Busy Clinic? Should You Hire A PT Or Drop A Low-Paying Insurance? Discussion With Will Humphreys

Has your clinic been busy these past months? Are you considering hiring new PTs to solve the problem or dropping low-paying insurance? Will Humphreys , the owner of Rockstar Recruiter , has been helping PT owners recruit well-aligned, quality PT owners. He joins us on the podcast to discuss whether owners of busy PT clinics should keep waiting lists for patients. Will also shares the two things that reminded him of how business owners should generate profit – increasing revenue or decreasing expenses? Tune in and di scover what we need to consider to solve the problem of having a busy clinic and, at the same time, generate profit.

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I’ve got my good buddy, Will Humphreys , back on with you. We get a lot of good feedback about when we are on together. I’ve had multiple people come up or email me and say, “Those are my favorite episodes when you and Will get together.” Thanks for joining me again. I appreciate it.

It’s my pleasure.

There’s not an immediate target for this conversation but we have some fundamentals that we want to cover.

If anyone is reading, going, “Why am I going to read this crap? I don’t even know what they are talking about,” I promise you. You will leave this episode going, “Will and Nathan were right. That was an amazing episode.” If not, I would love to hear about it.

I’m one who would rather under-promise and over-deliver.

Someone’s life is going to change. They are going to be in their car sobbing, “I can’t believe it.”

Last time we spoke, you told us all about your launch of Rockstar Recruiter and how you are helping PT owners recruit PTs across the country. Why not start there? Give us a little bit of update on how things are going? What are some of the feedback? What are you seeing in the industry if it’s changing? I’m assuming it is.

Is it changing? It’s crazy. I feel like I’ve learned more about recruiting in the last several months, even though that’s all I did for large companies and our company. Anyway, it has been fun. I have been embarrassed to admit that I’m obsessed with recruiting. It’s like saying you are in the Star Wars at a level that people are like, “That’s a little bit weird.”

For me, what’s so cool is that that’s where the whole journey begins. Building that dream team is easily one of the coolest parts of the journey but it’s also the hardest. You and I both hated it for so long. Rockstar Recruiter is this online coaching program where I work with people in groups. There’s online content teaching everything that I used to do. They launched it in January 2022. For me, this was a passion project. It wasn’t chord anything else that I was working on but was something that people needed help with.

I was shocked, to be honest, how well it’s worked. It’s wrong to say if you are selling a product but it’s true. For me, I knew how to do it. I questioned whether or not I was going to be able to help people do it. The results have been unbelievable. We’ve got people who, after three months, stopped showing up to the calls because they not only hired what they needed but they’ve got enough people in the wings to where they are like, “I got to worry about other things.”

They know what to do next. That’s the beauty of your program. You are teaching them how to fish. It’s not just getting you the therapist that you need. They can take what they’ve learned and go back to your online webinar content and remind themselves if they have to. They have a recruiting program to build off of.

I thank you for saying that because, for me, my favorite thing is seeing someone go, “I hired somebody.” It’s hard because when you don’t know what to do, it’s like, “I don’t want to learn how to do it.” Once you learn, you never have to learn it again. It’s the single most important skill we can have as owners. People do not realize the cost of not knowing how to recruit. If we pay a recruiter $5,000, that’s cheap. Some recruiters cost way more than my course even costs. If they bring in the wrong hire, LinkedIn estimates that it’s four times the employee’s salary. It’s what it costs you in the end. If you are hiring someone at $70,000, it doesn’t seem like you are losing hundreds of thousands but you do in terms of all these different efficiencies that you can track.

You can lose efficiency. That loses patience. Word of mouth is lost. You must go through the whole process, which takes administrative time and burden.

Those are all quantifiable. The unquantifiable pain is the nightmare of dealing with an employee who isn’t completely bought in. How do you put a price tag on that alone? Seeing people hire not just make hires but hire that I know are going to be better fitted for people’s companies, I would argue maybe it’s the most rewarding thing I’ve done since I exited my private practice. I feel I’m helping people in a way that reminds me of being a therapist. You see people run who haven’t run in a while. You see that joy. These are people who have run and have never had the chance to run before in their businesses. It has been fun.

What’s a summary of what is in Rockstar Recruiter? If people are interested, they know what they are getting into.

Learning how to recruit is the ultimate power as an owner because when recruiting better, we show up differently when employees have issues and complaints.
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I teach the core concepts as to what the market is doing. I will talk about that if you would like. I share with people three main concepts, how to define who they are looking for, what they say to those people, and then where to find them. It’s always the who, what, and where when it comes to recruiting. In the coaching, we go well beyond that. In group coaching, it’s a matter of interviewing people and so on. The who, what, and where is the how because most PTs do pretty good converting when someone shows up to be interviewed. What they don’t do well is find good people to come interview with them. I do support those other functions.

One of the things they get at Rockstar at no additional cost is the ultimate PT bonus plan. How do you retain a PT once you finally hire them in a way that keeps you profitable? In the program, we talk about the who, what, where, and how around that to get leads in the door so they can convert them. That’s the overview of what it is. There’s a lot of online training. I have templates. The templates alone are worth the cost of the course. It’s job ads, job offers, bonuses, and everything you can think of. They can download these things and edit them to their liking. More importantly, they know why those templates are better than anything else out there.

It’s not just the online webinar stuff you do weekly. You have a Facebook group. You do weekly coaching calls.

We have weekly coaching calls. We have a Facebook group. I’m doing all sorts of fun things. The big thing is this. At the end of the day, I always tell people, “If you want to boil everything in Rockstar down to one thing, it’s teaching PT owners how to build a network of potential hires that know, like, and trust you.” There are three main programs, one of which I created newly. I never did this before but I created it for Rockstar.

It’s called the LinkedIn Igniter Program. It is a five-minute daily effort that is producing leads for my clients in a way that I couldn’t have predicted. I learned it from a LinkedIn expert in a different industry, not for recruiting but for sales. I adopted it for PT recruiting. I’ve got PTs who have said they haven’t hired anybody or even interviewed somebody in months, and after the LinkedIn program, they are interviewing people weekly.

We are going into July of 2022. You start in January 2022. 6 or 7 months isn’t a long time. The industry is pretty much the same in terms of the need for PTs across the board.

On average. We go through this success period. From April through June 2022, PT owners tend to start worrying a little bit less about hiring. All the flooding of new grads and the fact that at the end of the year, PTs haven’t been happier or a little bit more open. We find that in April, May, and a little bit of June, my PT owners are a little bit less worried about hiring. I call this the harvest season, where all the work that we do, if you do it right, in the worst-case scenario, once a year, you go harvest and build your company. My efforts are evergreen. People that work with me hire year-round.

I thought it might be a little bit different. I would assume between April and June, that’s when the new grads are starting to look, reach out, and find. You are saying that the PT owners aren’t necessarily pushing hard during those times. Is that what you are saying?

It’s the same thing. You are right. The students are becoming more available. It’s because the students are more available to interview, and PT owners are making hires. The second they start even filling their needs, what do they do? They immediately start worrying about other things.

They stop recruiting altogether.

It drives me crazy because the whole purpose of Rockstar Recruiter is to provide an owner with a year-round program that almost runs itself so that they never have to worry about hiring ever again. When someone gets a hire with Rockstar, and they fall off the call, I’m like, “Stop it. Just because you got your money’s worth and feel you can move on, you want to suck the juice out of this program.” My clients who have stayed with it all the way through to completion are telling me, “Will, I didn’t even know what it was like to have a bench of PTs.” I’m a little surprised that it works because I didn’t know I could teach it.

What’s amazing is that they have been able to do it here in a six-month period. What took us years to get to that point? You are getting people there in six months.

They are getting results within 2 to 3 months, and that’s when they fall off. That’s where I’m like, “You got to stick to the whole six months. Why would you ever want to have to pick this up again?”

The power behind not just filling that spot but then where we recognize the true power of it was when you could start replacing people who weren’t a good fit with better potential fits or the fear of somebody leaving. Heaven forbids somebody give me their 2 or 4 weeks’ notice, whatever it is. I don’t have anyone waiting in the wings. That means I’m going to have to jump in and tread again. I’ve dreaded that. You work out of fear. This keeps you from doing that. It gives you so much power.

I’m so glad you said that. Learning how to recruit is the ultimate power as an owner. I love that analogy. When we were recruiting better, it was amazing how differently we showed up when employees had issues or would complain. We weren’t jerks about it. It’s not like, “We can replace you,” but knowing we could totally change the dialogue and minimally reduce the amount of sleep that I lost. Maximally, it increased our income because then it was like, “I don’t know.” There’s a joy in having a team that loves each other so much. It’s almost like they don’t care about us as owners. I would love it if everyone could experience that once in their career. The program takes you to that point.

In time, because you are hiring intentionally, I can see the culture has created such. You are getting people who would love each other like family to join your team.

It’s like one of those wheels. Once it starts getting momentum, it starts the recruiting. Retention starts taking care of itself. That’s what’s cool about it. For me, when people don’t sign up, the only thing I’ve ever heard them complain about is that they don’t have the time to implement it. That’s it. It’s crazy because I’ve built the program to where if people can even do half an hour a week, they will get results. If they can do an hour to two hours a week, they will get there. No question before the six-month mark. That has been proven.

Gratefully, we’ve taken dozens of companies through this program, right across the country, Alaska, New York, you name it. We have been through a number of different regions, small remote areas of the country, and big, populous areas. These techniques solve any of that. They are so different than what every PT owner is doing. That’s part of the magic of it.

There’s value in what you already laid out and the benefits of recruiting programs on a regular basis. If people want a discount on Will’s Rockstar Recruiter program, reach out to me directly at Nathan@PTOClub.com . I will hook you up with Will. Through that introduction, you will be able to get a discount on his program. If you go directly to Will, you are going to get his program but if you are going to get the discount, you got to reach out to me. Email me first.

It’s a significant discount. That’s the best way to do it. I love that you are supporting the program, so thank you.

I know exactly what you are doing, and it’s amazing. Related to that, and this is why I wanted to bring you on. The conversation I’m having with my coaching clients, especially with those that are busy, what they are looking at is they’ve got a backlog of patients. Their average patient visit frequency per week is suffering in terms of a patient that has to reschedule and isn’t able to get a time that works in their schedule. They are only coming in once or twice a week instead of 2 to 3 times a week, which should be their plan of care because schedules are booked.

I don’t think it’s a majority of the clinics that are out there. Many clinics are still trying to reach capacity or maybe they are having in the 90% efficiency range. A few of them that I’m working with individually are talking about, “So-and-so is going on maternity leave. So-and-so is going on vacation for a month. I might let them go. If they did resign, I would be in a world of hurt. I’m looking at a future where I’m going to have to step in and treat full-time.” This is not their ideal scenario and is in the best interest of the business.

The conversation during these one-on-one calls has been, “Wouldn’t now be a good time to keep recruiting to find the other therapists, especially those that are aligned for you? Can you not drop insurance, especially a low-paying one?” That has been my push. I’m starting to talk to them about dropping low-paying insurance. I had Sturdy McKee on the show a few episodes ago, talking about the same thing.

That’s all he did and what he coaches on. Why not get into the recruiting efforts, and get to Rockstar Recruiter? Maybe though, now with such high demand and low supply, the cost of your services should go up but they don’t because we are tied to these contracts. Why not create that because the demand is there? I wanted your thoughts.

I want to know more of your thoughts on it, too. This is probably one of the most important things we could be talking about. All those people who were skeptical at the beginning of this call don’t even know what they are talking about. This is this conversation right here could potentially be worth tens of thousands of dollars or more to people. My thought is this. As you were talking, it reminded me of the only two things we can do to generate profit as business owners. That’s increase revenue or decrease expense.

When we are looking at those models, smart business owners, especially outside of healthcare, are always looking at 20% of their business that’s taking 80% of their resources and only contributing to 20% of their income. As PT owners, there is so much fear. I’m not going to say it like I figured that out because when you and I had a practice. I was terrified of saying no to insurance. Maybe that’s a good question back to you. Why were we afraid? Why do you think most owners are afraid of dropping insurance?

The ones that come to mind and that people speak about are, “What are the doctors going to think?” We want to make it as easy for doctors to refer to us as possible by accepting them all, accepting all the insurances, and taking the kick in the pants on the patients’ behalf and almost from an altruistic standpoint, even though it’s biting us in the back. We will take the shot. There is that because I’m assuming out of fear of a backlash from the physicians, even though if you communicated the message properly to the physicians, they would understand.

I don’t know about you but I’ve seen plenty of physicians who were saying, “As of such and such date, we no longer accept blank insurance.” They know the financials and what we are doing. If they knew that we were getting paid less than our expenses per visit with such and such insurance, UnitedHealthcare comes to mind, they would understand. There are some doctors that might not. That seems to be one of the biggest reasons why.

The other reason why is things are going okay, so why rock the boat? In terms of also considering, “If I did drop that insurance and that represents 10% of my patient load, what are my PTs and PTAs going to do? How am I going to keep them busy? I got to keep them busy somehow.” Another thing is based on our lack of business and financial knowledge.

Across the board, when you and I went into business, and it would be the same for most owners, our focus, based on our limited knowledge base, was on top-line revenues. “What do I got to do to increase my total visits? Top-line numbers even. What do I get to do to increase my revenue without consideration of profit?” Back in the day when we started, did you even know how to figure out your profit margin? No. Those are 2 of them are excuses, and 1 factor into why we keep taking those poor insurances.

There's a joy in having a team that loves each other, that it's almost like they don't care about us as owners. If only everyone could experience that once in their career.
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There is a mindset that goes around all of this. It is perpetuated starting in our PT school programs where the teachers are like, “Don’t overbill because then you will go to hell.” Medicare is going to come and take away your home, your car, your wife, and your kids. There’s that feeling of fear that they generate, especially if you are an owner of like, “I don’t want to rock the boat.” The way we experience money is probably the bigger issue around that as well.

One of the dumbest things I’ve heard in our industry, and multiple owners say this. I’m judging you if you say this, “There are no problems that new patients can’t fix.” With an inefficient profit margin, you are going to add more water into a vase with holes in it and think the overflow at the top is going to somehow account for the outflow at the bottom that shouldn’t even be happening.

That mindset is a piece of it. I love how you described it because those were the reasons I would have never considered dropping insurance. I want to go back and slap myself in the face because all these problems are solvable. I’m not trying to solve each one in detail but the first thing about it is you even started solving. If we are going to cut insurance, we don’t know how to deal with it, and we are too afraid of it.

Is it that hard to solve by having a conversation and saying, “We lose money on people with this insurance? We will no longer take UnitedHealthcare as of this date.” You go train the doctors on it. All of which would support you. Do you think you are going to lose all your business? If anything, they will respect you as a business owner. Maybe that message is even more like, “For us to provide the care that your patients deserve, we have to work with insurances that we don’t lose money on.”

The second thing is this idea of, “What do I do with my PTs if I lose 10% of my volume because UnitedHealthcare is 10% of my volume?” That’s a math problem that any eighth grader could do. First of all, “How many patient visits should every PT see for me to be profitable? How much of this decreases things?” It takes a lot of stress off of situations as you see started with, people going on maternity leave are not being able to recruit as well.

There’s some pride, too. I’ve worked with owners recently who have shut down locations or had to reduce the number of PTs that they have because their volume has shrunk during COVID and hasn’t fully recovered. It’s hard for them to say, “I used to be this owner. I had a certain size company, but now, it’s only this big.” I’m like, “You are way more profitable.” I would rather have one location at a 50% margin than five locations at a 0% margin. The second location you can brag about but it’s like, “I’m running a good hobby that doesn’t pay me squat.”

I liked what you talked about in terms of communication. Two things, the communication and efficiency part. You have to sell this to your team as well. “What do you mean we are not going to take UnitedHealthcare? That’s a lot of my patient’s load. What am I going to do?” When they recognize that patients can’t come at the frequency that they need to come in per your plan of care because of a tight calendar, this is the best-case scenario.

We are talking to the people who are having a hard time getting the patients in. Maybe they have a backlog of new patients or their patients aren’t getting the frequency they need. Your patients aren’t getting the results that they deserve. They are not getting the results they need with PT. Patients are getting frustrated. Your PTs are getting burned out because patients aren’t coming. They are not compliant because your schedule is not available.

It’s about talking to them and the patient population like, “Everyone in the country should know that economic conditions are such that it’s hard to find help. When you base it on economic conditions and difficulty in finding appropriate staffing for our teams, we have found that we cannot provide the care that our patients deserve. Thus, we have to limit what’s flowing in so we can provide the best care to the patients.” Communication is a huge part of it.

The efficiency part of it is exactly that. You might drop 10%. Considering patients aren’t able to come in at the frequency that they want to come in, we have availability for patients to reschedule, which happened to be the higher-paying insurances. Now you are getting paid. The patients are getting seen. They are getting the results that they want. What’s best for the patient ends up being best for your financials because your average reimbursement per visit goes up without any increase in your fixed costs. That extra visit from a higher-paying insurance patient goes to bottom-line profit. Efficiencies are seen in that regard.

It’s so true. It’s funny because now I’m starting to realize that even at a deeper level, how by eliminating those low-cost insurances, the first-person benefits. Reiterating what you said, we are talking about a case where you’ve started a practice, and it’s grown. You are hitting a wall against growth. This would make a ton of sense. If you are starting out, no one knows you, and you are saying you only take Blue Cross Blue Shield , I’m not saying that’s even a bad thing. That might be the single greatest way to start a company.

To get started, most of us become everything to everyone, which means maybe we become nothing to no one. As we become more successful, we have that power. The patient benefits. The PT benefits because they start learning about real business, which will make them better employees. The bigger thing is that the industry is better.

If every physical therapist owner in the country drops UnitedHealthcare, a national underpayer of our services, if we all got together like we should be doing as orthopedic surgeons do, by the way, and globally we all say no to UnitedHealthcare, that we won’t work with them for less than $100 a visit nationally, and all dropped them, UnitedHealthcare will lose their crap.

They would take half to yield to us. When we do that, we are taking a stand for the industry. That makes those insurances a little bit less burdensome cost-wise for the patients. The patients benefit again. It sucks because we want to be everything to the doctors. How do you see that person in the room with a total knee replacement who’s got insurance that you’ve dropped?

There are plenty of other physical therapists who aren’t going to have the courage who are going to treat that person. Even if everyone did drop that person, no one took UnitedHealthcare, and that lady needs the knee replacement rehab, then and only then could you do a pro bono visit and have it really be about altruism. It’s not about calling it altruism when it’s your lack of knowledge of how to mitigate it. You measure it. You celebrate it like, “Here’s how much money we’ve given back to our community.” You recognize it in a way that’s measurable versus eating it, thinking you’re being generous.

What even stood out in my conversation with Sturdy McKee is recognizing what your value is. One point that you skipped over, not that it was a bad thing, is that you could have a cash rate that adequately represents your value. This person could pay as well. If they need the service, they pay cash for massage therapy. They will pay cash for chiro visits.

We should have an appropriately valued cash rate in our clinics that is not $60, which ours was back in the day and more representative of the value that we can provide. It’s hard for PTs to recognize that value. You have to talk them into the value that they provide. When I first heard and said it to others, it almost felt like I was talking into a vacuum because I quite didn’t feel it myself. We are the musculoskeletal experts.

By putting myself in that position, it’s like selling my own house. I know all the deficiencies in my house. It’s hard for me to sell the beauty of my house because I know all the screws that are loose and everything that needs to be fixed. When I try to sell myself as a musculoskeletal expert, I know my anatomical neurological knowledge is deficient. I might miss some diagnoses.

It’s hard for me to call myself an expert. Comparatively, we are the experts in musculoskeletal care. It’s hard for us to put our profession on that pedestal and call ourselves the experts because we know our limit limited abilities, our deficiencies, you name it. Until we believe that, it’s going to be hard for us to demand more.

Maybe that’s what this show is about. What you said at the end, there is a global issue, whether or not we choose to take insurance, we charge cash pay, how much do we charge cash pay, all of that stems from what Sturdy said, which is knowing our value. We don’t know our value. I love that example you gave. On my YouTube channel, I did a video analyzing the actual study that showed in all healthcare, and it’s got graphs and everything. They did testing to find out who in healthcare knows the musculoskeletal system the best.

The best person in the world is an orthopedic surgeon. We are not as knowledgeable as them. From that point on, it goes from a physical therapist with a Doctorate, a physical therapist with a Master’s, a physical therapy DPT student, a physical therapy student, and then it goes to family practice. It’s the order and a dramatic drop-off. As far as rehab is concerned, we are 100% because surgeons do one thing. We are everything non-surgical for rehabilitation and post-surgical but we act like we are some service that gets prescribed out to Lipitor.

Try PT 2 to 3 times a week. That’s how our PT shows up in the evals. It’s almost like we need to take a hard look at what the cost would be if we didn’t treat people to determine what we are worth if we could put a monetary value. There have been studies that don’t help but physical therapy versus MRI and opioids, those studies are out there and it’s like, “Why wouldn’t you believe in PT?” It’s because we don’t believe in ourselves.

Let’s take someone who has an injured back or a frozen shoulder. Let’s walk them through their emotional and physical costs from beginning to end on what that’s going to cost them monetarily and subjectively as much as possible. Let’s go back to that first interview with the patient. If we knew that number, and I don’t know what the exact number would be but I’m willing to bet it’s multiples like ten times more plus money, at least. I’m being conservative. What would it cost them to pay $200 a visit?

Every visit, one-on-one for an hour, you are getting access to 6 to 7 years of study or how many years of implementation in practice. I’ve seen how many thousands or hundreds of people with this condition. I am your salvation. Maybe not me but what our company can do for you is going to cost you exponentially less and save you more time and pain. You are going to get there. Let’s charge them $60 for that. You know this because we talked about this book before the conversation, the $100M Offers . What’s funny is when we price things low, people experienced the service or product like it’s not worthwhile.

People who joined In The Black, I give them Rockstar Recruiter. It’s stupid but I give them access to it because they are already with my billing company, and I’ve had one company do it. I’m talking out of all of my clients I can track to see who’s done 0%. It’s because I gave it away. It’s not worth anything but when my clients for Rockstar Recruiter pay for that course, they have life-changing results. It’s so funny because that’s what we do in PT.

What if we charged $500 a visit? People would say, “I don’t know if I can afford it but it must be freaking work.” I have been angry most of this conversation. I’m getting riled up. I don’t even know. It’s because I see it, and we’ve lived it. We’ve gone through the other side of it. We realized that the biggest problem of all is that our industry does very little to support the mindset of our PTs, that are some of the most amazing human beings on the planet.

This isn’t attached to that I have been spouting for the last few years that I have been coaching PT owners. I see the industry and how many PT owners need your services in terms of needing PTs. I’m like, “Why do we keep pushing for more PTs when the demand is huge for most clinics. Why not make us make ourselves more efficient/productive? If your PTs are running at 100% efficiency, 120% efficiency,” believe it or not, they are going to burn out. You can’t keep running them that hard. What’s the one thing we can do to make all of this a little bit easier and more profitable? It was to cut out the lower insurances and slow down the patient volume.

What you might find out is patient volume. After 2 or 3 weeks, come back up to where it was before. That’s time to cut the next insurance out until you’ve met a happy equilibrium or find that next PT but start cutting. I saw that with my friend in Vegas. He cut out low-paying insurance. It was horrific. It was 30% of his patient volume, which scared him. He was ready to cut. When he did that, he was going to let go of one of his therapists.

I said, “She’s a lion. She’s a good therapist. She’s productive. Let’s not do that.” Their patient volume went down 30% immediately. Maybe six weeks later, they were back to the same volume they were before, with a bunch of higher-paying insurance patients who couldn’t get in at the frequency they wanted to before and were staying more compliant on the arrival rates better. He’s thinking, “I’ve got another target for another insurance company but I’m going to start marketing more.”

Supplanting that drop in insurance with a greater marketing effort allows him to foresee the potential where instead of $60 something a visit, which honestly was where he was, initially getting up to $90, even over $100 per visit on average. Be more, and have profit for the first time in a few years that he hadn’t seen before. That story has started changing my mindset and thinking, “Why couldn’t other owners do this?”

The two things we can do to generate profit as business owners are to increase revenue or decrease expenses.
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It’s inspiring to see people do that. What’s cool is that there are many different ways to cut the pie. You are offering a controversial or at least a disruptive idea. That’s something that goes against the standard operating basis for most of us as PT owners. There are also so many other ways to cut that pie. The one thing that you and I did that I’m super proud of is that we took insurance companies that were $50 or $60 a visit. We created a plan where we did see those people but we saw them for the amount of time that we got reimbursed. Immediately, we had employees go, “Are we about the money and all that stupid stuff?”

It’s the emotional stuff.

It’s almost like emotional blackmail. What we don’t understand drives us to create an emotional story that goes against our ethics that isn’t even true. When we taught PTs, it was like, “In UnitedHealthcare, we lose money if we see someone past 30 minutes. What we are going to do is teach the front desk to schedule 30-minute appointments for people with this insurance. We are not going to hide it. We are going to tell them, ‘Your insurance reimburses us for half an hour worth of work. We are going to give you that much. We would still like to see you.’”

We train the therapists to say, “With your condition, we shouldn’t have any problems with this.” In most cases, it was enough. There were those cases where the replacement, for example, that they needed more than a half-hour, then it became a decision, “Is this going to be a pro bono case? In essence, are we going to eat that difference on occasion?”

“Are we going to see them for an hour and only get paid for the half-hour?”

We decided we would do that selectively versus making that the policy. The reason I say that is because there are so many different ways to make your company more profitable. You are too busy treating or managing this machine to even give yourself the chance to do the real deep thinking on what you could do that’s different. That’s where the innovators come in. That’s why you and I are doing what we are doing now.

It’s not to make money in an industry that we know. It’s to disrupt this whole damn thing and get people thinking differently. The only way we survived was by working with people who also thought differently, most of which were even in our industry. We are trying to serve people by doing that in their own world but they don’t need us. People could do that on their own if they believed that they could put profits first and realize the patient is the first person who benefits from that.

That’s what it boils down to. The future of physical therapy is completely dependent upon the individual practitioners generate. Individual outpatient ownership is completely dependent upon profitability. When you are still getting paid the same flat rate now that you were several years ago when you signed the XYZ contract, UnitedHealthcare comes to mind, maybe it was profitable back then.

It hasn’t changed in several years. We are looking at 5% to 8% inflation over the next 2 to 3 years at a minimum. The cost of your expenses is going to go up higher than it already is. That same contract doesn’t meet your needs. It’s almost like getting rid of a girlfriend or a bad employee. They don’t meet your needs anymore. It’s easier to drop them.

It’s true. We got to drop off the baggage. We got to do whatever it takes. You have a PT, for example, who’s not cutting it. They shouldn’t be in your company but you are scared of what’s going to happen when they leave. Drop them. The insurance company isn’t paying what they are worth. It’s so funny how you and I grew. We had multiple locations. It became this almost Utopia practice that I can’t believe we got to that place. The whole journey would have been much easier if I had been treated.

This goes again for a lot of what you and I preach but there are two models. You can be self-employed. There’s nothing wrong with that. There are pros and cons to that. If you are going to be a real business owner and try to make a difference in the lives of your patients and employees, especially if you want an upgraded life for you and your family, we have to say no. We have to take a stand. That’s who we are standing for. We are standing for those people when we drop the insurance or correct the employee.

Honestly, going back to your principles, the biggest thing is learning, tuning in to this show, and hiring you as a coach. If people are like, “How do I do this?” I would recommend you go hire Nathan immediately because I don’t help with that. Nathan would. Nathan knows a lot about this. That was the type of stuff you used to bring to our partnership all the time, ideas like this. Getting help is always okay but it’s just being an action around it. That’s what taking a stand is. It’s deciding to take action no matter how small and being consistent.

I like listening to podcasts. I remember one guy in a podcast said, “I’m intrigued by the people that have tuned in to all my podcast. I want to ask them if they are any better for it. Have they implemented anything from it?” I would rather you read one of my episodes and implement everything therein and then move on to the next episode. Maybe reread that episode over and over again until you’ve figured out that one thing.

It’s the same thing in terms of books. You can read all the books. Plenty of people have read all the business books but their businesses are no better for it necessarily. They can give you all the rote answers that are necessary if a question comes up but they haven’t implemented anything. We won’t get anywhere as an industry until we put action into place. It’s not about value-based care. It’s not about showing our worth. It’s none of that.

Nothing is going to happen significantly until we start putting action into place. You don’t have time. You don’t have the money, the profits for action if you are not running a profitable clinic. You can’t do more with the APTA and maybe special interest groups that can help us in this regard. You can’t help with the state PT board. You can’t help your community if the profits aren’t there, to begin with.

That’s a beautiful way to put a bow on a package on this. It’s one of those things where I would love the idea that there’s always hope and progression but you are pushing the point of, “It’s time to do something about it.” I’m sure people have made a difference by tuning in to the many people that you’ve had on this show. I know those people as well, who read the books but don’t implement them. They don’t get anywhere, movement over motion.

Is that yours? Did you trademark that one?

Its profitability unlocks probability.

I’ve trademarked that one. It’s profitability unlocked possibility. I feel what we need to do is have multiple episodes talking about how we think about money. How do PTs think about money, and how should we be thinking about money? If you are a PT and you are reading this, your goal should be to make as much money as humanly possible.

I will say parentheses ethically. A bunch of morons out there who bill patients who weren’t even showing up. They are on vacation in Hawaii and students. That’s called being unethical. That’s never acceptable. What if our goal was to make as much money as possible in physical therapy? What would happen? I guarantee we would start showing up like doctors and not a service that gets referred out to.

We would still do research and make sure that what we are doing matters. If anything, we would make extra sure that what we are doing is the best thing we could do for our patients because we are trying to create maximum value and maximum exchange. If we started showing up like dentists do, this isn’t even unheard of in healthcare. That’s what dentists do every day. We just lean into what they do. They only deal with a part of the mouth that’s this big. We deal with all of this goodness from head to toe. We deal with all of that per square inch. You could make a lot more money.

If you want to reach out to me regarding Rockstar Recruiter, Nathan@PTOClub.com . If people want to talk to you about In The Black and your billing offers, reach out to me. Don’t call Will. Don’t bother. I will be your assistant . Thanks again. It’s a great show. Thank you, sir.

Teaching entrepreneurs how to maximize their income, profits, and net margin is what I do, but helping them change how they think, reclaim their freedom, and discover what is possible is who I am.

I teach the value of this key phrase: Profitability unlocks possibility.

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