the time we give it, some little quickie. Who is going to come in and in matter of a couple of days learning their whole job?

How long do you consider your onboarding, your training?

Every position is a little bit different, from a therapist to a physical therapy tech to a reception to a billing person or whatever. Every person grows and develops at a little bit different speed. One person might be twice as fast as the next one. We're less interested in time but more interested in the fact that person is making progress towards and their effort is there, they're willing, they're trying, and then we work with them. It can be anywhere from oftentimes six to eight weeks, and sometimes it's three to four, five, six months.

We even have some of our training. They'll go through a second round, a certain period of time down the road, which then adds in a higher gradient of training that would be too much right out of the chute. It also reiterates certain pieces so they can get it again. Sometimes studying something more than one time allows for it to sink in a little bit more. We have a couple of things there and we're always willing to help that person. What we more look for is desire and willingness, a person who wants to progress and grow in their career. We spend the amount of time in that at that point.

How do you weed somebody out if you've figured out that this person isn't going to work on your team? Take me through that process. I’m assuming that you figure it out pretty quickly with the amount of training you do because you do a lot more training than most. How do you weed someone out if you recognize that they're not producing what they are supposed be?

A well put together training lineup sequence program will definitely help. In that process, if you're working with someone frequently and consistently, you'll start to recognize the people who weren't there for the same reasons that you want the rest of your team there for. If you're working with them closely during those early days, it starts to show up a little bit. Oftentimes, their willingness starts to change, their frustration. There's frequently, instead of trying to figure out what needs to improve, oftentimes there's a “why things can't be done” approach.

A person will always complain about stuff and they'll tell you why it can't be done. They don't go, “Yes, let's try that again. Let me see what can I learn about this? What part of this can I get better at?” There's always more of a resistance about why it can't be done as opposed to an attempt to try to find the solution we need to it. You start getting a feel for that. Once we get that feel, the progression of their training starts to change a little bit. We're going to have a little bit more of a direct conversation about whether they want to be there. What it is that they want? Sometimes they're not always bad folks, but this isn't what they want to do shows up.

You'd rather find that out quickly and honestly if they're aligned with you or not.

The sooner, the better. That's a good piece of advice there, the sooner, the better you can find that. Here's another thing that I’ll throw out as a piece of advice or as to comment out there for the practice owners. Sometimes when we hire, we hire a little bit out of desperation. We get busy and we weren't prepared for it. We weren't ahead of the curve. What ends up happening is we wait until we're super busy. We're not confident in our numbers so we don't make the move early when we should be. we know our numbers are going to stay, everybody's freaking out, and we go hire the first person or first therapist or first receptionist that comes along.

We’re put in a difficult situation because of someone parting and we hire more out of desperation than trying to find the right fit. When we do that, oftentimes, one, we don't get as good of a quality of candidate that we hired as a new team member. Number two, when that person's not working out, we hang onto them too long because we don't want to do it again. It was such a hassle to go hire that we don't want to let this one go because we can't face having to do it again. Both of those are strong reasons of why we go around with a less than high performing team or what I like to sometimes say sandbags. We're trying to run a race with sandbags on our back.

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I’m trying to think of what you hear quite frequently in business terms where you take your time in hiring, but you fire quickly. It sounds not only do you take your time in hiring, you take your time in training those people up. When you figure out they're not the right fit, you're pretty quick about it and you pull the trigger.

Absolutely. Each one of our partners that we work with is learning that themselves because they're the one running their practice and we’re consulting them. If I am directly onsite running that practice, I’m probably fast. I’ve done this for a long time. I’ve been around the block a lot of times and you’ve come to recognize. What I love though is there's always an intention to want to help that person. Most private practice owners are strong in their desire to help people. That also make us a little bit of a sucker at times because we hang on.

We want to help our employees as much as we want to help our patients. What you understand is that person has to meet your desire to help them and they have to meet you halfway. You can't walk them to do better than they want themselves. They have to want, at least as much, to do well as you want them to do well. We like to help them and spend that time with them, but as soon as they're not working out or we recognized certain things, we move pretty fast.

I read a lot of books on business. You go to conferences, you have a lot of mentors out there and that's probably one of the consistent things you hear from successful business owners. Hire slow, fire fast. It's true, but it's much harder to do in person than it is until you’ve got a good feel for it, and then you could do that. You also got to be willing to learn from each one of those times you didn't do it great. You’ve got to be willing to go through it a few times. You’ve got to be willing to experience every aspect of that. Sometimes the hard parts of running a practice, Nathan, we don't always welcome them as well as we welcome the good parts. We have to welcome every part of it because if you don't, you're not learning as much from it as you do the good parts.

A lot of times when we were running into tough parts, we have a tendency to wish it wasn't there. We don't embrace that moment as a learning opportunity. We don't do everything we can to learn from it and see the places that we made mistakes in on the front end. Consider it an opportunity as opposed to, “This is something uncomfortable, it's painful. I’m going through it and I wish I wasn't.” It doesn’t work that way. You’ve got to be willing to take one on the nose sometimes and enjoy it. You’ve got to want to learn from it and embrace that moment.

Consider it a learning experience. You mentioned that you read a lot of books. Are there some books in particular that are favorites that stick out business-wise that you would recommend other PT owners read?

I probably have not read a single book that encompasses every aspect. I’ve read many books and I like each of the pieces that different parts of them bring. Sometimes I get inspired more by reading about people's story. I read how they overcame their willingness to go through adversity, their toughness when they were getting hit. I love these stories. I love hearing other people have the ups and downs because sometimes when we see a successful person, you don't always realize that they had to work to get that, that they had to go through a lot of different growth phases.

They had to mature. They had to go through ups and downs. I find that inspiring because during the times when it is tough, during the times when you're battling a little bit, it's nice to have that motivator of knowing other people have gone through that and to not in any way slow down, to not hold back at all. I love those aspects of it. I’ve read many books. I’ll do some study on marketing. I have different potentially recommendation of books and different aspects that you can go down that route and things I like to look at there a little bit. I love reading about people's story as much as even a direct technique and whatnot because we have our systems that we use quite a bit and we try more strengthening in certain areas. I’ll do quite a bit of study on marketing or whatnot.

The one thing that is unique about you is that you have a number of clinics across different state lines. Is there any challenge to that that you've come across?

Yes, there is. You're going to have to learn a new practice act. You're going to have to learn a new employment law. The insurance contracting is not always the same across regions. Every time you go into a new region, there's quite a bit of research and due diligence that goes into that process. Anytime you get a distance away from your clinic that you can't easily drive to it, you've got to be stronger in certain areas. You have to be if you're onsite every day. Probably the biggest challenge is learning how to get distance from your clinics and still have the right things being done. That goes back to a strong business model, strong training, strong understanding of what to teach people, and becoming good at business, being a good executive and strengthening your team.

It goes back to the number of the things that we've already talked about. Number one, hiring the right people because you need to have the right people managing that site that is far away from you, and doing a lot of the proper training. A lot of that training can't occur unless you have pretty solid and stable policies and procedures in place to make sure that everything's running the correct way. You're looking at all the same key performance indicators. You're all focused on the same statistics and even focused on a similar meeting rhythm that you can report accordingly.

You hit on some of the key points there. A good book that talks a lot about getting the right people in the right seats on the bus is Jim Collins’ Good To Great. It’s a book I enjoyed as well. Not excellent exact techniques on how to run your business, but a recognition of the fact that those that are more successful are doing things different than those that are not. It's not based on luck. It's not based on a variety of factors. It’s based on learning what to do and doing it. That's a great book. You’ve got to have a good organizational structure. You've got to have good metrics, analytics, statistics.

You've got to have the ability to have meetings and be well-coordinated as a team. You've got to have good written materials, policies, procedures, knowhow, recipes, correct technique that you can teach people. Success is about figuring out what to do and then being able to execute that game plan. Ability comes down to three key factors, being able to see what's happening, the ability to know what to do with what's happening, and then the ability to execute based off of what you wanted to do. There are a lot of people who come up with a plan and failed to correctly execute it. Those factors as a team, any team comes back to also the ability for good leadership. Every practice out there has to embrace that opportunity to be a good leader has to like everything that comes with that, the good and the bad.

PTO 07 | Growing A Business
Growing A Business: Every person grows and develops at a little bit different speed.

Sometimes when you're the leader, you're also the first guy the fingers point at. You’ve got to want that. You’ve got to be willing to embrace that. The more technique and the more skill you have behind you, the more enjoyable. It gets fun. Just like an athlete, you see an athlete who's good, they make it look easy, almost fluid, they're smooth, they’re skilled, it's like an art. A good executive is the same way. They become artful in what they're doing. They're skilled and they make it look easy. Realize that that's a reflection of their confidence, not their skill set, and the time that they put in to grow.

Most practice owners, if they might recognize that they're not all the way there yet, would recognize that as long as you're trying to grow, you're constantly trying to improve, and you have a path towards that growth, that's what you're looking for. That's what we want to do because I know where you're at. You guys have done great things with your practice too. I know a little bit about your story and as you guys know, we're always striving. We're always trying to get better. We're always growing. That drive and feeling confident that you're going down a path that's going to lead you where you want to go makes it more fun. It becomes enjoyable the more skilled you become at it.

Tell us a little bit about how people can get in touch with you? Tell us a little bit about Health & Rehab Solutions and what you are doing at this point, if they are interested, how to contact you.

Health & Rehab Solutions has a couple of different routes in which we look to accomplish our purposes, grow, and accomplish our successes. One is through partnering with either existing practice owners. These are practice owners that either recognize that they want to strengthen the business side of their practice and they see a strategic partnership as the best route to do that. One of the things to understand about our company, if you are an existing practice owner, is we have no private equity backing.

We don't have investors that we're having to serve inside of our model. We've done everything we've done self-funded and we're still run and owned by physical therapist. Health & Rehab Solutions is owned by myself and my partner, Ryan Robinson, who is also a physical therapist. Between the two of us, every time we partner with a new partner and help them run and grow their company, is another physical therapist. That's quite a bit different than this big market out there which is dominated by these big industries who are backed by private equity and venture capitalist group. At the moment you do that is a different game.

One of the things that we are unique in the market right now is we're an opportunity to partner with 100% physical therapy owned group as opposed to a private equity group. We like to call that more a true partnership because we believe some of the other models out there would have the tendency to be sometimes a little bit of a biased model. They're set up a little strong in one direction or the other as opposed to this direction. That's how we look at it a little bit. It's important for people to know that differentiation.

We'll partner with existing practice owners, go in and start teaming up with them on their practice, sometimes to solve what is a challenging market. A lot of times to get back on track with helping them go towards their goals. A lot of times where they originally wanted to go and where they're going or what they've accomplished thus far is not what they have in their original vision, in their original set of goals. It's time to get back on track with that and go.

Some people we've partnered with also see our opportunity to partner with us and then increase their platform for growth. Not only does it solve some problems that they have, but it also strengthens their opportunity to grow. They get the structure that we've created, they see our systems, they see our model and how well it's been put together and how it allows for that. It's one of the pieces and the things that is truly strong. We also will partner with the practice owners that are aspiring practice owners, people that are up and coming, looking to make that move into practice ownership.

Getting a strategic partnership will allow them to accomplish more than going out on their own. Once we have a partner from that point, we have our own strategic plan and growth plan with each one of them. Sometimes we're making with that single person and that partner or growing quite a bit of their brand and their clinic. We have four or five clinics now. We have some companies that four or five clinics and are wanting to continue to build inside of their own geographic region.

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If people want to reach out to you and get to know a little bit more about your company, how did they do that?

The best opportunity would be to email me at BlaineS@HealthRehabSolutions.com. You can also contact us through our website, HealthRehabSolutions.com and get in touch with us that way as well. There's contact information on there. There's an email you can email in addition to my email that I gave you.

Thanks for sharing. I appreciate your time, Blaine. The work that you're doing is phenomenal. Your purpose is obvious and you've got a ton of experience to share with not only the people within your group and with Health & Rehab Solutions. Based on your work in the business and with the APTA you've got a wealth of experience. I look forward to hearing more from you in the future.

Thanks, Nathan.

Thanks.

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About Blaine Stimac

PTO 07 | Growing A BusinessBlaine Stimac, PT, MSPT, received his Masters of Physical Therapy from the University of Montana in 2000. He has been a private practice owner since 2001 and has received extensive training in business and management technologies becoming an expert in private practice. He serves as the CEO of his practices and has engineered a multi-practice group that has experienced significant growth over the past 5 years. He has been involved in the acquisition of 7 practices, including 14 clinics, during his career in private practice. Blaine co-founded Health & Rehab Solutions, LLC to further expand his successful practice model. Blaine is also dedicated to the physical therapy profession and private practice. He currently serves on the Board of Directors as the Treasurer of the Montana Chapter of the APTA and is active advocating for his profession on a statewide and national level. He is an active member of the Private Practice Section of the APTA and recently authored an article for IMPACT magazine. He has become an opinion leader within his profession by advocating for private practice and consulting multiple practice owners in improving their practices. Blaine is passionate about creating a group of private practices that are known as the benchmark in what a private practice clinic should be. Outside of the office Blaine spends time with his family and watches his three boys learn, grow, and live life to the fullest. He is very active and can be found whitewater kayaking, skiing, biking, hiking and enjoying the adventures of the mountains.

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