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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Ian Johnsen, PT, MSPT has been a success in his small private practice in the Seattle area and, like me, decided to launch a podcast and introduce more private practice owners to the resources and success stories that are out there. So I decided to have a conversation with him to learn a little bit more about him and what he's doing to be so successful. He was kind enough to share a couple of his marketing secrets, which any practice could benefit from right away! He also shares some of the resources that are guiding him along the way to success. Funny thing, there are a number of resources that are the same ones we use and espouse here at PTOClub! Have you used the same ones?
On this episode, I get the opportunity to interview a fellow podcaster, Ian Johnsen who hosts a podcast called Practice Perfect. He interviews healthcare professionals, especially healthcare or private practice owners along the same lines as what I'm doing. I took the opportunity to sit down and talk with him. This is more of a conversation that is rather free-flowing with Ian. We talked a little bit about his podcast and what got him into that. We also talked about some of the struggles and success that he’s seen as a small physical therapy practice owner. We also talked about some of the books that have been influential for him as a practice owner. We also talked about a couple of secrets that he's used with the marketing techniques that have been beneficial for him in getting patients that are higher reimbursing. Also, focusing his marketing efforts and thus improving his efficiency and productivity in this marketing efforts. We talked about some of the secrets that he's used in his practice. Hopefully, you can take a little bit from what Ian has learned and also relate and maybe implement some of the things that we talked about into your own professional experience.
What made you decide to do it?
Frustration, more than anything. The whole issue with not being educated on running a business. That was it for me. This was something I wanted to put out for everybody that's in the same boat that I am so that they can get educated along the way. It's a big give back in the selfish side. I get to meet cool people and build connections.
I want to know a little bit about your story, where you're coming from and what you're doing now. Also a little bit about what you learned from the podcast and whatnot. What got you started into PT and where are you at now?
I grew up in Washington up in Everett. My dad was a mailman. I lived with him and my stepmom once he remarried. He was a nighttime bartender. Money was a bit tight up in the north end. I watched my dad go to work every single day and grind it out at 5:00 AM and make it back home at 5:00 PM and crash on the couch after making the kids dinner. He put the time to help the family survive. At fourteen years old, I'm thinking, "I don't want that life at all." I went after the idea of finding something that would hopefully pay well. In my mind, that was medicine. I was heavy into playing soccer and running cross-country and that stuff. I wanted something in sports and medicine combined. I went that route. I went to the military because I didn't have college money. I jumped to the military. I got the four years in. I started taking a couple of classes while in the military and then I used that college fund once I got out.
I discovered that sports medicine for me wasn't a thing that I could wrap around. It didn't exist in where I was searching for. Once I got it, it meant that I would be a doctor and then have more schooling on top of that, probably become a surgeon and distributing medications. It wasn't what I wanted to do. I want to heal people naturally. This was the field for me and it was a step-by-step process from there. I went to a two-year college. I went to Shoreline Community College. I got my Associate's in Science. I hopped up to the four-year school, which is called Western Washington here. It was a lovely school with a nice Exercise Science Program, lots of kinesiologies, biomechanics and all that good stuff. In there, I found Kathy Knutzen who was my counselor and program director. She suggested moving on towards either chiropractic or PT school. We made the format of the classes to be such that I could do that. When I found my school, which was Regis University out in Colorado. I went there and I fell in love with their program. I highly recommend everybody go out to that one.
Your story is not all that different from mine. I grew up in a middle-class neighborhood but money was tight or at least from my dad's point of view. He always complained about, "We don't have money for that.” That was a common refrain. I had uncles that were in healthcare. I saw, "This guy has some financial stability and my cousins have things that they want and can play with and they have the freedom to do that." I started moving towards healthcare as well and I then came across Physical Therapy Owners as I was doing my undergrad. These guys had decent homes and they provided for their families. They didn't have to take the MCAT and they didn't have to go through all the schooling that an MD did. I was like, "That's for me."
As I volunteered, I had an adrenaline rush after adrenaline rush every time I volunteered at these private practices. I knew this is for me and I was developing relationships with some of the people that I would meet once or twice a week, however often I volunteered. I thought, "There's no way in the medical field that you can develop a personal relationship like that and get them better in a rather quick manner and not have to do all the medical schooling and MCAT testing. I thought that was for me and that's how I got into it. It all stemmed from the same thing, looking for some stability in my life and then things worked from there.
The PT practice is not always super easy. In 2006, I was in some form of the practice. This was back when I was getting my feet wet. I went from the hospital. I stayed in a hospital setting for a year and I got some good mentorship from the folks that were there skill-wise. There was a group of PTs, probably eight of them. I learned a lot of cool things there. Then I transferred out to the private practice realm and found a guy that was doing what I thought I wanted, which was to have a small clinic with himself being the primary owner-operator. I learned as much as I possibly could from that guy financially and from the billing side. The good and the bad because there is always some bad in there too.When you write down the fears that you have and what those worst case scenarios could look like, it dissipates. Click To Tweet
Then you decided to strike out on your own and since that time, have you found resources or have reached out to consultants or coaches to help you along?
There are always going to be mentors and coaches in the process. I don't think you can get through this without that. It's part of why the podcast exists at this point so that we can mentor people along the way. I'm not an expert yet. I'm still struggling and when I grow, everybody else can hear it and they can grow with it too hopefully.
One of the reasons why I started the podcast is I didn't see it back in the day. I opened up my clinic in 2002. At that time, I wasn't seeing the resources or they didn't seem readily available whereas they seemingly do so now. I've interviewed a number of them and talked to a few people and have had some of my own coaches since that time. I wish I had gone back and I would tell myself nowadays to get some coaching because like you said, we don't do this stuff. We are physical therapists who happen to own a business. Getting some of that insight from somebody can always help along the way. Have you followed any particular books or theories or coaches along your path?
One of the guys that's been with me for quite some time now, his name is Michael O'Neal. He's a podcaster. He does Solopreneur Hour, a one-on-one coaching for solos. He's done a good job initially at pushing me forward and helping me with marketing ideas and marketing strategies. I'm playing with the focus of where I want my best clients to come from, finding who that best client is and building your avatar. Digital marketing is definitely a piece of it. Mentoring me through the podcast portion too to get that going is good. Other business mentors also. I learned a lot about how to build a practice in terms of where do new patients come from and acquiring those guys and then building the systems around the business. It partially comes from people teaching me, but then partially from some of the books that Mike O'Neal had recommended. I always had six books and I can never remember all of them. One of my favorites is still simply working towards systematizing everything in your business. That book was called The E-Myth Revisited. It's a super easy read. A nice audio book and I read that first and then I read Rich Dad Poor Dad. Get both of those books. Get Think and Grow Rich to get your mindset framed. Then you can start to develop. I love The 4-Hour Workweek. That thing was genius and funny. It could be out-of-date a little bit, but it got my mental juices flowing on other things I could put in place besides doing day-to-day practice.
I did an episode of The Best Business Books that are most often referenced between me and my guests and it’s a lot of those same ones except The 4-Hour Workweek and I should have mentioned that one. For sure, The E-Myth, Rich Dad Poor Dad, Think and Grow Rich, Good to Great by Jim Collins and Verne Harnish's two books, Mastering the Rockefeller Habits and Scaling Up. A lot of it between all of those books is to get clear on what your mission, vision or purpose is and shift your mindset to making this a business and not a job and systematize. To get everything in your head down on paper so that it ends up being a business that can run without you, right?
Exactly and be sure that you're following your passion. If you're not passionate about what you're doing, you're in big trouble.
What are you doing now in your clinic? What's your size? What are some of your goals? Where are you at?
Prior to that, I want to give you one more book to check out. I'm digging into Profit First. The cool thing about this is that it's basic but powerful in terms of helping you organize your accounts properly. Instead of running everything out of one account, you parse it into five accounts. You have an income account, you’ve got a tax account, you've got the owner's income account and the profit account. He's big on making sure you take profit every single time or a couple times a month when the deposits all show up.
We talked about that a little bit and it blew my mind on an episode that I did with a guy named Christopher Music. He's a financial advisor for a lot of private practitioners. One of his first rules is set aside 10% at least every month. Simply just set it aside. The 10% goes to you as the owner every month and he said you make your business work off the rest. Once you do that and get used to it, you find ways to pay bills or increase gross revenues if you have to. If it does not turn out at least that much, then it's not worth it.
This is similar. It's all these separate accounts we talked about and then you set an overall big-time goal of what those percentages should look like. Then you start in smaller versions of that and just start setting aside all those monies and all the different accounts that you've set. You don't have to worry about your taxes.
I’ll have to check it out.
Definitely do that and I hope everybody does because it's changing things rapidly for my group. In terms of what I'm up to and what the clinic's doing, the size of the clinic and all that, I'm still not that big. I’ve got a second PT with me and she's part-time. I could probably handle her full-time. I'm busting my butt internally at the same time. I'm doing a full load. I'm there from 7:00 to 5:00 typically. I've been getting out around 3:00 or 4:00 to get the kids off to dance classes and do podcasts and different things that I want to work on. I've got about three equivalent full-time aides. We work in batches or in small groups. Each PT typically has one to two aides working with them. We spin it a little differently. We don't even have a receptionist, which I'm about to change. It’s getting a little bit challenging at times as we get busier. What I wanted was not to have Marge sitting on the front desk, playing with her thumbs and not being effective. I'm learning that I can make that person accountable and use them in a much better way than what I've seen used in different clinics.
That front desk person and that can be the boon or the bane to clinic, they are so huge. They're not practitioners but they are the first and the last person that everyone sees coming into your clinic. If they're not doing well, then you guys will suffer. If they are good, they are good and they end up being better than you sometimes getting people into the door. It's a huge role in the clinics and it's a huge hire. They've got to be aligned with you and they've got to have energy and they've got to be part salesman to make sure they come in three times a week. They've got to be courageous to collect the copays and the deductibles and all that stuff and be anxious to make calls. It's a certain personality set.
They have to be so personable. They've got to have interpersonal skills locked out and you've got to identify that magical person, almost like at Disneyland person right off the bat.
That can be a tough hire. You want to make sure their value aligns but they can be huge. To have someone like that that's making the calls and scheduling patients and stuff, if you can get that off of your plate, then that's a huge bonus for you as well. It improves your productivity. Was it really hard for you to bring on that second physical therapist? Was that a difficult jump?
I was scared out of my mind. You're talking dollars at that point. You're looking at a big cost jump right out of my pocket. When you hire them on, you're already trucking it, whatever your max amount of client load is. I'm going to bring you on and you get half of that and then my potential goes down. You have to have it ready to go that you can crank up the volume of clients as you bring that person in and have the staff and all the support to handle that. If you don't get that right, it's tough.
That's where you have to find the right physical therapist that's value-aligned and treats patients at least similarly. Maybe they could be compatible with your treatment skills. Someone that has a similar mindset at least. Now, you're actually managing somebody. That's a different story.
I found the perfect candidate. This woman was an aide that worked for my old boss and she went to PT school. As she's going through PT school, she's looking for a place to intern. We interviewed her first. Then she comes on and she has a lot of the same skillset that I have. A lot of the same theory, it's a beautiful balance. We work well together and get patients better quickly.
It's a necessary step. I'm sure you felt the push and pull. It sucks to take that money out of your pocket, but at the same time you know that if you're going to grow and really become an owner, that you need to bring on other people in and systematize that process.
Once you have that person and they're rolling and they're doing their job and they're doing all the notes that sometimes you don't get completed in time, you become more profitable because of that. Because of the fact that you can get behind the scenes and work the processes harder and make sure the front desk is doing what they need and then things ramp up.
That's a huge step for any practice. Me personally, I recognize the same thing. After hiring that first person and getting them on board, then it becomes a lot easier to bring on other people because you're not feeling the financial pinch as much. Your revenues are increasing. You've been through the fire and it will work out somehow. You're not going to go bankrupt after all and lose your house. You're going to make it. It's also a necessary step to push you into working on your business instead of in your business.
I'm going to step back to those financial scares and not getting your mortgage payment paid this month and in all the big scary things that happen. They'll work out. They do. You have to figure out how to make them work out and not be scared.
I listened to Tim Ferriss’ podcast where he talks about managing fears like that and he was talking to another business owner who would sit down when they have those anxious moments about making significant changes in their businesses. To consider the real, maybe even the imagined worst possible scenarios that could happen and then work your way backwards like, “Worst possible scenario is a go bankrupt and lose the clinic, then what?” “I'll find another job. There's always a demand for physical therapists.” “Would that be all that horrible?” It would be a blow to the pride, but financially we could still make it. There are some ways that you can work your way out of that. Did you do anything like that as you dealt with your anxieties regarding bringing people on?
That was part of that The 4-Hour Workweek book too. I went through that entire exercise. This is what is out there and this is what could happen if I screw it all up and if it does get all screwed up, fine. This is where we live for the moment. Then we reorganized and then push again. You write down those fears that you have and what those worst-case scenarios could look like. It dissipates. It's an interesting exercise.
Instead of letting your imagination run amok, you can confront the fears head on and come to terms with it right then instead of brewing on it for days, weeks, months at a time and say, “We're going to do this. It's the best decision I'm making for my business and it's the best decision that I can make with the information that I have at this time. I'm going to move forward with it knowing that there is a possibility that things could go wrong, but I can handle whatever goes wrong. This is how I will handle it and then move forward. How long has that physical therapist been with you?
I believe she is going on the second year right now. It's coming on two pretty quickly.
Is there quite a bit of competition where you're at for physical therapy clinics and for physical therapists?
Yes, it's a pretty affluent city. Bellevue, Washington is home to Microsoft and you've got Expedia. There are a lot of good paying clients that will come through the door, but there are a lot of clinics too. We've got ATI Physical Therapy that bought up nineteen clinics. There's a group called RET, which is up to 23 clinics strong. There are plenty of big boys out here. There are not a lot of one-off shops for PTs anymore. I don't know a ton of them. I can count on one hand how many they probably are. There are probably more hiding out there. I feel like there's quite a bit of competition but there are niches for everybody as well.
What have you done to separate yourself or have you done anything in particular?
One of my favorite niches is to get in with chiropractors for what I call the finishing touches of treatment. That's a strategy that might work for others and that means not looking at them as enemies but looking at them as colleagues that need some help in trying to wrap up cases. I go in and I have a lunch meeting with somebody we specifically talk about that, “I don't want to steal your client. You can have them as a forever patient, but I do want to make sure that as you manipulate and will identify people that are weak. I know that you don't have the time to totally strengthen them unless you've got somebody in house doing therapy and exercise. Let me have him for four weeks. I will set them up on a home program and then you can get that case closed and get paid. We’ll finalized and make it stronger.” Those types of words are helpful for getting some confidence in what I do so they can understand it. I'm not trying to steal from them. I'm trying to help him out. On the flip side of that, I get some high-paying clients. Like the Tim Ferriss’ 80/20 rule, if I can get in and get my best paying clients first, then that takes the financial stress off the company.
You've seen a lot of success from that. That's a niche that I haven't heard of much.
That ebbs and flows so you really have to stay on top of it like anything. Those relationships fall apart at times if you don't stay on them. It is an effective thing and that could help small private practice groups quite a bit. If I can get somebody in a motor vehicle for six visits straight, the visit is $220 a pop, then why am I going to concentrate on lower-cost clients coming from a doctor that's hard to get into and talk to when I can easily make a lunch appointment with a chiropractor?
Do you find yourself referring back to them?
A lot of them want that, but when you go in and let them know upfront how it typically works, there isn't a lot of that that happens. If they can use it as an adjunct and not expect that and if I can queue them up for that, it's okay. There have been a couple in that meeting that are starting to ask me and I say, “If you've got a massage therapist on staff, if you've got something I can refer into, then I will send you my clients that I think need a bigger adjustment.” In Washington State, it's interesting. We’ve got the right to manipulations in the State. In order to be able to do them, you have to have some advanced training on top of the PT classes we've already had. I believe almost internship with somebody that's a manipulator. You might go with the chiropractor to get that certification. I could be a little bit wrong on some of that. I haven't researched because I didn't care to. I've been taking the approach that I'm not well-versed in doing manipulations anymore. I was great out of school. I don’t do them so I can send them to them and I'm okay with that if I find the right chiro.
A lot of people could use that because I'm the same way. I don't necessarily view chiropractors as competition, but we could work in conjunction with each other quite a bit on a lot of these patients. Tell me a little bit about Mike O'Neal. Is he a physical therapist or is he a simply a coach that you used?
He's a podcaster. He hosts a podcast that's called the Solopreneur Hour. He's got some great tech info in there for everybody. It's some good courses that he's developed and good strategies too. He does help solopreneurs. The guys that are going out on their own trying to start things up. I found him because I was listening to podcasts. One of them that I listen to is Entrepreneur on Fire. That’s John Lee Dumas’. The first time I heard that thing, I'm like, “There are people out there like me. This is great.”
Entrepreneur on Fire is what lit me up to podcasts as well.
It's done that for a lot of people. A lot of people went out and copied it. I love the way you're doing it here. The real conversations. That's how I play it too.Like the 80/20 rule, if you can get in and get your best-paying clients first, then that takes the financial stress off the company. Click To Tweet
You talked with Michael O'Neal that you established an avatar. Can you talk a little bit about that and what your avatar is for your clientele? The first time I heard about an avatar for my clinic or for my business was through Paul Gough’s Podcast. He talked about his avatar and his ideal client. He mentioned he detailed it all out about who he wanted to see and how he's been successful. Tell me a little bit about your take on avatars and what yours is.
In meeting with Michael, it was developing a fitness program that I'd come up with called LEVO Fitness and it's somewhat in stasis right now. We were really trying to focus in on who would be the best client for that. You go through everything. You're going through your demographics, even the gender. You're looking at his avatar. Her name was Mary. She's 50 years old. She stays at home. She has kids there. Their house has $200,000 in income. It was very similar in what you're trying to accomplish with this and then your messaging just becomes to that person. Inevitably, you're going to get a whole bunch of surrounding people that will pay attention and come in. It may not always be Mary at 50. It's going to be a Susan who's 25 that really liked the exercise program, whomever.
For the PT clinic, it's a little bit interesting because who are we marketing to? I can set an Avatar for a woman at that age group, but that's not where the majority of my patients come from yet. All are cash based in England. We have to directly market to those people in the community and we can do that, but it isn't very effective yet. ClickFunnels can help with that and Facebook and Instagram and all that kind of stuff. We're getting there but right now we're still really reliant on a referral, and that referral will either come from a patient or you’re getting it from a physician. Who is the best referring source is what we have to look at.
That's huge especially when you're considering your message, you want to go directly to that avatar. You want to go directly to that person so that you can get through to them. Ideally, it's the person that’s handling the finances and in-charge of where these referrals go and whether that's the doctor or whether that's the mother or the father of the household at a certain age. Someone who makes the decisions.
In the case as you're asking me about my avatar, I would say that it's a physician or chiropractor and there are two avatars. There's that chiropractor I talked about that needs those finishing touches to those cases and then there's the physician that has a lot of low-back patients or pelvic alignment patients. If I could find those particular people and show them my results, then I can start taking those referrals. It really becomes a message of what I can do for their clients and how quickly I can get them better. I'll never go to a doctor and be like, “I'm so good at doing this and so good at doing that.” I'm not going to give them my skillset and my resume and beg them for an appointment. I'm going to show them results from the words of the patients. Those testimonials and bring them in and show them if we need to and try to convince them to try us out and just give them results and given great communication.
There's a physical therapist owner here in my town who I work closely with. He decided to narrow down his marketing to physicians quite a bit. Most of the physical therapy owners, they're going to market to every physician that's out there. Anybody with a pulse that could refer a patient, we're going to market to them. He decided, “Forget it. The orthopedic surgeons are too finicky and a lot of them are taking physical therapy in house. I'm going to focus my marketing efforts on the family practitioners and the internal medicine guys in my area and talk to them about what's important to them.” He says by doing so, by actually scaling back on his marketing and focusing a little bit more, he's exceeded his revenues this year by at least 20% to 30% and you wouldn't expect that.
Maybe after you've been in it for a while, you would. It makes complete sense. I stopped marketing to orthopedic surgeons. They have their own staff and I'm not interested in that anymore. Family physicians and internal guys, definitely. To niche down, take it a step further and create a relationship with five of them. These physicians and nurse practitioners and everybody, they're seeing a caseload of 30,000 people a year. You need to survive as a PT independently five visits and five new evals a week and then you learn how to keep in front of those clients through the years and all of a sudden, you have repeat customers over the years.
Tell me a little bit about your podcast. That's how I came across you. I was intrigued by a fellow physical therapy podcaster. Tell me what your focus is on at Practice Perfect.
It's very similar to what you're doing in the PT realm but I had a bigger, wider scope looking at practitioners as a whole. Definitely, I'm going to be a little bit more PT-biased but I'm interviewing medical people from all the spectrums. I'm getting doctors. I've interviewed naturopaths, acupuncturist, some marketing people and some financial folks. Anybody that can help us push our businesses forward and grow in a much smarter way. That's the main thing with that and we went over why it exists.Relationships fall apart at times if you don't stay on top of them. Click To Tweet
Anybody that can utilize the people that we bring to them or the ideas that we bring to them via podcasts, for me, it's simply to provide that resource. There are other practitioners, private practice owners that have gone through some of the same things that were going through or have gone through. You can learn from them. You don't have to figure it all out by yourself, whether they’re programs offered by PPS through the APTA or consultants and coaches that I interview or books like you mentioned. There are ways to get the information that you need to be successful business owners.
I've talked to so many different practitioners already and almost every time I talked to somebody, we've got another idea from another resource. That person might be an acupuncturist and they've had this amazing experience where they're selling these supplements out of their clinic. They realized that they can't take time away from their day to fill these things and put them here and get clinic interruptions. Then they have to walk away from their patient and set these things up and all of a sudden, they’ve decided to open an online store. There are all these cool ideas flowing from different practitioners. I'm even thinking me telling you guys about directing your focus towards some chiropractors for a little bit to see if you get a $220 visit instead of an $85 per hour visit. Those are real value for us when we have these discussions and what we’re looking for is even one little tip that makes you light a fire and make a difference for people. It's like doing PT. You made somebody better. I made that arm better. That shoulders moving 90 degrees in every direction. The same thing for these practices. If we get the practices up in any way and see measurable improvement and somebody writes me a message via email that says, “I implemented that and it worked.”
If you hear something positive coming from a listener, nothing beats that. It's like getting a patient better. How can people listen to your podcast or if they wanted to reach out to you, how do they do that?
Just head over to iTunes, Google Play and Stitcher Radio. It’s where we're at. If you don't have that on your phone, download it now and do a search for Practice Perfect. I'm on Instagram as @PracticePerfect. Facebook is @PracticeCast. I'm starting Facebook groups as well and trying to get listeners involved in those groups so that we can have conversations within those things too. If you're interested in that, you can email me at Ian@PracticePerfect.net. I'm open to any kind of questions you may have. Those are all the ways to get to me quickly.Systematizing your processes is the difference between owning a job and owning a business. Click To Tweet
Thanks for sitting down with me. It was great to hear about your story and we're on the same page as to what we're trying to do to help other private practice owners. I don't think there can be enough of us out there to guide and steer and be resources for people, especially in the PT world. I don't think there's been enough focus on the business aspect of the physical therapy profession personally. People like you help out in that regard.
We're going to help out a lot. This is something that's been missing and hopefully people take notes and see that it's a necessity. Maybe we can actually get some change to happen within some of our schooling systems.
More needs to be done from the schooling standpoint. I know more can be done from the APTA standpoint. There's a lot of room for growth and that's cool to see. There's a very bright future for us as we continue to focus on the importance independently on physical therapists.
I've got the main podcast which is like that and I dropped a few episodes and I'm doing this thing called the Daily Drive now. I hit record on my phone in the car, on the drive home from a day in the clinic. You get to hear some of the real time struggles that are happening in the clinic to me. It's a nice little extra piece for people to listen to you. I've got ranging from financial crisis to somebody's not showing up on time and how to deal with that person, reviews and all the nitty-gritty of what's going on in the daily life of a practice owner.
That sounds cool because I've always thought that a sitcom based on a physical therapy practice would go pretty well because we see some pretty crazy stories out there. I'll definitely take a listen to that. I'll check it out. Thanks for your time. I appreciate it.
From Ian's Practice Perfect podcast iTunes page, it says:
"How much Business Education did you get in your Degree Program? Struggling to make it to the next level? Just starting or trying to expand your business? Build your "Perfect Practice" in a fraction of the time. I didn't start to find success until I started listening to business shows like Entrepreneur on Fire and the SoloHour. I cried the first time I realized there were others going through the same struggles. This show exists because I wanted to hear from people in similar industries that are CRUSHING it, to learn from them and to build a better future."
Listen to the podcast and Ian will give you rundown of what he's all about.
This is a continuation of my interview with David Straight of E-Rehab.com. He’s the Co-Owner of E-rehab, which is a marketing company focused on digital marketing for physical therapy practices. If you want to know a little bit more about David Straight, his bio and E-Rehab.com and how it came to be and what they're currently doing, you can check out part one of this episode. In part two, we go into developing your marketing strategy a little bit more for online, but also talk about the marketing strategies that you have for physician referrals. We can't forget that, and it's important to have that relationship with physicians in the community.
We talk about essentially developing your marketing strategy both online and with physicians. I want you to focus on the exercise that he shares in the beginning, that he recommends is the foundation for your marketing strategies. He talks about some of the basics for what your website should look like and what your message should be. Pay attention to the first part of the interview as it pertains to digital marketing, he has a ton of good stuff to share. We'll continue on with my interview with David Straight of E-Rehab.com.
I like what you were talking as we got started that it's imperative that the PT owner finds out what they want and what's the message that they want to convey. A lot of physical therapists have fallen into the trap of providing the same thing for everybody, just like every other physical therapy practice and that's not finding a message that can resonate with people and set them apart. Is that something that you also work with your clients and helping them find their message and maybe what does set them apart and how they can specialize and not be so commoditized?
In fact, it's even simpler than that. One of the best exercises that I would encourage people to do is take about twenty minutes of their time and ask five of their employees the following question. In 30 seconds, tell me what their physical therapy practice does, record that, and then transcribe that. You can use Temi.com, upload the recording from your smartphone and it will transcribe it all. You'll find that in most cases, there are all kinds of ambiguity and it's gray and people have a general, “We're a physical therapy practice,” but there isn't any consistent message. It's a great place to build culture, to team build, to help people be clear about what you do and how you can help the community. Nowadays, there is so much noise and cutting through that noise in a world where most of it turned off through clarity can certainly take your business to the next step.4 Key Aspects to a PT Website: Clean and clear tag line, Call to Action, Proof of Success, and Clear Categories of Services. Click To Tweet
Since there's a lot of face-to-face communication, it's a great way to help your team sell your practice for you. All you do is you extrapolate that with a little bit of messaging to the next level and you take the type of message and you put it on your website. Some things that I recommend that people have is to have a clear tagline about what you do and address both external and internal problems that people who are looking at your website might have. Take for example, an athlete has a knee problem. That's his external problem, he has a knee problem and maybe he sprained his MCL. His internal problem is that he's missing football with his buddies and he's not able to contribute to the team.
Another example might be a mom who has severe neck pain. Her problem is she can't move and she can't turn her head, but the real internal problem is that she isn't able to care for her kids. She doesn't have time for all of this stuff because all these responsibilities piled up. The last example going through another market segment and so you would message them differently would be a 60-year-old guy that has an arthritic hip and likes to play golf. All this external problem is that it hurts when he swings a golf club because of his arthritis, but the internal problem is that he's not hanging out with his buddies on the weekend and that fulfills him in his life. Be clear about your tagline, who you help and how you help with their external and internal problems.
The second thing is to have a clear call to action on your website. I can't tell you how many websites I've seen that don't have their phone number at the top right. That's the standard. Since not everybody wants to call right away and some people are more digitally oriented, have an appointment request up there at the top. Repeat that in the middle of the page and at the bottom. That's another thing that you can do. The third thing that I would suggest is to show proof of success. There are multiple ways you want to do this. First is use what we call outcome-oriented imagery. Think about those three groups or going back to your business plan and your marketing plan defining who you want to be. Think about those different audiences and think about the positive outcomes. Maybe a woman, if you're doing women's health, you have a happy smile with her husband next to her. Maybe if you do sports stuff, think about an athlete that’s excelling. Those are the pictures you have.
That's one thing and the ratings and reviews and patient video testimonials. They are super simple to get nowadays. That segues into showing the proof that you've had success with people. The other thing is breaking down services into clear categories that you offer instead of just being physical therapy. We have these tremendous specialties now. Do you think it's bad that nobody goes to physical therapy for musculoskeletal? Nobody's going to therapy for things like vestibular and women's health, they’re not even on the radar.
Have clear categories and then optimization for the mobile experience. You think that would be second nature, but I still see a lot that has very poor mobile experience. The other thing is to make online part of your educational process. Your website and the things you do online are not just for generating new business, they’re for transactional as well. You can have patients fill out their forms on your website, you can have appointment requests, and you can educate people about how you're going to help them on your website. Transactional and educational things can be accomplished there as well. Those are the things that people should definitely implement in the design and development of their website.
I love that because it's pretty simple. Make sure you have the tagline, your call to action, proof of success, and clear categories and services. Those things are basics and I'm sure you could look at many physical therapy websites and not see those things clearly laid out. If you're considering the patient experience, your website has got to be high up on your priorities for making sure that's a positive patient experience. Ease of access to communicate with you is right up there. You want to make that transition to you as smooth as possible.
Google says that patients want an easy and frictionless experience when dealing with healthcare providers online. Psychologically, we tend to think of things in threes and fives. What are the three steps to get started? They could be different things for different people. It might be, give us a call, schedule an appointment, start feeling better. Step one, step two, step three. Give us a call, come in for an initial evaluation, start your treatment program. You can define those. If you literally say, “With three little icons or three cards, step one, step two, step three,” these are the three things you should do right now, with a clear call for action right after it that says this is how you engage with our business.
There is so much garbage in marketing and people try to get fancy. They try to come up with weird things and we're like, “What is that? What are you trying to say to these people?” They don't want to do anything on your website, they want to feel better. That's all there is to it. Making it simple in a world where we scan websites to demonstrate to them this is how you engage with our business and you can get started, that's another thing I highly recommend to people.
If you look at some websites, it's more about, “This is who we are.” You want to present that out there, but the call to action should be readily available. We look to these services in it and if you want any of these services or you’re interested in what we can provide for you, this is how you can get in touch with us. It's got to be front and center.
What we like to say is that the patients that come to your website are the heroes, the therapist is the guide to get you back to where you want to be. If you're very inner-directed in your messaging, “This is our mission. This is what we do,” there's a place for those things, but it’s turning that focus outwards on the true heroes, which are the patients that want to get back to their life. It's so critical, and this is something that people screw up all the time. What they do is they confuse physical therapy and they think that people want physical therapy. No one ever wants to call an emergency plumber. If I have a need though, then I want my need fulfilled now and then I never want to see you again.
Keep that in mind with your messaging and then the different promotional vehicles you use. You can't induce demand for physical therapy. You can induce demand for fitness. You can induce demand for supplements. You can induce demand for massage. All of those things are hedonistic or people want those. They make you feel good. Physical therapy is a utilitarian service and it's for good to help them get out of pain and to recover function. Keep that in mind with your messaging and the vehicles you use. That's why you find the social media, for all it’s good, shouldn’t be your top priority, unless you spend a lot of money. This goes back to your market, how they behave, the message that you create, and the medium you use to deliver that. It all comes full circle when you think about it in detail and you have a good plan.The patients that come to your website are the true heroes. The therapist is just the guide to get you back to where you want to be. Click To Tweet
I appreciate you taking the time to share so much of your insights, Dave. It's been great. More physical therapists need to recognize how important it is to put together ideas. Recognize where they are in their stage of business and put an effort behind. Budget out for their online marketing presence and push that forward so they can stay on top of what's going on in the trends that are happening. Did you say you wrote a book? Is that something that you want to share with us?
I wrote a book and I’m in the process of revising and writing the second edition. It's called Book your Practice Solid: How to Use the Internet to Generate More Business for your Practice. We're talking a lot about online marketing, but I hope I have impressed upon people the importance of having a bigger strategy, a marketing plan. Finally, depending upon your market, one of the best opportunities to generate business and for over 100 years, the pathway to getting into physical therapy has been through a referral from a physician. That study was from 2009 to 2013.
While referrals have declined, I would argue that it's because people are busier, there's more regulation, there's more documentation. Traditionally, people fall back to habits that they were taught. The reality is that more people are dying of opioid addictions than ever and that no one knows about physical therapy. While for example, your general practitioners and your internists have the highest level of trust, this is in consumer reports, they have the lowest satisfaction when it comes to the management of back pain. That can be extrapolated to the management of any musculoskeletal problem. While we hate the idea of going to a doctor and then the front office person says a doctor doesn't have the time or they don't refer to physical therapy, we already have our source.
We do that, go to one doctor and we've heard this negativity in our profession. We extrapolate that to all doctors. When it comes to marketing, marketing is always about numbers. While I may go to twenty doctors and ten of them tell me to take a hike and don’t come back, five of them might be interested and five more will say, “I need help with my patients and I know it but I don't have a lot of time.” If you speak to physicians in their language, clinical research and you don't necessarily make it the goal to talk to the doctor, but to build the relationship with the entire office, you have solutions already prepared. In fact, you know better than they do because you have more education about your practice.
You can develop some tremendous relationships and help the doctor out where they wouldn't have known about it before and they haven't learned it in medical school. Your orthopod thinks physical therapy is a protocol and your GPs and internist maybe optionally got a class where they were taught about how to evaluate musculoskeletal from a PT, ten or twenty years ago. As a result, they write a prescription for what used to be your Cox-2 Inhibitors. Those killed a lot of people's hearts so then they flipped over to opioids. Now we've got a bunch of addicts. I would encourage people to understand who they're selling to. This is selling, belly-to-belly, we defined it selling. That's face-to-face. It's about understanding that there's still an opportunity there to go out to the doctors, and your GPs and your internist are the best.
As Tim Flynn says it so well, “We want to keep people out of the medical industrial complex where they get over-medicalized and over-diagnostically tested and over-treated when they could have gone to us first.” We don't want to demonize the doctors, we want to reach out to them as well. That's where a lot of people don't. There's this understanding that we want to have consumers directly to us. At the same time, for many, if part of their marketing plans is to actually perfect the sales process with physicians, it can transform your business dramatically.
That's huge because the patient's going to get to the general practitioner if they're having some issue. They're not going to spend all their time online and they don't necessarily know about physical therapy and what it can do and provide. You have to maintain that relationship with the physician and it's a sales process and let them know that we are the experts in rehabilitating musculoskeletal issues. When a patient comes through for back pain, they need to come and see us as soon as possible. We get the best results if they come sooner rather than later.
You made a key point there. You said something in passing that was key though, we need to show them. What most salespeople do and physical therapists usually do is they go into the office, if they're lucky, they get past the gatekeeper and they might be taken to somebody else, but they only go once. Secondly though is they give brochures and referral pads. They don't speak to or are willing to show the doctor what their solutions are in a language that they understand. That's not your brochure. It's clinical research.
When a pharma rep comes in and they come in several times a day, they're using case studies and random controlled trials and things of that nature to get the doctor to question whether or not this is something that might be appropriate for their patients. You do that and what we recommend is to couple that with social proof. Survey your doctors in the community. Survey all of the doctors and ask them questions that are all naturally going to point to you being the solution. Use peer pressure, so to speak.Turn your focus outwards to the true heroes, the patients who want to get back to their life. Click To Tweet
All of the doctors think they know about physical therapy and all the doctors think it’s appropriate to refer my patients to one alternative. Doctors down the street are saying this. You should have this thought process to that your patients want solutions, they don't want drugs, they want alternatives. We're hearing that and the evidence supports that. Not by brochure, that's being another commoditized type of sale. Prove to them that it's better than the other things they're doing. Finally and most importantly, do that repetitively, the same message over and over again. When you see you're getting through or you're not, you can switch your message but through repetition, that sales process, you can sell.
We know better or I would argue about best of all, what to do conservatively for musculoskeletal problems. Keep dripping that message on them over the course of several months and then when you have some influence with them, then you can switch to the next message. The only way that happens is if you go out, you work out, you get outside of your office and you sell. Scale that to someone else who does it for you. I thank you for allowing me to share that because that's what's made a huge difference in our practice. It also helped several others when they explored that part of their marketing plan that's generating more physician referrals, in conjunction with also looking at going to the community and generating repeat business too.
I love that you shared that because we have to recognize that a lot of people, not just physical therapists, shy away from the term sales. No physical therapist wants to be seen as a salesman, but you’ve got to recognize that. I love how you brought up that the reason why the pharmaceutical reps go into the offices and share case studies and talk the terminology is that they're talking at the physician's level. Rarely have I seen where we go in and have that same level of conversation, where we're talking about case studies and what we provide that is been shown to alleviate back pain or have been successful and the results are this. I don't think we do a lot of that kind of leads to the doctor.
We don’t. We're almost physical pharmacists. We fulfill the orders and for those that actually have taken upon themselves to learn how to do this, they're having conversations. The response is typically, "I had no idea you ever did that. I had no idea you knew that." When the opportunity exists, where you can have those conversations and you bring to the table solutions to problems that others don't even know, it puts you in a great place when you're building that relationship. I highly recommend it if somebody wants to grow and that opportunities to learn how to sell. That's training that we have for our clients that are interested. The reward is potentially tremendous. You can develop ten, twenty, 50, 100 more referrals literally. We've seen that per month, if you do it right. When that reward is potentially so high, there's a lot of resistance or work to master that process. It's not, “I'll click the button to pay to run Google Ads.” That's easy and everybody does it. This is something that it takes some time and effort and consistency but if you do, it can make a difference for you.
I can only imagine that the one way to set yourself apart in the physician's eyes is to be the guy that knows what he's talking about. Share some of this information and talk to them about studies and case studies and of physical therapy. One of the reasons why physician referrals have decreased so much in our current experiences is that they just hand the prescription to the patient and say, “Go find a place. Pick from a list,” and they're going to look at your online presence. Can you see how effective that would be if you went to the doctor who has recently talked to you about what it takes to overcome lower back pain? They might say, “I have a lower back pain patient, I should send them to this physical therapy because these guys know what they're talking about.”
We did things to facilitate that. We'd go in and spend a day with the doctor, find out what they were saying and identify opportunities where patients typically come in for example and say, “My back's killing me.” You and I know that pain is not proportional to pathology. That being the case, we would help the doctors. The doctor would know very well that, “I shouldn't order an MRI. They hurt their back four days ago.” The best thing to do is to get them to physical therapy or help them understand that because the pain is bad, that doesn't mean you have a blown-out disc that's going to cause whatever. We went in and we helped the doctor by saying, “What if we developed some educational collateral for you?”
They will give this to the patient and say, “If you get to a physical therapist that I'm going to refer to you, within two weeks, you've got a 50% less chance of having a surgery, 50% less chance of having injections, 40% less chance of imaging, 11% less chance of a prolonged use of medications.” It reinforces what the doctor didn't know because they didn't get this information. They may have thumbed through it, but they go back because they're so darn busy. They don't want to piss off their patient. They want the patient to come back to them. Why is it that we see drug commercials all the time? Because the doctor's going to make a decision as to whether or not that's appropriate for their diagnosis, but the patients drive a lot of the care. It's proven. There's certainly an opportunity to collaborate with doctors which are out of our comfort zone. That's where that magic happens. I encourage people to make that part of their marketing plan but also implement the other things as well.There is so much garbage in marketing and people try to get fancy. Click To Tweet
It's not all about the online stuff. We have to have a good online presence and have a budget set aside for that, but you can't give up the relationships that you have with the physicians. That’s your bread and butter.
You have a mature and successful practice, but for somebody who's just starting or somebody who's struggling or somebody who wants to try to get to the next level, they have no knowledge of how to sell. They've heard nothing but negative about it. They may read this study where referrals are declining over time. Physical therapy and healthcare are hyper-local. Just because it happened somewhere else that way or just because you read a study with thousands of referrals or hundreds of thousands of referrals, it doesn't mean that that's necessarily what's going to happen in your community. I would encourage people to explore the opportunity. It's not just with physicians either, but reach out and find out how they can help other people and share what they do. That starts first with having confidence about what you do and why you're justified to have that piece of the fire or why you should be treating that patient versus a personal trainer, a chiropractor, an acupuncturist or a medical doctor.
You need to understand that. That's training that we help people with and a lot of people don't know that. It comes from not tactics. I've seen so many people go through the cycle. It's like, “I need more referrals, I need more money.” The natural thing would be to go market. They don't, because they feel inadequate, so they go learn something. When they go learn something, they go, “Now I’ve got to execute it, but that's what I don't have time to do or I’m confident doing.” They go back and then they fall back to the cycle, “I need more money and I’m in fear and uncertainty and in doubt. I need to learn something instead of the market.”
They're always looking for silver bullets and I can tell you that big businesses don't become big businesses by firing silver bullets or throwing spaghetti at the wall. They have a marketing plan and a business plan. They use tactics like online marketing tactics to help them achieve their marketing and business goals. This way your podcast is so valuable for people and all the experts that you have on is so valuable for people. For me to say, “Just follow or just sign up with me and all of your woes will be over,” it's not going to happen. If you want to be successful in this hyper-competitive environment that we're in, the thing that gives me so much hope about the future is number one, value is going to continue to drive the healthcare market. We still have value-based networks.
Even though everybody's selling and buying and collecting outcomes, it hasn't been connected yet. That's one thing. The other thing is the massive need for what we do and the under-utilization of our services and for those three reasons, even in the right markets, you can't compete in some markets. Sometimes it's impossible to penetrate but most of the nation, there's still a great opportunity to be successful as a private practitioner.No physical therapist wants to be seen as a salesman, but you've got to recognize that. Click To Tweet
I'm glad we’ve got to talk a little bit more about stuff related to not just the online presence. We can talk about some of the face to face, one-on-one relationships that need to be built in order to be successful. It's not just salesmanship with a physician, but you’ve got to learn how to sell your services to the patient. Learning how to sell is something that's imperative for us as healthcare providers.
If I may take all the stuff that we weave through and circle back to summarizing. First, it’s about understanding who you are and having that confidence and then defining the people that you want to treat, defining who your ideal target market is. The next thing is positioning or developing your message. That's where we talked about positioning and having a clear concise message. It’s doing that online and offline as well so everybody in your office knows exactly what the message is. Once that's online, using those different communications vehicles as different types of media to get that message out through the most common way people access information and that's online.
Also, it’s understanding when they come in, how to sell that service. It’s going to the doctors and being able to communicate to them because that's the traditional pathway that's still people come through. At least 70% of the time in my study, 60% or 70% are still referrals first, the first time they come in. Following through with some things to see if people can come back or were they likely to refer, which are other topics for other times.
If people wanted to get in touch with you, David, how would they go about doing that?
They can email me at Dave@E-Rehab.com. They can go to our website at E-Rehab.com and request a free consultation on there if they like. We have multiple calls to action. They can give me a call at 760-585-9097. I love to talk about this stuff. Thank you for the opportunity to have this dialogue.
You had a ton to share. I appreciate it.
I'm happy to share my time with others because I still have that fire as you can tell about our profession as being the best first choice for naturally conservative care for musculoskeletal and others too.
Thank you for your time. I appreciate it.
Thank you, Nathan.