Reality Episode #5 – Making Great Progress As A New(er) PT Owner With Avi Zinn, DPT

Continuing where  they  left off in  their  last discussion,  Nathan Shields  sit s  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 h ow 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.  

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W e’re doing  R eality  E pisode  #5  with Dr.  Avi Zinn,  a  p hysical  t herapist and  O wner of  Druid Hills PT   in  Atlanta.  Avi, i t’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  yea rs   of  following your progress . Y ou’ve made some awesome progress.  C ongratulations, 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.
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W here we left last time is you had made some changes.  Y ou 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  P rompt 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 . Y ou had a lot of changes.  W e want to follow up on that stuff and more if that’s okay during the  show .   S tart with something that’s been most dramatic for you.  

F irst of all, thanks for having me back. I love doing this ,  always.  L ast time ,  we were talking about my front desk . T hat’s been the biggest change for us for a lot of good reasons.  O ur front desk, she was leaving to go to OT school . W e were looking for a new patient care coordinator.  W e were trying to get her started before our previous one was leaving  s o we can do some training.  

Y ou had some overlap and support there as they’re training.  

I t worked out that way.  W e got on our new patient care coordinator to start. She started in December  2020  with enough time to overlap for about a month.  S he got some good training . T hat was great to see how   s he  eased herself into our  office.  

What were some of the things that you were looking for in your next front desk person? Did it  v a ry  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 .   S omeone 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.   

Y ou 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 . I f it’s a female, you almost want that motherly type.  

T ake care of the clinic  and the  patients . M ake sure everyone gets the appointments they need . Le t them know  that,  “W e’ll get you on the schedule.  D on’t worry. We’ll make sure you get your visits. “   W e got her on . T hat was a good transition because of all the extra training . W hat 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.  P art of it was using some of  P rompt ‘ s reporting .   T he EMR software that we switched over to have some awesome reporting . T hey have this plan of care compliance report, which you can pull up the next week’s list of patients.  

I t 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.  T hat has been so helpful because we’re able to get that report on Monday morning.  B y Tuesday, maybe Wednesday, we’ll already know what our schedule is looking for the next week  be cause we’ve already called and scheduled all of our patients.  B y Wednesday, we’re looking at next week . W e see it’s full  and   t hat’s good  or w e have a bunch of spots open . “ Let’s boost the ads. “   T hat’s been helpful. That’s been cool .  

F or those people who are  reading ,   SOP  is   Standard Operating Procedures  or your policy and procedures.  T here ’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.  I t was   every step from the first call until they see the physical therapist.  W e created that.  W hen our new front desk came on, we trained her with that patient journey.  I t was  like ,  “S tep one , t his is what happens when they call . S tep two, you follow up with this . S tep three, you do  it . “   T hat was something that was cool.  With that, a ll 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 . T he PTs were telling them,  “Y ou get to come in twice a week for six weeks. “   T hey were coming straight up to the front after their visit and  scheduling  out all their appointments.  

W e’re seeing that because  we’re  managing the expectations.  W e’re setting up our patients for success.  W e’re seeing in our cancellation rates .   W e ‘ re lower than we’ve ever been.  Last  time,  we were at 5%.  W e’ve never been that low before. I attribute that to our front desk managing our expectations and getting our patients . T he PTs are doing a great job with everything they do . T aking 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.  S econdly, 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 . O n 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. Y ou have conversations  like  that .  

I was listening to  Jerry Durham ‘ s  show. He  talks about front desk stuff a lot . O ne little thing he said on one of his  shows  was often ,  no one asks for the patient who’s calling to  t alk about their story.  I t’s always  like ,  “L et’s get this information so we can put you in our chart . L et’s get this so we can set you up. “   I t’s never  like ,  “W hy don’t you tell me a little bit about yourself and what’s going on so we can learn more about you , w e can know what to do to best get you to where you want to go ?” T hat 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.  W hen they come, they already trust us because they know we’ve talked to them and ask them about them.  T hey’re coming in ready to do whatever we tell them that is going to be best for them.  

Y ou’ve changed the mindset at the front desk   and  with your providers as well to say ,   “I t’s not all about what we need. ”  W hen they call, it’s not  just  about,  “W hat’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,  “T ell me what’s going on.  Y our 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 ?  

T hat’s exactly what she’s doing.  T hat is part of the reason that we’re having a high arrival rate . F rom the beginning ,  they’re calling us ,  they see that we care . W e do care . E very 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  w hen 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  Ke e t  H ealth  on an episode . T hey stress the customer experience as well. I did a  show  with  Jerry   years  ago   when we did our first one about the customer experience.  O ne 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 . M ap that out  and   how  we can  improve and more fully live out our core values at each of those touchpoints.  W hen you do that, it forces you to think differently instead of ,   “W hat do we need ?”  but rather ,  at each of those touchpoints,  “W hat does the patient need and how can we help them have a better experience with us ?”  

T he guys  at Keet Health  swore  and   t hey said,  “I f you can improve that customer experience, you will triple your marketing efforts. “   Y ou 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 . T hey’re not dropping off after the  3rd, 4 th ,  and 5th  visits. They’re staying with you  for  longer periods of time and thus seeing results . T hat first domino is how  we  can do this differently to show that we care more in order to get their buy-in .  

E verything you said is what we’re experiencing.  T here  are  plenty more that we can do to enhance the patient experience . F rom 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.  I f we’re getting them in twice a week or completed plan of care, that means they’re getting better . I f they’re completing their plan of care, that means they’ve completed their physical therapy.  H opefully ,  that means that they’re back to doing whatever they wanted to do in the first place.  

T hat  also  goes to your point  where   y ou are getting results and this is where it triples your marketing efforts . A t this point and at this stage of your ownership, you’re  a few  years  in. Y ou’re starting to see some of those return patients or they’re referring family and friends.  W hen 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.
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We are starting to see that.  I nterestingly enough, historically ,  a lot of our referrals have been from the direct – to – consumer  Google  A ds .  

You were solely built on that for the past  few  years.  

From the beginning when I first started , w e 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 . T hat’s the way it worked for us.  A s we got busier, we had to turn down the ads because we don’t have room for everyone that’s calling . W e’re looking to hire because we’re so busy.  W hat was interesting is that we’ve turned the ads off but we’re still getting as many people calling . W e’re seeing that it’s return patients .   W e’re getting people who have come back every year . E very year, there’s something new . T his is their PT place.  W henever something comes up, they come in . W e’re seeing our patients who are coming in ,   w e ask them who referred them . W e’re getting a higher percentage of people coming in from their referrals from past patients.  W e are seeing that, which is cool.  

I s 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.  I t was right before Corona.  I t was something that we didn’t implement.  T he plan at some point  is  to build that in .   O ne of the things from the  Lighthouse Leader Group,   Jamey Schrier  group, which   you put out a  show  with  him ,  they do this QA . O n the fifth visit or something you have, you do, not a  re- eval but a quick check-in .  Are you progressing well?  T he 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.  D o you have any friends or family that  you know  that could benefit from our services ? W e do want to help people. ” I t’s a good opportunity to take advantage  w hen people are seeing good progress to use that, to ask for them to send their friends.  

That was a real ly  successful action for us.  I t’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.  T o 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 . M ake sure  you  tell your doctors.  I f you have a ready-made template to have the patient ,  write a note and you can fax  it  off to the doctor .   T hat can be a successful action . N umber two, you can simply say,  “T hat’s awesome. Do  you know  anyone else that’s having issues so we can help  them  like  we’re helping you ?” I t’s a quick and easy way to ask for referrals but it’s also a way for you to solidify . “Y ou are getting better . W e can do this for a lot more people. “   H opefully ,  that cements it in their heads.  

Y ou said something that I’ve been realizing lately .   It the  m indset  of   w hat you said about PTs ha ve  a hard time because they feel salesy when they’re trying to convince people to send their friends.  O ur true purpose is to help as many people as possible.  O nce 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.  A s a PT, we’re doing it all the time . W e’re trying to educate our patients. We’re trying to get them to comply with our plan of care.  W e’re trying to sell them all the time.  W e are almost salespeople by nature of trying to get them to complete their plan of care.  R ealizing that  a n d  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.  

S peaking of plans of care, your usage of  P rompt EMR and some of the reports they provide .   Y ou are amazing compared to the other EMR s   like  business management reports. Prom pt  does a great job at that .  

I’ve been surprised  that  they keep developing their software and everything they put out . A s 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 . W e called it the weekly walkthrough .  We w eekly walk   through each physical file  o n  the active patient file shelf with our fingers  and  w alking  it  through with the front desk , saying ,  “W here’s this person ? W hat are they doing?  A re they scheduled?  H ow are they doing? Are they coming back? “   T hat was a weekly thing that we had to do every week.  F or you to simply be able to pull that up and save all that time, you’re not even involved at that point . T hey are expected to pull it up and do the work.  

I t’s automatic .  The f ront desk pulls it up on  P rompt.  It’s t wo seconds  to  pull it up and then she shares it as a shared Google file through  Google Drive , which is also amazing. Google  Dr ive ,  in general ,  is so cool.  I t’s shared to all the  P T s  and then they make a note on each one  like,   “That person was dropping  down to once a week ,   m ake sure to call them ,”   or  “T his person  is  discharging this week. “   It  happens so quickly.  

Have you been overall happy with  P rompt ?  

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 ,  a lthough I jumped back into treatment . W e’ve been busy.  O ur schedule is full. I’m trying to hire someone . W e’re also saying to our patients,  “W e want you to commit to twice a week. “   I f we don’t have room on the schedule, I feel  like  a little hypocritical not letting them have those twice a week visit s .  I t was important for me to jump back in   to allow our patients to get on the schedule. I did one note on  P rompt for it on the documentation side of things. I hadn’t spent too much time doing the documentation but overall,  we’re  happy with  P rompt.  T hey’re great.  T hey continue to develop their software. I still think that they’re going to be the best ,  if not ,  getting close already.  

T hey’re making so many changes, not knowing exactly what’s happening on the documentation side and on the billing side . F rom what I hear ,  there’s room for growth there . I t’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.  

T hat’s also one of the cool things that I  like  about using them . T he y’ re a young company . W e  have  been working with them in their early stages . S ome of the suggestions we give to them, they listen to us . H opefully ,  as they grow, they’ll continue to listen to people .   E arly on ,   s ome of the suggestions we make, they implement  it  and put into their software.  I t’s cool to be a part of that  a lso .  

H as the billing been going okay with  P rompt as well ? Y ou made some changes  with  similar timing.  T hat can be a big upset to have an EMR change  a nd  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.  I t took some time for things to work   well together.  I t was   new, not only for us   but also a new software for the billing company.  E veryone had to figure it all out.  T hat was from the beginning. We had a meeting with the billing company and  P rompt talking about if we’re going to make this work . T he billing company had a list of things that they needed  P rompt to change ,  modify ,  or add into their software in order for them to be  successful .  W e prioritized a certain number of things . T hey’ve hit upon all of the main things at this point.  T here  are  more things that  the  billing company want s  them to implement.  F or the most part, they’ve been able to take suggestions on the billing side as well  and  change them  in   P rompt.  T hings have been going  well.  

P rior 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  B l a ck ,   t he billing company .   It  was  M ay  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  ha ve improved since then ,  but at least it freed up your time.  

I t  free d   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.  T he 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.  T he loss that I was writing off is more than enough worth it to pay a  billing company to do it .  

W e might  ha ve 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  i n – house and train your own person or bring on someone with experience?  

T he biggest reason was that it was COVID. It was too hard to think about bringing someone in and training at that time.  I t was that.  T he other thing was  because  the company is  W ill Humphreys . Y ou 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  w hereas if I was going to have to hire someone and train them .  I f I was to be the one to train someone, I wasn’t the best biller person.  H ow would I even train someone to do the best billing practices?  I f 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.
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The  other change that you made was to   s tay with the same consulting company but have a different one-on-one coach . W hat have you   been doing differently than  the  previous coach?  

T hat’s been cool.  O ne of the reasons that I switched was  I  wanted to get a different coach . I  hadn’t been  in   a  year.  I t was interest ing  to see what other coaches had to offer.  T he 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 . I t was the end of 2020 . W e worked on a budget for 2021 . T hat was something I had never done before . I t was a cool practice but it was  also  super helpful.  

2020 was a different year than anything ever before.  W e had to look at 2019 .  I use that as a template to grow . W e 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.  W e came up with an idea of how much we could use in our office and then worked backwards from there.  W e ended up choosing our 2021 budget as we were going to use a 30% increase from some of our best months of 2019.  T hat 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,  “I f we want a 30% increase , w e need this many visits for this month and this month . W e need to ramp up .”  

W e were able to dial in all the numbers and look at , “W e need all these stats to work out this way. “   F rom 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 .   “ I f 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.  I f next quarter ,  we need to get to this number ,  I need to hire  and  star t  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 ?  

T he 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.  

W e never had a chance to do that.  Y our coach tends to be a numbers guy .  He’s an accountant by trade.  I f 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. I t’s easy for them knowing  QuickBooks  to input the number s,  bring it all up ,  how that affects the expenses ,   or a  bookkeeper might have that same capability .  

T o look at your 2021 goals  and   how   that is   going to  affect us financially .   I f we want to get these goals ,  what does that look  like? H ow does that change things ? H ow are we going to hire?  I t’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.  I t’s cool that you married the two together with this meeting.  

It was cool.  T he last thing you said when we need to hire was one of the things that first stood out to me . W e needed to ramp up in quarter  2   or  3 . W e needed th ese  many more visits based on our projection.  W e need to hire .  I realized  i t’s February  2021 .  W e’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 ,   “T his is when we need to do this.  T his is why we need to do that based  on  the numbers. ”  

Y ou have some real guideposts to say,  “W hen we hit this number ,  these actions need to fall into place. “   T hat’s what it sounds  like .  Y ou’re at that point .  

That’s how it feels.  W e’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.  I t’s been great.  

I love that you looked at it for the whole year annually and then broke it down into quarterly pushes.  W e’re coming towards the end of the first quarter. I assume you’re on track.  

We are o n track.  W e’re trying to  hire.  I wanted to get more into the numbers.  O ur  arrival rate  is great.  O ur utilization is great .  February  2021  was our highest number of visits that we’ve ever had in a month. Thank you  very  much.  I n March  2021, w e’re already  100  more than  February 2021 .  F irst of all, March  has  23  w orkday s  versus 20 workdays in February.  I t’s a little bit of a difference . I t’s also  just  been because of all the different things that we’ve implemented being able to look at the numbers ,  also with using  P rompt and being able to make sure the plan of care compliance report is keeping our schedules full.  W e’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 . W hen you look at your front desk and you’re  like ,  “I know t his person  is  going to be gone in January  2021 s o 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 .” T hat 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 s ame thing with your EMR .   Y ou’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  s ame thing with your bill  where  you’re looking at that . N umber one, you hired a great billing company because they provide you reports and communication.  I know  that because  I know W ill . T hey provide great reports and great communication to you . Y ou 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.  

Y ou leaned on your coach.  You r eturned back to the financial numbers.  L ooking 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  a lso using Google  A ds to your advantage to grow your practice. You’ve outsourced a lot of things to your advantage.  T hey’ve all paid off.  

It’s funny that you say that using the numbers . T he 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.  I t 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 . B efore ,  I’m  like ,  “T his feels right.  I think  it  wi ll  be good. ” T hank God most of the time ,  it’s turned out that way.  This time w ith the numbers, I’m making these decisions and  I know  this is the right thing to do  b ased on the numbers .  

You ’ve  got some growth and expansion goals.  T he 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 ?  

W e’ve done this distancing thing for a long time  that we feel like  comfort – wise , w e can fit more than we were comfortable  several  months ago . W e can hire another  PT .  W e’re looking to hire  now . W e could even hire another one after that in this space.  I t’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.  T here was an opportunity to take over the middle floor  so w e would be able to double our space.  It  was possible that we could have expanded in our own building.  

I think i t’s not going to work out . H e’s selling one of his companies . T hey’re  going to  maintain that middle floor.  I t’s not going to be available for me anymore . I t 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.  M ore and more people are getting vaccinated. People are comfortable . W e realize we can do a little bit more with the space that we hav e.  

Physical therapists are almost salespeople by nature who are trying to complete the care plan of their patients.
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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 t he beginning of the year 2021, we were having cancellations  and  no one was calling. It was  just  the beginning of the year . D eductibles  we r e  resetting . It  was still Corona.  A ll 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 .   A lso ,  moving forward, the number that we’re trying to base it  on  i s 85 %  or 90% utilization capacity for more than a few weeks . W e know  t hat’s not  just a 1  or  2 – week thing. That’s a trend that’s going to stick around us.  W e ’ve  got to bring people on.  

When you can be a n  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 . ” Fo r us ,   i t would mean,  “W e’re going to get serious and interview these people. “   N ot knowing how you do things, it’s  like ,  “L et’s start ramping up.  L et’s start that cycle of action. “  

I will say that I learned from  W ill 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.  I t 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.  W hen 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  i f you’re trying to wordsmith the ad correctly . W e’ve got an ad that works . I t’s up and it’s going . Y ou’ve got some resumes already. Maybe you boost the  I ndeed payment to get more views on it . T hat’s great that you’re not starting from scratch.  

W e’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.  H e  like d that   we were a company that stuck to our values.  H e said all the things that I wanted someone to say . H e’s a new grad  s o 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.  W e were thinking it  woul d be better to have some one  with little experience  i f it’s the right person . W e’re not against hiring new grads.  W e’ll see ,  b ut he spoke about all the right things.  

Y ou looked at your team and  sa id ,  “W hat 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.  

I t’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  i f we bring someone else  in. I t make s  us a stronger team altogether.  

W hat’s super exciting about you bring ing  somebody on  is  you’re already 95% efficiency, utilization capacity, whatever word you  want to  use but your Google  A d spend has been lower.  Y ou bring that person on . I f you want to fill up their schedule , y ou’ve got to boost your Google  A d spend.  

T hat’s how it worked with our last hire. We filled her schedule quickly with the ads.  W e have to pay for that ,  but it’s a way to fill up the schedule and do it faster than the normal potentially.  W e’ll see if that works that way.  W e lowered our ads . They’re  at  a  minimum . W e’re still totally full.  W henever we do hire, that’s the plan . W e’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 . T hat’s something that I haven’t had with any of the providers about having them be accountable to fill up their schedule.  T hat was a conversation I had with the team when we had this  6  to  8- week dip of us being   at 80%  t owards the end of the year  and  in the beginning of the year.  W e had a conversation about accountability versus responsibility.  No o ne is accountable to fill up their schedule, bring in new patients as much . T hat would be great but the way we have things set up, I use the ads . T he 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.  W e did have a meeting . L et’s talk about when we do see a dip in the schedule . Let’s  have a plan for knowing . I t 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  s o that way we can get to it earlier on.  T hat was  to  the last point, which was interesting about accountability versus responsibility.  

E verybody on your team should be marketing in some way or another where you’re spending money on Google  A ds. Their responsibility is to get patient compliance and ask for referrals.  I f 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.  

Y ou 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.  O ne of the things was you ask,  “A re they supposed to shadow other PTs? ”   T hat’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.  T hat 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.  T hat 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.  W e 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 . Th ere was some general stuff  like ,  “W e’re going to go over the employee handbook. We’re going to cover these principles and what you’re responsible for.  W e would break down into specific responsibilities.  A s a front desk, you’re responsible for these stats and this is how we can train you . F or a PT ,   t his is what you’re responsible for ,  these stats . T his is how we’re going to train you. “   I  can see that maybe as a potential growth  a venue for you is setting up . H ow 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?  

T he truth is I did that for the last one .   W e created a little bit of an onboarding process of  1 ,  2,   3  weeks in 30  to  90 days . I t was more of training them . W e 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 ,  o r is it  just  you at the top?  

T hat’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.  W e put that on hold . W e’ve been talking about developing that role.  I t’s been interesting with her because she’s been affected by COVID with her kids.  H er kids have been remote learning this whole time.  S he said to drop her hours.  I t’s been interesting talking about the leadership role . W e ‘ re going to make her clinic director . S he might not have enough time to do it.  S he had to drop her hours . I t wasn’t her fault or anything.  

W hat’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 .   W hen we started doing these leadership meetings every week with her, when we talked about ,   “L et’s look it up . H ere’s a list of all the things I would want a clinic director to do. Why don’t you look through this list ? C hoose all of the high – energy things that you would want to do.  M aybe we can build a role based on those few things.  T hat way ,  it’s not a clinic director in the traditional sense ,  but at least it gives you some more leadership opportunities to do. “   W ith the time that you have and the hours, you can still treat but also take on some leadership things.  I t’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  a s you’re starting to develop these policies and procedures or shore them up that you’ve done over the last little bit . Y ou’re starting to establish some goals.  T he 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.  T hanks 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 . Y ou have access to a ton of great people and a population that is receptive to Google  A ds.  Y ou’re doing some amazing stuff especially years out in ownership.  Y ou’re already successful . W e’ll stay in touch for sure.  

Thank you, Nathan.  I appreciate hearing that too.  S ometimes I don’t know where I should be compared to   few  years in ,  whatever it is.  I t feels  like  we’re growing in a good way as far as what our reputation is.  T hat’s been the biggest thing . C learly ,  the clinic is full.  P eople do  like  coming to our place and we have a great reputation around town.  T hat’s been reassuring to know that people are valuing our service.  

Y ou’re going to see that jump in return patients here in the next  few  year s , p eople that are referring family and friends  such  that yo ur  return patients are going to be 50 %  to 60% of your patient population.  S imply by adding the physician relationships that you develop over time and your continued work with Google  A ds ,  turning on that faucet, turning it down, turning it up as you need  i t will allow you to continue to grow.  It’s  great to get in touch with you again . K eep us updated . Is there  anything else you want to share , Avi ?  

W e went through a lot.  H opefully ,  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.  I t’s fun to be able to look at my progress or what I’ve gone through . T hese are so fun to do because of that. It lets me see where I’ve been and where I’m going.  

C ongratulations  a nd keep it up.  W e look forward to talking again .  

Thanks a lot , Nathan.  

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The post Reality Episode #5 – Making Great Progress As A New(er) PT Owner With Avi Zinn, DPT appeared first on Physical Therapy Owners Club.