Nathan and Adam dig into the underlying causes, from leadership identity to scalable financial systems, and provide actionable insights to help you regain control. If you’ve ever felt overwhelmed by your finances, this conversation will change how you see your business forever.
In this episode of Private Practice Owners Club Podcast, join Nathan Shields and Adam Robin as they tackle one of the most common challenges private practice owners face: cash flow issues. But here’s the twist—cash flow isn’t the actual problem; it’s just a symptom.
Tune in and discover how to turn financial stress into financial confidence.
𝗖𝗮𝘀𝗵 𝗳𝗹𝗼𝘄 𝗶𝘀 𝗮 𝘀𝘆𝗺𝗽𝘁𝗼𝗺, 𝗻𝗼𝘁 𝘁𝗵𝗲 𝗰𝗮𝘂𝘀𝗲 – Learn why financial struggles often stem from leadership, mindset, and operational inefficiencies rather than a lack of revenue.
𝗧𝗵𝗲 𝗶𝗱𝗲𝗻𝘁𝗶𝘁𝘆 𝘀𝗵𝗶𝗳𝘁 𝘆𝗼𝘂 𝗻𝗲𝗲𝗱 𝘁𝗼 𝗺𝗮𝗸𝗲 – Owners must transition from being therapists to true business leaders who take full ownership of financial health.
𝗛𝗼𝘄 𝘀𝗺𝗮𝗹𝗹 𝘁𝘄𝗲𝗮𝗸𝘀 𝗰𝗿𝗲𝗮𝘁𝗲 𝗺𝗮𝘀𝘀𝗶𝘃𝗲 𝗳𝗶𝗻𝗮𝗻𝗰𝗶𝗮𝗹 𝗶𝗺𝗽𝗮𝗰𝘁 – Implementing small changes in over-the-counter collections, billing, and scheduling can dramatically boost profitability.
𝗪𝗵𝘆 𝗸𝗻𝗼𝘄𝗶𝗻𝗴 𝘆𝗼𝘂𝗿 𝗻𝘂𝗺𝗯𝗲𝗿𝘀 𝗶𝘀 𝗻𝗼𝗻-𝗻𝗲𝗴𝗼𝘁𝗶𝗮𝗯𝗹𝗲 – If you don’t know your financial KPIs, you’re flying blind. Learn how tracking key metrics can transform your bottom line.
𝗧𝗵𝗲 𝗽𝗼𝘄𝗲𝗿 𝗼𝗳 𝗱𝗲𝗰𝗶𝘀𝗶𝘃𝗲 𝗹𝗲𝗮𝗱𝗲𝗿𝘀𝗵𝗶𝗽 – Hear real stories of practice owners who turned things around by stepping into their role as true decision-makers.
It’s time to stop blaming cash flow and start fixing the root causes. Take ownership, shift your mindset, and implement the strategies shared in this episode.
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How are you doing?
Charged. Ready to roll. What's up?
I love your one-word open. Charged. That's great. I'm excited about talking about this because it's in my wheelhouse. I like talking about money. You know how I get excited about that. We are talking about financials, cashflow in particular, the fears related to it, and why we are having cashflow issues. You are talking to a number of owners. You are talking to them about our coaching program and what we can do for them. I'm assuming you are talking to a number of owners who might be having cashflow issues. Is that about right?
For sure.
Is it rather common?
It either comes down to time or money. These are the two big bottlenecks for people.
For investing and coaching, right?
Correct.
It’s not uncommon. There are plenty of owners out there that are struggling a little bit financially. They want to get through payroll or they have extended themselves on equipment or simply the purchase of their practices. You brought this up in particular because the lack of cashflow isn't the issue. That's what you recognize as you talk to them. What are some of the things that they are bringing up that lead you to believe that cash isn't the issue? What made you bring this up?
I have been studying this more. It's fun because I'm on this journey with you guys and I'm a student of this game. You could never not go a little deeper into things and understand things fully. I had this revelation. I was like, “What if I told you your lack of cashflow is not the problem but it's the symptom of the problem?”
People are going to be like, “I don't have cash and that's a problem.”
It's like, “Why don't we have cash?” Our instinct to blame it on exterior circumstances like, “It’s because I can't hire people,” or, “It’s because of the insurance rates,” or, “It’s because of this or that.”
People are like, “It’s because I can't get referrals. I need more new patients.”
It’s a very limited mindset that keeps people trapped in this hopeless situation that they have created for themselves. What if you recognize that there's a whole lot you can do? You could fix the root cause of this problem, and that is the thing that will generate the cashflow. I felt like it would be cool to have that conversation.
For me back in the day, that mindset was, “I have a lack of cashflow, so I need more new patients. Simply, I need to market more physicians.” That was the only perspective that I had. I was like, “I need to get more referrals from more physicians so that I can generate more patient visits and thus make more money.” It was almost like if I saw a nail, I hit it with a hammer. That's all I knew how to do.
That perspective has changed now that I have learned more about business and been through enough experiences where it's easy for us to tell people, “It goes deeper than that,” and have a conversation like this. I was bringing up my presentation at the last conference about pretty easy ways that you can increase your revenues by 10% without a single new patient coming in the door. Those are some of the things we are going to talk about.
Maybe it goes a little bit deeper than that sometimes too. I know I have been burned. You've probably been burned by buying something, thinking, “This is going to solve XYZ problem,” and it didn't solve the problem. You’re then like, “Now I'm out X amount of dollars.” There's the fear of that. There's the fear of , “They are telling me I can do this. I have never done it before. Maybe I don't have a lot of confidence in myself to get it done,” or, “That sounds like it's going to take some time. It’s going to take some effort. Time is one thing that I don't have when I'm seeing 40 to 50 hours of patient care each week and trying to run my practice on top of that.” It can go deeper. Those are some of the things that we want to talk about.
Change is hard. That's what it comes down to. The hard thing isn't necessarily changing what you are doing. That's the outcome. The hard thing to change is the identity that you have. It's not hard to drive to the gym and go to the gym but it's hard to become the person who prioritizes their health and fitness, which will require me to sacrifice something so that I can prioritize the new thing. It's this shift in identity that's hard. I know how to do this thing, but this thing is like, “I don't know what that is. It's scary. It's vulnerable. What would happen if I let this go?” That's that psychological shift that's hard for most people.
We are talking about deeper stuff because the lack of cashflow is a symptom of the problem. What you are talking about here is there are many of us like this. This is how I was frankly back in the day. I wanted to own my clinic but I didn't want to take ownership of the clinic. I didn't want to look at myself as the reason why I liked cashflow. I didn't want to look at myself that I’ll lose people by attrition because then I have to focus inward. It's easier to put the blame externally on something or someone else and say, “I'm a victim of XYZ.”
I was talking to one of our clients. He had this PTA that has been a negative force in his clinic since. He's been on the team for several months. I come to find out that nobody likes this guy. He's a 10-year veteran in physical therapy and has a hard time seeing 8 patients a day. They do 40-minute visits or something like that. He's always late. When his feet are held to the fire accountability-wise, he's like, “If I'm not getting paid extra for coming in 5 to 10 minutes early, then I don't want to be 5 to 10 minutes early.” There are all these things that are going against the guy's values.
The owner said, “I don't want to see this guy's face ever in my clinic again.” I'm like, “You are the owner. You don't have to work with the people that you are working with if you don't like them. You don't have to barely break even every week because you are the owner and the change agent.” It's almost like, “What am I supposed to do if I don't like this guy and he's a negative influence? What kind of blowback is that going to get?”
You have to change who you see yourself as in order to make massive changes in your clinic.
When I found out that nobody liked the guy, he had plenty of reasons to fire him but he still wanted to run it by legal. I was like, “Get on the phone with legal right now and fire him tonight. Thankfully, he did. Thankfully, he fired him after we got off the phone. He told me how many sleepless nights he's had over this guy, how to approach him, and how many times he has held him accountable. I'm like, “Fire him and sleep better tonight, please.”
It goes back to some of us wanting to be owners without taking on the identity. We want to see change come about. We want to see insurance companies pay us more. We want our employees to produce more, do better, and be better without changing ourselves. Once you become that change agent, you take on the identity of a true owner like, “I am responsible for everything that's running in this clinic. If something goes wrong, it's up to me to recognize what the issue is or empower my team to recognize what the issue is.”
There are different ways where you can exert ownership. It doesn't have to be you on top of the problem. You can empower other people to do that but that starts with you empowering them. To your point, you have to change who you see yourself as in order to make changes and make massive changes in your clinic. If you want to make more money that requires you to take ownership of all the things that generate money in your clinic.
I have had Eric Miller plenty of times from Econologics. I shared this in our group call with our coaching clients. He said that when there is a cashflow issue in your company, the first thing you need to look at is your purpose. You would think he's the financial advisor and he is going to say, “Know your numbers. Talk to your billing company. What are over-the-counter transactions that are happening at the front desk? What is their over-the-counter collections rate?”
He's like, “No. We have to go back to purpose. Are we truly living our purpose in the way that we do things? We need to get clear on that. What is our purpose? What is our reason for being here? Is everyone on the team bought into that? Have some discussions, vet it out, and talk about it. Make sure we are all on the same page. If we have that foundation off of which to work from, now we can move forward and institute changes appropriately.”
He sounds like a smart guy.
Eric knows some things.
It's so true. It gives me chills thinking about it. It affirms so many experiences that I have had in my practice, in my business, and in my life as a leader. Every time I choose to take ownership of the thing, it improves. I like the word purpose, but for whatever reason, my language has shifted more to identity. Who do you want to be? It’s a similar concept but maybe there are some subtle differences. The reason why you are not creating change is because you are not being who you truly want to be, and that's hard.
Everybody that's reading, I want you to stop and envision yourself five years from now. You are this elevated version of yourself. You are a more powerful leader. You've solved bigger problems for people. You've created the life of your dreams. You've created the practice of your dreams. That person is going to come down and he's going to give you advice on how to make more money. What is he or she going to tell you?
What are you waiting on? Who do you want to be? Is that the identity that you want to be or do you want to continue to keep the identity that you have? Who's the only person in the world who can make that decision? It’s you, so what do you want to do? It doesn't get any simpler than that. We have got to stop the victim and the blaming. It's on you. You can create change. All you have to do is decide that that's what you want to be.
I have a friend Billy who exemplifies what you are talking about when you are talking about envisioning where you want to be. After going through that exercise, what I'm hearing you say is don't wait to become that kind of owner until you get there. You need to become that kind of owner now in order to get there.
The reason why we are not creating change is because you are not being who you truly want to be, and that's hard.
I heard this from someone else. If you want a $1 million practice, you don't start acting like a $1 million practice owner when you hit $1 million. When you are making $200,000 and $300,000 a year, you make decisions as if you were a $1 million practice owner and you act like a $1 million practice owner at that stage, which will accelerate and get you to $1 million.
I bring up Billy because he said this before. I said, “You are making some good decisions that impress me because you are not where you want to be.” His language is such that, “I need to do this in order to get to where I want to go. I need to do this because when I'm at the five-clinic level, I'm going to need this in place. This needs to scale. My decision now needs to be scalable.”
He could do the financials. This is his real bugaboo. Shout out to Billy if you are reading. His bugaboo is paying bills and running the numbers. He hates that. He's like, “I can't keep doing this. This is taking energy away from me.” He could do it but he says, “This isn't scalable. Who do I need to find to guide me, direct me, or do this for me so that it's part of the process and gets me to scale faster? I brought on a bookkeeper. Now I need to vet bookkeepers so I do this the right way. What software do I need so that I can scale this company and not get by for a 1 or 2-clinic company? For my 1 and 2-clinic company, I need the 5-clinic software program.”
You want to make the decisions for where you are going for five years from now, not 5 days or 5 hours.
Not the Band-Aid.
Correct. I'm sure you've experienced something like this with your team. It's like, “We need to onboard a new person next week. We have to fix this piece of the onboarding process. What if we had to onboard 100 people next week? What would we do?” “Let's do that. Let's build the onboarding process like that. That way, we can put this onboarding process on the shelf for the next five years and it's going to work. If we are going to fix it, let's fix it right.”
Taking bold and courageous action toward where you are going or who you want to be usually wins and scales. That's going to take some scary stuff. You are going to have to invest time, money, and energy towards things that you believe in, even if it's scary. Even if you are not sure how you are going to get there, do it anyway. Do it scared. Shout-out to Billy.
Coming back to the beginning of our conversation about financials, you said it. It is a symptom of other problems. When someone is having a cashflow issue, where are some places that you recommend they start looking?
We have to build the foundation. It's all about, “Let's build a strong foundation.” I can tell you what not to do. Don't immediately buy a shockwave machine and try to sell cash pay services. Don't do that first.
Do not be like, “Let's invest some more money in a piece of equipment that costs 5 to 6 figures.”
The thing is like, “I'm going to throw this money at this thing that's going to solve it.” What I would recommend is let's take your current model and bulletproof it first. What we want to do is not make money next month. We want to make money for the rest of our lives. My goal with owners, assuming that cashflow is one of their biggest concerns, the first thing that we do is to go through that profit accelerator piece, which is we are looking at the four touchpoints. One is the over-the-counter collections.
My goal is to double your over-the-counter collections. Even if we were only able to increase them by 10% or 15%, that's a transformative difference. Those of you who are reading, I know what you are thinking. You are thinking, “We do a pretty good job at that.” If I could look at you right in your eyes, I'd look at you in your eyes and say, “No, you are not. You think you are, but I promise you are not.”
If you can't give me an exact percentage of your over-the-counter collections rate, then you don't know how well you are doing.
There are levels to this thing. Verifying the insurance and asking your front desk to do that is not enough. Even measuring isn't enough anymore. There are more things you can do. Double your over-the-counter collections. Of the other three touchpoints, another is your fulfillment piece, which is how you are delivering care. That comes down to things like how you are scheduling, what are your productivity expectations, how you are billing the number of units, and the quality of units you are billing. There are some elements there.
Then, it's your billing and collections team. What does your AR look like? What's your denial rate? What are your clean passthrough rates? What’s the average number of days before you get paid? Those are the big ones. We need to front-load the heck out of that stuff so you are getting cash instantly hitting your bank account. The last thing is your financial management piece, which is like how you are managing your cash inside your practice via budgeting, bookkeeping, and managing profits.
Knowing your financial KPIs.
What you could do is build guardrails around the way money moves in your business such that it all funnels down to the bottom line. There's some structure you can build there. If you make 2% to 5% dents in each of those buckets, you will transform the financial health of your practice. Are you going to get rich? Probably not, but are you going to be predictably profitable and have a scalable model? Absolutely. That's where I start. Let's build the foundation first. That's the key. The cause is you are not doing those things. You don't have the scalable financial systems in place that generate the cashflow. You fix those symptoms. Either the systems aren't there or they are not being executed.
They are not efficient.
If you fix those things, you will create a model that's profitable.
If you are going to generate more cash, you need to do more and better cash-producing things in terms of systems. I mentioned Eric Miller and his presentation on when there's a cashflow crunch. I did the episode with him a few years ago. You can look at it. Go to our website, PPO Club. There's a Podcasts tab. It gives you an opportunity to search by keywords for previous episodes. You could put in cashflow and I'm sure his episode would pop up pretty quickly. You have to track your money lens. Where's the money going?
This is the bloodline of your clinic. This is how you survive. You need to have a touchpoint on where the money's flowing, how it's flowing, where it's getting constricted, where it's getting taken out, and where it's being minimized. That's what you are talking about here. We are talking about the money coming in. Chronologically, it comes in through the front desk first before it goes anywhere else. Are you collecting all of the co-insurances, copays, and deductibles at the time of service? If I were to go back to my clinic, no way would I let deductibles linger out there until they come through the insurance company. You can't do that.
You can do whatever you want, but good luck.
I saw a statistic by McKinsey, which is a super powerful accounting firm, that said that money that is not collected at the date of service, usually, you lose about 50% to 60% of each dollar if it's not collected upfront. If you get hardcore and improve that over-the-counter system with the front desk, that's a pretty easy 10% to 15% increase in your revenues because you are no longer taking the risk of it not getting paid, frankly, but you also don't have to waste the biller's time to send out the bills. It saves money. That can be hard for people to do if they haven't set up their clinics like that from the very get-go.
Most therapists aren't good at asking for money. That's why you get a front desk person who has no issues talking about money. They are the type of people who are like, “I don't care. This is your insurance. It's not mine. You owe us $80 today.” They are like, “If we are going to do this right, we need your credit card on file because I don't want to ask permission every time you come in. I'm going to charge your card.”
Someone brought this up. They are like, “Doesn't that mean you might have to send out a lot of refunds after a while?” I'm like, “I would be more than happy to write 100 checks a month than to be asking people for money with their bills in the mail or sending out texts, emails, or however you are collecting. I'd be more than happy to send them refunds if it came to it.” If you do that, you’ll see immediate changes.
It’s transformative. The other thing that people get bogged down with is they don't understand their metrics. Honestly, their providers are underproductive. That's a big one as well. There is maybe a leadership gap that causes that. They are usually the most productive person in the clinic.
The owners themselves.
They are very productive. They are the biggest revenue generator. Therefore, they can't escape the clinic because if they do, they will run out of money. How do we empower our team to be as productive as we are? It's either a training issue or a leadership issue, which is around, “I don't know how to hold that standard,” or, “I don't know how to help the team see why this isn't the benefit of everyone and not just the company.”
You had to go through this yourself. There are two parts to it. They lack the clarity on what that training looks like to get everyone else to be more productive. For you and me, it was almost natural. I don't know what my secret sauce is but I can see a ton of patients and I can bill for them appropriately. Thus, I am the greatest revenue generator in my clinic. You are my coach and you are telling me I need to step out of patient care. Tell me how that makes sense. Tell me how that makes financial sense. Having gone through it, what was your experience?
I never avoided it but it was scary for me because honestly, I had limiting beliefs around money. I didn't want my team to think that I was all about money because I would be scared of how they might judge me or how they might think of me. I would speak ambiguously around that topic and be passive-aggressive around it. I ended up sounding like a jerk when I didn't mean to. I didn't know how to step into that place boldly and unapologetically because I didn't truly even believe it myself. It was more of a me thing that held me back.
Through doing that and through challenging your own limiting beliefs, you realize a new truth through the hard thing. Now, I can be like, “Welcome to the team. We need you to build this many units.” If there are any problems, I can be very bold around that. I’m like, “This is why it's important and this is how we do it here. Do you want to do this? You don't even have to. You can go work somewhere else if you need to, but this is how we do it here. We'd love to have you. What do you say?” When you can get clear and explicit and have that belief about it, then you can communicate it clearly, and people are like, “This makes sense.”
That's what helped me when I had a coach to get through some of these sticking points. I wanted to talk about those things, but for the same reason you had, I had a fear of how they were going to judge me if I was going to be all about the numbers and all about the money. My coaches were able to guide me on proper scripts. Maybe the conversation wasn't about the metrics. Maybe the conversation is more about fulfilling our purpose. How do these metrics match up with our values? How does improving the financial status of our organization improve the opportunities for each provider and the profession?
It is bringing it back to them. It is like, “Do you recognize that if you bill the absolute maximum or bill for the services you ethically provided, you are worth more in my organization and you can make more money? Do you recognize that?” What if the rest of the physical therapy profession built the maximum they could for all the ethical care that they provide? Don't you think it'd be easier for us to then say, “We provide X amount of services and we are not going to take less. We expect to get paid for that. We are not going to take a cut of the contract because we have already matched our salaries accordingly.” You are coming from a position of power.
You have to get a stronger identity so that you can invite others to join you. That's what leadership is.
What the coach did for me was give me a perspective and/or a verbiage to use. That one was super helpful for me because I could have these conversations and it wasn't about these objective measures, which are super important. To me, the point became that these metrics are representative of how well we have lived out our values, how well we are living up to our purpose, and how well we are providing care.
It is like, “I believe that my care is worth much more than a therapeutic exercise unit because I put some thought into my treatment. I'm going to bill and document for a therapeutic activity unit of care, which will pay me significantly more. If I do that 3 times over in the same visit, then my care is worth $13 more in that visit. If you spread that out and multiply that, my care is worth significantly more and I'm worth more as an individual because I can do that, I can document it, and I can provide great care and get results.”
They have to step into leadership, which means they have to go into areas that they are unsure of. Especially when it comes to billing, you need to know the codes. You need to know the difference between AMA billing guidelines and Medicare billing guidelines. If you don't know what they are, that's your job as the owner to go figure it out. There are a ton of resources out there like Gawenda and BCMS. WebPT has blogs on it. You can find that.
There’s ChatGPT.
Find the stuff. That's what your job is as the leader. As you do that, you make more money. If all your team’s billing Medicare billing guidelines, you are making a lot less money than you could. If all of your providers are billing 3 Therexs and 1 manual therapy each visit, you are making a lot less money than you could. Getting training on that is imperative.
I tell my team all the time, “It's not what you are doing. It's who you are being.” Shout-out to Catherine. She's awesome. We are rebuilding our leadership development program. We’ve got some evolving leaders in the company. I'm pleading with her around it but she's like, “How are we going to do this? How are we going to do that? How are we going to structure this on the first call?” Sometimes, I have to remind her, “It's not about what we do. It's about who we decide to be when we get there.” It’s coming back to the purpose and values. It's like, “Why don't we go all in on that, and then let's see what happens?”
Maybe learn along the way.
You mentioned the purpose and values. For the owner who's timid and scared to approach your team, I'm wondering if you haven't fully bought into your purpose and values yet. Maybe you have a little, but there's more potential for you to commit to them. I'm wondering if that gap in commitment might be the thing that inspires your team to commit with you. You have to get a stronger identity so that you can invite others to join you. That's what leadership is. Once you do that, that's what a culture is. You start shaping up your culture and then your team starts to believe and they will perform.
In our coaching program, we have a profit accelerator that goes through these four stages. It's a lot of that. There is a lot of knowingness that needs to take place but it starts with saying, “This is who I am. I'm an owner.” What do owners do? Don't think about the owners around you. Think about the world-renowned owners. What are they doing? Think about Elon Musk, Jeff Bezos, or Bill Gates, no matter what you think of all the politics that's going around.
The Shark Tank guys.
Do you think some of them have therapists, coaches, advisors, and mentors? They do. Michael Jordan had a coach throughout his career. When you are in it, you can't see everything that's going on around you. These coaches also give them guidance and direction. They give them kudos or a pat on the back when they need it. They are also a sounding board.
I remember a Tim Ferriss episode that was interviewing a coach. He coached Steve Jobs and Bill Gates at the same time, two opposing companies. He didn't take any salary. He's like, “I have no stock in this. I'm giving you guys the straight. I don't care because I have no stock in either of your companies.” They leaned on it big time, all the time. That's what the benefit of the coaching was.
I can go back to the fundamental changes I made as an owner when someone gave me a little bit of guidance. It’s like, “Let's open up this window over here and see what light it produces in your room. Maybe it's better.” I'm thinking about the guy who fired his employee that we were talking about in the earlier conversation. I had a follow-up with him. I was like, “What's your workday like now that you've taken ownership of the people that work for you? Maybe a little bit better? Are you sleeping a little bit better?”
I am inspired by the young therapist who's starting a new clinic. I'm like, “Go for it. I got you. How can I help?” I will get on these calls with these people to coach them up and be like, “What are you working on? How can I support you?” I spoke with a young guy named Garrett out of Idaho. Shout-out to Garrett. He's starting his practice and he's asking me about units, billing, over-the-counter collections, and all this stuff. I said, “Here's the trick. You need to surround yourself with people and resources such that you enter each day in an optimistic state, a place of encouragement, possibility, and optimism.
You need to surround yourself with people and resources such that you enter each day with an optimistic state, a place of encouragement, possibility, and optimism.
We need to try to keep you there often. If you can stay in that state often, you will become the thing that can make this thing work.” What happens is we get stuck in our own limiting beliefs. We have all experienced that where we are lost, depressed, anxious, and overwhelmed. It's spiraling. We put ourselves in a box and nobody wins. We need you guys to win. We need entrepreneurs to win because when you win, the profession wins. The providers win. The patients win. Everybody wins.
There's a lot of excitement there when you can step out of that box and have the opportunity to see things for what they are and not be emotionally caught up in it.
Clarity. The emotion is gone and you see it clearly. You see it as it is.
I can be a little bit more creative. I can think from the creative side of my brain instead of the reactionary side of my brain. Emotions and money go so closely together. When there's a cashflow crunch, that's emotional for most people. Frankly, I tie a lot of my self-worth and my self-image to the money I'm making. Maybe that's a very male thing to do because we are providers at heart. That's a big blow when money's tight. It's almost all you can think about.
Even though you are in the situation, to be able to step outside of it is where others come into play. The positive people like you are talking about, when you can have interactions with them, whether it's a fellow team member, a mentor, or a coach, and they can help you step out of that for a second, what are some other possibilities?
We want to stay in solution-based thinking.
I had a coach once and I will never forget what she said. She was like, “You are saying a lot of your self-worth is dependent upon your production.” I'm like, “Yeah. It's where I live.” She was like, “Are you telling me that if you were on a ventilator and not productive, your wife and your children would love you less?” I was like, “No.” She was like, “You are telling yourself a lie.” Without going through the words, I'm telling you because I'm willing to let myself go into that emotional state.
You've attached to that thing and it's like, “How do I let go of it?”
That was several years ago. I still have to think through that process.
How do you feel like that mindset impacted you and your decision-making along the way with money, hard conversations, leadership, marketing, and growth? That monster in front of you, if you can't get around that, you can see how that would impair everybody.
It affects everybody else. If my emotions are running hot, it's going to affect my wife, my kids, my fellow employees, my team members, and my leadership team. I am trying to stay out of that. The more you can be in that rather more optimistic and creative state, the better for you and everybody. Anything else you want to share on the topic? We covered a lot. I gave some steps on how to improve cashflow.
You could go down and search for episodes. There are all kinds of stuff. You want to improve your billing and collections. You want to prove your accounting. We can beat that horse to death. We have talked about that until we are blue in the face. The main point I hope people got is that the lack of cashflow is the symptom of the bigger problem. The bigger problem is tied to the identity or the purpose and values that you are choosing to hold onto or choosing to live out or the lack of systems or the execution of those systems within your organization.
It can go back to identity. It can go back to knowing enough. It can go to a lack of clarity or commitment.
It's a lack of you, a lack of the owner. The way I have started to frame this up is that the business becomes so complex. We work hard and build up this complexity or this chaos around us and the business consumes us such that we have nothing left to give to our team, our patients, our family, and the things that we value, and we are not giving enough to ourselves.
We are not learning, growing, and acquiring new skills. We are not elevating our leadership. We are not having hard conversations in a productive way. We are not building the onboarding. That is the thing that is keeping you stuck. Once we can clear your plate and give the hero of this journey, which is you, the tools and resources you need, you will transform your life.
To wrap it up, I shared with you the testimonial that we got from Christie. That made my day. She sent a text over to me. It was out of the blue. She said, “I’m looking at last year's financials. I have increased my revenues by over 20% year over year, and my profit margin is well over 17%. It’s the highest ever. I'm shooting to get to 20% in the next couple of years. I chalk it up to you guys.” I was like, “That is amazing.”
That was so cool because when I first met her a few years ago, there was not much cash. She was frustrated with her team. The production of the team was overrun by HR issues. She was a young mother who had a young baby at the time. I want to say the baby was less than a year old, somewhere in the 0 to 2-year age range. She didn't have a lot of time for the baby and didn't know what to do. COVID was a huge hit. To see her transformation and that she has time for herself. She still wants to treat, so she treats twelve visits a week. She's in control of that. It's her decision that she wants to do twelve visits a week.
She’s like, “I'm doing this for fun.”
She could step out of that at any time. She has a team that's productive and she has leadership in place. Thankfully, she was willing to share the testimonials. It was awesome to see because she transformed her life.
After knowing Christie’s story, I invite you to imagine the type of impact that would have on the people and the things that you know that you care most about. It could be transformative for you. I would invite you guys to think about that because you are worth it and people are counting on you.
If people want to get in touch with you, how do they find you?
I have been spending a lot of time on social media. I'm on LinkedIn and Facebook as Dr. Adam Robin. I'm on Instagram. I'm creating a little Instagram following. That's been fun. You guys can check me out. I have a YouTube channel. We have the PPO Club YouTube channel. You can check me out there. Always shoot me a DM if I can support you. If you ever want to talk shop, you can email me at Adam@PPOClub.com. Join the Private Practice Owners Club Facebook group. We are doing live training every Thursday. I have a ton of free things to give you. Anything I can do to support you, let me know.
Thanks for sharing. Talk to you later.
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