Angie McGilvrey, PT of Apex PT had the opportunity, after a hurricane shut down her clinic in Florida for a prolonged period (sound familiar?), to revamp her clinic and create her ideal scene. One of the things she committed to when she opened back up was greater usage of social media to market her clinic and attract her ideal clientele - female athletes between 30-40 years of age. By focusing targeted messaging to her avatar on a couple of social media platforms and posting content consistently, she has been able to not only grow her clinic but see more of the clients she wants to see. Plus, she's created a reputation as being THE place for athletes to recover in her community. She's been able to niche down and grow because of it.
I've got a fellow friend and HODs or Hands-On Diagnostics owner with me, Angie McGilvrey, out of Florida. She and her husband, Joe, own Apex Physical Therapy in two locations. I want to bring her on because she's done a lot of great work in growing her practice and has used social media to do a lot of that work. I want to get into her story to share what she's done on social media and how it's been successful for them. First of all, Angie, thanks for coming on. I appreciate it.
Nathan, thank you for having me.
Before we get into the social media stuff, you've been an owner for many years, so congratulations. You’ve got multiple practices and you guys have been successful. I'm sure the story hasn't been sweet-smelling roses all the time. To give everybody a little bit about your journey, do you mind sharing your professional story quickly?
My husband, Joe and I, opened Apex Physical Therapy in 2005. We packed everything we owned up in U-Haul. We were from Chicago and said, “We're going to Florida. Forget this cold weather. We're going to give this whole PT private practice a try.” We are blessed to be here growing and being productive many years later.
Have you been in the profession for a while? Had you been practicing for a while before you decided to open your clinics?
We did. We were practicing underneath other owners for about five years before we decided to take the leap.
Did you practice in that area in Florida first and then open up your clinic? Or did you go to Florida and decide we're going to open from scratch?
We opened from scratch, cold turkey.
That takes some courage. You had some confidence and I'm sure you hit the bushes. You worked and marketed hard, all that good stuff. I'm sure you've pushed hard and it's part of your success. Are there any particular times along the way that were somewhat hard on you that turned out to be a learning experience and a success in the end?
Yes. I would say two large things come up. The first one being in Florida, we have a high Medicare population. I can't recall the year right off hand, but we went through a Medicare audit one where they put us on 100% prepayment review, which meant that in order for us to get paid by Medicare, they had to review all of our documentation first on 100% of our patient volume. I did learn how to document for medical necessity.
Florida got hit with that, didn't they? It's a Florida thing.
Unfortunately, there are some fraudulent things that happen. Secondary to that, everybody was looked at with high scrutiny. I am proud to say that we came out of that on the other side, but it is a huge learning experience and something that made me a lot stronger in understanding medical necessity, billing, coding, documentation and all those things that as PTs, we don't sometimes want to care about, but I figured out fast why we have to care about it.Social media, strategically utilized, instantly puts you in front of your ideal patient without dealing with a physician's referral Click To Tweet
How long were you under review?
It lasted about six weeks until we finally were able to get off of 100% and down a different percentage. We had to work with an attorney and all the things. It was rough.
How far into your ownership was that?
I believe it was about 8 or 9 years in.
You are going strong, but that’s a huge roadblock in the middle.
Medicare was our payer, like 75% of our population, especially the season is Medicare. This was a big undertaking.
That was number one. Did you have a second one?
My second one was in 2017. We were hit with Hurricane Irma and that was a big deciding point and a big pivotal point, which leads us into the conversation that we're having around social media in the sense that we chose after Irma to rebuild our practice. One of those building blocks that we used was growing and niching through social media.
Did you have to close down your clinic for a period of time?
We did. We had some damage. We had no power for about ten days in the entire Florida, which was 90% of our patient population left and evacuated. Even if we would have power and been ready to operate the day after, none of our patients were here. Everybody was gone. The whole state had been evacuated, especially in our area. That was a scary time to figure out how do we get through this. I do have to say with the COVID pandemic that we've all been dealing with, Hurricane Irma was the best thing that I could relate it to and figure out, “What did we do then to navigate?” Our practice went down to almost nothing. How do we use that experience to navigate through COVID? I'm grateful for them looking back because I know that they contributed to our successes.
It's not uncommon. As I'm working with clients or talk and interview people over the years, it's tough to go through those hard experiences and you wouldn't wish them on people or yourself, but after having done so you come through having learned so much and having grown stronger. In your case, you were able to create a different practice than what you went into Hurricane Irma with. That's relative nowadays, even with the pandemic. That was a lot of push over the pandemic as I talked to people on the show and my clients. It was like, “Here's an opportunity. It sucks, but how can we make the most of it? What can you do so that you can make the changes in your clinic to reflect what you want in your clinic? Who are the clients that you want to see? Who are the fellow team members you want to work with? Are you seeing the paramix that you want to see? Do you have policies and procedures in place that make things easier? Do you have time set aside for admission or tests?” I could go on and on, but taking advantage of these opportunities is what makes us stronger. It gives us opportunities in the face of challenges. As you did that, how did you then work social media to your advantage to create what you wanted? I would love to know what you did, why and what were some of the instigating factors? What was your clinic like before to what did it become?
The clinic was very much a general outpatient orthopedic, physical therapy practice. It has no different than any other outpatient orthopedic. If you looked out the window, it would look like all of the others.
We take all comers, whoever has got a script, we bring them all in.
We take them all, we do it all, we market to everybody, we take all the insurances. We do everything. We market 75% of the time to referral sources, mostly physicians and those others in the medical community. That's what we looked like going into Hurricane Irma coming out on the other side. One of the biggest things that the storm taught us was that, as you said, we have the ability to create change. We have the ability to reset this practice to what it is that we ultimately wanted to be. We wanted it to take more control and be more at the cause of the specific patient we were working and identifying our avatar. Also, be at cause at bringing those patients into the clinic without having to rely on a third party referral source. That's where social media started coming into play for us big time.
Social media is something that I wish I had more time to do that. Did you think about that in the past or was this something that forced your hand into, “How are we going to take advantage in social media came to mind?”
It was more the latter. I've never had my own Facebook, Instagram, Twitter, nor Pinterest. I was the person who fought social media for a long time until I started listening to a mentor who I've used in, Gary Vaynerchuk. I have to give him credit for what I've done and what I've learned through social media. I started to learn that if I wanted somebody's attention and especially my avatar's attention, I had to go where they were and they were on their phones. More specifically, they were on social media. I was like, “Angie, you better get your butt on social media.”
What's your avatar?
Our avatar is the 30 to 40-year-old female athlete, specifically the CrossFit athlete.
You're CrossFit as well. Are you performing CrossFit athlete yourself and Joe?
You can speak their language, you know what they're dealing with, you know the moves and the lifts, and some of the common injuries that go along with being a CrossFit athlete. That's exactly where you live in that space and it's easy for you then to talk to those people I assume.
It's a little counterintuitive to what I heard and that was to create where you live and that is, if you're on Facebook all the time, create a lot on Facebook. If you're on Instagram all the time, create a lot on Instagram. Maybe there's something to that, but you had to learn how to navigate and use some of these social media accounts. Was that a tough learning curve? Was that hard for you to adopt? Has it become easier for you?
It's like anything else in life, you have to start doing it. That was it. I had to start doing it. Joe was always involved with it on a small level, but it was when I decided that we had to put a ton into this and I wanted to be that driving force. I had to learn by doing. The first 500 posts that I made, it's like a therapist, the first 500 backs that I treated didn't do that great of a job, but the more we do, the more we learn. It's the way that it goes in. I still am learning all the time and I'm trying different things, seeing what captures attention, what is giving more value and what do people respond better to. It's a work in progress.People want to do business with people. Click To Tweet
To get into the weeds a little bit, are you using your own personal account or is it an Apex PT account that you're using on these platforms?
It is a business account. My practice is a small business and our philosophy is much that mom-and-pop small business family feel. We have in two locations. We know our patients and we develop meaningful and lifelong relationships with them. We infuse a lot of Angie and Joe's story, Angie and Joe's history and some personal things with Angie and Joe in there because people want to do business with people. That's what we've done.
How much time are you setting aside to do all these posts and get your stuff out on social media?
As a team, there are three of us that do this, myself, Joe, and one other gentleman in my practice. Between us, we can talk about what I mean by working, but this is working. The entire part of working social media, we do 5 to 6 hours a day collectively between the three of us.
You're each doing a small portion, at least an hour or two. When you're talking about that, you're talking either you're creating video or content, you're editing, posting a video in some form or another.
That side of it, but then also there's the other side of it and the engagement side.
Tell me about that.
We work from two different angles. It's the content creation and the posting, and then also the customer engagement. We will go through and literally either search through the #CrossFit or #Fitness or something like that. We'll see the accounts that pop up and you go on and somebody posts something and you comment on their posts. We’re engaging in two-way conversations with that avatar patient of ours. Sometimes this person could be across the country. You never know what that brings because maybe that person from across the country says, “Let me give you a follow.” They follow you. They see something cool you're doing. They post it and maybe they've got 100,000 followers and all of a sudden, you’ve got the attention to somebody down the street. With what technology has done in the way, it opens up our market so big to who we can create conversations and engage with and get our product out in front of them. It's not limited to our 10-mile radius like we used to think.
A Gary Vaynerchuk thing to do is to get engaged on all those hashtag groups and throwing your two cents and then people follow you and it cross-references each other. It sounds familiar. Do you use any gadgets to help you along the way with a few accounts and platforms running? Are you using something to help you out?
I tried to dabble in Hootsuite for a little while, which is a platform that lets you do all of the pre-programming and setting. It wasn't fitting for me. I know there are other people that use that, I don’t. We post to the date, to the moment like, “What is happening?” I'm like, “Look inside the clinics.” That lends itself to doing it on the fly sometimes.
If I see something on your posts, more than likely it's been done sometime in the last 24 to 48 hours, and it's not something that was done a week ago that was scheduled to post at a certain time, which Hootsuite will do for you.
Sometimes that does happen. We do have some scheduled content to create like, “I want to do some videos around musculoskeletal ultrasound. Let's make sure we get those videos.” The majority of it is me and/or others in my clinic being followed by a video camera. The way that I get my content is I have a videographer that follows me about 4 to 6 hours a week. Based on that, he creates content off of the rides me working with my team, working with our patients doing our thing. It's extremely authentic. It's not like, “Let's sit down and let's rehearse what we want to say about this.” It's seldom that we do anything like that.
What platforms are you on? To follow up, is that something you filter down to certain platforms after starting on a bunch or have you stayed on all of them? Where did you start and where are you now?
We started with simply Facebook because that’s the largest out there. However, when you start to look at some of the demographics, my avatar spends the majority of their time on Instagram. I do both. We put the majority of our stuff on Facebook and Instagram. I also do a personal page and an Apex page on LinkedIn, where I will reuse a lot of the same content or videos, but I would spin the messaging a little bit more knowing that I'm talking to another physical therapist or somebody savvier in my space versus talking to the general public about physical therapy.
In LinkedIn, you're talking to business professionals typically, and that's what they're looking for business-related stuff. You're sharing your story and what you're doing and I've seen many of your posts on LinkedIn and you do a great job. Do you also do stuff related to physical health and caring for certain injuries? That's a lot of what I don't see on your LinkedIn stuff. I'm wondering if you massage your content on Facebook and Instagram for injuries and diagnoses in particular as you're talking to your avatar.
Facebook and Instagram stuff is a lot more about like the last post I did. I was doing a contract relaxed technique with a runner's hip, but it was all talking about my youngest runners with hip pain, this is why it happened and this is what we do about it. It is basic.
You have a videographer, but for a guy who's maybe a smaller clinic size and treating quite a bit, when you first got started, was it simply you and Joe and an iPhone essentially?
We would be on the iPhone and we would be going throughout our day. I would look across the clinic and I would see a patient doing cool exercise and be like, “Let me pull my phone out.” Video fifteen seconds of that exercise, knowing that later, I'll post that and talk about what they're doing. I have a patient come in that I would have one of my CrossFitters. We were working on with the PVC pipe working on a lift and I'd say, “Let me video her or video me. I'm going to post that later.” It was not until within 2019 that I started having the videographer be with me.
Do you get consent from your patients to post those videos? Is that something that's part of the intake paperwork or do you let them know verbally ahead of time that this is going to get posted?
Yes, we have a video image release as part of our standard paperwork. On the days that he is there filming, they see that he's walking around or whatever, and I always make it a point to be like, “Is it okay that we get some of this on video?” I make sure I get that extra okay any time I do work with minors that are athletes as well. I always reask verbally mom or dad again to make sure everything is good. The cool thing about getting their consent and doing that is I make it a point whenever I'm posting about a certain athlete or there in my video to build that person up into talking about how they're inspiring this post and this is how awesome they have done.
I'm proud of them because that gives them a huge amount of value and self-esteem coming back at them. It's turned into, “That's cool. Apex posted my video.” It makes them feel good about themselves and their progress and that piece of it I love. Being able to tag them and say that is amazing for them. On the other side, it also drives business for us because then they will typically repost it with, “Thanks Apex. You guys are awesome or whatever.” Not that I'm looking for that, but when it happens, that's wonderful and I'm grateful for them to do that.
It's cool on two levels that you get to highlight these amazing people that come through your clinic and share how awesome they are because it's not all about Apex all the time. If you read, Building a StoryBrand, we are the guides in their hero story. The patient or us as we're looking at someone who can help us, we are the hero of our own story. We're looking for the guides to help us be better. That's what you're able to show in those videos. It's nice that you get some turnaround because these people who are more than likely your avatars are going to post on their websites to other avatars of yours with the people in your network that you would be able to treat as well. It's such a cool concept that you highlight them so much because a lot of what you see with PTs is, “This is what you do for your back. These are the stretches. Here's the anatomy.” That's not engaging. When you see other athletes performing, getting treated, exercises that they're doing, that’s somewhat engaging because you pulled into a little bit of a story there and that's cool.
I try to tell a little glimpse of each of their story, like, “She had this and now she has this. That's why we're working on this.” It brings it to real life.
Don't you use YouTube?Friends and family are always huge referrals. Click To Tweet
We do, but I need to be better at it. I was told by a digital marketer that it becomes the second search engine behind Google. We need to become better at YouTube.
We got into the weeds there a little bit. You made it intentional to use social media to your advantage and grow in a different way than you were before. How has it changed your clinic by niching down and using social media?
It's been awesome. The two pain points that we went into Hurricane Irma with were marketing to the physician as well as seeing anybody and everybody. I treat two days a week. I love treating. If I choose to treat. My entire schedule that is all I treat. I treat is athletes and most of them are CrossFit athletes, but it has blended into, “If she knows how to CrossFit and she knows how to treat Spartan racers, and she does CrossFit and Spartan Race then I know she can help me because I am a baseball player.” That's amazing as well as my practice has been branded in our area as the place for athletes to go, which is super cool.
I've heard that from various physicians in talking and communicating. We are having a PA or a physician say something to a patient and the patient comes and tells me, “They told me because I golf and I need to get back to golfing. I'm an athlete so I need to go to Apex because that's where the athletes go.” To hear that is super rewarding. It has completely flip-flopped our marketing. We market 80% now direct-to-consumer and 20% of it is massaging the relationships and the rapport that we have built over the past years with the various medical people in our community.
To be honest, the coolest flip of the table is when I have a CrossFitter who hurt her wrist doing a lift, doing a clean. She bent her wrist all the way backward and was like, “This is bad news.” The way she contacts us is she direct messages us through Instagram. I want that to be a point there in that this opens up a new line of communication for people to get it. She didn't go to our website. She didn't call our number. She direct messaged us on Instagram and said, “Can you help me?” I was like, “Yes, come in today at such and such time and we'll help.” That's huge. She came in and talks about what was happening with her wrists and the other.
We ended up doing an MSK or Musculoskeletal Ultrasound to look at her wrist. We're super concerned. I didn't do the MSK. It was my husband’s ball. I can't remember exactly what his major concern was, but he had one and he said, “You need to hang on a second. We're going to get you to the orthopod. You do need to be screened by an orthopedic before we go any further because I'm concerned about it.” He text messages in orthopod that we have a great rapport with, “I have an athlete here needs to see you.” He’s like, “Send them over at whatever time.” We fed the orthopod the patient versus buying the $700 lunch and begging for patients. The patient went to the orthopod and was cleared. Everything looked good. She came back to us and did rehab a couple of visits. We had her right back to doing CrossFit and she was super grateful and blessed. Her turnaround was within two weeks that we had this whole process wrapped up, had her back doing her thing. That is the power of that social media connection because she follows us on Instagram.
That goes to show the value and the power behind a direct to consumer marketing. It's something that I was pushing for during the shutdowns of the pandemic is we can't rely on referrals sources anymore. This is an opportunity for us to change our marketing patterns and go direct to the consumer because that's where more of the people are. What is often the touted stat? That only 10% to 15% of the people that have musculoskeletal injuries get to physical therapy. That means we're fighting for 10% as we're going to physicians when there are 90% of the people out there who need us. As you've changed your marketing, has it significantly changed your numbers in terms of the types of patients that you see? You said you were 70% Medicare. Are you still at 70%?
No, which is fantastic. In the beginning, I complain about having the risk in Southwest Florida of a Medicare audit. That was a basket that we didn't want to put all of our eggs in. In the heart of our busy season, we do have where all of our snowbirds come down from January to April. We ride about 60% to 65% Medicare. Outside of the season, those numbers dropped significantly to maybe 40% to 50% at the most. We've been able to change that demographic and diversify that payer mix.
You've been purposeful about it. Thus, where do you get a majority of your patients from? I don't know if you knew your numbers beforehand, maybe 95% of your patients came from physician referral. How has that changed by using social media and whatever else you're using? How many patients do you get from physician referral now compared prior to the hurricane?
I'm going to say pre-COVID because a lot of things changed with that. I would say that from a physician referrals standpoint and in just that small percentage of massaging those relationships, those things didn't change all that much. Friends and family have always been a huge referral pattern for us. That has always been above 50% of our referrals that has held there significantly. Between social media and us going to actual PR events and going straight to the consumer marketing directly to them, whether that be at a gym, a CrossFit box, community events. Before when you could have a race or a CrossFit competition that has boosted up into close to 20% of getting that specific that people are coming into our practice.
This is an additional revenue on top of what you are already getting.
We have to not think about what happened with that, but pre that, we were on a tear. I'm grateful to where we've bounced back. We're in a good place but we were going into that season.
I think there might be a fear out there that if an owner is going to start niching down, that they are going to do so at the sacrifice of the other patients that know, like and trust them. Did you find some of that or did you find that this is simply expanded your scope by niching down?
That was my worry in the beginning. I thought the same way. I thought I only niche and market to this specific 30 to 40-year-old female CrossFit athletes like, “What the heck am I doing?” It expanded my practice. I realized number one, we did have a strong foundation of friends and family, to begin with. That foundation was key. I also think that in doing that and being able to serve that avatar person and serve them so well, they will still recommend their brother, sister, mom, dad, their grandma or grandpa, the other person at the gym. They're going to become your ambassador even more so. The CrossFit athlete has been my avatar, but I would say my schedule, I have with school season and track season starting, half of my schedule is full of cross-country runners.
You might not have seen these people before in the past.
My entire schedule would have been 65 and older Medicare.
Has that also affected your recruiting and the PTs that you've brought on board? Do you have a different type of PT that works with you now?
One of the taglines or hashtags that we use is #AthletesTreatingAthletes. Putting somebody in that space and recruiting a PT or a PTA to treat that caseload, they need to be like me from the standpoint of they live in that world. They talk that talk, they are an athlete, they understand injury, the pain and the mental of, “I'm injured and I can't play. I can't perform.” They've been there. That's hugely important.
You not only niched your patient load, but you also niched your team members.
Some of the successful PTs I know out there like Sturdy McKee, he's got a practice in San Francisco. They won't hire a PT that hasn't played a team sport before. He thinks and their philosophy is that, “If you played a team sport, then you know how to work well with other people to be productive and achieve a goal.” That's one of their criteria. You might not necessarily have people on there that do CrossFit, but they need to be athletes. Is there anything else you want to share about niching down and how it's benefited you and your practice? You have shared a ton of great information already.
Coming from my story in 2015, it was the PPS Conference. I don't know if you were there Nathan, but we did the PPS Conference in Orlando. Gary Vaynerchuk was one of our keynotes. At that point, he asked everybody to raise their hand if they have Facebook. I was one of the five people in the room that didn't raise their hand because everybody had Facebook. I looked around and I was like, “I'm proud of this. I don't need that stupid Facebook. That's a waste of time.” To go from being that person to now seeing how powerful and utilizing this tool, it goes to show that if I can do it and use it to niche and build my practice, anybody can. Anybody that wants to do it and has the intention to do it, you can do it.
It takes work and you have to set aside time specifically for it. If you don't, it's going to easily fall through the cracks of your “busyness.” I'm sure you schedule the time, make sure you hit it every day. It's about consistency when you're talking about social media.
It is my habit.When you're putting stuff online, just give value and entertain people. Click To Tweet
Do you post every day or do you post three times a week? What's your schedule?
If I count Instagram, Facebook and LinkedIn separately, including posts and stories, we do close to 100 posts in a week. I would like to even do more, but we didn't start that way by any means. This is building. We started with one post a day to multiple and multiple people doing it and posting stories and all of that.
It is cool to see how you've grown and used social media to your advantage as an owner, especially among physical therapy owners. I don't think that's utilized as much. Our profession is usually about a decade behind everyone else, so it's cool to see how you've used it, and thanks for sharing. If people wanted to follow you, what are some of your social media addresses?
Instagram is @ApexPhysicalTherapySWFL and Facebook is Apex Physical Therapy. Those are the two places that are the best to find us. It's Apex Physical Therapy on LinkedIn or me as Angie McGilvrey on LinkedIn as well. Thank you.
Is there anything else you want to share with us, Angie, before we sign off?
When you're putting stuff on there, give value and entertain people. That's what I try to do is give them as much value, think about what they want and entertain them. That's what has made it successful on my end.
It doesn't seem like they necessarily want to know all about physical therapy and every injury. I've had clients who have posted pictures of sunsets and I've gotten more engagement from the picture of a sunset than they did about anything else they posted. It's funny how it works. Thanks for your time and for sharing. Congratulations on the growth and all the great things that you do. I love seeing your posts on LinkedIn. They've been motivational and inspirational. It's awesome to see how you're using it to your advantage.
Thank you, Nathan. It was such a pleasure to be on. I appreciate you.
Physical therapy and fitness is my passion! Leading my team at Apex, we empower athletes of all ages and levels to move better, feel better, and live better!
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Getting patients to enter the door may seem simple but is actually one of the hardest steps PT clinics tackle. Today, Nathan Shields talks to Peter Decoteau, the marketing director at Physical Therapy & Sports Medicine Centers (PTSMC), the largest privately-owned PT group in Connecticut. Focusing on breaking down any barriers that keep new patients from coming in the door, Peter recognizes that the first barrier for a majority of people is simply knowledge - not enough people know what physical therapy is, thus your message has to recognize that. He shares aspects that make these technical such as location, insurance, and those can be further addressed after you've captured their attention. Peter believes that regardless of the steps taken, it is necessary to know what your brand is, who your ideal client is, where they get their information, and the content they need to hear all of which leads you to begin to generate marketing campaigns.
My guest is Peter Decoteau. He is a Director of Marketing for a large physical therapy company in Connecticut. I brought him on because I want to talk a little bit about a couple of things. First, the things that we need to consider as we are advertising directly to our local community or direct to consumer marketing. Secondly, what are some of the things we need to do on the back end, which is number one, how did we get that patient who is interested to convert? Number two, how do we track the KPIs related to our marketing strategies.
Important stuff as we're considering that a lot of our marketing strategies need to spend more time and effort either direct to consumers, via mail, email, or social media and rely less on physician referrals. That's the trend that we're seeing. I'm trying to highlight physical therapy clinics that have been successful at doing it. If you do have a marketing strategy, I’d love to see how yours compares to what Peter represents. Also, if you don't have a marketing strategy, consider some of the basics during this episode that you need to do to be intentional about your marketing efforts to grow.
I've got Peter Decoteau. He is the director of marketing, Physical Therapy & Sports Medicine Centers, Connecticut's largest private practice group. I wanted to bring him on because I saw a past impact magazine article in which he talked about marketing. I'm always open to that and we need to consider marketing outside of the traditional physician relationships. Based on his article and further talking with Peter, I wanted to talk a little bit more about marketing and some of the things that we need to do and look outside of the traditional relationships or things that we're doing. Peter can give us some light and insight into how to make it easier for new patients to get in our door in general. First of all, Peter, thanks for coming on. I appreciate it.
Nathan, thanks for having me. I'm happy to be here.
Give us a little bit of breakdown about you. You're not a physical therapist by trade, you're in marketing, but tell us how you got into this all and your experience with physical therapy.
I came into physical therapy cold. I didn't have any experience with physical therapy personally. I had not gone through physical therapy. It's an interesting experience to come in not knowing too much about the industry. I have a strictly marketing background. I started in a nonprofit in Hartford, Connecticut and then moved onto a private school up in Simsbury, Connecticut. I was an ad agency for a little bit as well. The benefit for me of having those experiences and coming into this environment is that I have a pretty broad breadth of knowledge in terms of different approaches to marketing. The different pieces of marketing like PR, digital or advertising, all those different things that you'd want someone to be doing.
A different perspective.
Working with different audiences. If anybody out there has worked with a nonprofit, they would know that you were pretty much every hat possible there. It was a good starting point for me. I was doing some multimedia marketing for them, but I was also doing some membership relations and some sponsorship relations and things like that. It gave me a good foundation for where I wanted to go next. The opportunity to come into Physical Therapy & Sports Medicine Centers came from working with someone in our leadership group. I was working with her husband at the private school and they needed someone to come in and do a little bit of consulting for some of the digital marketing and social media stuff that they were looking to expand upon and reach a broader audience with. I jumped on as a consultant in that way. I did a pretty extensive audit of their digital presence and gave them recommendations and I was doing some ongoing work with them.Do whatever you can to break down the barriers for new patients to get into your clinic. Click To Tweet
When the opportunity came out for a marketing director to jump on board here, they reached out to me and things were tumultuous at the ad agency. That's a different story. Suffice to say that they don't exist anymore. It was good timing, jumped on board here. I had already been working with the team here. I knew that it was a good fit and I was interested in coming into the physical therapy world knowing that it'd be doing something that at the end of the day is helping people. Not necessarily for me doing the hands-on treatment, but getting people into the physical therapy clinics, especially clinics that we have that I believe do top-notch work. It felt like it was a good industry to jump into.
That's cool that we have you on because you bring a different perspective than the typical physical therapist that might be talking about marketing. I want to ask you, are there some false ideas that physical therapists have about marketing and how it should be done that you have to come in, break down or challenge and change their perspective about it? If so, what might some of those things be?
The number one thing that I've seen, in coming into the industry and being a part of the private practice section committee, is that physical therapists greatly overestimate how much the general public knows about physical therapy. We tend to exist in an echo chamber of our making. In an impact article that I've put together, we're the fish living in this water all day. We tend to think that everybody else sees it the way that we see it. We talk to the general public. You realize that their knowledge about the scope of services provided through physical therapy, the way that you might come to physical therapy, even where their nearest clinic would be or the difference between outpatient and inpatient.
There's not a lot of knowledge in the general republic and that is a matter of messaging for the industry. For the most part, the industry itself was mainly surviving on doctor referrals to physical clinics. Most of the messaging had to happen from the therapists or if they had marketing people, which a lot of them didn't to the doctors and to trust there and build relationships there, which is still important. Given that direct access is something nationwide that came out in Connecticut. The focus should be on pushing forward on self-referrals, direct access, teaching people even what that means and what that is, especially the scope of service that we provide.
Tell us a little bit about that because that leads to our topic as far as how to get those new patients in the door, direct consumer marketing. It’s getting the knowledge out to the broader audience because the stack gets thrown around and I don't know where it was found. I wouldn't be surprised if it's true that only 10% of those patients with musculoskeletal injuries get the physical therapy that they would need or could need to overcome their injury. That means that all of us are fighting for a pretty small pie. If we're focused on the physician referral route, there's 90% of the population out there that could use our help that isn't getting it because they don't know about us. We take for granted that everybody knows about physical therapy or at least some version of it. Maybe they don't understand how physical therapy could help for minor traumas, for simple injuries and stuff like that. Talk to us a little bit about how you work to help those new patients get in the door from the population and utilize direct access.
I love that you use that number. That's a number that our Vice President of Business Development, Mike Durand. He’s been a part of this company and he was an athletic trainer before. He throws that out all the time and says the same type of thing. It's like, "If that's true, which the study shows that's the case, that we're all fighting for that little piece of the pie instead of working together to try to make the pie bigger for everyone." If we're talking about ways that we can increase self-referrals or increase our patient volume with people who are not coming directly from the doctors, is that we first focus industry-wide on our messaging and create a little bit of consistency.
At least acknowledgment to get the messaging out there in a broader sense before we start doing more clinics specific or company-specific messaging, if we do that successfully in terms of having clear, consistent messaging, talking about the benefits of physical therapy as a whole because that percentage of the pie gets broader. Even if there are fewer people specifically knowing about our clinic at some point, all the whole thing grows. We'll be reaching maybe more of a niche audience, but that niche audience is also bigger. Our patient volume still grows.
It sounds like your marketing starts with developing the knowledge-based of the community as to what physical therapy itself is and how you can benefit those people who are having less traumatic issues. Maybe simply low back pain, you're marketing your message is a little bit more knowledge-based and then you add your tag or logo at the bottom? How do you guys go about doing that?
We talked a little bit about this, something that David Straight had mentioned on a previous episode of yours, which I encourage everyone to go back and read it if they haven't. He talks about starting with establishing your brand identity and figuring out who your target audience is. Also, figuring out where that audience is in terms of platforms you can reach them most effectively. We always start there. Once we've gotten to that point, we know who we're talking to, we know who we are and how we're positioning ourselves and we know which platforms we're using. We get to this piece about the intellectual property that we can bring to that, the content that we can put together.
The value to the users or the audience while also educating them on this broad range of topics that we're talking about. That doesn't necessarily have to be broad with each piece of content, but that we're covering a lot of bases in the messaging that we're putting together. The more that the audience sees these messages, the more comprehensive of the picture they get and the more personality they get about our companies specifically. The pieces that I'd say differentiate us from the other clinics that are in Connecticut.
I love that you bring up David Straight's episode one of the few first episodes and you talked about marketing. The evolution of your marketing doesn't necessarily change. You've got to figure out who you are and who your ideal client is? Some people might say, "What is that avatar?" Once you have that figured out and what you do best and what patients you want to work with, then you can focus on, where did those people get their information from? Is it social media? Is it mail? Is it email? Is it postcards? Is it community events? You can focus on the content. Based on knowing who your demographic is, you can structure your content accordingly. To invite those specific people in the door, that's how you would structure your marketing program as you're going direct to the consumer.
In terms of what we're talking about with getting people into the clinic, educating the public both on an industry level and then on company or clinic specific level. What we're talking about is breaking down the barriers of entry to the general public. This piece of it that we're talking about is the barrier of knowledge. It's a general knowledge barrier that people have for physical therapy. What are the things that we can do that breakdown that knowledge barrier in a general sense of the benefits of physical therapy? That specific level of physical therapy can help with your recurrent back pain that you might not need surgery for but keeps you up at night. Here are the ways that our clinics specifically can help with that because we offer dry needling. We do hands-on therapy. We focus on the manual. We are closer to you than the other clinic. There are these other things that make us a better option for you. We can start from that broad sense and get more specific as we continue to try to reach that audience in the way, read the messages that resonate with them.
If you look at their websites and some of their content, they might focus more on the treatment they provide instead of the benefits they can provide to the patient. As we're talking to ourselves, we know the benefits of say, dry needling or some manual therapy technique but that's not what you want to highlight and advertise. You want to get down to their knowledge level and also, what's important to them, which are their functional capabilities and how you can improve those and focus there. What you provide is off to the side. This is how we do it. If you can simply get them to buy into what you're doing to improve their lives, you can talk about how we do it later on.
Our motto is improving the quality of people's lives. That's the thing that we always go back to because we do say that PT in general if you're going to a good physical therapist, that's what they're doing. They're improving the quality of your life because you can sleep throughout the night. You can pick up your grandkids. You can play rec league soccer on the weekend, which I do. I've needed to go back to physical therapy for that specifically to get me back out on the field. Those are things that provide quality to my life or somebody else's life that we're trying to get you back to. Starting at that point and then getting more specific.
I like to think about it and you talk about a marketing funnel, getting people down in the funnel and then wondering where do they go once they convert? I made up in a previous position. I tried to visualize what it looks like to me after they've converted and put a little bit of a tornado in the middle of the following, say, "If you've created the awareness and then you're getting to the point where the people exist in the middle point." Especially with physical therapy, which you want them to be aware of the fact that you exist and you have these benefits. Maybe that person doesn't need physical therapy but you want to be there for them when they do need it.
You want them to exist in this little middle part of the funnel that's like a little tornado of information that they can keep on receiving. How can we keep them engaged? How can we keep them interested? How can we get new little tidbits of information to them? That's the way that I like to think about it. The content marketing that we're doing that we are getting people to that point and then staying in front of them with all this relevant information that speaks to both the services that we provide, but also the personality and the differentiator points that we offer. When you talk about something like dry needling, you're right, we're not going out there necessarily promoting dry needling to the general public as a selling point for us.Reach the audience by reading the messages that resonate with them. Click To Tweet
Once you're engaged with us, we'll do videos about dry needling and talk about the benefits of that and show you what it looks like. I had the barrier to entry for that would be thinking that it hurts. Can we show you in a video that we're dry needling, someone and they're not reacting to it at all? We did a video with one of our clinicians. She specializes in temporomandibular dysfunction. She dry needled two parts of one of her aide's phases. We'll first show the type of treatment that you would be offering, but also, ancillary it showed that it did not hurt her at all. The more we can bring that type of content into the fold, the better.
As you consider breaking down the knowledge barriers and providing them what they need to know about physical therapy and how it can help them? Do you have a secret sauce when it comes to getting that conversion? If they call and they want to utilize direct access and come to you without going to a physician, what can you share about how you get those people to convert and become new patients?
I wish we had all those answers because that would be fantastic. That's something that we're working on daily. I talked to our operations people and our employees as much as I can about the things that we should be doing that are consistent. I see that as two separate things. One is the functionality of getting them to convert. The other is the interface with our employees when they're interacting with them on the phone or when they come into the clinic. The functionality piece is, we try to optimize everything we have. Everything that a potential patient might be interacting in a way that again, breaks down the barriers to getting them into the clinic.
For example, if you're someone who doesn't have any relationship with PTSMC in the past, and you probably maybe even not had a relationship with physical therapy in the past or you've had a bad relationship with them, which is something that we hear sometimes. What's the information that you're looking for? How are you looking for it? How can we get it to you faster and easier and more effectively? How can we make it easy for you to book an appointment? Ideally, what's happening in the person's thinking, "I need physical therapy." The doctor said, "You need physical therapy." I'm going to tell you to find your therapist, which happens more often. They go to Google, they search for it. You come up, they go to your website, they're looking for maybe, do they take my insurance and do they offer the treatment that we're looking for?
We know that those are two things that people are looking for most often than not. Are you getting them to the right page initially? Is it easy for them to find that information? Once you've given them that information, how easy is it for them to book an appointment? The way that we have it set up for us, our organization is that we built a new website specifically with that user process in mind. It's optimized for the user flow. Also, for the SEO flow to the individual pages, search engine optimization flow. On purpose-built out landing pages for every treatment option. We've got that landing pages for every individual clinic so that if you're Googling, "Best physical therapy in Avon, Connecticut." If you do it in Connecticut, the first three things that probably show up are one, a Google Ad campaign that's running for that says best physical therapy in Avon, Connecticut, that when you click on it, it goes directly to Avon's location page.
The second thing that shows up is probably the organic result for that. The third thing that shows up is probably either the maps result or staff result for the same thing. We're trying to dominate the search results there as relevant as possible. When they get to the site, make it easy for them to find that additional information. We have, I believe, two or three conversion points for submitting a request for an appointment through the website on every single page. There are a floating button, a sidebar and a top bar that says, "Request an appointment." Everywhere on the site, it's there, it's ready to go.
Whenever you want to request an appointment, we're ready for you.
Ideally, what would happen is that they would click on that and they'd be able to integrate with your scheduling and requested an exact date and time. We're not there yet. It's somewhere that I would hope for us to be pretty soon. Also, there's some friction in terms of what's available in someone's schedule. Maybe it's available for a reason that you know all about because I'm not in the clinic. It was a little bit of like, "How much can you do there?" You're breaking down those different barriers to book an appointment or they put them to call and they're going right to the clinic that they're trying to.
It's great that not every individual practice owner is going to have a director of marketing like you to handle a lot of the Google Ads, the SEO and stuff like that. What it shows is, we put out some marketing promotional material or an ad, you name it, but in what you've done intentionally is, how can we make this as easy as possible for patients to get in the door and make an appointment and convert? That's a necessary exercise for any owner. That is to say, we put out this ad when someone calls or when we're calling out for a referral, how easy are we making it? Are we forcing them to give us all their insurance information before we answer their question? Are we making them jump through hoops and getting the date of births and that stuff?
Are we more focused on them and maybe what their name is? What their ailment is and how it's limiting their life, maybe establishing that relationship right off the bat. I'm saying there are other ways that you can go about it and it's worth the exercise for owners to sit down and say, "At this touchpoint with a potential patient, how can we break down the barriers?" Maybe they've got an understanding, a knowledge-based. What can we do to make it as easy as possible for them to make an appointment? Everything we can or in that call and I'm sure you're doing it with your calls. You're also doing it with your website. How can we make it as easy as possible for that internet traffic to translate into a visit as well? You can look at those touchpoints and say, "How can we make this as easy as possible?”
You bring that up and that speaks to that other point that I was talking about the interface part of it. One of the things that we try to do, everything I was talking about the functionality wise is called technical side of it. At the end of the day, we always have to remember that we're dealing with people who are probably in some pain or representing someone who's in pain. Not only that, but they have to deal with the pain of going through the healthcare process, which is usually not simple. From that point, can we come to them from a perspective of empathy? Can we make that part of it easier? When they come into the clinic to treat the real pain that they're dealing with, they haven't had to jump through all these hoops beforehand?
Typically, what we do on that end is a lot of different folds to it. I would say that our operations group does a good job of onboarding people to the particular culture that we have at PTSMC. We focus a lot on the differentiator for us being one of the tenants of our mission statement is lifelong relationships. That's a key tenant of that. We want to be known as the physical therapy company that focuses on, we say that the person, not the problem. When we onboard people, we focus on that as a key element of everything that you do when you're working. You're getting people in a database and your scheduling. You're first and foremost, a representative of that philosophy that we have here.
Likewise, we do that with our clinicians too and we have to do that with the front desk people were feeling most of the phone calls. Another thing that we do that speaks more to the marketing side of it is we do a separate onboarding event process with all new clinicians’ call, "Living The Dream," which is they met our president loves to say. We've got to wrap it into that. It's focused more on that what we call the soft skills that you don't necessarily learn in PT school that are related more to that interpersonal piece. What's beneficial for me as a marketing person to be involved in that is again, not knowing that I'm not a physical therapist and I'm not having these face-to-face interactions with them. Giving them some more consistent tools to bring to those interactions that might help the growth of both their client base and the clinic more broadly has been useful for them. Sometimes it's something as simple as always have business cards on you.
When you're discharging a patient, if you think that they had a positive experience, which we think that most people do and our survey scores reflect that, give them a few. You can say, "I'm your person. I'm your PT. Hand this off to any friends or family that you think is dealing with pain and tell them about direct access because people don't know about that. Let them know that you've got a guy and I can get you in as soon as possible." That little intimate touch of saying like, "You've got a guy, here some cards, and bring other people into the fold." It both allows you to get that word of mouth out there for the referrals, but also, it puts the value into their hands that they've got a connection that they get to reveal to people who are in their circle enough to take advantage of. We do small things like that.
As you're Looking at some of these efforts that you're putting out, are there certain KPIs that you follow to see if these are being effective or not? You brought up Google Ads or SEO costs, how do you measure KPIs or ROI on some of these things?
I tell partners at all the different clinics and this is my number one byline to all of them. My job is to get people into your doors. That's the ultimate thing that I do. If all else fails, if we're getting more people into your doors from a marketing perspective, then I'm doing my job. Their job is to provide world-class physical therapy care, so that people want to spread the word and come back as return patients. Let their friends and family and colleagues know and all that stuff. We do a lot more than that in terms of supporting brand awareness within the clinic and supporting the clinicians to get out in the community. The number one KPI for me to answer that question is that if we're getting more patients into the door, either self-referred, returning patients or referred patients, then that's the number one KPI. In terms of tracking the performance of individual campaigns that we're running, it's a lot easier to create KPIs and track them when it's coming from a digital campaign. For Google ads, you can track the clicks through to the website and the conversion rate from those clicks.PT clinics must remember that they are dealing with people who are in pain or sending someone in pain. Click To Tweet
There's direct percentage of saying, we have a little bit of an equation that we use that's like, "If we're spending $300 a month with this clinic on Google Ads and we're seeing six conversions through that ad campaign because their phone calls and requests through the website, we're going to estimate that only three of them are coming in. What are three patients worth in the life cycle of a patient coming for ten treatments?" The average is nine or ten. That return on investment might be $3,000. We can say those numbers of conversions and the percentage of click-throughs and say, "For that ad campaign, we're getting a ten-time return on investment of those numbers." You start to look at that and say, "How can we get those percentages higher? How can we tweak the campaigns?" Those are the types of KPIs that we start to focus on in terms of like, "We want to get more conversions through that, how can we do that without blowing out our whole budget?"
What's a percentage of return that you're expecting typically? What is the sweet spot for you at least this number and above?
We tend to see it. It works out well because we have the 25 clinics, soon to be 26, where I built out from the start a few ad campaigns on Google and optimize them as much as I could, knowing what our budget was going to be. I pretty much copied them and duplicated them down, changing the location information in the contact information. We're working off of these few optimized ones. We're the good month for one of them, we might see a 10% conversion rate, which is pretty good. Typically, we're probably seeing 4%, 5%, or 6%, which is still pretty high I as an industry average, which is good.
You work with a large company and you had soon to be 26 locations, what would your recommendation be for a guy that's only got one or two locations? He can't bring on a full-time person for marketing, maybe has room for part-time to find somebody or maybe as needed for a campaign. How would you recommend they go about looking for marketing help or doing it themselves?
I always say to start with the low hanging fruit. In this case, if you had to pick out two people who are your ideal client personas whether those are based on payer mix. Maybe you have enough volume, but you want to get volume from a higher payer or payout. Maybe it's volume focused specifically. What's the low hanging fruit in terms of the people that you know or in your area that need PT who aren't getting it or don't know about you? Start with the groups that you would most like to reach as the low hanging fruit, easiest people to get to. Figure out where they are and be specific about what you're doing in terms of the platforms that you're using. One of the things that I tend to see, and I saw this at the ad agency too, that we would bring on clients who wanted to do everything.
They were only working with the small budget or maybe it was a small organization we were working with. We dealt with a lot of that and nonprofit because nonprofits don't have a lot of money for marketing. You want to do a little bit of everything. You want to chase every new trend and you want to be on the TV and get the print ads and also do the social media thing and do the Google thing. It's important to focus on those audiences and focus on where are those audiences are or those audiences are and be that targeted and specific. It's better to maximize the effectiveness of something efficient in terms of your budget and your resources and time that you can put into. Rather than spread yourself thin and maybe see success at a few of those different things which are using up way too many resources. Be specific.
You've brought up a couple of things. Number one, be specific. Focus your marketing efforts on something and focus on that only instead of trying to hit every button out there. You also brought up something else that it's important to bring up in that is most small clinic owners don't necessarily have a budget. Number one might be figuring out what your budget is for marketing or this campaign, and then set that money aside and limit yourself to that budget and see what it does for you. Make sure you're measuring it appropriately. I brought it up with David Straight and I also brought up with Neil Trickett. What your budget is for marketing can vary wildly simply because if you're a startup and you're new. You're opening up a new location, while you want to put more money aside for your marketing purposes and may be up to 10% of your gross revenues if necessary.
Whereas if you're going along and you're nice and steady, you've got a reputation, you've been around a long time, maybe that number pairs down to 3% to 6% of your gross revenues for marketing. Number one, come up with a budget first. I like what you said, "Focus on what you want to do." How do you focus while you focus on where your demographics are? Who do you want to hit establishing your brand identity? Who's your typical patient, the ideal patient? Focus on those platforms with that predetermined budget. That budget can allow for maybe bringing someone on as needed to fulfill that campaign for you or doing it yourself if you have the capability of doing so.
I'm in a unique position at PTSMC because the way that the partnerships operate is at each clinic technically has its individual budget. We all have things wrapping up into a broad marketing bucket budget for us to work with for the most part. I have to have these conversations with each partner at the beginning of the year and then in the middle of the year when things are rolling out. The piece about, how much are you willing to spend to maybe test a couple of things out to see what works? How much are you willing to spend on things that we already know works? What's that breakdown look like? An important piece of it, what are you doing to drive organic results as well? Things that don't require too much of a budget and that's when we get back to this knowing the language to talk about self-referrals.
Having the knowledge and the language to use in talking to patients to tell them to talk about you're going on in the community or leave reviews on Google, leave reviews on Facebook, things that you know have a pretty high yield do anything asking for those things. I was talking about this piece of patient interaction that's called the point of delight. It's a marketing term that speaks to this point where people, I've received great service and they're looking for a way to reciprocate. Especially when it comes to physical therapy. They may not be paying too much for it. Hopefully, their insurance company's paying for it.
Maybe there was small copay, but they don't feel like in terms of the monetary interaction that's happened, that they've necessarily reciprocated for the service that they've received, especially if you're building a relationship. That is trustworthy, caring, they feel like they need to do something to make it up to you. Catching them at that point and saying, "Would you mind leaving a Google review or going on Facebook and sharing some of our staff or I would think most value telling people about us." That's free advertising for you. Having the language to do that, it doesn't require any budget, once you get that point if you're doing those things and you want to continue to grow and expand your patient volume, yes. How much are you willing to spend? Are you willing to test out a few different things?
Not spreading yourself thin, but you did the research, you looked at your analytics, you know that they needed the demographics, they're trying to reach out to you. This is where they are. Let's try a couple of different AB tests and see if we can track results there. Also, having the tracking measures in place to know if it's working or not because I've seen a lot of that too. Where it's like, "We're doing the social media stuff or the Google stuff." It's like, "How are you tracking performance on that? What does success mean to you there?" "We want to see more patients." Like, "Are you separating them and tracking them individually to see that this one's working, this one's not?" It's having all of those points in place before you start rolling things out.
It's important to ask the question, "Do you want to try new things or do you want to continue with what you're working on that will determine your budget?" You're going to spend a little bit more, but you don't want to forsake the stuff that's you've got going already. You want to continue doing what you're doing and then if you're going to do something new, make that an add on so you can see the benefit of it. You have to be intentional about that and plan those things out.
Don't be afraid to cut off the things that aren't working. We saw a lot of that when I came on board originally. We have relationships that had been going at certain clinics, whether or not they're community relationships where we pay $1,000 to be a part of this event. Also, print relationships where we have a monthly percentage of the budget going to these print ads for these smaller local publications. I'll see value in those things, but typically it's not that top-level value. I see a lot of value coming from people reading the paper and seeing the admin like, "I should go to physical therapy." For me, is there a way to leverage that relationship? Can we talk to the sales rep or the smaller publication?
Usually, it's a small staff to leverage the consistency of advertising into actual news coverage? Those things have a value that you might be able to parlay your investment into it, unlike a regular basis. For the most part, you come in and you see that we're throwing a few thousand dollars a year at this print ad stuff and we haven't done any of those relationship pieces. They're expecting it to keep on coming in and you pull the plug and talk to the clinician and say, "Do you know if you're getting any new patients out of this?" I would say, "Someone mentioned it to me one time. I don't know." We'll try to create some metric for measuring success there, but if we don't see that in the next twoReviews are reciprocations of the services clients receive. Click To Tweet
Move that money somewhere else that's more effective. Anything else you want to share with us before we take off, Peter?
I'll say one thing and this is a call out to all physical therapists out there, whether or not they have a marketing team or if they're small staff doing the marketing for themselves. I'll push this again because we talk about it a lot at the PPS and APTA and all this stuff. For us, a rising tide certainly lifts all boats. We as an industry, do have a great opportunity to take advantage of the huge percentage of people out there who need physical therapy but aren't receiving it. Also, for some reason aren’t getting the information about the benefits of physical therapy, the scope of services that we have. The ways that they might be able to bypass whatever healthcare system they were working within using referral direct access to come straight to your therapist in ways that that might save you time and money.
If we can be more consistent in not being necessarily self-serving on a marketing side to talk about, we're the best all the time. Let's talk about physical therapies the best because it's a part of a healthy lifestyle. If you commit to it and if you build a relationship with the physical therapist in a way that you might have a relationship with primary care doctor, attendant or anything like that then. Down the line, first off, that's a longstanding relationship that you have. Also, that person's going to have a healthier lifestyle and be able to maintain activity and stay active in the older age. For me it's more about broad messaging, getting those talking points out there, direct access, the scope of service, and then being specific about what the differentiators are for you. That speaks to your brand identity as you've outlined it.
I love the insight and that you're willing to share some of what you guys are doing. I appreciate that. If people wanted to reach out to you and ask you questions or where you might be doing, are you willing to share some of your contact information?
Sure. I'll share my email, Peter.Decoteau@PTSMC.com. Always feel free to reach out to us on Facebook. You can message us on Facebook. We have one account for the whole company. We try to keep it all tight together.
If people want to check out your websites, you were talking about the Google Ads that you use and how you set things up to allow people to request a referral or request an appointment, what is the company's website?
It's easy PTSMC.com. The individual locations are available there. Hopefully, you'll see in the coming month we're rolling out. This speaks to the idea of breaking down barriers, but we're rolling out an AI chatbot on the site. The goal of that is to get people to the information they're looking for as quickly as possible. We know that people are looking for insurance location or treatment. It pops up and says, "What can we help you with?" If they don't need any things, it goes like, "Here it is." Try to get people to the stuff that they're looking for.
We'll have to check it out. Hopefully, it's already in place.
Hopefully, it's in place and it's all working correctly. If it's not, you can email me and tell me that it's not.
Thanks for your time, Peter. I appreciate it.
Thanks for having me on, Nathan.
Ben has been a member of Teton Therapy since May of 2010. He graduated with a Doctorate of Physical Therapy from the University of Mary in Bismarck, ND and conducted his field work primarily in out-patient settings while in school. During his time at Teton Therapy, Ben has taken many continuing education courses on topics such as Dry Needling, Kinesiotaping, neuromuscular re-education, running analysis, and injury prevention—a topic which he immediately found a passion for and has since conducted classes to the community. Ben quickly applied this vast amount of knowledge to the practice and sharpened his therapy craft. His general interests include water sports, running, outdoor activities such as camping, competing in triathlons, and most importantly spending quality time with his wife and children.
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Dr. Avi Zinn, PT, DPT, OCS, the owner of Druid Hills Physical Therapy in Atlanta, Georgia has been gradually growing his practice with the goal of giving high-quality care to his patients. Since our last episode, he has procured a PT business coach to reach the goals he has for his business. Today, Nathan Shields checks in with Avi to see how it's going so far, what he's learned, and his experiences since they last spoke. Discover what Avi has learned and the traumatic experience that challenged him as a young owner.
This is episode two of my reality podcast episodes with Avi Zinn, tracking Avi's relationship that he's developed with a coach and consultant over the past few months. If you haven't read the episode, go ahead and do so. That'll give you an idea of where we're coming from because that was prior to Avi starting his coaching. In this episode, we want to focus on simply what his initial experience has been and some of the things that he's had to deal with since we spoke. He had some trauma that happened in his clinic and I hope we pay proper respect to the nature of the issue and how Avi got through it appropriately. It was a difficult situation for him and his clinic to go through. Hopefully, we handle that situation appropriately and understand that Avi had to navigate a ton of emotions while also trying to be the leader and a stalwart of his clinic on behalf of his team, patients, community and families involved. This is an interesting episode, but we got a lot out of it.
The Owner of Druid Hills PT, Avi Zinn. If you read the first episode with Avi, you'll understand that what we're doing here is simply tracking Avi's journey as he brings on a coach, a business consultant, if you will, to help him in his business. We shared a lot of his professional story and what he'd done before that point. Correct me if I'm wrong, Avi, you had hired the consultant as of our last episode but hadn't started doing anything with him formally.
Right, Nathan. I can't remember what month, it was a right around the same time. I may have hired them on, signed up with them, but hadn't gotten anything going.
I wanted to follow along with Avi maybe every quarter or so and see what his progress is like. What he's learning from his coach? What's helping, maybe what's not in some of his experiences as he's taking it on. I started asking you questions already, but thanks for coming on again.
I'm glad to be back.
If you want to follow Avi's story and learn a little bit more about him, read the first episode. Since we talked, tell us a little bit about some of the things that you've done with your coach, some of the things you've learned and some of your experiences.
First of all right from the get-go, things started well. Getting all of my numbers in order, taking all the analytics with WebPT. We had all these analytics but I didn't know what to do with them. We took all of our analytics, all of our metrics and put them all on a dashboard so we can objectively look at the numbers and track them and follow them. Right from the start, we were able to see an increase in efficiency, looking at better utilization. The numbers were able to be tracked. From the start of the coaching, it has been able to get me through a lot of not knowing, being able to like, "I see what that is, now I know what to do."
In relationship to the numbers, there's something to it, but there's a thing out there which is measured, improves, measured, and reported improves exponentially or something like that. What you find is as you start looking at the numbers, even if you don't put a lot of effort into improving the numbers, they start improving somehow. The universe starts pushing you in the right direction if you will. It's simply tracking the objective numbers and your KPIs in your clinic. That exercise alone seems to start improving things.
It feels that is happening by having those numbers on the dashboard and looking at them every month and comparing them, we see positive changes.
The cool thing about it is you're looking at it objectively and I'm not speaking for you, but for myself and maybe some other owners, you might feel things are getting better or you might feel things are getting worse. When you look at the numbers, you have the data right in front of you and you know if it is getting better or how worse it is getting or how much improvement you've made. It's good to have that certainty, if you will.
To get back to the question about how things are going. Having my coach that I speak to every two weeks and we talk about the numbers and see what needs to be changed, how could we change, what can we work on. Going back to the first one we did. Talking about The E-Myth originally and a lot of people read The E-Myth but they don't implement it. Having these numbers, the coach and the accountability is allowing me to stay focused and not get distracted by any of the millions of other little things that anything could happen, accomplish or try to affect and change what we're working on.
Considering you talked about accountability, do you feel a little bit of pressure? As you know that your meeting is coming up with your coach that you go, "I need to get this stuff done," whereas maybe you wouldn't have that before?
That's why it's good to have that person. I'm assuming your coach is a physical therapy owner as well or was or something like that. They can relate to, they can talk about the same language and use the same vocabulary. You started using the metrics, started following your KPIs. You're meeting with your coach. Are you doing anything else on top of that?Always look at the numbers and make sure things are going as you want them to, and then go from there. Click To Tweet
The coaching program, there are also a whole bunch of modules that they have set up for let's say patient engagement or internal marketing or all these different modules. Another good thing that the coaching helps with is you're focusing on those numbers, “Let's talk about what we think can help change that.” If it's making sure that we're focusing on not having the patient drop off or making sure we're more efficient and completing plans of care. There are modules for, "This is what works and this is what you can do." There are all those things that I'm working on. At the end of each call, there's the plan of action and then by the next call, I'm like, "I finished this and I implemented that." That goes back to knowing that is coming up. I’ve got to make sure I get all those things done before the call so that I can say, "I've completed that module and let's work on the next thing."
You've got some homework to do in between. As I'm talking to people who are calling me about doing coaching, this is good to have this real conversation. Because when I tell them we're going to meet bi-weekly and discuss what's going on in their clinics, they think that it's just a call and that's it. What happens is you walk away with a ton of homework to do, sometimes even a little overwhelming if I'm not mistaken.
There's still a lot to be done. It can be overwhelming.
There are many things to do where the coach can help you do it and maybe you've experienced this, help you prioritize what needs to get done more urgently or simply prioritize. “Let's make sure we hit this thing first and if you can get to it, that’s great, but let’s focus our energies.”
My coach, being that he is a PT owner, it comes in handy because he can say, "This is what works for our clinic or proven in the program. These are the things that I can see based on the numbers, based on what you're saying, and based on what we're talking about, that this is what you should work on. If it's time management, then do that mount module and work on chunking your time so that you're efficiently using your time and not being all over the place and getting things done more efficiently. If it's patient engagement, then you start working on these things because that's what we ultimately need to get on to help with that.”
In your program, do you follow a step-by-step process? It’s like, “We're going to focus on number one first and we're not going to stop talking about number two until we get to number one figured out.” Are you able to work with them about things that are of a more urgent nature? Say if there's some disciplinary action that needs to take place, talk about disciplinary procedures and how to handle an employee. If you need to recruit somebody because numbers are going high. Are you able to discuss some of those other things as well in place of the program itself?
There's flexibility within what needs to be worked on and what the priority is. There are the modules which are prerecorded videos, you can watch those at any point in time. We have our coach, we have our call, there's module one through however many, but it doesn't mean that you have to start with number one. “Let's look at what does Druid Hills PT needs?” We're looking at the numbers and visits are fine but maybe there's a poor utilization or I say, "This week, I noticed that we are having problems with cancellations still. Let's focus on that. This week, I noticed that my front desk isn't able to collect as much from the patients. How do we change that?" There's room for flexibility and working on what needs to be worked on, not just following step-by-step through the program.
What's a typical agenda for your meetings with your coach?
We get on the call and talk about some positive things that I've been able to change or implement since we talked. It could be anything, focus on starting on a positive note. It could go 1 or 2 ways but so far, I've had enough to bring up that I wanted to work on. Whereas there were 1 or 2 times where I'm like, "I need your help, what do you think should we work on?" A lot of times, I'm like, "This is what I've been focusing on. I've completed that. That's working pretty well." One of the things originally was working myself out of treatment. I got that under control for a little bit. I was like, "I've done that. How can I use my time better?" My coach says, "You can watch module whatever for time management and then talk about different strategies on what to do with the time and how to utilize it better." There's not necessarily one exact structure of the call other than trying to look at what we think needs to be done. We always look at the numbers and make sure things are going as we want them to and then go from there.
That sounds similar to what I do. It usually starts with what were the wins? What are the successes since we talked? What's top of mind that usually there's something that's happened that you want to talk to out and address? If there's not a whole lot there, then typically the coach will have something that he wants you to maybe consider or focus on as well. Maybe it's the next step or it's something that you might not have looked at, “Have you considered this?” There's some fluidity there based on my experience with coaching. Usually, you want to talk about things that are top of mind, but the coach then also can bring in things that you might not have considered at this stage of your ownership. Does that sound similar?
I only know much and that's why I'm doing the coaching. Hopefully, a good coach can do exactly what you said.
I'm assuming you're progressing fairly well towards the goals that you have set forth already for the year and whatnot?
Yes and no. A few things came up and it's been interesting. One tragic thing happened. One of our PTs was killed in a car accident and it's been crazy. That's what could have been a crazy, downward spiral for the business. It didn't turn out that way. It's ultimately because of the coaching and having that accountability. At first, it was certainly a shock and it was something that I never had to deal with. As a business owner, I had to make sure that the staff was okay. I had to make sure that all the PTs, the patients were okay. Some people didn't want to come back and that's completely understandable. Those are all things and dealing with the PT's family and it was overwhelming.
What a difficult experience and I didn't even think about this because you'd shared that with me but to consider what is expected out of you as the leader in this regard. You're not only responsible for your emotions and handling yourself, but you've got to consider the other team members, the patients that you see, this physical therapist's family and that's involved. Maybe any responsibility you have might have towards them that had to be overwhelming. How did you handle that?
I handled it all right. It was shocking. The first week, I was sitting in my office staring at my computer not knowing what to do. I will say going back to the coaching, you had to separate the emotion from it and then still recognize that this is still a business. Not to be insensitive, but the business needs to continue to move on. That alone that was tough to be able to put aside emotions and focus on the business. It felt insensitive, but it had to be done.
You want to honor them and you want to honor your emotions and your feelings. If you're looking at it from a logical standpoint, the business going down doesn't do anybody a service. You’ve got to keep it up and running because you've got multiple families and your community relying on you to perform still. That's got to be a hard position to be and to find the energy to move forward in that path. Sometimes some of these objective measures helped you out along the way.
The objective measures, having the coaching, having accountability, being able to look at the numbers and at the end of the day everything that happened, I had to jump in and treat more and pick up those patients. At the end of the day, having the numbers and looking at them objectively and being able to look at them rationally and not emotionally and irrationally, allowed me to look and see. The business is not doing anything that different, maybe not growing as much as I was expecting and wanting to, but it wasn't falling apart and becoming this downward spiral. Everything was being able to stay stable. We were looking at the numbers and then having that accountability of talking through it with someone and getting a little bit more direction on what could be focused on more than other things that would be helpful had to have been what allowed me to get through that time.
I can't imagine the support that a third party like your coach provided at that time from the business perspective. The support that they could provide you because you'd laid a foundation, a framework of measurements of policies and procedures that we're able to keep you guys going so you can lean on it. It was a foundation. You could lean on this structure that you'd already built, even though it's not quite finished if you will, but you're able to lean on that and maybe give you space to work on your emotions as you were dealing through this issue.
That's interesting that is what happened in that. Maybe we weren't getting this crazy growth I was anticipating or not even crazy growth, just moving forward. At the same time, because there was that foundation, the integrity of the business was there. Things were able to continue without having to get caught up in losing revenue and whatever. That allowed me to deal with what was going on maybe emotionally. Maybe there would be a time in the day where normally I would be super productive, but that hour I sat in my office and staring at the wall or something. That integrity and that foundation created the space to allow me to do that.
What was the therapist's name?
His name is Tyler Wallace.
It’s a tough situation. I honestly haven't come across a lot of that in my interviews. I had to deal with the death of a longtime PTA that was part of our company. She was amazing. She was with me for fifteen years or maybe more. She was a big part of the company, a real light in our clinics every day. She almost became like a sister to me. It's something that I'm finding and it doesn't go away easily even a fellow employee is still working through their emotions in regards to that passing. It's a tough one. It can be hard because the team members become part of your family. Sometimes you see them more often than you see your family. It can be a difficult experience. I have to commend you for the work that you did ahead of time. You’re creating the foundation of policy and procedures, objective measures, and having the coach. It's hard to say what it would've been like if you didn't have those things in place? Hopefully, we can look back and say, "Some of those things we're able to carry you through."
I believe that is completely what did it. This has been something I've been struggling with, not to be insensitive and not to honor the process. There were a lot of interesting things that happened with the business. By the nature of losing a PT, we had fewer PTs, but because we were implementing all of these different practices and trying to become more efficient and focusing on whatever we're focusing on. The numbers were improving at the same time. We were paying fewer payrolls because we had one less PT to pay and we still see the same amount of visits. The PT schedules were more full and we were becoming more efficient. We were having less drop-off because we are focusing on getting the patients to complete their plan of care. You've got two sides of the thing. This horrible thing happened, but in the end, a lot of ways the business benefited from it. It's hard to say that because of the actual situation but that ultimately goes back to the coaching and the ability to be able to objectively look at the numbers and see that these things work. By looking at the numbers, we can not only get through hard times but grow from them at the same time.
From a larger perspective, I don't want to minimize Tyler's passing, but you had gotten to a point where you weren't treating at all for the few weeks before his passing.
That's true. I was down to no treating.
Focused on business, time with your family, time for hobbies. I see it quite often, not necessarily that someone's going to pass, but obstacles come in the way. Whether that has to let go of somebody or personal issues show up as you're making these steps in progression, life is going to get in the way. It's because you have some of these structures in place that make getting through those difficulties easier. If someone does pass away, we've got these structures in place and we're watching the statistics. Someone who we thought was an integral part of our program and a rock that we couldn't let go of. Maybe they leave for greener pastures or for disciplinary procedures or whatever it might be. You come out the other end, things can improve. Whereas in the state beforehand, if you hadn't measured those things and structures weren't in place, then it would have been complete chaos with a lack of control or power or whatnot. You give yourself to whatever happens. You're simply riding the waves, but you're able to have some power if you're able to structure your business and your management appropriately.
Having those numbers, having that accountability from the coach and having the structure, I was talking about in the last episode that we did, my PT, my first employee, she had reduced her hours. She was doing some home health. I started looking and I hired a new PT full-time and then she decided to do full-time home health. I had this new PT and she had this planned two-week vacation before hiring that we all knew about and it happened at the same time. This went from me backing myself out of treating, having three almost full-time PTs to then having one full-time PT for two weeks. One full-time PT and then me going back into full-time treating all of a sudden. After going through all of that and then looking at the numbers, seeing that at the end of the day, we were 20% more efficient with our utilization.
Our bottom line was in line with what we were even with one less PT. It came back full circle in that when you had asked me about, "How did I decide to hire someone on early?" It seemed out of the norm, usually you don't hire on that early because you want to make sure everything is more efficient, 90% full. It came back for full circle in that. At first, after all this happened, I'm like, "I need to start looking for a new PT because I need to fill that spot." That's not the biggest priority because I realize that we can become as effective as long as we're efficient. That's what the coaching and consulting are helping with is becoming more efficient. Ultimately we're doing the same with the business with fewer PTs, which is what exactly what we're trying to do.It is ideal to build a culture and create a string foundation along with striving for business efficiency. Click To Tweet
What are some of the things that you're looking forward to now going forward? You've been through a tough experience that was his passing. What are you looking forward to as you're moving forward? Where are the things that you're working on as you progress through 2020?
The first mastermind, the group with all the consulting, we all get together quarterly. Right after that, I came back and we had this whole meeting and talk to everyone about the company’s vision and trying to talk to the staff also to see, maybe they have some input on the vision. What do they want to see out of business? What are they looking for? How can we all get on the same page as the vision of this company? I've been thinking about that a lot. What is our vision? What is my vision? How can we include everyone that works here in that? What I am focusing on is I've got two great PTs that are working and I'm focusing on them and trying to get a great team, focus on the staff that I have. Try to get everyone to work together with the same goals in mind.
The vision as simply put is trying to help as many people as possible. We want to be there for the community. I'm telling all my staff that I'm doing the coaching and explaining to them that I'm focusing, anytime I come to the office and say, "We’ve got to do this and this is how we’ve got to change things." It's not because I'm trying to micromanage things. It's because this is what we're doing to try to get to that goal, that vision. This is what we're going to do to get there. I'm focusing in on the staff that I have to build the culture and create a strong foundation of not just the business efficiency, but also the team and the culture of our business.
You say that you're focusing on them, focusing on your physical therapists. What are some of the things that you're doing to focus on them?
I had a meeting with the PTs. First of all, I acknowledged that I appreciate their hard work. That simple thing is probably something that doesn't happen often. Focusing on them, meaning they are my employees, but I also appreciate them and I want them to feel like they're a part of this as well. That is something that will help the business. It's not I'm doing it so that they can feel more appreciated. It's more like if we're all here doing this together, we're going to be able to make this thing work a lot better and help more people. Making it known that they're appreciated, not just tell them that you appreciate them, but asking them what they think we can do better. What is it that we're doing that they see from a different set of eyes that would be different, that would help out? I'm one person and there are a different set of eyes on the business and they see it differently. Their opinions are as valuable. Listening to them and trying to gain that and implement those ideas is going to be super helpful.
What a great way to develop your culture and also get your providers engaged and bought into the company by simply asking their opinions like, "What do you guys think? What should we do?" Recognizing that you don't have all the answers, that maybe they could do some things or have some answers that are better than yours. That's a great exercise that you started and you can continue to do with them to start developing this culture that you have in a new company like that. That's a great step. When I'm thinking about the vision, usually I see it as coming from the top down. It's an essential vision for the company but it sounds like you took them through an exercise where you wanted to see what their vision for the company was as well. Am I right? This is something that your coach has taken you through while you got it from the mastermind but your coaches had been following up with you and seeing how things are progressing
Correct, and giving ideas on how to even bring up the topic or the exercise like my coach was, "What's your vision?" I was like, "To be a good business." He's like, "You need maybe to have a little bit better vision than that." I went home and that was some homework. That was one of our coaching calls. It was like, "Next coaching call, I want you to have your vision." I spent the next two weeks, I watched some TED Talks about people, company visions. I read some stuff and created what I thought would be our vision, not just for the company's growth but also what we're trying to do for the community as well.
The effect in the community, the larger purpose, that stuff and how you want to be seen. You have some other mastermind groups that you're going to go to. You'll have your bi-weekly meetings. Are you going to any conferences then as well?
We have another mastermind coming up. We'll see what new nuggets we get from that.
Based on your initial experience, you've only been with your coach for a few months. What would you tell somebody who's considered it or maybe even not considered? What would you tell our audience about your initial experience with having a coach?
I would say that if you haven't gotten a coach yet, you should go ahead and do it. Even if you're thinking of starting a business, I would say it’s probably better to do it even before starting so that you cannot have to fix what is broken, but start on a much better solid foundation having that. Having that accountability and those calls are helpful to have so you can be focused and committed to what you're trying to accomplish because it's easy to get distracted. There are many millions of things that you could spend your time on but are not important. If you need to get things done, you having that coach and that accountability not just to guide you but also to keep you accountable is instrumental in being able to grow the business.
What would you say your ROI so far on investing in a coach? Maybe you do not see it in sheer numbers, maybe you are, but what would you say are some of the ROIs on what you've invested in so far?
I would say numbers are not the easiest thing to see yet, because of all the things that had happened and we're down a PT. We're at the same as far as the bottom line where we were. Everything else is more solid, more a better foundation. As far as the return, knowing that I have someone to fall back on after going through something like this and able to get through it in such a positive and productive way was more worth more than anything. There's no way that I could've gotten through that without having someone else to keep me focused, keep me rational, keep me objective instead of getting super emotional about it.
I'm glad you had that support. Condolences to you, the families and your team. It’s a horrible, horrific experience to go through. I wish you guys the best and I'm glad to hear that you've got some support and it sounds like you guys are starting to get your footing back and moving forward. I'm sure there are things to work through still, but you have some vision. You're starting to develop a culture and you're starting to get back on track.
We're getting there.
We'll stay in touch. I'll follow-up with you again. We'll see where you are at the time but expect huge changes.
Thanks for your time, Avi.
Thank you, Nathan.
Dr. Avi Zinn, PT, DPT, OCS is the owner of Druid Hills Physical Therapy in Atlanta, Georgia. He opened his practice at the end of 2017 and has slowly built it up—transitioning from a staff of one (himself) to a team of administrative staff and treating therapists. He continues to grow the practice gradually. Avi’s main mission for Druid Hills PT is to provide high-quality, personalized care to each and every one of his patients.
Avi has his doctorate in physical therapy from Touro College, and is a Certified Orthopedic Clinical Specialist. He lives with his wife and three children in Atlanta.
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In 2019, Ben Larsen, PT, DPT, co-owner of the Teton Therapy Cheyenne Location, had great goals of increasing his number of total visits per week by year-end to well over 200. Little did he know that by making appropriate, time-honored decisions he would hit well over 300 visits per month come 2020! His path to success wasn't based on a new treatment technique or referral source. Rather, as Nathan Shields and Ben discuss in the interview, Ben hired people that were in alignment and he implemented what he knew he should be implementing (things he learned from his consultants and coaches in the past), and started tracking stats and training his team (future leaders). Suddenly, patients started coming in greater numbers than he had ever seen before and he wasn’t treating most the time! A great story of small and simple actions generating great results.
I'm bringing on one of my friends and coaching clients. I hope it doesn't come across self-serving but I had to bring this guy on because he has made incredible gains. I wanted to talk to him about what he's done and what were some of the specific actions that he took that got him to see such significant gains. From what I recall from the discussion is that nothing new came up. We talk about hiring the right people, having the right mindset, figuring out your purpose, stepping out of patient care, taking control of your environment, all things that can be seen in Ben's growth. My guest is Ben Larsen. He's out of Cheyenne, Wyoming, and making great strides and looking to grow and expand. Hopefully, I'm along the ride with him as a coach but he's implemented many great things and made all the right choices so they can see significant growth and hopefully continue to see it going forward. Hopefully, Ben's story is an inspiration to you as well and it gives you some ideas about the next steps that you need to take to see your goals and dreams come to fruition.
I'm excited to bring on a friend of mine that I’ve known for some time and has become a coaching client, but he's had such tremendous growth. I wanted to share his story and talk about some of the things, especially the successful actions that he's done to double his growth in his clinic. First of all, the guest is Ben Larsen, Co-owner of Teton Therapy in Cheyenne, Wyoming. Ben, thanks for joining me. I appreciate it.
Thanks for having me. I’m excited to share our story and how we've grown this.
I know your story and I’ve had the opportunity to watch you from a distance. If people have checked the previous episodes where I interviewed the Co-owner of your company, Teton Therapy, Jeff McMenamy. He's got a great story starting from working in a racket ball court and starting his physical therapy clinic way back in the day, but he's grown, expanded and brought you on as co-owner in Teton Therapy in Cheyenne but you've done a lot. I want to highlight you and your story and your successful actions. Let's go back a little bit. Do you mind sharing with us a little bit about your professional path?
I went to PT school just like everybody else. I went to a school in North Dakota, the University of Mary. Jeff McMenamy who's my business partner, is an occupational therapist. He's from North Dakota. He was there at a career fair. We talked and it's a funny story. He tells it better than I do. I show up in a full suit and tie and he says, "What do you want to accomplish as being a physical therapist?" I was naive when I looked at him and said, "I want to own my own practice." This is the first time we've talked. At that point, he mentioned how impressed he was with my drive and my determination to expand as a professional. I signed up with him to go ahead and work for him.
I move my way up within two years as a clinical director and then as vice president of operations. In the meantime, I did a lot of training on business techniques and different management techniques through measurable solutions. I got trained in how to run the company from a vice president of operations standpoint. I'd been doing that for several years and he approached me. We had an option to move the clinic down to Cheyenne. He asked me what I thought about doing that and moving my family to a new area. I took my wife and kids down here and decided that this would be a good move for us. We moved down here and opened up the clinic with not knowing anyone in Cheyenne at all.
I put up a sign out by the door that says, “Please call for information and consultations,” a couple of months before we opened. We did a little basic type of stuff to tell people we are coming in town. We opened the door with zero patients on the books. When it hit the pavement hard, it all started with a Parkinson's support group. I met my first patient there. She brought her in. We did a couple of treatments with her. She told her doctor. The doctor was having some issues. She came in for me to treat her because we're getting such good results with her patient. She told her friend, who was another doctor who was having some elbow pain. She came in and I treated her. It expanded from there of initially first treating physicians and then getting the word of mouth out and then expanding the practice.
You've got a nice connection there.
Over the past several years, every year, we've had substantial growth, but 2019 has been a big growth for us. Like most practice owners, when you first start out, you make a lot of stupid decisions and you're trying to fill spots. Your hiring is okay as you're first learning it and then it gets better and better. We've had a complete staff turnover at least once. Within a couple of years, we've brought on some real key players that as we started transitioning people. We've seen significant improvement within the quality of care we're giving first off and then second off in our business growth because of that quality of care. That's been our biggest thing.If your goal is to be completely autonomous, you got to be able to handle everything. You can't just handle the basic things. Click To Tweet
Finding the right people, hiring the right people, and then helping them to expand in their position in and what they want to accomplish as well. As I sat down with you, we looked and it was more than doubled. We almost tripled based upon having the right staff members in place, expanding the right way, following the right systems, and implementing things that have helped. The basis of my story is starting from about nothing, to where we're getting ready to hopefully get into a new space. It’s finalizing some things on that, to where we'll be able to double our space and hopefully continue to expand our practice and provide good quality care for the city of Cheyenne.
I don't want to go gloss over it too quickly. I do want to get to what some of the specific steps that you've taken that tripled your number of total visits per week. Can you share with us a couple of your bad decisions that when you look back on, you’re like, “That was bad, I should not have done that,” or “I would have done things differently?”
When I started out, I had done all this management training. When I first did the management training, it was more like, "I'm doing this for the company." Most people are going to have executives out there who they bring them on, they do the training, and those people are doing the training because they want to expand the business for that particular owner. When you become your own owner, you get this mindset of, "I’ve done that training. How do I want to do this?" You start thinking about how you'd want to do things and trying things that haven't necessarily been tried or tested.
Are you doing things differently than what you're trained to do?
Yes, because you're trying to make your own way. For me particularly, I’ve had this owner that has developed me into who he thought to be that good physical therapy owner. I had some ideas, some preconceived notions that there were some things I wanted to do differently than what we were doing at the other clinic. I stopped implementing some things that are successful in other clinics that bit me hard. I needed to get back to the basics. That was the one thing that if I could go back, I would stick with the basics of the training and implementing the statistics. The things that we use in our business to make sure we're producing and doing what we need to do. That would be the one thing that I go back on that I would stick with the training that I had and move forward with that. The second thing is sometimes we hire out of desperation instead of hiring out of what we need. Everyone's had it where they want a position filled with someone that can fog up a mirror. They walk in and they've got the proper license and you hire them, but they're not necessarily the right person for your company. There's a couple of times where I wish I would have taken the time and done better with the hiring process like we do now and found that key quality person that fits with our group, team, dream, and purpose, all those things. Those two things are the biggest things. One is sticking with the basic technology of managing the clinic. The second one is to hire based upon what we need not just to fill a position.
You looked back on some of those decisions in terms of hiring out of need and I wonder how much time did I lose by finding a person instead of waiting for the right person. We've had instances where it would have been better for us if we had simply let go of the entire team in a poisonous clinic and started from scratch all over again. It would have saved us a year of headaches if we started from scratch. Sometimes it's that distinct in my head that sometimes you have to wait for the right people. I also want to congratulate you. You said you're going to expand. You're looking at a new 6,000 square foot facility that you're going into. I misspoke. You're not only doubled, but you tripled in productivity. Of course, things didn't happen all of a sudden and I know it wasn't like one new provider started sending to you. You didn't necessarily niche out and do anything in particular. As you look back along the timeline, what started this process of growth if you look back a year and a half ago to lead you to the point where you had such dramatic changes?
Looking back, there is a key event that happened that sucked. It was the worst experience of my life. I had an employee that totally went ballistic on me. He was upset about things. It wasn't a good situation. He reported me to the board saying we were doing an insurance fraud, claims that made me decide what type of a team do I want to have and how do I want to foster this team to do what's best for patient care. It changed the way that I hired after that point because, initially, our HR person would contact them. This is particularly with physical therapists. I would say, "Once we get down to the top five, give me their names and I’ll set up some time to interview them."
This time I said, "Who's your top ten? I want to make personal phone calls to each one of them before I even bring them in and talk to them." I laid out everything on the line. I was very open within these interviews and talk to these individuals to try to find the right people for our team. We looked at is this person the right person for what we need? I got down to one particular candidate where there were two that I liked. I sat down and thought this process out. I didn't make a quick decision. I thought about it and what we needed. There was one thing in particular with the one that made me think, "This one is the one we need. She's going to take our clinic to where it needs to go based upon our conversations and what I saw."
With this particular one, I had some hard times with it because the HR person, our VPA, she was leaning towards another candidate. She's great and I totally trust her completely, but I didn't feel right about that other candidate. We were about ready to pull the cord on the other candidate when I said, "No, I feel there's something with this other candidate." I talked to my business partner. I told him what I thought and he called both of them. He felt the same way with this other candidate that we hired. We pulled the trigger on this. She's been one of our best producers because we followed that gut feeling of what's best for the business and for the clinic. That's been the biggest thing for me, looking at things in terms of what's best for the clinic. Sometimes it's not necessarily what's best for me personally, but it's what's best to expand the business and make things work for the team as a whole. When I started doing this and adding additional therapists, I was very upfront with my expectations.
It's a funny story. I have this PTA. We were sitting down at lunch and we were super busy and I said, "I need somebody but I don't know if this is going to be a full-time position. Would you be interested in coming on part-time or coming on as a temp position and then it could go into a full-time position depending on how you do?" During the conversation, I don't remember saying this but she said, "If there is someone who doesn't fit in with this team, I'm going to straight-up fire them." She tells me that. It struck a chord with there that I'm serious about this team needs to be working hard together to get to our purpose, which is taking care of patients.
That's what we need. The biggest key to our success is finding the right team. You've probably seen this as well that when you find that right team, the patients seem to come. When you have that right flow, the patients show up because there's something about it. That's what we've got. In times when we're going to slow down, all of a sudden, we get these boom of patients coming in. It's from word of mouth and it's from people seeing what we're doing. They're happy with the results and sharing it with everybody else. It all starts from that team having that same purpose, working together and working for what is best for the clinic.
It sounds like what you did and unknowingly is try to find people who were in alignment with you. You had the best interest of the company in mind and that goes to show how important it is to have that filter. The company comes first. The owner comes second and then the employees come third. It seems like from your story that you focused on finding people who were in alignment with you. It was cool that you could call Jeff, the co-owner and have him also phone interview these people because you and Jeff are aligned. You two can find the right person who was in alignment with you and that starts creating a culture of like-minded people who share the same purpose, vision and goals. It starts to accelerate the growth process. I've seen it hundreds of times and it happens all the time with people I have on the show.
As you start finding those right people, you start developing a culture. Culture is simply the way you do things at Teton Therapy in your case. People do things the same way. They're saying the right thing, they show the same values, and they treat patients the same way. Not to say that they're the same, but the culture is similar and there's a feeling there that starts to gravitate like-minded individuals to the practice to work with you. That's a sense that patients can get when they come to your clinic. They'll start coming. They'll start returning, they'll start referring friends and telling their doctors. It's almost like you can't stop that as long as you continue to hire the right people.
On top of that is I got to a point where we were doing well in the last part of 2019. We were getting things in but then the next step is that network out. That's when I approached you about coaching because I needed the next step, which was to help somebody get me to the next step. I'm talking about phase one versus phase two. Being an owner is phase one, you're that clinician, you're in there. You’re handling all the day-to-day stuff. Phase two, you're transitioning out and you're handling the business side of it. It comes down to as a therapist, you have to decide. With my two hands, I can only do much to help people.
I can only see many patients, but if I take my skills and my two hands and teach others how to do the same thing I'm doing, the amount of people I can help is unlimited based upon the amount of people I can train. Those people can then expand their hands to help more people. The whole goal of a therapy clinic is to help as many people as you can possibly. You can't do that if you're doing treatment all the time and you have to make that decision of, "It's time for me to transition to do a greater good." Therapist is a great good, but there's a greater good of training others to do it that you can help more individuals. You can help more people.
To go back into your story a little bit, and I don't want to gloss over this because it's important. When we talked, I was excited to work with you because you said, "I've learned all this stuff. I've learned the management technique. I've read the books. I’ve got the training. I know what I'm supposed to be doing but I need someone to hold me accountable." I remember that sticks out in our conversation that we had back then. As we started training, you recognize that you need to do less treatment on patients and get out of the full-time treating.
I hope you don't mind if I share but then you got Bell's palsy. Physically, you were not capable of seeing patients anymore. Correct me if I'm wrong, that was a turning point where you were able to step back and see what would happen if you physically weren't present and recognizing that, "Now that I’ve got my head out of treating patients because I'm forced to at this point, I can see the things that I can do." Whereas, when you were treating patients, maybe you didn't have a clear vision. It seems like you had to go through that experience to see that.If the game's easy, it's not worth playing. You've got to have a harder game. Click To Tweet
That was a big part too because at that point, we’re almost 100 less visits than what we're doing just within that last time part of starting this process of the coaching and me stepping out. There's part of you that thinks as a therapist that if I step out, this clinic is not going to do as well. You figure you're going to lose visits. You'll never be going to hit an all-time high unless you're sitting out there treating patients. What I found out was my mindset changed of we're not going to hit an all-time high unless I don't see patients. I can't see patients or we're not going to hit it an all-time high. I have to be doing other stuff. I can't be out there on the floor.
If I am, then my time is not being used for more of that working on the business as not working in the business. That's been a big change. That's been something that's been working with you, working with Jeff. Because we all have that sense when we stop treating patients, it's that timeframe of what do I do now? How do I make this productive? How do I continue to grow the business when I'm not the one who's doing everything? It's a big mindset change and you do need somebody to hold you accountable because if you don't have somebody to hold you accountable, you do find yourself very scattered. What do I do? You find yourself gravitating towards getting back on the treatment floor again, which is not where you need to be.
That's the easiest path and that's what you know. You spent the last 30 years studying to become a physical therapist. Naturally, if you have some free time, you're going to go with what you know and treat patients, but you've got to pull yourself back. It takes a mindset shift. I see this with my coaching clients. There has to be a change in the mind and it doesn't happen immediately. It usually happens over time to the point where they recognize that, “I can do more for the business and for my team, my other providers, my front desk members by not treating patients and focusing on the business to give myself freedom, the bandwidth, the mental freedom and the energy to work on it and make it a better place for my team. Make it a better place for the patients that come in the door and be a greater influence in the community.” It's that mindset shift.
I look at this with my kids. I don't want them to be as good as me. I want them to be better. I want them to do things better. I want them to not have to deal with all the mistakes I have and had to deal with. I don't want it to stay the same. Within the physical therapy profession, I don't think we understand what physical therapy is going to be like in 10 to 15 years. It's going to be different in the way we approach things, the way we do things because we are constantly growing and improving this profession. As business owners and private practice owners, we've got to be at the forefront of training our therapists to be better than we were as therapists. Giving them our basic knowledge and then letting them expand that so that we can continue to expand this field. If our goal is to be completely autonomous, we got to be able to handle everything.
We can't just handle the basic things. We've got to be able to handle everything within the musculoskeletal system and the realm of physical therapy but always pushing those boundaries. That's why, you and I, both involved within hands-on diagnostics because that's what they're doing in Measurable Solutions and another company I'm part of because that's what they're doing. You network with those peoples who are pushing those boundaries because that's what we have to do in this profession if we want to see it succeed. That's what you have to do within your business is pushing the boundaries, not stick in that cookie-cutter box that we have been in the past. The past isn't going to get us to the future. It's the present of working and improving our goals, improving ourselves, improving what we do as professionals.
Did you find it was hard to make that mindset shift? I mentioned that it usually doesn't happen overnight but take some time. What made that switch for you? When did you recognize that, I can't keep seeing patients? I want to go back and reiterate what you said since you stepped out of treating full-time your business has increased 100 visits per week since you stepped out. It did it without you. What was the shift that helped you change your mindset?
It's deciding where do you get the most gratification. For me initially, it was treating patients but then as I'm treating patients and as most of us know, when you've been treating patients for a long time, it becomes second nature that you're not thinking about. You're doing a good job treating the patient but you can tell that it's not challenging you. You get to a point where treating patients becomes this easy thing. Some people reading this may say, "I don't think it will ever get that way." It gets to a point where it's not the easiest. It's the easier thing to treat. The more gratifying thing for me was bringing on new therapists and watching them succeed. That's where I get my joy from. When I see my therapist totally handle a difficult case and they come out like, "I’ve got this guy better." That's what excites me.
Watching them do that and giving them tools to do that. We brought on an OT and she's got her caseload up to where she's seeing exactly what she needs to do. She's built this amazing caseload and seeing that was huge for me. That was a happy moment for me of seeing somebody push it and work hard to obtain something that a goal she had. That's where it comes from. You step out to work on a higher purpose of helping others, helping your staff see success, seeing them help people. You're in the background going, "This is amazing what these people are doing and these clinicians." Even your front desk staff and other things and other positions you have. Seeing them expand their positions and helping people, that's what's brings you greater joy for me, particularly. Anytime I’ve had treating a patient, that's a huge success.
You came to a point where simply treating patients didn't meet your purpose. My coaching clients who experienced this are people who are like, "I’ve got other things on my mind." They're stressed and torn. They're like, "I need to see patients full-time but I know there's the stuff that I'm learning from Nathan in which I need to implement in the clinic that I'm not getting to. I'm thinking about the business while I'm treating my patients." It's an internal struggle. For me, looking at it from the outside perspective, it's that internal struggle. The purpose that you had up into that point in treating patients had changed. Even without you’re knowing or you recognize, “I have a different purpose in mind now.” It's that transition from one purpose that got you to where you were to a different purpose that's going to get you further. You have to figure out what that greater purpose is like you mentioned.
For you, it's to create an environment in which other people can flourish and grow either as providers and hopefully in the future leaders within your own company. Be a greater influence not only in their lives but in their family's lives and in the community that you serve. I see that. We talk about a mindset shift, that's part of it. It's also a change in purpose that you have to come to grips with that as you grow, your purpose isn't being met by treating patients but your purpose is different. For you, it was to grow people. For other people, that greater purpose is meant by having more clinics and growing that way. It can be individual. That shift has to happen and you have to find that greater purpose to go to in order to do let yourself stop treating patients.
It's finding your greater purpose, playing a different game. That's another concept that is part of it as well. The game gets to a point where it’s easy and you need a harder game. If the game is easy, it's not worth playing. You've got to have a harder game. You've got to challenge yourself or you don't want to get up in the morning and do what you need to do. It's constantly keeping yourself up to playing a bigger game. Maybe you add more clinics and that maybe our next step is we're adding more clinics. I've got some big goals and we've talked about some of those things. Some of them I look and go, "I don't know how I'm going to accomplish this but we're going to try other things." It seems goals that I’ve had in the past that are coming to pass and seeing greater good throughout the community. We all do this profession because we want to help people. It's not a money thing. It's a helping thing.
That's why we put all this time and energy into this. I learned this from Jeff, my business partner that I can only do so much with my two hands but when I train others, I can do so much more. I can see more good done through my company because of that. Because of me not being the one who has to touch everything, I can now step out. The nice thing too is it's a different game because you can step in whenever you want. You can help out your employees. You can help them with handling difficult situations in the clinic, but you can also step out. You're not the main guy anymore but you're that teacher. You're that leader that helps them to develop how they need to develop to be the high-quality clinicians and the high-quality people they're capable of being.
Looking back on your timeline, much of it is similar to what we see in the other physical therapy owners. The successful ones. You started hiring the right people, people who were in alignment with you. I know your timeline as well. Go over it and you can correct me if I'm wrong. You also brought on a marketing person to help you out and take that off your shoulders. You also had some consulting and training. You've also done some networking. You already did two of the three steps that I always promote in that is you already reached out and got some training because that was part of your leadership development. You were also part of networks. You reached out and network. When I started working with you, we started focusing on that third piece, the stepping out process and getting out of treating full-time.
We started working together. You brought on another front desk person and based on my experience, and you can share yours as well. Around 120 to 150 visits per week, you need a second front desk person. They can only handle so much. You're bringing on other providers. You've gone from visits that were in the hundreds per week to over 300 visits per week. You've got great goals to get even busier. It's important to note that timeline that you started hiring other people. A marketing person was beneficial and other front desk person was beneficial. You might say that I helped out a little bit as well, but you made that you made those important decisions after hiring the right people and then you exploded after that.
The biggest thing is we're constantly looking at what's the next hire we need to do because it is growing so fast. This might make some therapists, especially owners on this show a little like, “This guy's nuts, how was he able to do this?” We saw a need. I got to travel to try my caseload by having that intention, having those feelers out within recruiting, traveling agencies, to get somebody on immediately to handle those needs. We're in the process of filling that position with somebody more permanent and then adding more part-time help to offset our schedule. Our biggest issue is space. We don't have space until we get into the new building to expand what we want to. We're expanding hours and looking at other options. That takes into account of, we need to add some part-time help to help with this. It's constantly keeping that mindset of what's the next hire? What's the next step? What do we need to do before we get into this new building? How do we handle that? That's where a lot of my time is spent, being that vision of where we are taking this thing.
The time that you spend is much more intentional looking forward. Instead of fixing what was wrong in the past, you can look forward and look, "At this current growth rate, we need to hire another person. We need to find this person." Looking ahead, you can do that simply because you're not treating much if not at all. You're able to intentionally find those right people and take the time it takes to find the right people. There's so much value in that. As you were treating patients full-time, did you foresee that you could fill up your schedule with all of this administrative/executive work? Were you at the point where you're like, “I don't know what I would do with my time if I wasn't seeing patients?”
Initially, you think that the concept of “What am I going to do with my time if I'm not seeing patients?” Once you step out and you start filling it in with executive functions, you think, “How did I even run this company by treating patients because I’ve got some stuff to do?” What it comes down to is once you stop treating patients and you see all the balls that you're trying to juggle that you weren't juggling. You claimed you were juggling but you're not. You can't because you're so focused on patients or you look in your like, "That visit was okay with that particular patient but I don't feel that my quality is up to par where it needs to be." When you focus on those things, you realize that I can't do things halfway for one thing and be okay doing it halfway for another thing. I've got to be fully focused on one thing. I can't have two things that I'm trying to focus on or I'm not going to be focusing on anything.Help patients start the process, change the things they need to change and stop the things that are preventing them from getting better. Click To Tweet
If you're focused on two, it's going to go all over the place. With that being said, since I have the time to handle the executive stuff, when there's an issue on the floor and I do need to see a patient, I'm focused on that patient. I know I have the time to handle the other stuff later. This is a part-time thing of me helping out as needed. It helps me focus more because I know I'm going to have the time on the back end to handle the business stuff, to handle the administrative stuff. I'm okay to focus on this patient. I can focus on the administrative stuff because I have that time. When you're treating full-time, you don't have that administrative time. It's always in your head, "I'm not handling this." You're swimming trying to make it and you don't. Eventually, you start drowning and you're like, "I got to handle this." It's a big mindset change but once you make it, it's so freeing. You free yourself up a lot.
One thing that the audience doesn't know also is that Ben is good about having weekly team meetings with his providers and the whole team, not just the providers of his clinic every week. One thing that sticks out to me from our past conversations that is a conversation that you had with them about control. You could see that the numbers were slipping a little bit, whether it was arrival rates, the number of billing units they were billing per visit or the efficiency of care and noticing that people were dropping off. I don't know what triggered that but as you're watching the statistics, they had dropped a little bit. You felt like the need to address the providers about control. Tell me a little bit about that story simply because it's important to give owners and leaders some of the verbiage or ideas to talk to their teams about being in control of their positions.
We get very complacent with things and we try to make ourselves okay with issues in the clinic being okay. For example, so-and-so didn't come in because they're sick or we had a downturn of visits because it was snowing. We can always find excuses for why things aren't happening. Not necessarily, my teams are good about taking control and handling things. They do a great job of taking ownership of when things happen and trying to solve issues. We all tend to do this when things start slipping, we start making excuses and we start figuring out, we can't control this and that. It came up to discuss what the term of control meant. We’re discussing with the team saying, "Let's define control as the ability to start change or stop something. Let's stick with that as our definition of control." I said, "What can we start? What can we stop? What can we change within our patients?" Define that and saying, "What we have to do is control the things we can control and then we'll deal with the other things as they come up." When you look at illness, weather, and all those things, those are minimalistic on the ability of a patient to come into treatment. Most of the time, why a patient won't come in is because there's some other internal reason they're not telling you.
They're claiming it's an illness, weather conditions, a work issue, or all these other things, but most of the time, there is something else going on. A patient is not committed to the treatment plan. The therapist doesn't have control over the treatment plan. Pushing that on the therapists of saying, "You need to control these patients. They're coming to you to be able to handle this situation. You need to be able to help them start this process, change the things they need to change and stop the things that are preventing them from getting better." That's what our focus is. If you're not able to do that, sometimes you have to have hard discussions with the patient. Maybe therapy is not the right answer for them at that time. Maybe tweak a couple of things, get them recommitted and then you've got a patient who's making progress with therapy. That was the biggest thing I talk about with them is making sure we're handling the patients. Making sure that we're getting those things done that the patients need so that they can handle their condition. My therapists do a good job. Our percent arrival rates stay above the 90%.
They do a fantastic job of getting their patients in and committing them to their treatment plans to a point where we have them sign a document and that first part of their treatment is saying, "This is what our plan is. We want you to complete this plan. Please sign this if you're in agreement." Most of them are signing, they're excited, and they’re ready to make these changes. That's the biggest thing when those stats come down. It’s looking at what we can control and focus on that and not focus on the things you can't control. You can't control the weather. We'd like to. You can control how you're treating the patient and helping that patient to see the value of physical therapy. You can work with that patient to make sure that physical therapy becomes a top priority. You can also have those discussions when a patient is not doing what they need to do of it's time to have those tough discussions and physical therapy is not right for them at this point. Maybe you need to part ways. There are definitely some difficult conversations you have to have, but you also have to be willing to do that to control your situation.
As you're talking about it, I love how you defined control and you put the patient's plan of care in the provider's hand. They need to follow up but they also have to be bought into what the provider is selling. Would you go so far as to say that if those numbers are coming down, if the arrival rate is poor, the patients are dropping off and not completing their full plans of care, if they're only coming in one time a week, hit and miss that maybe the provider isn't fully in control of the patient care and they're leaving it up to chance?
That's a big thing and that's an issue that we have within our profession. We tend to get complacent and feel that way of, "I can't control this patient, so move on to the next one." That's where we have to stop and say, "What could I do to better sell this patient on treatment? What do we need to do differently? Do we need to do some more testing? Do I need to have a second therapist look at this person and see if there's something I'm missing?" It brings in that whole team approach of what could we do to make this experience good and to help that patient get better. It's funny because we've done surveys.
Most patients say the reason they liked coming here or they like coming to physical therapy, getting better is low on the list. The first ones are experience with the therapist and how much the therapists cared about me. All these things are more important to them than getting better. When you foster those two where you're focusing on the patient experience, that ultimately gets them better than any physical therapy skill you can put on them, it doesn't matter as long as you're giving them that high-quality experience. You're making the time. You're showing them your vested in this and getting them to be vested in their health, that's what gets them better.
I totally believe that's true. Many patients don't know what quality therapy looks like or feels like. They're coming into it as a blank slate. The experience you provide them is going to color so much of what they know about physical therapy and not necessarily the techniques you can provide. There are many different techniques that can get people to the same place. Your skills only add to the experience. The better they are, the faster they're going to get. Fundamentally, it comes down to developing a solid relationship with the patients. Getting that buy-in to the plan of care and providing a positive experience for them, which I would assume is focused on improving their functional capabilities.
As long as you've bought in and in control and not saying, "So and so didn't show up, he's not going to get better. Leave it at that.” A therapist that's in control is going to get on the phone and say, "What happened? We agreed to a plan of care that will get you better. I can't guarantee that you're going to get it better if you don't follow it." Instead of the therapist that forgets that so-and-so fell off and two weeks later says, "What happened to that guy?" Being in control shows up in your statistics as you're measuring them. If the therapists are in more control, then you're going to see a better arrival rate. You're going to see you more completed plans of care, etc.
It's great when a patient gives you cookies and all that stuff. That's great and you know that they liked you. One of my patient was on the final day and this particular patient turned to the front desk and said, "I feel like I'm leaving a family." That's the mentality you want in your clinic. You want them to feel like this is a place that helps them get better. This is family, this is a place they can come to if they have issues. That particular patient would have happily come back if they needed it or they're telling all their friends about it. That's what you want. You want to create that family atmosphere that's light and fun, the patient's getting results, everyone's high toned and well personally. That's what you're trying to foster in your clinic. When you can do that, the success comes.
It was cool that you recognize that based on some of the statistics that you had been tracking and recognize that this is what my providers need to hear. I know that your statistics turned around within the week or two after that in huge uptick because they started to take control. You couldn't have done that if you hadn't been tracking your statistics regularly. Ben, I know we can go on forever but I want to thank you for taking the time, especially as busy as you are. You have more free time to do an interview like this, which is cool. Thanks for sharing your insight. As I said on our coaching call, "I’ve got to have you on." I forgot you tripled your visit totals per week. I was like, "I’ve got to have more people like you on." That's why I interview people like you. It's because there are plenty of successful actions that other owners could gain from. Thanks for coming on. I appreciate it.
You're welcome, it’s a plug for you. Nathan, as a coach, has been extremely helpful for me, giving me that accountability. It's taken my mindset from where it was before is, I got be in training to catching the vision of why I need to be out of treatment. Sometimes you need that outside person looking in versus those people who are involved in the day-to-day. That outside perspective helps. A big part of the reason why we're doing this well is because of the coaching. We talked about the consultations stuff that I’ve had with other companies as well, particularly working one-on-one with you to look at the statistics and decide how do we improve this. We've seen my goals have been met. The first day we talked about getting me out of treatment and doing that over a six-month timeframe and we're already there. It's verbalizing those goals and then having someone to keep you accountable for is important. Someone outside of the business who's not caught up in the day-to-day side of things, that's key. I'll plug you every day because of that because you've helped turn around this business for sure.
I love to hear that and I appreciate it. I get so excited after all of our calls and share it with my wife like, "Ben is killing it. It's exciting to work with him." Thanks for the plug. I appreciate it. If people wanted to reach out to you for whatever reason, are you open to sharing your contact information?
The best way is email because I'm not the best in answering the cell phone. My email is BLarsen@TetonTherapyPC.com.
Thanks for your time, Ben. I appreciate it.
Ben has been a member of Teton Therapy since May of 2010. He graduated with a Doctorate of Physical Therapy from the University of Mary in Bismarck, ND and conducted his field work primarily in out-patient settings while in school. During his time at Teton Therapy, Ben has taken many continuing education courses on topics such as Dry Needling, Kinesiotaping, neuromuscular re-education, running analysis, and injury prevention—a topic which he immediately found a passion for and has since conducted classes to the community. Ben quickly applied this vast amount of knowledge to the practice and sharpened his therapy craft. His general interests include water sports, running, outdoor activities such as camping, competing in triathlons, and most importantly spending quality time with his wife and children.
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Are you in a place now where you're struggling to grow and increase your clinic’s cash flow? Host, Nathan Shields, helps you in this new series that breaks down one of his main programs called 180 Days to Peak Productivity. Having been exclusively providing this in his business consulting and coaching to independent PT business owners around the country, Nathan now opens up this seven-step process for you! He shares a general framework that will get peak production and efficiency out of your clinic, leading to greater patient results, revenues, and profits. In this episode, Nathan kicks off the series with the first step of the Peak Productivity Program. Following these steps is what you'll need to make the most out of what you've established and set yourself up for growth in the long term. Pay attention to what Nathan is going to share, and hopefully, you'll find yourself with more profits and freedom!
If you've read my blogs, you know that I've been providing business consulting and coaching to independent PT business owners around the country since about mid-2019. In a series of episodes going forward, I'd like to share with you a general framework or an example of what I'm providing my coaching clients through the work that I'm doing and at least one of my main programs. It's not the be-all and end-all of what I provide and I don't believe it's the answer for everybody. It's simply a good framework for most of my clients that I began working with.
What's the program? It's a seven-step process that I call 180 Days to Peak Productivity. The seven steps include particular statistics or key performance indicators, KPIs, that need to be tracked and improved, programs that are shared and need to be implemented in your company and exercises meant to set and maintain peak productivity standards going forward in your business. Each of the upcoming episodes dedicated to these seven steps, I'll delve into one step at a time that gets my clients and will get you closer to peak clinical production.
The seven steps are not in random order. I purposefully set them up as I did in a sequence that is based on a couple of things. Number one, what is the easiest thing to implement that gets the quickest return. Step one is a free download on my PTOClub.com website. It's all about immediately increasing your revenue in 30 days. Subsequent steps take a little bit more work and they involve more moving parts, namely more members of your organization, yet continue to generate greater returns not as quickly as step one.Making the effort to track and improve this one KPI will result in added revenues for your business (without a single new patient!) Click To Tweet
No matter how well you do in the implementation of my 180 Days to Peak Productivity Program, it will fall flat with your team and it will be hard for you to sustain the gains you make if you don't develop an underlying purpose and establish company values. The importance of both purposes, the why of your clinic and values, how you operate is the subject of a different conversation. I've interviewed Sturdy McKee about purpose. I've interviewed Stephen Rapposelli about values. I interviewed my business partner Will Humphreys about creating a culture within your company. I've interviewed them in the past and I would refer you back to those episodes if you haven't established your purpose and values yet and encourage you to do so. Getting those straight sets you up for sustained long-term growth and success.
I spend plenty of time initially with my clients who have yet to establish those things because I know their value. They are necessary to establish if you want to have freedom and growth in your company. Let's get into the seven steps of my 180 Days to Peak Productivity Program. I'm excited to share these steps with you. If at any time you'd like some help on how to implement these steps or coaching on other aspects of your business, things you're having difficulty with and whatnot, reach out to me individually. I'm excited to share what I've learned with you.
Step one to your path to peak productivity out of your PT clinic is to increase your revenues in 30 days. It's the first step in achieving peak productivity and it gets you the quickest result from your investment of time and energy and gives you one thing to focus on of the many plethoras of things you could do. In fact, if I told you you could increase your revenues by 10% by doing just one thing, would you do it? Of course. If you get nothing else from the other six steps that I'll share, at least focus on this first step and forever. It's a free download on my website, PTOClub.com, so you don't have to take notes. Go to the website and you can download it for free.
The one major result from this step is increased revenues and more importantly, increased bottom-line profit because I would assume that your expenses should stay the same even though you take this first step. You don't have to see more patients. You don't have to do any more marketing. Simply be more efficient with the patients that you're currently seeing. The other result as you go through this and the full seven-step process is that they will give you the financial bandwidth to invest more money and/or time back into you. If you have greater revenues, you'll be able to hire the next team member to take the burden off of you, which will allow you to work on your business more, which will generate more patients and opportunities for growth.
With greater revenues at your current volume, you could hire a part-time virtual assistant to do minor admin work or marketing tasks. You could hire another part-time or full-time physical therapist to allow you to work on your business and give you some admin time. Also, provide you the funds you need to invest in a coach or consultant to guide you to become a better business owner and meet your goals. All of this is to say that increasing revenues open more opportunities and freedom. Freedom to work on the business, to spend time with your family or spend time on your hobbies.
The first step in the Seven-Step process to Peak Productivity and Freedom is a simple one. It will not only generate more revenue but also begin transforming your clinic, whether you're a new or established owner. You have to continue to manage and monitor this first action step and that is to track the average skill units, billing per visit, per provider and by the clinic. I call it Skilled Units per Visit or SUV. Consider the following checking questions. Once you have your patients in the door, are you maximizing your services provided? How would you know and how would you monitor that? Are you and your provider team accounting for all of the skilled services that you provide? Are you unknowingly providing your services at a discount or for free to the benefit of the insurance companies and to the detriment of your clinic?
The answer to these questions is to manage, track and improve your SUV, your average scaled units build per visit. There are four steps to this and the first one is to figure out what your average skilled units per visit build is. You have to eliminate the CPT codes for heat, ice, electrical stimulation and ultrasound if you do those things and focus only on those servers that are reimbursed for skilled services, evals, re-evals, manual therapy, etc. Some EMRs are adept and allow you to generate the report by CPT code and many don't. It will probably be a manual effort for some of you that you eventually will turn over to someone else to do for you, but whether it's you or someone else down the road, it's definitely worth the investment of your time. For flat ratepayers or payers in which you only build one unit per visit with one CPT code, you may have to manually adjust your numbers.
3.0 automatically instead of one if you see a patient for an average of 45 minutes or 4.0 if you see patients for an average of 60 minutes, even though you're only billing one code and so on. You'll have to manually adjust the numbers. Step two is to determine what number is the right SUV for your clinic. Many clinics see patients for an hour. That would put you in the 4.0 skilled units per visit range. If they want to do modalities after the hour and the treatment extends an hour and fifteen minutes because you put ice and stim on at the end of the therapy session, it’s great. That gives you even more possible revenue. The skilled units should equate to the time spent in the clinic. A minimum of 4.0 if it's a 60-minute visit.
If your skilled units per visit average are between 3.4 and 3.6, you should be at 4.0, then obviously you're immediately losing out on 10% to 15% of potential revenue. We saw our patients on an average of about 60 minutes or more and that's expected our providers to properly document and bill for a minimum of 4.0 scale units per visit average each week. Be sure that you are properly, ethically providing and documenting for your skilled services. Most important, don't succumb to devaluing your services. Now, you are tracking the SUV. You have decided what it should be and what is right for your clinic. Step three is to set the standard. That's not only sharing what it should be but also starting to hold the provider team accountable. You know where it should be and you know where it's at.
Looking at the numbers, is there a gap? There typically is and it's usually around the 10% to 15% range. Therapists are known for what I call a compassionate billing out of the fear of overbilling. Overbilling isn't an issue if there's equal stress on proper documentation to support skilled services provided, but it's equally unfair and unethical to underbill for your PT services. It cheats the company and the owner from revenues. It cheats the profession by devaluing your services. All for the benefit of insurance companies who ultimately pay less for physical therapy and thus show evidence for why they should continue to decrease reimbursement rates to physical therapists.Don't hammer the entire team if just one person is an outlier. Handle the situation individually. Click To Tweet
Clinics who track this statistic initially may have an average skilled unit per visit of 3.4, 3.6 or 3.7 range for patients that are present for 60 minutes on average. Improving this that alone 10% to around 4.0 is an automatic increase in revenues. It should be noted that this deck should improve during weeks with high cancellation rates. More skilled services and additional therapy could be added to patient care for their benefit should the patient before or after them not show up or cancel. If there is a gap, now is the time to set the expectation with your providers. Start tracking the stat and push production to meet the expectation. This requires getting the team buy-in either via one-on-one meetings or during a regular team meeting in which you can explain the value of maximizing skilled services for each visit.
I would refer you to an episode in which I interviewed Arlan Alburo. He discussed the thirteen-step process for getting team buy-in. Look back to that episode and use those thirteen steps to your benefit to get team buy-in with a successful implementation of this program. Ideally, this new program and expectation will then be put in writing as part of the physical therapist and physical therapy assistants' job description and then provide providers in the future a standard going forward. We're tracking the statistic, we know it should be. We've put it in writing and we're announcing the minimum expectation of our providers going forward. That forces to track that routinely. This is one of your cardinal weekly KPIs going forward. It should be in line with total visits, new patients, arrival rate, those main KPIs as well as others that you might be tracking.
Track it for each location and track it for each provider. Many times, what we found in our clinics is that a majority of the providers were billing well above 4.0 as appropriately and documented appropriately. Usually, there was 1 or 2 that would fall into the 3.6 to 3.8 range and bring the entire team down. You don't want to hammer the entire team if just one person is an outlier. It's an opportunity to go one-on-one with that person and handle that individually. The important thing is to set it, monitor it, and track it routinely going forward.
Assuming your billing and collections process is smooth and steady, this process alone, once implemented will increase your revenues in 30 days. What would you do with a 10% increase in your revenues? What would you invest that profit in going forward, your family and your reinvestment in the business and yourself? This is the beginning of your transformation as an owner. This first step will help you gain greater freedom and more profits. Remember, if you want help with this or other aspects of your business going forward, I'm providing consulting and coaching services for PT owners to help get you where you want to be. Reach out to me at Nathan@PTOClub.com. Check out the website and the first steps for the free download on the website.
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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.
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.
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.
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.
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.
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?
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.
Dr. 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.
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!
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.
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.”
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?
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.
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.
Brian 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.
This is Steve Rapposelli. I'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 I 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. I got a friend to manage that for me. That ended up being my business partner, Will Humphreys. He managed 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 a 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.
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 X 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.
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.
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 I 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.
Stephen 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.
Growing 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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