Continuing where they left off in their last discussion, Nathan Shields sits down once again with Avi Zinn, DPT of the Druid Hills Physical Therapy in Atlanta, Georgia. Despite being a new PT owner, he already made some big changes in the last episode – changing his EMR, outsourcing his billing, changing his business coach, and was expecting his front desk to change in the near future. In this episode, they discuss the effect of those changes and how he started 2021 with a bang using a roadmap for continued growth and expansion. He's made some great decisions along the way and is headed for even greater success. Moreover, Avi also shares some strategies he follows when hiring new PTs, particularly with how online ads work in the recruitment process.
We're doing Reality Episode #5 with Dr. Avi Zinn, a physical therapist and Owner of Druid Hills PT in Atlanta. Avi, it's been a while since we started this up.
I was looking back. We started around November of 2019.
We're going into a few years of following your progress. You've made some awesome progress. Congratulations, by the way, especially for a young physical therapy owner like yourself.
Thank you.Organizational skills are one of the main characteristics every good front desk officer must possess. Click To Tweet
Where we left last time is you had made some changes. You were in the beginning phases of making a number of changes. Number one, your front desk was about to leave. Number two, you had switched over to Prompt EMR. Number three, you’ve switched your billing company. Number four, with your consulting company, you got a new coach to work with you one-on-one. You had a lot of changes. We want to follow up on that stuff and more if that's okay during the show. Start with something that's been most dramatic for you.
First of all, thanks for having me back. I love doing this, always. Last time, we were talking about my front desk. That's been the biggest change for us for a lot of good reasons. Our front desk, she was leaving to go to OT school. We were looking for a new patient care coordinator. We were trying to get her started before our previous one was leaving so we can do some training.
You had some overlap and support there as they're training.
It worked out that way. We got on our new patient care coordinator to start. She started in December 2020 with enough time to overlap for about a month. She got some good training. That was great to see how she eased herself into our office.
What were some of the things that you were looking for in your next front desk person? Did it vary much from your new one or were there certain character traits you were looking for? Are there certain things during the interview process that you tried to vet out?
One of the main things that I was looking for was someone with good organizational skills. Someone who was able to follow our workflows and be able to take the stuff and efficiently do whatever needed to be done. There are so many different tasks to do at the front desk.
You want someone at the front desk who's so high tone, great attitude, willing to go the extra mile, caring about every patient that comes in. If it's a female, you almost want that motherly type.
Take care of the clinic and the patients. Make sure everyone gets the appointments they need. Let them know that, "We'll get you on the schedule. Don't worry. We'll make sure you get your visits." We got her on. That was a good transition because of all the extra training. What was also cool at that same time was I was focusing on the SOP and figuring out what we can do to improve on what we've already built with our previous. Part of it was using some of Prompt's reporting. The EMR software that we switched over to have some awesome reporting. They have this plan of care compliance report, which you can pull up the next week's list of patients.
It shows exactly who is scheduled and who's not scheduled, if they're supposed to be scheduled two times a week or one time a week, whatever it is. That has been so helpful because we're able to get that report on Monday morning. By Tuesday, maybe Wednesday, we'll already know what our schedule is looking for the next week because we've already called and scheduled all of our patients. By Wednesday, we're looking at next week. We see it's full and that's good or we have a bunch of spots open. "Let's boost the ads." That's been helpful. That's been cool.
For those people who are reading, SOP is Standard Operating Procedures or your policy and procedures. There’s some huge value that you went through your policy and procedures during this training to shore it up.
We did. We created our patient journey. It was every step from the first call until they see the physical therapist. We created that. When our new front desk came on, we trained her with that patient journey. It was like, "Step one, this is what happens when they call. Step two, you follow up with this. Step three, you do it." That was something that was cool. With that, all of a sudden, we started seeing that by managing the expectations of the patients and explaining everything with that workflow of patient journey, our patients were coming in prepared to do their physical therapy. They were already bought in. The PTs were telling them, "You get to come in twice a week for six weeks." They were coming straight up to the front after their visit and scheduling out all their appointments.
We're seeing that because we're managing the expectations. We're setting up our patients for success. We're seeing in our cancellation rates. We're lower than we've ever been. Last time, we were at 5%. We've never been that low before. I attribute that to our front desk managing our expectations and getting our patients. The PTs are doing a great job with everything they do. Taking away some of that pressure to get them to buy in on that first visit by explaining everything to them beforehand has been wide. The front desk has been so successful and integral.
First of all, congratulations on a 95% arrival rate. Secondly, it sounds like you've given some of the responsibility for the compliance to the front desk by what they're saying before they even come in for the first visit. On their phone calls, as they're talking to patients, they're telling them what to expect, what it's going to look like, and what successful physical therapy looks like. You have conversations like that.
I was listening to Jerry Durham's show. He talks about front desk stuff a lot. One little thing he said on one of his shows was often, no one asks for the patient who's calling to talk about their story. It's always like, "Let's get this information so we can put you in our chart. Let's get this so we can set you up." It's never like, "Why don't you tell me a little bit about yourself and what's going on so we can learn more about you, we can know what to do to best get you to where you want to go?" That has been another part of the success. It was a different approach to talking to our patients when they're calling, show them that we do care about them, and try to get them in. When they come, they already trust us because they know we've talked to them and ask them about them. They're coming in ready to do whatever we tell them that is going to be best for them.
You've changed the mindset at the front desk and with your providers as well to say, “It's not all about what we need.” When they call, it's not just about, "What's your name? What's your date of birth? What's your insurance?" Instead of going down that checklist, one of the questions that may be if not one of the first questions is, "Tell me what's going on. Your back hurts you. Why is that hard for you? What can't you do because of that?" Are those the conversations your front desk is having at the beginning?
That's exactly what she's doing. That is part of the reason that we're having a high arrival rate. From the beginning, they're calling us, they see that we care. We do care. Every place cares, but when it's trying to schedule, it's all just about numbers and trying to fill the schedule, it's a different mindset or approach when you let the patient know that you are caring about them. It shows.
It goes back to a conversation that I had with the guys at Keet Health on an episode. They stress the customer experience as well. I did a show with Jerry years ago when we did our first one about the customer experience. One of the exercises is to map out the life cycle of a single patient and all of their touchpoints with you at the clinic from your website or the first call to their first visit, confirmation calls, follow-up visits, discharge then to billing and collections. Map that out and how we can improve and more fully live out our core values at each of those touchpoints. When you do that, it forces you to think differently instead of, “What do we need?” but rather, at each of those touchpoints, “What does the patient need and how can we help them have a better experience with us?”
The guys at Keet Health swore and they said, "If you can improve that customer experience, you will triple your marketing efforts." You see that based on your improved arrival rate, your average frequency of visits, frequency per week of individual patients coming in improves, and full compliance to the complete plan of care significantly improves. They're not dropping off after the 3rd, 4th, and 5th visits. They're staying with you for longer periods of time and thus seeing results. That first domino is how we can do this differently to show that we care more in order to get their buy-in.
Everything you said is what we're experiencing. There are plenty more that we can do to enhance the patient experience. From the few things that we have worked on, we're seeing huge improvements and success. They're all around from us and for our patients too. If we're getting them in twice a week or completed plan of care, that means they're getting better. If they're completing their plan of care, that means they've completed their physical therapy. Hopefully, that means that they're back to doing whatever they wanted to do in the first place.
That also goes to your point where you are getting results and this is where it triples your marketing efforts. At this point and at this stage of your ownership, you're a few years in. You're starting to see some of those return patients or they're referring family and friends. When you treat people right, they're going to start referring other people or trust you enough to come back yourself.By hiring a CPA to coach you, you can rely on the numbers which is much easier than mere feelings. Click To Tweet
We are starting to see that. Interestingly enough, historically, a lot of our referrals have been from the direct-to-consumer Google Ads.
You were solely built on that for the past few years.
From the beginning when I first started, we got some good ads going and they were working. I never had to do too much relationship marketing with some of the other doctors in the community. Not that I didn't try, but we found that this was so much more successful. That's the way it worked for us. As we got busier, we had to turn down the ads because we don't have room for everyone that's calling. We're looking to hire because we're so busy. What was interesting is that we've turned the ads off but we're still getting as many people calling. We're seeing that it's return patients. We're getting people who have come back every year. Every year, there's something new. This is their PT place. Whenever something comes up, they come in. We're seeing our patients who are coming in, we ask them who referred them. We're getting a higher percentage of people coming in from their referrals from past patients. We are seeing that, which is cool.
Is that something that you set up internally or your providers coached or instructed on how to ask for referrals?
No. I started to try to implement that at some point. It was right before Corona. It was something that we didn't implement. The plan at some point is to build that in. One of the things from the Lighthouse Leader Group, Jamey Schrier group, which you put out a show with him, they do this QA. On the fifth visit or something you have, you do, not a re-eval but a quick check-in. Are you progressing well? The whole reason for that question is if they're doing well to then take it to the next step of, "You're making great progress. Do you have any friends or family that you know that could benefit from our services? We do want to help people." It's a good opportunity to take advantage when people are seeing good progress to use that, to ask for them to send their friends.
That was a really successful action for us. It's something that PTs shy away from because they don't want to feel salesy. If you're trying to fulfill your purpose as a physical therapist, you want to help as many people as you possibly can. To make it easier or easiest in the conversation like that is when they're speaking positively and glowingly about your practice, how much they love coming to work or about their condition in general. "I made some great progress. I can do this well."
That's number one. Make sure you tell your doctors. If you have a ready-made template to have the patient, write a note and you can fax it off to the doctor. That can be a successful action. Number two, you can simply say, "That's awesome. Do you know anyone else that's having issues so we can help them like we're helping you?" It's a quick and easy way to ask for referrals but it's also a way for you to solidify. "You are getting better. We can do this for a lot more people." Hopefully, that cements it in their heads.
You said something that I've been realizing lately. It the mindset of what you said about PTs have a hard time because they feel salesy when they're trying to convince people to send their friends. Our true purpose is to help as many people as possible. Once we recognize that's what we're here for and that's why we became PTs in the first place is to help people. I don't know who said it, but I heard someone talk about making a sale. As a PT, we're doing it all the time. We're trying to educate our patients. We're trying to get them to comply with our plan of care. We're trying to sell them all the time. We are almost salespeople by nature of trying to get them to complete their plan of care. Realizing that and switching the mindset of it's not trying to make a sale, but we're trying to do it because we're trying to help them.
Speaking of plans of care, your usage of Prompt EMR and some of the reports they provide. You are amazing compared to the other EMRs like business management reports. Prompt does a great job at that.
I've been surprised that they keep developing their software and everything they put out. As far as the business management side, they're doing great stuff.
That procedure used to be 1, 1.5-hour long procedure for us weekly. We called it the weekly walkthrough. We weekly walk through each physical file on the active patient file shelf with our fingers and walking it through with the front desk, saying, "Where's this person? What are they doing? Are they scheduled? How are they doing? Are they coming back?" That was a weekly thing that we had to do every week. For you to simply be able to pull that up and save all that time, you're not even involved at that point. They are expected to pull it up and do the work.
It's automatic. The front desk pulls it up on Prompt. It’s two seconds to pull it up and then she shares it as a shared Google file through Google Drive, which is also amazing. Google Drive, in general, is so cool. It's shared to all the PTs and then they make a note on each one like, "That person was dropping down to once a week, make sure to call them,” or “This person is discharging this week." It happens so quickly.
Have you been overall happy with Prompt?
I'm happy. The part that I'm not so involved with is the actual documentation because I have not been treating since before COVID, although I jumped back into treatment. We've been busy. Our schedule is full. I'm trying to hire someone. We're also saying to our patients, "We want you to commit to twice a week." If we don't have room on the schedule, I feel like a little hypocritical not letting them have those twice a week visits. It was important for me to jump back in to allow our patients to get on the schedule. I did one note on Prompt for it on the documentation side of things. I hadn't spent too much time doing the documentation but overall, we're happy with Prompt. They're great. They continue to develop their software. I still think that they're going to be the best, if not, getting close already.
They're making so many changes, not knowing exactly what's happening on the documentation side and on the billing side. From what I hear, there's room for growth there. It's good to hear that they are receptive and they're trying to be reactive as possible to make changes on the fly and keep things up-to-date.
That's also one of the cool things that I like about using them. They're a young company. We have been working with them in their early stages. Some of the suggestions we give to them, they listen to us. Hopefully, as they grow, they'll continue to listen to people. Early on, some of the suggestions we make, they implement it and put into their software. It's cool to be a part of that also.
Has the billing been going okay with Prompt as well? You made some changes with similar timing. That can be a big upset to have an EMR change and a billing company change about the same time. How did that all work out?
Everything worked out well. They're starting any new software or new company. It took some time for things to work well together. It was new, not only for us but also a new software for the billing company. Everyone had to figure it all out. That was from the beginning. We had a meeting with the billing company and Prompt talking about if we're going to make this work. The billing company had a list of things that they needed Prompt to change, modify, or add into their software in order for them to be successful. We prioritized a certain number of things. They've hit upon all of the main things at this point. There are more things that the billing company wants them to implement. For the most part, they've been able to take suggestions on the billing side as well and change them in Prompt. Things have been going well.
Prior to this, so the audience knows, you were doing the billing yourself and then you finally switched over to a billing company.
I stopped doing the billing when we started Back in the Black, the billing company. It was May 2020 or June 2020 in the early stages of Corona. I don't even know how I did the billing when I was doing it.
I'm assuming your collections might have improved since then, but at least it freed up your time.
It freed up my time. I know for a fact collection was for the denials. I know that I was writing things off back then when I was doing it. I didn't have time to follow up or know the best way to follow up, resubmit, and change a modifier. I was not doing that stuff. The fact that I don't have to do that, I don't have to worry about it. I have a company that's not only doing my billing for me but also bringing in higher collections. It's so worth it right away. The loss that I was writing off is more than enough worth it to pay a billing company to do it.
We might have discussed this at the last episode, but since we brought it up, what made you decide to go to a billing company instead of keeping in-house and train your own person or bring on someone with experience?
The biggest reason was that it was COVID. It was too hard to think about bringing someone in and training at that time. It was that. The other thing was because the company is Will Humphreys. You recommended it. I asked you about him. He was starting his billing company. I felt like I already could trust that they were going to do a good job whereas if I was going to have to hire someone and train them. If I was to be the one to train someone, I wasn't the best biller person. How would I even train someone to do the best billing practices? If I was going off of knowing that someone had previous billing experience, I didn't feel like it was, at that time, the right time to hire someone in-house. It made more sense to outsource it.Early-stage mentoring can make up for the lack of experience of new graduates. Click To Tweet
The other change that you made was to stay with the same consulting company but have a different one-on-one coach. What have you been doing differently than the previous coach?
That's been cool. One of the reasons that I switched was I wanted to get a different coach. I hadn't been in a year. It was interesting to see what other coaches had to offer. The coach that I started working with was not a PT himself. I found that intriguing to work with someone who's a CPA. He's been a business consultant. I found that interesting to see what we can do. A lot of what we focused on in the beginning was the mission, values and purpose. Some of the stuff that I had already worked on with my previous coach is to fine-tune that a little bit. It was the end of 2020. We worked on a budget for 2021. That was something I had never done before. It was a cool practice but it was also super helpful.
2020 was a different year than anything ever before. We had to look at 2019. I use that as a template to grow. We worked backwards because it was still Corona. We're trying to get a sense of how much space we have to grow in the practice with maintaining the distancing. We came up with an idea of how much we could use in our office and then worked backwards from there. We ended up choosing our 2021 budget as we were going to use a 30% increase from some of our best months of 2019. That was a cool exercise to do. I'd never done it before, but I was able to see the whole year in advance to say, "If we want a 30% increase, we need this many visits for this month and this month. We need to ramp up."
We were able to dial in all the numbers and look at, "We need all these stats to work out this way." From there, we were able to break it down into quarters and that helped. It was a big mindset shift, understanding how projecting and planning works. “If I look at this quarter, in order to hit our goals, we need to hit this.” I have a better sense of what we need to make sure to do. If next quarter, we need to get to this number, I need to hire and start looking for someone to hire. I need to make sure that these numbers are hitting the goals. It was cool for me to do that because I hadn't done that before.
How did you land on the 30% increase? Is that something that you had decided upon?
The way we work backward was we chose a number that we felt comfortable as far as how many people we could fit into the space because of Corona and the capacity of our clinic.
We never had a chance to do that. Your coach tends to be a numbers guy. He's an accountant by trade. If people who are reading would want to do something like this, by all means, get together with your CPA, have that relationship with your CPA, and you're communicating with him regularly, maybe you can ask for a sit-down and talk about the upcoming budget for 2021. It's easy for them knowing QuickBooks to input the numbers, bring it all up, how that affects the expenses, or a bookkeeper might have that same capability.
To look at your 2021 goals and how that is going to affect us financially. If we want to get these goals, what does that look like? How does that change things? How are we going to hire? It's so important that a lot of times, as we look at our goals, we look at those goals and set them aside, but not seeing how they compare, what effect they're going to have on our financials, and when we'll need to hire. It's cool that you married the two together with this meeting.
It was cool. The last thing you said when we need to hire was one of the things that first stood out to me. We needed to ramp up in quarter 2 or 3. We needed these many more visits based on our projection. We need to hire. I realized it's February 2021. We're planning on hiring by June 2021 because we need to get these numbers for the budget. I need to start looking so that we're ready to hit our number. I was able to use that and see, “This is when we need to do this. This is why we need to do that based on the numbers.”
You have some real guideposts to say, "When we hit this number, these actions need to fall into place." That's what it sounds like. You're at that point.
That's how it feels. We'll see if we stick to it and how it goes, but it's a great place to start for me based on the fact that I've never done it before and then allowing me to try to plan and grow. It's been great.
I love that you looked at it for the whole year annually and then broke it down into quarterly pushes. We're coming towards the end of the first quarter. I assume you're on track.
We are on track. We're trying to hire. I wanted to get more into the numbers. Our arrival rate is great. Our utilization is great. February 2021 was our highest number of visits that we've ever had in a month. Thank you very much. In March 2021, we're already 100 more than February 2021. First of all, March has 23 workdays versus 20 workdays in February. It's a little bit of a difference. It's also just been because of all the different things that we've implemented being able to look at the numbers, also with using Prompt and being able to make sure the plan of care compliance report is keeping our schedules full. We're on track with that budget as far as where we should be, if not more.
The things that have worked out so well for you are that you have focused on numbers to guide you instead of feelings. When you look at your front desk and you're like, "I know this person is going to be gone in January 2021 so we need to start the hiring process late October 2020 or early November 2020 so that we have someone in here by December 2020 to overlap and train." That allowed the front desk person to not only train but also review the policy and procedures, make sure they're up to speed, appropriate and that they're following them.
The same thing with your EMR. You're using it to track your numbers, your statistics, see the growth, and the business but also to see who's falling out and how we can recapture them. It’s the same thing with your bill where you're looking at that. Number one, you hired a great billing company because they provide you reports and communication. I know that because I know Will. They provide great reports and great communication to you. You outsource it knowing that someone else is going to be able to care for it better than you could since you're not the billing expert.
You leaned on your coach. You returned back to the financial numbers. Looking at your overall story, you’ve reached forward and received help in terms of finding an EMR that can help you better manage, finding a biller that's outsourced that knows more than you do, finding a coach to help you see your weak spots, help you shore those up, marry those things together, and also using Google Ads to your advantage to grow your practice. You've outsourced a lot of things to your advantage. They've all paid off.
It's funny that you say that using the numbers. The last few times that we've spoken, you've asked me questions where my answer is a coach wouldn't love the reasons of why I chose this. It sometimes was based on feelings and not the numbers. Once I've had a better grasp of the numbers like I have, I can tell you that when I make those decisions, they feel so much more sure of that decision. Before, I'm like, "This feels right. I think it will be good." Thank God most of the time, it's turned out that way. This time with the numbers, I'm making these decisions and I know this is the right thing to do based on the numbers.
You’ve got some growth and expansion goals. The next step is to bring on another PT. Are you looking at another PT after that? Do you have a space for that or will you have to be looking for another space or a bigger space?
We've done this distancing thing for a long time that we feel like comfort-wise, we can fit more than we were comfortable several months ago. We can hire another PT. We're looking to hire now. We could even hire another one after that in this space. It's also interesting that I've been talking to my landlord. I don't know that it's going to work out like we originally talked about. There was an opportunity to take over the middle floor so we would be able to double our space. It was possible that we could have expanded in our own building.
I think it's not going to work out. He's selling one of his companies. They're going to maintain that middle floor. It's not going to be available for me anymore. It would have been great to be able to know that I could expand and not have to move or get a second location, but either way, we're looking at our space and we're realizing that we can fit a little bit more than we thought we could go earlier on in Corona when we're all being cautious. More and more people are getting vaccinated. People are comfortable. We realize we can do a little bit more with the space that we have.Physical therapists are almost salespeople by nature who are trying to complete the care plan of their patients. Click To Tweet
Maybe a lot of people reading have this question. What is your tipping point for hiring the next full-time PT? Is it a certain number that you have to hit that you know the numbers? How do you figure it out?
To answer your question, at the end of 2020 around the holidays, our numbers started dropping a little bit. At the beginning of the year 2021, we were having cancellations and no one was calling. It was just the beginning of the year. Deductibles were resetting. It was still Corona. All of a sudden, we had a time where we've been jam-packed. I didn't even have that much time to see we're at 85% capacity, 90% capacity, and 95% capacity. I didn't even have to look at the numbers. It was because we didn't have room to fit anyone on the schedule. I knew that it was time to hire. Also, moving forward, the number that we're trying to base it on is 85% or 90% utilization capacity for more than a few weeks. We know that's not just a 1 or 2-week thing. That's a trend that's going to stick around us. We’ve got to bring people on.
When you can be an 85% to 95% efficiency with your schedule and then your front desk is complaining, "I don't have anywhere to put these patients," then that's a good sign that it's time to start up the interview process. I say interview process because from our perspective, you always have an ad out for a PT. You're always collecting resumes. We're always "hiring." For us, it would mean, "We're going to get serious and interview these people." Not knowing how you do things, it's like, "Let's start ramping up. Let's start that cycle of action."
I will say that I learned from Will because I do coaching with him as well. I don't think it's his term, but stacking the bench. I learned from him to always be looking. I've had ads running. It is time to start being serious about it, but it is something that I've at least been entertaining or trying a little bit with keeping that bench stack. When it's time to hire, we'll have a few people that we can get in touch with.
You can start calling those people that you have on resumes. You don't have to create the ad and post it on Indeed, which might delay you a few days if you're trying to wordsmith the ad correctly. We've got an ad that works. It's up and it's going. You've got some resumes already. Maybe you boost the Indeed payment to get more views on it. That's great that you're not starting from scratch.
We've already dialed in a lot of our ad contains a lot of our purpose, vision, mission and values. A job to treat patients, benefits, and salaries. He was wanting to be a part of a team. He liked that we were a company that stuck to our values. He said all the things that I wanted someone to say. He's a new grad so I don't know if we're going to move forward with him or not. I have to make that decision. We've hired a new grad in the past. We were thinking it would be better to have someone with little experience if it's the right person. We're not against hiring new grads. We'll see, but he spoke about all the right things.
You looked at your team and said, "What could we need? What could we do to round out this team of providers where it could be shored up?" You know what you're looking for, which is cool.
It's been different this time with the interview process because of being a little bit more in tune with what you said, knowing what we need, what our team might be lacking, or what everyone could benefit from if we bring someone else in. It makes us a stronger team altogether.
What's super exciting about you bringing somebody on is you're already 95% efficiency, utilization capacity, whatever word you want to use but your Google Ad spend has been lower. You bring that person on. If you want to fill up their schedule, you've got to boost your Google Ad spend.
That's how it worked with our last hire. We filled her schedule quickly with the ads. We have to pay for that, but it's a way to fill up the schedule and do it faster than the normal potentially. We'll see if that works that way. We lowered our ads. They're at a minimum. We're still totally full. Whenever we do hire, that's the plan. We're going to ramp up those ads, turn the budget to however much and see what happens.
When you bring someone new like that on, do you have a conversation with them that maybe they're going to shadow somebody until their schedule gets full or we're going to do what we can to get you busy? Do you also expect them to do some work on their end to market and build up their schedule?
To the last point, no. That's something that I haven't had with any of the providers about having them be accountable to fill up their schedule. That was a conversation I had with the team when we had this 6 to 8-week dip of us being at 80% towards the end of the year and in the beginning of the year. We had a conversation about accountability versus responsibility. No one is accountable to fill up their schedule, bring in new patients as much. That would be great but the way we have things set up, I use the ads. The way it's always been.
I'm the one who brings in the patients with the ads, but everyone is still responsible to make sure that their schedule is full. We did have a meeting. Let's talk about when we do see a dip in the schedule. Let's have a plan for knowing. It looks like we're going down in numbers. Let's make sure we have a plan to make sure that this doesn't happen like it just did so that way we can get to it earlier on. That was to the last point, which was interesting about accountability versus responsibility.
Everybody on your team should be marketing in some way or another where you're spending money on Google Ads. Their responsibility is to get patient compliance and ask for referrals. If they have some downtime during a slower season to make calls to past patients and follow up on them, they have some responsibility towards that as well.
You asked when hiring on, is there an expectation when their schedule is filling up of what they should be doing? I'm glad you asked that because no, I don't have that. I know that I need to work on that. One of the things was you ask, “Are they supposed to shadow other PTs?” That's a great thing to do, especially if it's a new grad because that could be a perfect opportunity for them to get a little bit of that extra mentoring and shadowing early on. That would be a way to be more comfortable with hiring someone who has a little less experience knowing that they're going to start and they're going to have time to do that mentoring in the early stages. That can make up for their lack of experience.
It's something that I don't think we felt we were honing in on or got good at until towards the end of our ownership, that hiring training process for all positions. We started getting good at it, but it wasn't towards the latter parts of our leadership development as leaders ourselves, where we focused on what does the training look like for every new employee as they come on in each different position. There was some general stuff like, "We're going to go over the employee handbook. We're going to cover these principles and what you're responsible for. We would break down into specific responsibilities. As a front desk, you're responsible for these stats and this is how we can train you. For a PT, this is what you're responsible for, these stats. This is how we're going to train you." I can see that maybe as a potential growth avenue for you is setting up. How do you establish a successful physical therapy on their post? What does it take? How long does it take? Is there a checklist of things that they need?
The truth is I did that for the last one. We created a little bit of an onboarding process of 1, 2, 3 weeks in 30 to 90 days. It was more of training them. We started. I have a lot more room to start enhancing that and focusing on that.
Are you starting to establish a leadership team as well, or is it just you at the top?
That's another thing that I've been working on is I'm trying to. I've been doing this for a while. I had talked to this one PT right before the beginning of 2020 before the pandemic hit. We put that on hold. We've been talking about developing that role. It's been interesting with her because she's been affected by COVID with her kids. Her kids have been remote learning this whole time. She said to drop her hours. It's been interesting talking about the leadership role. We're going to make her clinic director. She might not have enough time to do it. She had to drop her hours. It wasn't her fault or anything.
What's been cool is that we've been discussing changing that role a little bit. Maybe she traditionally has a clinic director do all these things. When we started doing these leadership meetings every week with her, when we talked about, "Let's look it up. Here's a list of all the things I would want a clinic director to do. Why don't you look through this list? Choose all of the high-energy things that you would want to do. Maybe we can build a role based on those few things. That way, it's not a clinic director in the traditional sense, but at least it gives you some more leadership opportunities to do." With the time that you have and the hours, you can still treat but also take on some leadership things. It's been cool to be flexible, tend to pivot with what we're working with and try to develop that leadership team.
I see that's where your path is next as you're starting to develop these policies and procedures or shore them up that you've done over the last little bit. You're starting to establish some goals. The next thing on your plate seems to be, from my perspective, the development of the leadership team, some of the day-to-day management, operations, and even some of the higher-level things can be taken off your plate. Thanks for updating us on everything. It's cool to see how things are progressing for you. You've got a golden touch. I don't know what it is you being in Atlanta. You have access to a ton of great people and a population that is receptive to Google Ads. You're doing some amazing stuff especially years out in ownership. You're already successful. We'll stay in touch for sure.
Thank you, Nathan. I appreciate hearing that too. Sometimes I don't know where I should be compared to few years in, whatever it is. It feels like we're growing in a good way as far as what our reputation is. That's been the biggest thing. Clearly, the clinic is full. People do like coming to our place and we have a great reputation around town. That's been reassuring to know that people are valuing our service.
You're going to see that jump in return patients here in the next few years, people that are referring family and friends such that your return patients are going to be 50% to 60% of your patient population. Simply by adding the physician relationships that you develop over time and your continued work with Google Ads, turning on that faucet, turning it down, turning it up as you need it will allow you to continue to grow. It's great to get in touch with you again. Keep us updated. Is there anything else you want to share, Avi?
We went through a lot. Hopefully, we'll do this again in a few more months. I'll give you an update. I love doing these updates. I always try to go over from the last episode. It's fun to be able to look at my progress or what I've gone through. These are so fun to do because of that. It lets me see where I've been and where I'm going.
Congratulations and keep it up. We look forward to talking again.
Thanks a lot, Nathan.
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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.