Profit & Freedom – Nathan Shields’ Guest Appearance On Practice Marketing Power Hour Podcast With Neil Trickett (audio)

Being a physical therapist to owning your own practice requires a huge mindset shift. You are no longer a PT; you are a business owner who happens to also be a physical therapist. When you are not clear on these boundaries, it can be so easy to chain yourself within the business and burn out. In this episode of the Physical Therapy Owners Club, our very own Nathan Shields sits opposite Neil Trickett of Practice Promotions as a guest on the Practice Marketing Power Hour podcast. He discusses with Neil what it takes to achieve Profit and Freedom in your PT practice. From his personal experience, Nathan talks about his journey—from stepping away from direct patient care to achieving greater success and fulfillment in his business. That progression requires a mindset shift for every business owner and, when shifted, opens up opportunities to experience greater profits and freedom in business.

(This episode is taken from a Facebook Live event in the Physical Therapy Owners Club Facebook Group).

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In this episode, we’re going to talk about how you can gain profit and freedom in your practice in 2024. I’m happy to welcome Nathan Shields here. He’s the Founder and Coach of the PT Owners Club. You want to check that out. Nathan is a very well-versed business professional. He’s a physical therapist himself and has owned clinics before. During his career, he has owned, grown, and sold 4 different PT clinics for over 7 figures. That journey has led him to launch the PT Owners Club to share his knowledge and wisdom to help other clinics be successful. Welcome, Nathan. It’s great to have you on the show with us.

Thanks for having me. That sounds like an amazing introduction for someone else.

You are an amazing individual. I’ve been very fortunate to know Nathan for many years. When he was a practice owner, we worked together and did some marketing for his clinics there. I’ve been to business training with Nathan. We’ve had a long history of working together. He’s a very smart person and has figured a lot of things out along the way. He is very fortunate to be helping other practice owners scale their businesses with his marketing business knowledge.

Thanks. I appreciate the kind words.

Let’s talk a little bit about that history. You’ve been incredibly successful as a business owner. We’ve talked a lot in our show with different specialists out there about as a practice owner, you need to stop seeing yourself necessarily as a practitioner and start treating and seeing yourself as that leader and business owner. For you and your business, how did that come about? When did you start to make that mental shift from being a practitioner to a leader?

That makes me think back to my first years of ownership. I started my clinic probably about three years after I graduated from PT school. I jumped into it because I found an open office suite for rent that was in an area of town that was growing and there weren’t any other physical therapists around. I was like, “Here’s the location that I can set up without a ton of competition.” I always wanted to do it and my wife was like, “I’m signing the lease tomorrow. Are you ready?” I’m like, “Yes. No. We’re doing this no matter how I feel.”

I started treating patients, getting busy, and marketing on my own. I did all that stuff. I bootstrapped it all. I remember, even within the first few years, thinking, “If I’m doing what I’m doing 5 to 10 years from now, I’m going to get burned out.” The constant refrain as I talked with family at gatherings was I love treating the patients and I hate working on the business. If someone could take all the HR stuff off my hands and I could treat patients, I’d be so happy.

Honestly, I kept my head down and worked that way. I continue to hire and grow. We were successful but I hated the business side of things. It showed. As I look back on things, I can see there were areas of my practice where I probably lost hundreds of thousands of dollars because I didn’t manage it well. I didn’t know how to manage things well, yet I was still doing fine financially.

I got to a point one time where I decided, “I can’t keep doing this.” I was fine financially but I was in a situation where I had many kids. During this ownership journey, I would get off work after 7:00 and maybe get home around 8:00 or 9:00. I wake up at 4:00 AM to do my notes, get ready for the day, and take off by 6:00 to get to the clinic for some of the first patients and get things ready and stuff. I would keep a schedule similar to the point where I would go days without seeing my newborns awake.

My wife would tell me all about the things that they did. I’d see my babies in the crib but otherwise, they were asleep and I never saw them awake. I didn’t notice it at the moment but on a Thursday, I haven’t seen my baby awake since Monday because of the schedule. Not only that but I know a lot of PT owners have experienced the same thing when they go on vacation. It seemed like everything hit the fan when I was on vacation and calls came out.

That’s when the physicians got upset and people quit when I was gone. The team had to handle it in my absence. I thought, “I can’t continue. This sucks. This is not what I signed up for.” I got the opportunity to get some coaching and consulting. The price tag was high. It was a shocker but I remember telling my partner, Will Humphreys, at the time, “We got to do something. I can’t keep going this way.” This is 8 to 10 years into ownership. I’d been complaining for 5 to 8 of those years about being a business owner and not recognizing that what I learned was that once I opened the business, I was no longer a physical therapist who had a clinic. I had become a business owner who happened to be a physical therapist.

That’s a huge mindset shift. For those who don’t quite understand, it’s not just a play on words. It’s a serious mindset shift. I didn’t understand that I was the thing that was keeping myself back. I was the reason that my schedule was what it was. It wasn’t someone out. I wasn’t taking control of my life and my business. Once I got some coaching and consulting to put me in that place to take admin time to work on my business and pull myself out of patient care, that’s when finally the mindset started shifting and things started clicking. That’s when my business started running better. That’s when I took control of my schedule and had time for my kids.

I got to a point where I no longer wanted to see patients. I found a lot more fulfillment in business ownership, leading a team, coaching my team, and building systems. No one can say they have fun building systems. Some people can but I didn’t. Nonetheless, implementing policies and procedures like getting some structure in place. “Let’s have a little structure and some meetings that are impactful and important.” That’s when I started recognizing what I wish I had known fifteen years earlier. I have to act as the owner and a business leader in spite of my ignorance and naïvete without having any training. I’m the owner first and a physical therapist second. I took a long time to recognize that.

I went through a very similar journey myself in practice ownership. That’s how most of us start. We have these great aspirations. We’re going about amazing business. We usually come from a place where we want to do something differently, where we can do it better than where we were working. We come in with that aspiration but we don’t have necessarily the know-how of the business aspect of it. We may be very good clinicians and continue to focus on improving our clinical skills but we don’t necessarily put much time into the nuances of learning business skills. A lot of times, it’s at the school of hard knocks as you go through.

It is a lot easier to complain about it instead of taking responsibility for it and learning some of the business stuff. At that time, I turned to what I might have thought was around me in terms of the community. I hired a business coach but that didn’t get me far initially. Looking back, I don’t remember much. He did a SWOT analysis with me once and that was about it. I didn’t know where to turn. That’s one of the reasons why I started my show. I felt like I was on an island and I had to figure this all out by myself, not knowing that there were business networks out there.

The APTA didn’t have a peer-to-peer network. There wasn’t the abundance of physical therapy business coaches as there are now. Coaching is pretty ubiquitous, whereas I don’t think it was in the early 2000s. Needless to say, I felt more comfortable complaining about it than I did about finding a solution. That can’t be the excuse for many people out there. There are plenty of podcasts, books, coaches, and resources galore for PT owners out there who don’t know exactly where to turn and what to do next.

You’ve consulted and coached a lot of different practice owners and businesses of all sizes there in your years. I’m curious, do you see this with people that make that leap and start to be extremely successful that it starts with the the individual first and their mindset shift? You can learn business skills and YouTube marketing. You can YouTube hiring and recruiting stuff but until you own that yourself like, “I can’t be a full-time practitioner,” to me, you can still enjoy that if that’s something that you have a passion for. Continue to help patients and practice with patients but you have to wear your business hat. I’m curious if that’s something that you’ve seen a lot in clinical owners.

I do a show as well, Physical Therapy Owners Club. I interviewed, like you do, a lot of successful PT owners. 98% or 99.5% of the people that I interview at some point have gotten some coaching or consulting. The typical story is someone opens up a clinic and all hell breaks loose. The world starts falling apart around them and they have a hard time dealing with it to the point of potential divorces and all that stuff. It’s very common, and then they finally turned to getting coaching. They can see that as the flexion point in their business where it makes you significant change.

I highlight that only because there are plenty of books and podcasts out there. You will make progress if you leverage those, the knowledge that’s in them, and implement them. That’s the important part because I know plenty of people who have listened to all the podcasts and read all the books and their business isn’t any different than it was five years ago. They’re still complaining about the same things. Implementing is an important thing.

There are plenty of books and podcasts out there. You will make progress if you leverage the knowledge that's in those and implement them.
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You can’t see the picture when you’re in it. The majority of people out there don’t know what’s happening in their business because they’re in the middle of it. That’s where the importance of having a coach and a third party comes and says, “I can see where you’re at and what you’re looking or working on. Honestly, that’s a distraction. You need to be focused over here.” That’s helpful. That’s what changed my business experience, professional life, and my life. Ever since I hired that first coach, I’ve had a coach in business life ever since for years.

Looking back on it here, as you own a business, it’s a journey. You can’t expect to figure everything out right away. It’s not like, “Coach, I’m going to start implementing all these skills,” and it’s going to be all fixed. That’s not how it works. It’s a journey. It takes time, repetition, and failure on different things. You need to have that guide that helps you along the way. I’ve gone through layers of business coaches and different types of consulting businesses.

One thing that I’ve learned is that the bigger that you get, the more consultants you need. You can’t be an expert in everything. You need to have consultants in hiring, recruiting, logistics, marketing, operations, and finance. The complexity of the business increases exponentially as the business grows. If you try to be the master of everything, you become the bottleneck in your business. I’ve seen that.

I notice you get to a certain level and then all of a sudden, it’s plateauing. You’re like, “I’m becoming the bottleneck again. I need to go to that next level and change things up again.” For me, retrospect looking at that, it’s been an interesting journey along the way. That’s one of the things that I would say to people out there. No matter what level you’re at, it’s a journey and you’re going to need some guides to help you get to that next level that you want to get to.

I’m at a point in my business experience and life where I’d rather pay a third party to do it instead of figuring it out myself. For example, I’m building an online course for PT owners. I remember interviewing different consultants. If I’m going to do it, I’m going to get a coach because I’ve never done this before. I’m looking at particular consultants and started interviewing a few of them. One of them I remember distinctly saying, “I’ll teach you how to do this and the design.” I’m like, “I don’t want to do it. That’s what I’m talking about. I want you to do it.”

She’s like, “I don’t think that’s out there.” “It’s 2023. I’m pretty sure there’s someone out there who’s going to do this for me. I don’t want to stay up until midnight learning the software program or figure out how to do blank. I’m more than happy to provide you with the content.” The third party’s going to do the rest of it. I’m sorry. I’m not technically savvy. Even if it’s not a coach or consultant, I’m ready to hire the experts.

I learned something not too long back here. I thought it was a very awesome phrase. It comes back to your biblical stories, which is, “If you teach a man to fish, he’s going to be able to fish for himself.” In business, it’s like, “At some point, do you want to learn how to fish or do you want to have someone give you the fish?” There are some parts where it’s like, “I don’t want to learn how to fish for this because it’s going to take me some work. Just give me the fish. That’s what I want to have.”

“I’ve got the money to pay for the fish. Do it now. Thanks.” That is Confucius who said that.

As we’re starting to look ahead in 2024, it’s time to start thinking about, “Where are we going to go here? What are we going to do? How are we going to capture the flag here?” For a lot of practice owners out there that talk and say something along the lines of, “I’m working hard but after all the little things that go into the business, my profit seems lower than they should be.” We know that there are a lot of financial challenges out there. If your practice isn’t giving you the freedom and profitability you want, what do you see needs to change first?

The default for most people is, “I need more new patients.” I remember one of my coaches back in the day, and I’m sorry if I allude to coaching all the time but it’s played an impact on my life and you can tell. I remember him making the analogy to, “We can get you a bunch of new patients. There are a lot of ways to do that.” We use practice promotions and we have our marketing strategies but isn’t that filling up a bucket full of holes?

We can add a ton of water to this bucket with a lack of systems in place. They’re flooding out. You’re not retaining these patients. To fill those holes, it’s got to be a multi-system approach to maximize profits from every new patient. It’s not just one department. You’ve got to have a strong marketing strategy but I did an interview where we talked about conversions.

Your marketing strategies could be great but your front desk person doesn’t know how to take that fax referral. My partner recommended it in his clinics. They have to call that patient within an hour. He’s like, “We envision calling that patient as they’re walking out of the doctor’s office, hopefully.” They call them within their hours of their policy or a patient calls us and sets up an appointment or simply calls to get information. If they’re not using that phone call to schedule an appointment, get them on the books, and get them in the door, then there’s a poor conversion ratio.

You could have the best marketing strategy in the world and lose it right there at the front desk. How strong is your front desk when converted? This is partly why I decided to create my online course. I’m not on here to promote this but it happens to play into this same thing. The idea behind it is, “Are you collecting everything you can at the time of service?” That includes coinsurances and estimated deductibles for that day. You don’t just let those slide and collect those later. You collect them at the date of service by estimating.

You could have the best marketing strategy in the world and you could lose it right there at the front desk.
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Cash is king. We’re going to make sure we get paid every dollar that should be owed for our service.

McKinsey and consultants did a study and found that every dollar not collected at the time of service leads to your collections ending up about 50% to 75% of the patient’s balance. You’re losing $0.25 to $0.50 of every $1 if you’re not collecting on the day of service, which is huge. Most clinics, 15% to 25%, maybe 10% to 20% of their overall revenues are patient payments at the time of service and copays.

I say, at least. You have high deductible plans. People got to pay mostly out of pocket.

If you’re not collecting the time of service, you lose money. Do you know your financial metrics? I love the adage, “When performance is measured, performance improves. When performance is measured and reported, performance improves exponentially.” Are you tracking your financial stats? We are talking about the average reimbursement rate. What are your projected collections versus your actual collections? Are you tracking your accounts receivables and making sure that they are in an acceptable ratio between 0 to 60 days and 60 to 90, 91, 21, and above?

Are you meeting with your CPA on a monthly basis? How are you holding your billing collections team accountable? Do you know how to do that, tracking their KPIs or meeting with them regularly? Are your providers if you’ve got more than yourself, even if it’s just yourself, are you billing everybody according to Medicare guidelines because you don’t have to and you probably shouldn’t if you want to maximize your reimbursements?

There are AMA guidelines that commercial insurance follows. You don’t have to follow the eight-minute rule to your providers. That’s why I say it’s a multi-system approach. If you’re going to maximize your profits and jack up your average reimbursement rate per visit, it starts there before I start talking a whole lot about your new patients. Continue your marketing efforts. Don’t stop doing this. Keep those as consistent as possible. Let’s start looking at some of your systems. Are they clean and clear? After that point, then I’ll talk to you about dropping low-paying insurance but not until we get some of this other stuff cleaned up first.

I remember having a conversation with every therapist that worked for me. You can always see it in their face. They would be so shocked when you showed them how much it costs per patient to run the practice. They’re like, “What?” “By the time I pay your salary, the front desk salary, the billing salary, rent, equipment, and all these things.” They’re not thinking with that but let’s say they have some knowledge and underlying experience like, “This is what it costs us to treat a patient. We need to be able to make much more than that to have opportunities. The front desk wants a salary raise. We want to have opportunities to help more people.”

You can have an honest discussion with your providers and keep them in some financial understanding. They don’t need to know all the ins, outs, and details because that’s not their thing but if they have some understanding, they can get behind like, “Why are we looking at billing codes? Why are we looking at the timing of certain insurances and coding that way?” They can get behind you with that. They’re looking out for practices, best interest, and the patient’s best interest.

It makes so much sense where you have to get your systems in place. You have to look at marketing, operations, and finance. Where I see practice owners struggle is that we can be helping them at home with their marketing in a bunch of new patients but they’re leaking out the front desk or dropping off after 2 or 3 visits because the patient experience internally is not there or there are issues with the way that the finances being handled and the patient has a misunderstanding and what they own. There are all kinds of variables there but the tighter that control is internally, the more successful you can be and the profitability goes exponentially up for that.

I’m talking about all these systems that you need to assess, review, and make sure procedures are in place. You can’t do that if you’re treating full-time. How do you stay on top of that? How do you create it in the first place? You could but what kind of life is that? That’s why it’s imperative to have some admin time for the owner to work on specifically these things. There’s so much to consider and look at but it starts with focusing on one area and going from there.

I experienced the same thing that you did. I had a PTA who was with me for a dozen years. She got to a point where she ended up being VP of Marketing. We showed her the P&Ls or the Profit and Loss statements from the previous months for all of our clinics. She’s like, “You lost money.” I’m like, “We probably lose money per month.” Sometimes you have those months where there are 3 payrolls instead of 2 until you lose cash on those. That’ll happen a couple of times a year or maybe in January or February because of the deductibles and stuff. You’ll lose money.

She was blown away. She thought I was raking in millions every year on the backs of these oppressed employees. She found out that I lost money a couple of months a year. Her total mindset shifted. She’s like, “I can’t believe you’re okay with that.” I’m like, “I’m not okay with it.” That’s why I keep telling you, I need you to make sure you are billing appropriately and push for more patience. Now you see where I’m coming from. She’s like, “Now I get it. Didn’t you tell me this years ago?”

Our Finance Director is awesome. She plays games. We’ll have a company conference a couple of times a year where everybody’s together. She’ll play a money game. This is eye-opening to the staff. We had some fake dollar bills or even real ones. I can’t remember. We lined everybody up and gave them a certain amount of dollars each person. You’re all the income that’s coming into the business. They would go, “This is a salary.” It takes half of the money away from half the people. “This is what we pay for insurance. This is what we’re paying for this.”

If you had 20 staff and they were down to 2 or 3 staff, that’s your profit. It brings reality to the staff of like, “We’re not raking it in here.” There are a lot of expenses that you don’t see. The way for us to improve those margins is how well we can have these systems and work together internally. When you’re coaching different practice owners here, maybe initially, they come to you and say, “I feel trapped in my business. What can I do about feeling trapped in my business?” What are some of the things that you can’t try to guide them towards?

We talked about this on an episode as well about people feeling stuck. They don’t know where to go. An owner in that situation doesn’t recognize that they are stuck because they don’t know what they want. If someone’s clear about what they want, then the next steps start falling into place.

A confused mind does nothing.

I’ve seen this with clients that I’ve coached. I remember someone being hesitant to hire a PT. I was like, “I’m encouraging you to hire this PT because I’m assuming, based on the goals that we set before, that’s what you want. Is that what you want?” He is like, “I don’t know.” I don’t know if it was fear.” That’s always a huge investment to bring on a PT, the salary commitment. The fear that comes along with that blocks some of that. Get clear about what you want and what your purpose is as a business owner. What is your purpose? Where do you want to go? What’s your vision?

If you’re not clear on that, then it doesn’t matter what you do next. You could do whatever you want. If your goal is to treat 40 hours a week and not work on the business, then it’s pretty clear that you need to start moving towards hiring an office manager who handles all the administrative stuff. You better learn how to manage that office manager because you’re still the owner. You can be an owner and treat 40 hours a week but you better find someone to do all the business stuff for you. That’s a lot.

I would have to argue that that’s not a reality. You can have someone handle a lot of things but you’re the boss. If you want to just treat patients, then maybe owning a practice is not for you. Maybe you better work for someone.

Maybe you should be a team therapist on another team. If you love treating, you can’t neglect your ownership and leadership responsibilities. Cut down to twenty hours a week you’re treating so that the team has a leader to look up to. Who do they look up to if you’re head down treating patients all the time? They know that you’re not doing this stuff you’re supposed to be doing.

They know that you’re ignoring and hiding from what your responsibilities truly are. They would love some leadership. They would love someone to stand up at the front and tell them where they’re going, lead the boat, and say, “This is why you’re here. This is why I hired you. This is where we’re going. This is how we’re going to get there. Are you with me or not?” They want that kind of leadership.

Some people feel like, “You have to be born a leader,” and you don’t. It’s a skill. If you’re a great physical therapist, that didn’t just happen when you started school. It took years for you to get to that level where you can be an awesome clinician. What’s interesting is when you’re an awesome clinician and you have all that experience and knowledge, people look at you and say, “You make it look so easy.” The same thing can happen in your business and leadership journey. It takes a lot of skill, repetition, learning, and experience.

Where you are now and next year is going to be different when you’re five years down the road. You’re going to be making it look a lot easier because you have all those lessons that you’ve learned across that time. As we’re looking ahead to 2024 for PT and practice owners out there, how do you help coach people toward realistic goals? Sometimes we can have crazy goals or we can undershoot our goals. Do you have a way that you help coach people towards making realistic goals? What they should be looking at?

I like helping them come up with goals. It’s not hard to come up with goals, whether some personal or professional goals. Imagine where you are twelve months from now for having the same conversation. What has to be true to consider this business a success? It’s a famous Dan Sullivan question exercise. We say, “We’re meeting. We’re here.” What has to be true for you to look back and say, “This was a super successful year?” It’s an easy way to get the thoughts churning.

They’ll say, “I want to be happy where I’m at. I want my clinic to be happy and also my family.” “No. You have to have some specifics. Let’s get down and dirty. How many patients are you seeing? What are your revenues? What does your life look like? Are you treating 40 hours a week? If you’re not, what are you doing with the other time? Are you spending more time on your hobbies or your family? Are you doing things you love? Have you gone on a couple of vacations? Let’s plan some of that stuff into place.”

What I find usually as I go through this exercise, and maybe you’ve seen the same thing, is people create comfortable goals. These are things where we can get there if we do it. I don’t have to change too much but I can push a little bit harder and the things that I know how to do. I will get to that next level or that level that I want to get to. I honestly changed your question a little bit. I wouldn’t use the word realistic. I would say, “What are some uncomfortable goals that we can get to?” I say that because I read 10X Is Easier Than 2X .

The theory is if you want to hit the 10X, you have to change your thought processes to focus on the things that make you the most money. 2X mindset is, “If I double my efforts, I should get 2X more.” If it takes as much effort to get 10X and you’re going to double your efforts like, “Let’s 10X it, instead of 2X,” you can see a significant change in your life and business.

I wanted to press the edges a little bit. I don’t want you to just have a 10% increase next year. You could probably trip and fall and get a 10% increase if you had a little bit more focus. I want you to do more. What numbers would we have to consider to make you uncomfortable? Let’s start talking about those and how can we get there. What are some of the things that you need to get off of your plate and hand over to the experts or other people in your organization who would love to do that for you so that you don’t have to so you can focus and do the things that you love to do?

I had a super successful client. She’s got 1 clinic but 10 ten providers in her clinic. She’s expanding to another clinic. She’s essentially treating full-time, 30 hours a week. She’s been there. She started it. She’s got a huge foothold in the community. Patients want to see her. If there’s a high-profile individual in the community like the bank owner, physician, or surgeon, she’s going to see them. No one else on the team is going to see them. This is her doing. She put this on herself.

She said, “I had the opportunity to go golfing.” She’s a great golfer and went on Wednesday Night League. Half the people there were previous patients and asking her all about, “This is my problem. What do you think?” It was a marketing affair. I’m like, “What would your life be like if you only treated 10 or 15 hours a week?” We golf every week or maybe a couple of times a week. She wants to get into pickleball. It’s a small community. She’s probably going to have a quarter of people who are patients and they get injured. She loves CrossFit. That’s the money pot of injuries.

“What if you spent fifteen hours a week playing golf, pickleball, and CrossFit as marketing efforts? You’re there to have fun and all that but you’re going to send people to the clinics.” She’s like, “Yes.” “What would your life be like then?” She’s like, “That’d be a dream.” “Why aren’t we there? You’re the owner. You can control your schedule and do whatever you want with your business. Go down to ten hours a week and start doing all those things. Your dream is up to you. You need to make the decision, implement it, and tell your team, ‘This is my schedule,’ and go.” That was scary for her but she didn’t recognize that it was right there in front of her. She was the limiting factor and the stumbling block to it.

You might see in clinics that the starting practice owner tends to be the go-to person and then you get some other providers on. After a while, it’s hard to get out of patient care because everyone wants to see you.

Everyone goes through that.

One trick that I did, and maybe some other practice owners are doing this, is that VIP or someone who wanted to see me coming to the clinic would technically be on my schedule but I’d also have the real therapist there. I would be there for 10 or 15 minutes of the initial eval with them and introduce Gene. I’m like, “Here’s your therapist, Gene. We’re going to work together on you here.” We’re looking together at the patient for the first ten minutes of talking.

I would be like, “Gene, what do you think?” I built up the expertise and authority of that other therapist. It’d be like, “James got this.” The trust factor is already way high with the patient and you leave. They’re happy. That first time a patient comes in, they’re like, “I’m so comfortable used to seeing Neil. I don’t want to see anybody else.” “That’s fine. Let’s see him together and then you’ll be very comfortable with Gene. I’ll be checking in on you. Don’t worry.”

The other thing that I’ve seen people do is limit their treating hours so much that they’re not willing to change their schedule to meet yours. “Nathan sees patients on Mondays, Wednesdays, and Fridays from 9:00 to noon.” I’m like, “I’m not available those times but I’ve got some other amazing therapists who can help you out in those times.” That makes it simple. That goes to a point, what do most owners do?

They’ll sacrifice their personal schedule and family to get one more patient in after hours that they have a relationship. It’s both a blessing and a curse. We have so much empathy and compassion. We know they need our help. We have the skillset to do it and we want to help them but people leverage that against us at the sacrifice of our mental health and well-being. It leverages our family’s time and the time we get to spend with them. Honestly, our hobbies get sacrificed.

Until the owner, who happens to be a therapist, recognizes that they are in control of their schedule and they can’t be in effect of other people’s schedules, then they start taking control and seeing benefits in their business. The patients get the care that they need. You’ve got amazing teams. Honestly, there are other physical therapists out there in the community. You don’t want them to go see them but at some point, you got to take control.

As we’re talking about those other teams there, how do you work with practice owners to train their teams so their teams are taking more responsibility and being more proactive in their particular roles, which frees up the time of the owner?

You have to learn how to become a coach yourself to your team. As I’m coaching, I’m going to ask the PT owner to start measuring specific Key Performance Indicators or KPIs. We’re going to track these stats. These are important stats. I track them because they’re the cardinal stats and they tell me the health of your clinic. You have to determine what those key stats are for the people that you’re overseeing and help them understand what those stats are and mean, and how those stats help us fulfill the purpose of the organization.

You have to learn how to become a coach yourself to your team.
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These aren’t just to collect stats and measure their stats. When we fulfill them, we know that the purpose of the organization is fulfilled. Make those connections, help them track their stats, coach, and train them on how to improve their stats. Also, train them on, “This is what it means to be a member of this organization. We have these specific values that are written, iterated, and reiterated time and time in our meetings. These are our values. Back in the day, professionalism, accountability, growth, and empathy are how we live those out.”

We talk about those and the KPIs. We’d have regular meetings, not super frequent but we had meetings to assess how they’re doing and questions that they might have, how they can be better, and if they’re falling short on any of the values like, “This is where I’ve seen that. This is where you can do better,” or if they exemplify the values to do the same like, “That was super professional. I appreciate your accountability. I see you growing according to whatever values you have.”

It takes some coaching. That takes a little bit of structure. Most people don’t know how to innately develop that structure unless they get some guidance and coaching. They are in the books. I always appreciated Traction by Gino Wickman. That’s a good one. There are others out there but that’s an example of how you can put some structure into your organization. You have to do the same as your teaching and training your teams.

I was at a business conference. It’s a great analogy and a way to explain it. A computer has an operating system like Windows or macOS. We think back to Windows 2000 as your operating system. That could only do so much. You had to upgrade to Windows XP and whatever Microsoft version there is. The operating system of your business needs to be modified and changed for you to be able to go to that next level.

If you’re a small practice, a lot of times, you need to get an operating system in there in your different systems and things that are happening. If you’re an established business, a certain number of providers, maybe multiple locations, you have some systems in place but the tracking of the systems and the way that you’re looking at things are using those systems and metrics like, “Is the operating system of the business at the level it needs to be to go to that next level?”

Usually, you have to upgrade your operating system to go to that next level. I love that analogy. It made total sense. What I’ve seen in my journey in business is that every time, you have to put some effort into modifying and improving your operating system to be able to make that leap to the next level.

For the readers, when we’re talking about the operating system, that’s your policy and procedures manual. That’s the analogy he’s making there. I know exactly what you’re talking about. If you’re a single provider, maybe with one front desk, your policing procedure manual has to do with how to manage the front desk and essentially, the new patient paperwork and how we bring patients back. I have another policy procedure manual.

As soon as you start expanding, you need a job description for another physical therapist or physical therapy assistant if you bring them on board. You need a different operating system when you bring on a tech. “This is how we use the EMRs and collect co-pays.” That’s all in the policy and procedures manual. That’s your operating system as either third-party software or EMR starts capturing credit cards so you can keep them on file. That’s an upgrade to the operating system. I wasn’t able to do that years ago.

We have to get a new operating system to modify for a situation like that. It doesn’t come easy. That’s the grind of business ownership. It was well spelled out in The E-Myth Revisited . That’s the story of the entrepreneur in spite of the industry. Write down your operating systems. Get those in place so that everything that’s in your head, what you see in your businesses, is in writing so other people can recreate that over and over again when you’re not there.

It doesn’t have to be in super fine detail. The team has to work on it together. I saw something. It was pretty fascinating but they were using AI to create the standard operating procedures for different positions. Let’s say, front desk scheduling, how they did it. They would take a little screenshot video with certain software that can then transcribe it, take the transcription, put it through ChatGPT, and make it a little cleaner and easier to operate. Before you know, it was a few iterations but within about 10 or 15 minutes, they had something that was all typed up and ready to go. The main thing is to get that knowledge down on paper so someone else can train on it and do it.

The training could be watching the video. If it’s easier for people to do a screen share, use Loom and say, “This is how we collect a payment. Go to the EMR and here.” That’s probably already there in the EMR training but people don’t do the ERM training. I can’t tell you how many EMR owners that I’ve talked to who say the issues are customer service. It usually has to deal with the owners that take on the EMRs, do the change, and then don’t watch any of the training. If you watch the training, you will know how to handle this particular situation.

That’s where you as the owner of your company are going to say, “I’m going to give you the time. You’re going to do the training whether they’re mine or the EMR so that you know where the answers are.” When you come to me with a question, my first response is going to be, “What does it say in the policy and procedures?” You are like, “I don’t know.”

This is when we started getting serious about our policy and procedures manuals and people started following them. I would respond with that with, “What does it say in the policy and procedures?” “I want some time off in October because my family is coming to town.” “What is the policy and procedure manual saying?” “I don’t know.” “Check it out. If it doesn’t have the answer, let me know.” I then wouldn’t hear from him. “What did it say?” “It said to fill out this form and turn it into my supervisor.” “Did you do it?” They’re like, “Yes.” Sometimes, it doesn’t say anything.

Rarely did they come in and say, “What do I do about this?” I’d say, “What does it say in the policy and procedure manual?” I already looked and it doesn’t say anything about that. I would love it if they had. I would have paid them $10 or $20 on the spot for inflation to give me that kind of answer so I know where the holes in my policy and procedure manual were so I could create a new policy. That’s how you get it to be alive and working in your business. You’ve got to push it into the business. They won’t readily sit by and do training like that.

We covered a ton of great information. Do you have any final words of advice for our readers?

People like listening and consuming podcasts but if you’re not, taking snippets of value from each podcast and putting it on your calendar to work on something in your business and being focused is not worth it. Sometimes you can get overwhelmed. There are a lot of things you want to do. Take 1 or 2 things and make it work. If you find a book that you want to implement some of those programs, stay on that book for months until what it is recommended has been implemented into the business.

If you’re not sure where to start, get a coach and a consultant. I’ve already beaten that one to death but the reason why you do this and why you started your business is because physical therapy owners need help. We’ve taken it in the shorts for too long. Reimbursement plus inflation have led to a real squeeze on our profits. PT owners, in general, need to become the best business owners if they want to survive.

Those PT owners who are surviving and succeeding are some of the best business owners out there. They could take that knowledge to any industry and thrive because what you see in other industries, the profit margins are such that they don’t have to know as much as we do. If you come in with that knowledge, you can do great things. I would encourage PT owners to not be passive, take control, get some guidance, and work on their business to recognize that they are business owners first.

Thank you so much. For readers, what’s the best way to get more from you? Is it PTOClub.com ? Check that out for Nathan. He is doing coaching and consulting for practices of all different sizes.

You can set up an appointment with me and my partner, Adam Robin, through PTOClub.com. If you want to email me directly with a question, it’s Nathan@PTOClub.com. The Physical Therapy Owners Club Podcast, like yours, is on iTunes , Stitcher, and all that kind of stuff.

Make sure that you subscribe to that. Check PTOClub.com . There is great stuff there. Nathan always has a ton of great insight there. If you have worked with him before, I encourage you to have a conversation and see if working with Nathan would be right for your business. Don’t forget to subscribe to our Practice Promotions YouTube channel for more podcast episodes. Follow us on Facebook , Instagram , and LinkedIn . There are more weekly business marketing tips that we’re putting out there for you. We’re signing off here but I want to say, here’s to your success. Thank you, Nathan.

Neil and his wife, Amy co-owned their successful physical therapy practice in Boynton Beach, FL for 8 years, developing marketing strategies and systems along the way. He has dedicated his career to helping elevate the profession of physical therapy in the public, by empowering rehabilitation practices to successfully market themselves to their local communities.

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