Effective Marketing To Physicians – PT Owners Club FB Live Event With PTO Club Coach Adam Robin, PT

The avenue to growth lies in how deep the roots of your relationships with others run because these relationships become your secondary referral source. One of the basics of physical therapy marketing is to create relationships with the local physicians who would likely refer patients your way. In this episode,  Adam Robin  and Nathan Shields of PT Owners Club Coaching talk about the tactics that make for developing solid MD relationships and building a marketing team to support the owner. Join them to learn more about the value of building your list and leveraging those relationships for growth.

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This episode is all about marketing. For those who are reading, I got my good buddy, partner, and coach in the Physical Therapy Owners Club, Adam Robin , with me on this episode. It’s good to have you. We’re going to talk about marketing.

Yes, specifically physician marketing because that’s what the people wanted. That’s what we’re going to give them.

We did the survey on the group, right?

We did a survey in the group, and we’ve had a lot of startup clinics joining the group. A lot of new clinics starting up and they’re trying to look for ways to get busy. The old school, “Let’s get in front of physicians,” is the first thing that people want to get into, which is a good place to start. Let’s talk about it.

Right off the bat, what do people get wrong about physician marketing?

I think that there are a few things that they get wrong, but the first thing that comes to mind is we show up to the physician’s office thinking that we need to be interesting and that we need to impress them. That’s a lot of pressure that you place on yourself, “I have to be special. I have to be unique. I have to be blank. I have to make them like me.”

Everybody wants to use the word niche. How do I show my niche?

“I need to be special.” It’s like, “What do I say? How do I be cool? How do I impress them?” I feel like the way that we show up is probably the first mistake that is made.

There is something to be said about standing out. There’s also something to be said about being authentic. I think those two things are different because the generic way of standing out that I’ve seen physical therapy owners’ market and marketers do is, “We care a lot.” This is their message, “We provide a lot of one-on-one care, manual care, and hands-on care.” What physical therapist doesn’t say that when they go into the doctor’s office?

The doctor’s office is like, “Oh my God.”

The referral coordinator is like, “Just tell me your name and give me your stuff. Let’s move past all this part.” In the desire to show off as you’re talking about and stand out, they end up doing the same old same old.

If you think about it, think about the physician or the referral coordinator, the person who’s on the other side of that conversation, what are they feeling? They’re like, “This guy is going to try to pitch me. Here it comes, guys. Here’s the elevator pitch.” It’s a weird thing. I know you and I are taking a sales masterclass and we’ve learned a lot about that, but the way that we show up is important. How awesome would it be if you showed up to that office and said, “This meeting is all about you.” “My name is Adam. I’m a physical therapist. I’m right down the road and I do physical therapy. I’m looking to make an impact but the reason why I’m here is because I love to learn more about you and what you do here. I’d love to serve you. I’m interested in you. Tell me about you.”

I always found an interesting tech because I’d hear about it in conferences and they’d say, “Tell me about the most difficult patients that you’re dealing with. Tell me about an ideal patient that I could refer to you. What kind of patients do you love to see so I know how I can refer to you?” Asking those kinds of questions about what they are seeing and what they want and need would probably be completely different than what they hear most of the time.

The moment that they sense desperation or urgency from you, you’re gone. You’ve tipped over into the inauthentic land and they tune out. They don’t want to hear it, especially new practice owners. This is a scary thing. You’re putting yourself out there. You don’t know what’s going to happen. This guy might be a jerk. He might tell you to kick rocks. Who knows?

However, I would encourage you to do a little mindset work before you enter into that meeting with that physician and say, “I’m detached from the outcome. No matter what happens as a result of this meeting, I’m going to show up powerful as a leader looking to serve whoever gets in front of me.” If they refer me to patients, it’s super, and if they don’t, that’s okay too because I’m going to serve them anyway. Showing up like that will unlock a whole lot of opportunities for you. It will decompress the room. People will open up and they will engage with you in an authentic way. A lot of collaboration and possibilities will be discovered if you set the tone early.

I know you’re different than me, but in this regard, I hated walking into those doctors’ offices. I knew it was what I had to do, but I hated doing it. I would sit in my car, listen to music, and get myself pumped up until I had to walk in. I’d walk in and I knew they didn’t want to see me and I didn’t want to be there. There’s the gatekeeper whose job it is to say, “No, they’re not available.” The only thing that helped me is to have a mindset of, “I’m developing a relationship.”

I’m not here to get a referral. I’m here to build a long-term relationship because I think one of the mistakes that’s made in marketing to physicians is that “I’m going to do this action and it’s going to net me this number of referrals.” With my relationship with physicians, it was more of, “I have a relationship with them,” and I did. I had a relationship with physicians that would never refer to me but I’d still go and see him. I’d say, “You know you don’t send me patients, right?” “We like this place,” or whatever. I was like, “You can at least throw me a bone once in a while.”

When you get to that point, you have a solid relationship or you have their cell numbers and you can text them at any time. When you’re looking for that then it becomes less of sales and more of building on the relationships and it’s easier to build on the relationship and not dependent upon the number of referrals that come across your clinic. For me, that was also more fulfilling. I could talk to them on a first-name basis. I could go golfing with them. I love golfing but it was partially marketing but it was also because I had a relationship with them and I like them. When the goal is to net a certain number of referrals from them, that comes across pretty obviously as you’re dealing with them. Don’t you think?

I love what you said there because you did it. It’s like, “Dr. Shields, I am not here to get referrals from you. I’m here because I would love to develop a relationship with you. I’m interested in learning a little bit more about your practice. Tell me, what type of patients have you been seeing lately?” What an awesome way to separate yourself.

It’s not uncommon to see this, but even to show up with the patient to their follow-up visits. The only time I would do that is if I was concerned about this patient’s condition and diagnosis and wanted to hear firsthand from the doctor what they’re thinking. It’s also an opportunity to get in and say, “I care enough to come, but I also want to get a relationship with you.”

When you’re talking about what they care about, they care about their patients. Maybe you could talk about their patients. What type of patients are you seeing? What types of problems are you seeing with the patients? Do you like to use physical therapy? If so, what do you look for when you’re looking for a physical therapist?

You have the clinic going right now, but towards the end, the last few years of our ownership, it very often became when we asked them about physical therapy, they said, “There’s a ton of you out there. We give the patients a list of providers and tell them to find which one is in-network for them.” Are you seeing some of that as your marketing right now?

Yes. Here’s the thing. You might go to a surgeon, a neurologist, a podiatrist, or whatever type of patient or some primary care physicians. Each office is going to manage referrals in a different way. They might have a list. They might have one person who handles all the referrals. In this office, the doctor handles all the referrals but part of what you would like to do is understand what is their process like and who is the person making the decision.

Also, what are they looking for when they make that decision? It’s like, “Dr. Shields, I’m curious. Do you guys use physical therapy?” “Yeah, we do.” “What type of patients do you see?” “We see a lot of back pain patients.” “Whenever you guys are looking for physical therapists, how do you do that? What’s your decision-making process?” “We send it to Mrs. Smith, the referral coordinator, and she puts them on a list. It goes out like that.” “Would you mind if I spoke with Mrs. Smith and learned a little bit more about that?” It might be important for you to know that Mrs. Smith is looking for where you’re located, what insurance you take, and what your NPI number is. She has some information that’s important to her so it’s important for you to make sure that she has that information.

That was always one of my first questions going into any office was, “I want to talk to whoever makes the physical therapy decisions in here.” That’s your point person because if the doctor doesn’t make those decisions, then you don’t want to take his time. Developing a relationship in the long-term is a good idea and should be top of your list but you want to connect with a person that makes the decisions.

It’s because no matter how good your relationship is with the doctor if you don’t have a relationship with a referral coordinator that’s dishing out the referrals, it might not make a difference. Getting to know him or her that that is the point person is vital and developing a relationship with them. You’re like, “What do I need to do to perform as a solid vendor for your patient services?”

I’m not here to take all the patients. I would love to be considered. What are you looking for? What would be valuable for you and how can I provide that for you when you’re making your decision? It’s a great question.

What are you looking for? What do you want to see? What do your doctors want to see? What do your doctors do not want to see? What are the guidelines that determine whether or not you send someone to one physical therapist over another? Do you blackball certain physical therapists for certain reasons that I need to know about? When do we cross the line? When are we aligned? It’s getting to know all that stuff and by the way, how many kids do you have? What are you up to? What are your hobbies?

Maybe these are conversations that you have over time. You have to be respectful of their time knowing that they’re typically a super busy clinic. That leads to the other idea. The people who have a mistaken idea about physician-related marketing are the ones who might say, “I do it when my numbers are low,” instead of it being a calendared routine. This should be a regular ongoing thing because when your numbers are low, then you’re going to be in that desperation mode a little bit more.

You’re also going to start riding the roller coaster and you know the roller coaster. The numbers are down so you go to market. You market, the numbers come up, and you stop marketing because you don’t have time anymore. The numbers start coming down again because you didn’t market so you go out and market again. That’s the roller coaster. Whereas if you have some consistency, you can plan on some consistent growth.

We have a one-year onboarding process for all new referring providers. It’s a series of contact points, emails, follow-ups, lunches, and it’s a year-long process. The thing about physician marketing is it’s only one of the four buckets but it is an important bucket. It’s not the most important thing and it’s not the only thing you should do with marketing, but it’s not something that should be ignored. The beautiful thing about physicians is they have access to a lot of patients so you can get busy very quickly if you understand how to build these relationships. However, it’s also a very volatile relationship because physicians move, their friend who’s a physical therapist opens up across the street, or they retire. Those things can switch on and off very quickly.

That’s why it’s important for you to continue to nurture, maintain, and continue to build relationships, or perhaps there’s a new referral coordinator in the building. The only way you would know that is if you’re in that office continuing to nurture that relationship because if you don’t know it, somebody else is going to figure it out and now they’re going to be the favorite. Continuing to be in front of them is part of the process.

One of the mindsets that I always had and I got this from someone else. This isn’t unique to me but they said, “My goal is to be the plan B for a bunch of physicians because inevitably, plan A is going to do something wrong or misstep. However, if I’m plan B for everybody, then eventually, I’m going to become plan A for a few.” The biggest concern that you could have is when you have 1 or 2 providers that are your sole referral sources.

There are too many eggs in a basket and the whole thing. You can’t do that. Not only is your referral dependent upon a singular source but only a singular source in a singular bucket and we do need to talk about what the buckets are so people know what we’re talking about. That puts too much weight on one thing. Spreading yourself out across multiple physicians and being their plan B also took the pressure off of me as a marketer at the time.

It’s like, “I don’t need to be your best buddy and your primary physical therapist. Make me an option. When the roulette wheel spins, make sure it lands on me once out of five times. Do that for me once in a while. I’m good enough there.” Eventually, I become plan A, and I’ll get 3 or 4 out of those 5 instead of one.

I would much rather have 50 different physicians sending me one referral a month than one physician sending me 50 referrals a month. I had a PTA one time who worked with me for a little while and he had some sales background. This is the way he explained it to me and it stuck with me forever. He said, “You know I love stories and analogies, but if you go into the ocean, you’ll see a big blue whale. He’s got his mouth open and he’s gobbling up all the creatures.”

“He’s a fat blue whale. You don’t have to be the blue whale, but if you look under the whale fins, there are these huge dolphins and other types of animals that are catching all the crumbs and they’re fat and happy too. Don’t feel like you have to be the blue whale. Be behind the blue whale be number two and be ready to capitalize consistently and you’ll build great relationships.”

You don’t have to be the blue whale; just be behind the blue whale and be ready to capitalize consistently, and you'll build a great relationship.
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As I said, I think that takes a little bit of the pressure off. It also keeps you busy focusing your energies not on just one place all the time. That also helps with your connection to the community as you spread yourself out like that. Whereas putting your focus on one area, one physician group, or one physician particularly. It limits your access to working with the community unless you’re in a small town. We’ve alluded to the buckets. Talk to us a little bit about what those buckets are.

There are four buckets of marketing and there’s probably a ton more but I like simple stuff. Bucket number one is current patients. We can leverage our relationships with our current patients to generate referrals. Bucket number two is past patients. We have a past patient list that we can leverage to generate referrals. Number three is physicians. The people who refer directly to our practice. Number four is going to be the community or people in the community particularly who have access to the patients that you want to treat.

The community also would entail the digital marketing space.

Digital marketing like Facebook. It’s leveraging the community as a whole as compared to a physician.

I like to look at the different buckets also as a grade of what is the easiest and least expensive to the hardest and most expensive. The easiest and least expensive way to get referrals is for current patients. Number one, make sure they’re completing their full plan of care and not dropping out early. Number two, asking them for friends and family, especially from those who are seeing positive results. You ask for references honestly of who else they know that’s in pain and ask them for a referral.

Past patients can either be reactivated by having reactivation campaigns or by asking them for referrals. If you’re on the phone trying to reactivate them, ask the same question. “Who else do you know that’s in pain that could use our help?” Those are the cheapest options. You don’t have to spend a lot of time and money to get referrals that way. These are people that already know, like, and trust you. You spend a little bit more time and money to get the physician referrals.

It’s going to take time but in the beginning, all you have is time and a little gas in your truck. You drive around and go see the physicians. Get you some business cards or a simple flyer. It doesn’t need to be this huge overwhelming thing. They don’t care about it. It’s something with your name and that’s got your contact information on it. Also, develop relationships. I would like to hit on a fact that you mentioned. Eventually, if you do this enough, you’re going to get a referral.

If you meet a few physicians, they’re going to send you a referral. Now, you have the opportunity to provide the best experience for this patient that you ever provided. Especially if it’s the first time somebody sent you a referral, it’s like, “Everybody, gold star this person on the calendar.” I’m going to make sure that this person is so unbelievably happy because by the end of it, what I’m going to ask them to do is go back to that physician and tell that physician how amazing I am and how amazing my place is.

“Patient, when do you follow up with Dr. Shields?” “On July 13th.” “My goal is for you to have such an amazing experience that when you go back, you tell him how amazing this experience is. Would you be willing to do that for me?” You’re leveraging the patient in a way that gets a positive testimonial right in front of the physician.

I probably shared this with you back in the day when we were coaching but one of our go-to things all the time is we made sure our providers and our techs did this on a regular basis. We learned it from our coaches in the past. It’s the success forms. Even if it was 2 or 3 visits into a treatment program, the patients would come in and say, “I can do blank now which I couldn’t do before. My pain is less. I’m moving better. I’m stronger. I’ve made this objective progress or this functional outcome.”

Maybe it’s not the end goal but we’re making progress. It was our protocol to say, “Great. Do you mind writing that down in a letter to your patient? We’re going to fax it to your doctor. It needs to be 1 or 2 sentences.” We had this templated piece of paper ready to go at any given time on clipboards. We’d bring it over to the patient as they are waiting for therapy or sitting on heat or whatever they were doing to say, “Dr. Blank,” and they would fill it in. “I just want to let you know my shoulder is moving a lot better. I can reach it overhead now which I couldn’t do before. Thank you for the referral to Rise Rehab,” and then sign their names.

We would have 3 to 4 of those faxed out to the physicians every day. The feedback that we got on it was good because the front office people would tell us, “The doctors love seeing those because number one, they don’t have to sign anything. It’s a quick read and number two, it gives them an update on how the patient is doing.” “I sent that patient to blank. They’re getting therapy and they’re making progress. I don’t have to sign or fax anything. I’m updated. We’re good.”

The physician is the hero. It’s like, “Thank you for being such a great doctor that you would send me to see them.”

They appreciate it. The things we’re talking about are what my cousin used to call hitting a bunch of singles. You don’t need to be hitting home runs and triples all the time. It’s the single and another single, and you back up single after single with the base on it that brings people along. You’re hitting singles all the time, and eventually, you’re going to start getting some runs coming across the plate. I keep that in my mind. We don’t have to be hitting the mother lode and getting six referrals after a single interaction with the physician.

We would like that if we’re going to spend a couple of hundred bucks on lunch but it is what it is. We’re here to serve. We want to maintain a relationship. We want to express gratitude. We want the doctors to know how well their patients are doing. Instead of waiting for 4 to 6 weeks to get a progress report that’s 2 to 3 pages long and requires a signature, let’s let them know. In the meantime, “FYI, your patient is doing great.” Our logo is at the top. They see our name. They know the patient is doing great. We did that. We got a result out of them and they appreciated that.

It reminds me of the flywheel effect from Good to Great . Jim Collins wrote a book called Good to Great. He’s got this phenomenon called the flywheel effect and it’s the same principle. The difference between people who achieve the things that they want and the people who struggle is they hit more singles. If I’m hitting 100 singles a day and you’re looking for one homerun a quarter, I’m going to crush you.

Hit more singles and the singles are about providing value, finding ways that you can serve, making people feel good about spending time with you, and then letting the people who are important know about it. Doing that at a high level, “How can I serve more? How can I get in front of more people? How can I provide more value?” I had a coach one time tell me, “I can tell you how busy your place is depending on the number of face-to-face interactions you have with your marketing list.”

If you want more referrals, you need to have more interactions with people. One week is not enough. Do five a week or whatever. Every now and then is not enough. We need to do it often and we need to create a system in which we can put it on autopilot to where it happens every single week. When your schedule gets busy, the mistake that we made is we stop hitting singles and we go back to not hitting any singles. When your schedule gets busy, you hire somebody and continue to hit more singles. Don’t fill your schedule up with the things that are going to stop you from hitting singles.

Talk to us about that. How do you transition out of patient care and the do-it-yourself marketing to bringing on that marketing person? How did you do it and what made it successful for you guys so that Adam Robin isn’t the person out visiting the physicians’ offices? I’m sure you still maintain some great relationships with the physicians in your town because you started it off. How do you hand that over to someone else?

Slowly like anything else. When you get to a place probably around 3 to 4 employees, you’re starting to develop a little bit of a team. Now marketing is no longer the only thing that’s important. If you’ve got a practice and you’ve got less than twenty visits on the books, I want you to spend 100% of your time marketing or 95% of your time needs to be marketing. Five percent of your time needs to be treating patients.

You don’t need another system or gimmick. Get out and build relationships non-stop. Eventually, you’re going to develop a team and marketing is no longer going to be the only thing that’s important to you. You have to develop systems and policies and train people. At that point, when you start feeling that pull or demand from other areas of your business, then it’s time to start considering, “Do I want to spend my time marketing and then hire somebody to do all the operations stuff or go into the operation side and hire somebody to do all the marketing stuff?” You have marketing or operations. You got to pick one because you can’t do both.

I ultimately decided to hire somebody to do the marketing for me. Even though I loved marketing, we didn’t have a marketing problem. We had an operations problem. I had to learn that skill. I hired my retired soccer mom. I’m like, “Here’s my list. Here’s my conversation of how I say things.” She went on a few visits with me. We met weekly. She brought some ideas to the table. I let her run with them. Before you know it, she had a name tag. It happens very slowly and organically.

Based on my experience, I attacked this in a couple of different ways. I took it upon myself to do all the marketing because I had the relationships. When I had 7, 11, or 20 visits a week, I had downtime and I was out marketing. I had to beat the bushes. I would go out and do the marketing and I have those relationships for a long time. I dreaded it. I hated it, but I had some positive relationships because I got it done and I met some physicians.

They have referral coordinators and we had positive relationships. I had a PTA with me, Stacy, who was with me for a long time. I don’t know how the conversation came up, but I was like, “I hate doing this. Would you ever want to do this?” She’s like, “I would love to go see the doctors.” I’m like, “Are you kidding me? There’s people out there that love to do this?” She’s like, “Yeah.” I’m like, “Why don’t I have you doing this? Why am I doing this?” She’s like, “I’d love to do it.”

She came out with ideas, goodies, swag, and all kinds of stuff to go with marketing. She had great relationships with all the doctors and like you, she shadowed me. I introduced her to different places. She built relationships that I didn’t have. It was totally positive, and like you, I’d meet with her weekly. Where she’s going? What her plan is the next week and she wasn’t full-time. She would treat me 75% or 80% of the time but just so that I wasn’t doing the marketing number one, which is where I would lose energy. Number two, she would do it consistently and because I dreaded it, I didn’t go out consistently.

She did it consistently and she loved it. It feeds her the energy to support those kinds of team members and what they love to do. She would go out and do a great job. The other experience I had was starting up here in Alaska working with my wife. She didn’t mind helping with the marketing. What she did and this is going a different direction. This is for people who are particularly starting off and maybe don’t have those relationships with physicians.

She was the face of the clinic that went out and met the referral coordinators and the doctors. I established it like that. I said, “When you get in front of the doctors, that’s when I want you to set up a meeting with me and the doctors.” You can imagine how that would make me look special. Why people are talking to your people to set up an appointment between the two big deals?

I would show up at the lunch. She would get everything set up, “Nathan is going to be here in a few minutes.” I’d show up and then the doctor would walk in. We’d meet and talk and get to know each other. It’s a totally different experience and neither one is better than the other. The benefit of that person being the face of the clinic initially, as you’re starting up, I can see the benefit of it being different from the first experience and that was as I grew bigger, the doctors knew less and less about the clinic and the other providers that were there.

When they would make a referral to the clinic, they would say, “I want you to go see Nathan.” They didn’t even know the name of my clinic. “I want you to go see Nathan. Here’s the referral path.” When patients called, they say, “I’m supposed to be working with Nathan.” They get disappointed because they’re like, “Nathan doesn’t treat patients anymore.” That would put them off and like, “Why would I come here if I’m not seeing Nathan?”

That would be an issue, whereas now when my wife goes there, they’ve developed a relationship such that it’s not about my personal relationship with physicians at that point and getting the referral to Nathan. It’s to Rise Diagnostics but there are two different ways to go there. If you hired someone right off the bat, they could be the face of your clinic. You want to prove what they’re doing and saying and maybe go with them. I could trust my wife. She’d been around enough so I didn’t have to do a lot of that, but there are opportunities to work with marketing people in different aspects like that.

If you read the book Traction by Gino Wickman, they tell you a lot about how to build out a role in a company and it doesn’t change whether it’s marketing or front office physical therapist. Once you learn that skill, it doesn’t matter what role you’re building out, but essentially, what you want to do is get clear on what singles you want to hit. That might be the number of visits completed. It might be the number of lunches that we completed or the number of letters that we faxed to the physician. That’s a single.

It’s like, “Let’s list out our singles. Have 4 to 5 different categories of singles and then measure them every week.” Let them know. “This is what I’m measuring and this is what’s important. I would like for you to focus on this and report this to me every week.” You can set up a weekly meeting. If you do those things, you’re going to give somebody the autonomy, the clarity of what’s important, and the free range to go and get it, they’re going to be a lot more effective than you are scrambling between running a practice, training a new therapist, hiring, and all those things.

It goes back to the quote, “That which gets recorded and reported improves exponentially.” If they have something to report on a regular basis, a Key Performance Indicator or KPI, as they report, as you said, you’re getting a bunch of singles. We’re being consistent enough that we’re starting to push the flywheel. As people are hiring marketing team members, I’ve had the question a few times and maybe you thought about it initially, but have gotten past it by this point. How often do I go and what do I talk about if I’m going so often?

For me, I was like, “How many holidays are there in a year?” You could easily go six times a year if you went off the main holidays. If you want to get creative, you can pick something weird like International Dog Day, and make that one of your marketing holidays as well. If you include some of the weird international days, now you’re talking easily 10 to 12 visits a year if you picked one a month.

That’s outside of anything else that you might be doing related to sharing patient information, doing a lunch, sending newsletters if you want to do that, or sharing information about what we’re doing at the clinic like new programs and that kind of stuff. That in and of itself could be pretty solid as a start to a marketing program for doctor interactions.

People and offices will respond to different channels of communication in different ways. Some offices might be like, “If you email me, that’s going to be the best way to get to get in front of me.” Some offices might be like, “I need you to pick up the phone and call me.” Utilize all the channels because you want to make sure that you’re in the channel in which they prefer. Not everybody likes you to come face to face all the time but you can fax them, call them, send them a letter, or ask the patient to report for you.

There are other ways in which you can communicate with them so use them all. The other thing about how often should I go is to ask them. I have this rule to always book a meeting from a meeting. Before you leave, say, “I would love to follow up with you but I don’t want to be too pushy. When’s the best time for me to come back.” “Come back in three weeks.” Write it down. “I’ll be back in three weeks. I’d love to follow up on this. See you in three weeks.” It’s not weird but if you show up randomly, then there’s that awkward weirdness of like, “What’s going on here?”

Book a meeting from a meeting.
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In those meetings, we would talk about, “Who are you going to meet with this week? Come at me with a plan.” The meeting shouldn’t be necessarily the development of that plan and maybe you can share with us what you’re marketing meetings look like, but it’s not in the meeting where you develop the routine. The marketing person, if they’ve done some homework and they’ve done a little bit of work prior to that meeting should be coming at you with, “This is who I met last week. Here are my comments if you want to read about them over here about each of the interactions and what I learned. This is my plan for next week, my approach for each one of them, and what my plans are for this week.”

Maybe looking into the next week, “Here are some of my ideas that I have to look forward to in the future that I want to talk about. Maybe get your input on, brainstorm, or ask for some help, ask questions, get your approval, and move forward so I can work on those projects.” Does that sound similar to the kind of meetings that you have?

It sounds perfect. It’s basically reporting on what was done, reviewing the scorecard of how many singles we hit, and celebrating the wins. Also, addressing any challenges that we might have and then reviewing the follow-up plan and the focus for the upcoming week. That’s it.

You’ll probably do that same question cascade for each bucket. You address each of the buckets in your leadership or in your marketing meeting.

We do it a little differently. It’s evolved. We have our marketing coordinator who oversees the entire marketing department. We have a digital marketing assistant who does all the digital stuff. Our marketing coordinator is responsible for our community and our physician marketing. Our clinical directors are responsible for our current patients and past patients. That’s a meeting but all we talked about during that meeting is physicians and community. There’s a separate meeting between the marketing coordinator and the clinical directors where they talk specifically about current patients and past patients related to that clinic.

Is it a group of them or is it the clinic director one-on-one with the marketing director?

Right now, we’re doing it as a group.

That’s a good idea.

They have to come in and identify their big three. How many word-of-mouth referrals did they generate last month and XYZ? It’s the same thing. What are the home runs or the singles that we hit? What’s our plan or our focus for the month?

We have to be clear here that we’re talking about goals that you have for the interactions with physicians’ offices, but you can’t forget that the main goal is new patients. These are all sub-statistics to the main statistic, which is getting new patients in the door. It’s because if we’re hitting all these singles and it’s not generating new patients at the very top, then we’ve got to change our batting approach. Maybe there are more foul balls than there are singles here.

We’re not converting.

Maybe there’s a hole at the front desk. You got to find out. When a new patient calls, are they not converting them into a new patient? What’s happening there? Why aren’t they getting in? There are a number of other questions, but you have to make sure that as we’re talking about all these things that we could be doing, you have to maintain that key stat at the very top and be tracking that on a week-to-week basis. “Are we moving in the right direction?” If we’re having dips, why are we having the dips? What do we need to change if we need to change anything or what do we need to keep doing?”

What gets measured improves. It’s going to dip but it’s so much fun to solve those problems with a team. The problem that most people have is either they have a dip and they don’t know what to do about it or they haven’t developed a meeting and a communication rhythm to solve the problem or they don’t even realize that they’re dipping and they’re too busy with patient care. It’s like, “If you would get focused on this for a little bit, you could make a big difference.”

How long are your meetings?

One hour.

For a smaller clinic, 30 minutes might work.

I would block off an hour if I were the owner because you might need a few minutes to prep and a few minutes at the end to close it, but it doesn’t have to be a whole lot of time. It just needs to be intentional.

You guys do it weekly because if you’re not doing it routinely or regularly, the same day and same time every week, it’s not going to get done, number one. Number two, you might miss those negative trends. It would be too late. You don’t want to have a negative trend of new patients and find out a month later that you had a serious dip and didn’t catch it. You’re going to feel that in your visit numbers, but the quicker you can address it, the more powerful you become.

I found that it takes about 90 days to make any meaningful impact on the referral generation. We want to be solving a problem and anticipating what our next focus is going to be in 90 days. We’re ramping down on one and then ramping up on the other. It’s not like you start and stop because you might hire a new therapist and that therapist might say, “I’m great at neurology. I do LSVT and I can treat Parkinson’s.” “We need to start ramping up a Parkinson’s outreach. Let’s get a list of neurologists together and we need to be doing that before they start, not when they start.” Ideally, around 90 days before they start or as soon as possible.

It takes about 90 days to make any meaningful impact on the referral generation.
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You’re looking at opening up a third clinic. What is your marketing plan prior to opening your doors?

I’m playing with something new. I can tell you that the way that we’re going to do it is we don’t have current and past patients in that area but we have a list of physicians in the area. We have a list of all of the important people that are in the area. These are going to be the influencers. We call them secondary referral sources. This might be the principal at the high school, the athletic trainer, the massage therapist who has a practice down the road, or the chiropractors in the area.

These people don’t necessarily refer directly to you, but they have influence over the people that you want to treat. We’re building out that list, name, contact information, and address. We’re reaching out to them and we’re having the communication. “My name is Adam. I’m moving to the area and I would love to learn about your practice, what you do here, and how I might be able to support you.”

How soon before you open your doors are you sending out that information?

I’d say as soon as I sign the lease.

It’s well before you open the doors.

As soon as I know for sure that we’re opening, we’re rolling out the marketing plan.

That could be 2 or 3 months ahead of time.

Correct. The other thing that I have seen people play with that has been successful is doing billboards like coming soon type of things and leveraging the community in that way. Also, mass mailouts, but that cost a lot of money. You might not be able to do that on your first clinic because you don’t have a lot of money but as you continue to expand and get the word out very quickly with those types of channels, I’ve seen people have success with that.

Do you have a specific budget that you set aside for your marketing? I asked that because I’ve had marketing specialists on the show in the past and they always say it’s hard to work with small business owners and physical therapists in our space because people will come and say, “I need your help in marketing. I need to get set up on Facebook ads and Google ads.” These people smartly ask, “What’s your budget?” It’s like deer in the headlights.

“I don’t know. What should my budget be?” They’re like, “What kind of results do you want? What are you looking for? How much can you afford to spend? How much should you afford to spend?” It’s up to you what your tolerance level is to put this money out there for marketing. What you have to spend determines what they can provide you and what you can and can’t do. In the past, as I’ve talked to these people in the show, they recommended that if it’s a new clinic, you might be spending 10% or more of your gross revenues on marketing.

If it’s a more stabilized clinic, that might be what you want to do for your third clinic, but you’ve learned some techniques and abilities that you might have to spend that much but you still get the word out. However, if it’s your first clinic, you probably need to consider that because your revenues are relatively low and you need to invest in some marketing to get the numbers up. As you’re stabilized, that’s probably more like 5% of your gross revenue. Have you tied your marketing budget to a percentage of your gross revenue?

Yes. I’m a little more aggressive because I feel like I have a marketing mind. I’m comfortable spending money on marketing.

Your mindset is also such and let me point this out to people who are reading. Your mindset is such that advertising and marketing to you is not an expense. It’s an investment. You’re doing it because you know the dollar that you spend on marketing is going to net me $5 or $10 down the road and not just the expense for that month. That’s a mindset that many small business owners, especially physical therapists have. It’s that scarcity mindset of like, “It’s another dollar that I don’t have.” No. It’s an investment in the building of your company and that’s expected.

Advertising and marketing are not an expense but an investment.
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It’s important for you to build out a pro forma and what is your practice going to look like in a year. How many visits a week is that? Let’s say it’s 100 visits a week or whatever and you’re doing $100 a visit. That’s $10,000 a week or roughly $40,000 a month. Let’s say, “I want to go from 0 to 100 visits a week in twelve months.” That’s going to be $40,000 a month. I would open a clinic spending 5% to 10% of that on day one. I would be spending up to $4,000 a month on day one. You have to build the marketing plan that’s going to get you there. It’s not like, “I’ll get there and then I’ll spend the money.” You spend the money and then you grow. It’s not that you grow and then you spend the money.

I love that mindset and I love how you broke it down like that. You’re basing your marketing budget on what you expect to have and not what you currently have.

I’m willing to stretch that depending on how confident I am that we can do it. How strong is my team? How strongly do I feel like I can leverage the community? Do I have 3 or 4 therapists on my team who are from the area and have a lot of connections? Those are all things that you can consider when you’re trying to predict how successful you can be there.

I’m stepping backwards a little bit because a question came to my mind. At what time did you take that marketing person from part-time to full-time?

It took a while.

What size of the clinic?

I think we were around doing $1 million a year or so just for the first one. I was going into my second clinic and making preparations for that. That’s when I knew I was going to need some help full-time with benefits, paid time off, and the whole thing. I needed a team. I don’t know if that’s right or wrong, but what I do is I take her salary and then I loop that in as a marketing expense so it doesn’t mess up my books. As long as I’m keeping my percentages where they need to be, then I know that I can do it.

I would say we were about the same and maybe that holds true across most places in the US. If I was a single clinic, maybe doing 150 to 200 visits a week, that’s probably more part-time-ish. It should be enough for a singular clinic. When we got to 2 and especially 4, we definitely needed someone full-time and then we brought another person on part-time when we got to the four clinics. That covered a lot of geographic space as well so it’s hard for her to get to all the clinics on a routine basis and visit them physically.

Hopefully, that gives people some guidelines as to where they are in their practice versus what they could do and maybe should do in terms of building out a marketing team. It’s all so important and I don’t think we have time because we’re coming up on an hour already, but you also leverage some VAs to help you with marketing. They are mostly in the digital marketing space, I’d assume, but are they helping with past patients maybe?

It’s all digital. They do a lot of text messages, emails, and social media.

They can do that all to pass patients, right?

Correct. There’s more than one way to be successful here. There are a lot of great digital marketing agencies that are out there that can build a package for you and automate some things. They’re fantastic. I have no knock against them. I’ve worked with several of them. However, my experience has been if you want to do a lot of things, then you’re going to have to take it in-house. A lot of agencies will help you with a little website work, a little SEO, and maybe an email campaign or two. However, if you want to do newsletters and text message automation, different types of campaigns, and a lot of complicated things at a lot of high volume, then you’re going to have to take that in-house or you’re going to have to pay a lot of money to an agency.

Have you ever had a point where you considered the four buckets where you said, “We’re not going to put money in energy into that bucket for now? We’re going to focus on the other buckets.” Were you ever intentional in that regard?

Yes, and we have clients in our coaching program who do this. We have clients who spend too much money on digital paid ads.

It costs the most and it takes the most energy to get any patient and it’s the least effective.

I’ve seen people spend $1,000, $2,000, or $3,000 a month on paid ads and have never visited a physician’s office yet. There are so many more effective ways. The most powerful engine and marking that you can create is word of mouth and through relationships. People don’t build relationships with an email or with a Facebook page. We need to shake hands and learn about the people in the community and build those types of relationships. I think that is the best place to spend your money. I don’t think I started spending on digital until I was over the $1 million mark. When I got to where I was opening my second location, it was only when I started spending money on digital.

I’ve had guests who have marketing programs and they’ve admitted the same thing. If they were to approach a clinic that’s not sending text messages and emails to current and past patients, they’re like, “We’re going to start a text and emailing campaign for you first.” This is because the Facebook ads are going to get you some consults. If they come from Facebook, they’re a little bit sketchy from what it seems and they’re hit and miss. They flake quite often.

Also, SEO is going to take a few months to ramp up to get to that point where they’re helpful. Again, as I said, the easiest, cheapest, and least energy it takes is to go straight to those. Where you’re going to get the most immediate impact with the least amount of money and energy is current and past patients.

You will get the most immediate impact through patient referral. It costs less money and energy.
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Start there and be intentional. You’re like, “Yes, I’m going to do digital stuff eventually, but let’s focus here in our community first and the people who know, like, and trust us.” Develop relations and maybe bring in a few physicians. Start doing some routine visits to physicians and graduate to the digital. I like that you shared that you didn’t even start until you had your second clinic.

I always tell people to get your website. Get a page a Google My Business page. You can do that for free. Also, get your Facebook page. Post some pictures on there every now and then. Meet all the physicians and influencers in the area and leverage the patients that you’re seeing to generate testimonials. Do a lot of that and be a crazy person about that until you’ve got so many patients on your schedule, and now it’s time to hire therapists. We can talk about what the next problem is after that.

We’ll do it again. Is there anything else you want to add? As I said, we came up across the hour mark, which was surprising because that went super fast. Is there anything else you want to add about physician marketing specifically?

John Hudson and I went to school together. He asked a question, “Do you start with a shotgun approach and hit every office in your area and then narrow down based on the providers’ office response?” Yes, you can’t catch fish unless you have hooks in the water. If I’m throwing 100 hooks out and they’re biting over there, then I’m going to go over there. I would spend a lot of time on the big fish but you can’t identify who your big fish are unless you’ve got hooks in the water.

You can't identify who your big fishes are unless you've got hooks in the water. That's the game you want to play in your PT Business.
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In the beginning, I would say yes. Meet them all unbiased, but eventually, it’s going to hit and you’re going to develop a relationship with that person. You then ask him, “Do you have any other physician friends who would benefit from something like this?” “Yeah. Have you visited Dr. Smith across the hall?” “I haven’t. Would you be willing to introduce me?” That’s your in. That’s the game you want to play as opposed to going across the town to some guy who doesn’t even know you.

I could put another spin on that, and I would say this is a graduated level of marketing because I had Dimitrios Kostopoulos from New York on a couple of episodes and his marketing was specific to the highest insurance payers. He had a tier A of the highest insurance payers, tier B, which was slightly above the expense rate per visit in his clinic, and tier C, which was at the expense rate and below that paid for less. His marketing was focused on those tier-A physicians and provider groups.

That’s another level. If you’re starting out new or if John Hudson is brand new to opening up a clinic, I’d get the relationships and start building them out. Find out, and maybe that’s part of your relationship-building, “What insurance plans do you see? Do we accept that plan or not? What kind of patient diagnoses do you guys have a hard time working with that we can help out with?” Maybe 6 months to 1 year down the road after you develop some solid relationships, then consider the tiered marketing system. I had to bring that up because that was a relatively new marketing strategy to me that I thought was super impressive.

I’ve never met the guy, but I’ve heard him talk several times.

He’s a smart dude.

He’s next level.

Thanks for coming on again.

Next time, I think we’re talking about money.

I like talking about money.

If you want to make some money, tune in on the next episode.

For our audience, make sure you’re joining the Physical Therapy Owners Club Facebook group. This is where we’re doing the Facebook Live events, and we’re planning on doing it at least twice a month. If you have any particular topics you want us to address, then we’d like to address them. Feel free to share. You can reach out to me at Nathan@PTOClub.com or Adam@PTOClub.com . Feel free to go to the website, PTOClub.com , and book a connection call with us so we can get to know about you and what you’re working on in your clinics. We love those calls, talking business, and helping physical therapy owner make such a great difference in the industry and in their communities. Is there anything else you want to share before we sign off, Adam?

No. I appreciate it. I’m looking forward to the next episode.

Thanks for sharing your experience. That was great.

He continues to work closely with business consultants to continue to grow Southern to be everything that it can. During his spare time, Adam enjoys spending time with his family and friends.
He enjoys challenging himself with an eager desire to continuously learn and grow both personally and professionally. Adam enjoys a commitment to recreational exercise, and nutrition, as well as his hobbies of playing golf and guitar.

Adam is inspired by people who set out to accomplish great things and then develop the
discipline and lifestyle to achieve them. Adam focuses on empowering and coaching his team with the primary aim of developing “The Dream Team” that provides the absolute best patient experience possible.

He believes that when you can establish a strong culture of trust you can create an experience for your patients that will truly impact their lives in a positive way.

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