Physical Therapy Owners Club

Radical Accountability With Your Team: Why Lowering Your Standards Costs More Than Money With Adam Robin and Nathan Shields

Mon, 27 Apr 2026 19:00:06 GMT

Most clinic owners don’t struggle because they don’t know what to do…

They struggle because they wait too long to do it.

In this episode of the Private Practice Owners Club podcast, hosts Nathan Shields and Adam Robin break down one of the hardest leadership decisions in business:

When is it time to let someone go?

This isn’t just about performance.

It’s about culture, values, leadership, and the hidden cost of tolerating the wrong people.

Through real stories and firsthand experience, they unpack what happens when a single team member starts draining leadership energy, creating tension, and slowly eroding the foundation of your business — even if they’re producing.

And more importantly… what happens when you finally act.

In this episode, you’ll learn:

● Why high performers can still be the biggest liability in your business

● The real reason most owners wait too long to fire someone

● How toxic behavior spreads and impacts your entire team

● The difference between performance issues vs. cultural misalignment

● Why “exhausting every option” is often a trap

● How leadership avoidance creates bigger problems downstream

● The role of standards, accountability, and clear communication

● Why raising your standards always leads to better outcomes

● How strong culture attracts the right people and repels the wrong ones

● What happens to your team, energy, and performance after you make the hard call

You’ll also hear how one decision shifted an entire organization — improving morale, alignment, and long-term growth.

If you’ve been holding onto someone you know isn’t the right fit…

this episode will give you the clarity (and push) you need.

��️ Learn how to protect your culture, lead with conviction, and build a team that actually moves your business forward.

�� Join our upcoming workshop and learn how to build a stronger, more aligned practice:

https://ppoclubevents.com/04-17-26-workshop

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Book a discovery call: https://calendly.com/ptoclub/discoverycall

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Listen to the Podcast here

Radical Accountability With Your Team: Why Lowering Your Standards Costs More Than Money With Adam Robin and Nathan Shields

I’m thinking about someone we had to let go who was not meeting productivity expectations on a consistent basis, and we gave him support, but he was not acting out towards other people. He got along with the rest of the team pretty well.

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Where do you want to start the conversation?

Leadership Capital: When It’s Time To Break Up

I am sitting here thinking about. When you know, what is the trigger? When do you decide it is time? I do not know if I even have a clear answer for that. Maybe I do not know if there is an objective. When do you break up with the bad girlfriend or the bad boyfriend? Eventually, you just get tired. Eventually, you just get tired, and you feel like, I know for me, having been here a few times.

I get to this place where I am really tired emotionally, and I feel like there is nothing left that I can do. I am out of answers. I have exhausted every amount of leadership capital that I have. At this point, the only way to satisfy this person is to change who I am as a person, or, another way of saying it, to sacrifice my values. If it is money-related, then sometimes it is like I have to sacrifice the financial health of the business.

Unfortunately, it never turns out well.

No one wins at that. You know, like, "It is time."

Can I share my experience? You say, "When is it time?" It is easier in our positions when we are looking at other owners and their employees and their stories. Even in my individual cases, I have been around enough that I start getting inklings. Something rubs me the wrong way. It could have been some experience, either firsthand or from someone else, or frankly, seeing some metrics like, "That is not right." Not that there is a red flag, but my ears perk up. I need to pay attention to what is going on here and see if this starts becoming a trend. You are really good at addressing those situations of addressing it immediately.

I have to.

I am not as good. I take my time, maybe I am quiet. I am the type that is like, "Let us see how this plays, let us see what happens here," where I could probably use more of your go-straight-at-it value.

Maybe it is a bad thing, too, sometimes.

We go with it. We work with it. I think that is where it starts. Where does this land on the scale of acceptability? Which value are we maybe straining a little bit to accept this action? Be mindful, be observant, watch, see what happens. Usually, by the time owners come to us about it, it is frankly time. When it gets to the point where they are talking to us about it, it is time to cut the ties. I always have to remember the adage. I have never fired somebody too soon. We will always give them a leash. We will always try to be empathetic, even blame ourselves for the person's mistakes or inabilities, before letting them go.

The more that we can keep our ears perked towards what is happening, be observant, and watch the objective metrics as they come to us. I think we are going to be better served to let people go quickly, and that would be in the best interest of the business. In your situation, what would you have done differently? If you were to look at a judge, how you guys did things. Do you think you did it well? Did you follow a good process? Were you maybe turning a blind eye towards some of those activities because they were a good producer?

I was a little bit disconnected from the business last year, but that is not an excuse. I did not fully understand the gravity of the situation with this person because I was a little bit disconnected, maybe a little bit more disconnected than I should have been.

Would you say your leadership team then was you gave him too much of a leash?

Yeah. I think that they had a hard time understanding when it was time to have the conversation. We learned that lesson. We have acknowledged that together, and that starts with me modeling that better and also holding them accountable to that better.

Were they withholding some of the issues coming up from this person? I recognize that some of my team members, whom I found out after the fact had had experiences with these people, that I did not find out until after I let them go. I am like, "Dude, if I had known that you experienced that with that person, I would have let them go three months ago, because that is not acceptable." It sounds like maybe they were not sending up all the appropriate information to you.

Subtle Hints Vs. Direct Accountability

It was just a confusing thing. They were hinting at things.

I know exactly what you are talking about. Hinting, like hoping that you would get the message.

I had to tell them, "No, I am never going to get the message." I am so squirrel-brain. I do not have time for small talk. You just got to tell me. If something is important, I have to train my team. If something is important, it is like, "Nathan, I need you to sit down because we have to have a conversation about something important." That is how you address it with me. I had to teach them that, and that never happened. It was like these subtle little things. I blew it off like, "We will just handle that or whatever." I never really gave it the attention that was probably needed.

If they do not make it worthy of a conversation, you are going to blow it off with the same amount of importance as their subtle hints. If it is a subtle hint, you are just like, "It is not worthy of a conversation. I guess you got it handled."

It was a weird thing because what happened was, and hopefully we are not getting on too much of a tangent, but my leadership team started to get overwhelmed. I started to have a little bit of like, "Why are you overwhelmed?" I started blaming them. "You are the one who is not overwhelmed. You need to get your stuff together. What is going on here?"

I started looking at them, and then it snowballed into a weird thing that we had to rally around, but it all stemmed from this one person. One person who ruined everything that we had. We learned a lot about that. I came in, and I cleaned the shop and basically said, "Great person, I do not know anything about you, but you are about to learn a lot about me, and we are going to get to the bottom of this. What is going on?"

You handled it personally. You did not leave that up to your leadership team. I am assuming that in the future, they would handle this, but since it had gotten to this point, you handled it.

This was one where I had to step in. My thoughts are like, "I am going to approach this person, and I am going to hear them out. I am going to hear their concerns. If there is an ounce of opportunity for me to serve this person and to improve what we do to help this person, I am going to do it. I am going to go all in on this person. “

Talk to me a little bit more about what your mindset was, and did you have a structure of how that was going to go? What was your mindset going into it, and how did you frame yourself, like, “This is how I want this to go, or this is the structure I want to use?”

I just looked at it from a place of full service.

“How can I help this person? We are obviously out of alignment with our values.”

“I take full accountability, full ownership. Something has happened underneath my watch. I do not fully understand it. That is on me. I do not care. How can I help you? I am going to show you how much I care and how committed I am to trying to find a way to make this work.”

When you come in, what are some of the first things you say?

"Listen, I understand that this is happening. First thing I want to do is apologize."

I was wondering if you were going to go there. At some point, you have got to come in with, "Listen, it has gotten to this point, so I have to take responsibility." I find myself in that frame of mind or starting the conversation off like that frequently.

"By the way, I am taking full ownership of this. I am not here to argue what is right or what is wrong. Does it matter? All I want to do is show up today. I am going to serve you. I am going to show how much I care about this relationship. How can I help?" I got all the demands, and I was like, "Fine. Action item." I got my VAs, boom, spreadsheet, and mailed it over to him. "Here are my action items. Here are the things we are going to do. We are going to put all this together." It was things like the schedule, the communication, and just little petty things. Moved it all forward, put a lot of energy behind it.

That was after the first conversation.

After the conversation. It was not enough.

This was not the we need to let you go conversation. You were not necessarily going to say, "If we do not get these results, I am letting you go right now." How can I make this best for you so we can work?

I am going to have to draw a line. I want to make sure that I deposit into this relationship enough so that I can draw a line and feel like I have done my part to be able to ask for that boundary. That is basically what I did. It is like, "Man, I have exhausted all of my resources at this point. At this point, it is either you are going to hit the standard, or you cannot be here anymore."

Was this a situation where productivity standards were not met, or was this the way he was interacting with team members?

Team members.

You provide him this support, thinking, "This is going to calm you down and help you be an adult in the room.”

I am going to show you how committed I am to hearing you and serving you.

He was still not interacting appropriately with team members.

Values Vs. Ideology: Finding The Line Of Professional Misalignment

No. It really came down to the fact that he had this idea of what ethical care looked like. After repeated conversations with him, it became very apparent that he had this ideology that was not going to be. There was no wiggle room with him.

It did not work with him.

From my perspective, he did not realize how compromised his judgment actually was, and how blinded he was by his own depth. It is not possible to do what you are asking. It is just not.

There is no world in which that happens.

It just does not add up. It became apparent to me that there was no way to serve him anymore. It was like, "What if you just paid me by the visit and changed the structure and gave me my own special thing?" I was like, "I think we are done. I think it is pretty clear that you are not happy, and I am not happy. It is time to part ways."

Did you see that you were making changes, and he was not? Did he make much effort?

We just were not aligned. That is all it was. I do not think it was personal. I think it was that he viewed the world through a lens that I would never see, and vice versa.

We all know where that ends. I am thinking about someone we had to let go who was not meeting productivity expectations on a consistent basis. We gave him support, and he was not acting out towards other people. He got along with the rest of the team well. I remember Will shared from his exit interview. Will was talking to him, but he shared that he is like, "Some of the stuff you have been talking to us about, like how you manage people and whatnot, yeah, I do not like that."

We were like, "Cool. This is not going to work. Let us find a place where it will work for you. Will you give us four weeks to find your replacement? In the meantime, we will help you find yours. Where are you going to go next?" We literally did that. We reached out to friends who had clinics near his house and said, "We have got this great provider, and he is not working out for us, but he could definitely work out for you."

He is like, "You guys would do that for me?" We are like, "Dude, we want to serve you. Just because it does not work for us, does not mean you are a bad person. We just do not align, and that is okay." I say that not only to share how we did it, but also to recognize that I would not be surprised if he went somewhere else and met those production standards. He was more aligned.

He is a hard worker. He was a very hard worker.

It comes down to values. We had another person on the call talking about how a certain process was not being followed by the providers in getting patients to show up. They have a process between the front desk and the providers to get patients who did not show. There are the same culprits who are not getting it done. Somewhere along the way, you have to recognize that they are not doing it. I shared this before in the show, the Alex Hormozi thing.

They are not doing it for one of three reasons. Either they do not know what the expectation is, they do not know how to meet that expectation, or they do not understand why it is important or how it affects them personally. Why is it in my best interest to do this? A lot of it comes down to that third one. Are we just aligned? We talked about production, and the other owner talked about her provider. It was about production, but also the values just were not there. This provider was more focused on other things. We can move on from that. That is all right.

The Toxic Drain: Protecting The Emotional Health Of The Company

The challenge that I have is whenever drama starts. Whenever the toxic behaviors start. Talking behind the back, belittling the company, creating animosity, and draining the energy of the people around you. That is for me like I am a bull that is all red whenever that happens. I do not tolerate it. I get angry. It is so disrespectful.

I would never do that to another person, especially someone on my team. That was the case here for me. I noticed that not only was my leadership energy being drained, but so was the leadership team. We were doing 30 and 60-minute meetings about this guy over and over. Trying to solve this riddle that could never be solved. At some point, you've got to just pull the plug. Basically, I continued to watch him erode our culture. At that point, when I am firing somebody, I want to make a very clear statement to the team as well.

I want to do this in a respectful way, but at the end of the day, I ask myself, "What would my team think of me? What message do I want my team to receive?" That is going to determine how I fire you. In your case, it sounds like this guy was just not aligned, but was not causing the disruption. That is a professional misalignment. When you are eroding the emotional health of the company, you are fired immediately.

If he were doing something like you are talking about, there would not have been this grace period. “Let us make amends, and things work out for you. It’s a nice transition.” No, it would have been, "Pack your stuff. You are out."

You are done, man. I have got too much riding on this. I care too much about this team, and there is not a lot of upside for you being here anymore, unfortunately.

“We cannot tolerate you being here anymore.”

“I am done.”

Do you see where maybe you could have or should have taken an off-ramp sooner in that relationship?

Had I been connected to the company a little bit more? Absolutely. One of the things that did cause me to hesitate, and when I say hesitate, I mean like three or four days, was financially.

I was going to go there, man.

The ROI Of Accountability: Why Recruiting Changes The Power Dynamics

“He was productive.”

I know. That is where many other owners and I hesitate. Usually longer than three or four days. Kudos to you. We hesitate because that is going to make my life really uncomfortable. It is going to make my team's life uncomfortable. I appreciate the revenue that they are bringing in. What am I going to do with all these patients now? How am I going to fill that spot? How much more can we tolerate of this person to maybe find the replacement or find the solution? That is where everyone gets stuck. You are an amazing recruiter. You are like a world-class therapy recruiter.

I got to add to that, too.

Now you are like, because I have been there. It s***. You are just like, "My employees hate being around this person. I hate being around this person. Maybe I just need to tolerate this person for a little bit.” It almost feels like a no-win situation. However, on the other side of it, it has always worked out better. My team rallies, our efficiencies improve, the environment is like butterflies and rainbows, and everyone's happy to be there. That shows up to our patients as well. You are in the middle of it. I know it is not totally easy, but it is better.

It is necessary.

What is the feedback from the leadership team?

They were nervous. I have got to remember this is a leadership team that has been beat up by their team for twelve months. They have been held hostage by this toxic thing for twelve months. They were tired. They did not really have the fortitude to make that call. They feared that if I fire that person, then that is going to trigger this person to quit, and that person to quit. We were going to start creating this. I had to stop. I was like, "Let them. We will start over. Whatever we have to do. We just cannot do it anymore."

Lock the doors.

We will shut down one of the clinics. I do not care. I had gotten to that point. All of this came back to, I knew that this year was going to be a rebuild year because of the turnover that we experienced. I knew that this was going to be a rebuild year. Going back to the book, Science of Scaling . We talked about that during our annual strategic planning workshop a little bit.

That is a good book.

We had to raise our floor. Raise our floor and narrow our focus and raise our floor. Essentially, what that meant was there was less that in order to grow and rebuild, we were going to have to tolerate less. That was my theme going into the year. I had that as a principle that I was committed to following. That pushed me through, helping me find clarity that I knew that this was the right decision.

The other thing is, it was like Monday or Tuesday, and I am stressed out because I am rebuilding this together. I am talking to Katherine, and this was a speech therapist. I am talking to Catherine, and she pulls up her phone, and she is like, "Look, that speech therapist we just offered just accepted the position." That was on Tuesday.

When did you let him go?

I got the offer on Tuesday. I let him go on Thursday. When you can recruit, you can push through. I was like, "It is a new grad. They are going to start on April 1st. I can push through for a couple of months without this guy. I am going to be low.” Guess what? That is why we keep cash in the account. That is why we have the line of credit. That is why we are here. We have prepared for this. Freaking go. We can make it happen. Just hired a PT. We have got a couple of OT interviews coming in. Let us do it.

The power of recruiting, man. We shared it at the workshop in January as well, but if you had a bench of available people, you would tolerate less on your current team. It shifts the power dynamics to the point where "You are being a jerk. You are productive, but we do not need to tolerate this because we have other people whom we have already interviewed. We know they are aligned with us. We are happy to bring them in. Here is the door."

Let me continue because this is important. There were a couple of other fringe people who were involved in this little fiasco in the clinic. One other PT, one other OT, and I had individual meetings with them. They were the first to find out that this guy was fired.

You went from one room to the next room. Just like what I did.

It was like the next day, one-on-one. It was like, "This is broken. What is happening is broken. You are a part of that. I am letting you know." I had a meeting with them on Friday. I said, "This guy is no longer with us. He has been terminated as of yesterday." "On Monday, I am going to get an email from you.”

Drawing The Line: Leveraging The Recruiting Bench

“It is either going to be your resignation letter or a letter telling me why you want to stay here and how committed you are to helping us grow this year. You decide." That was the end of the meeting, and they both stayed. You've got to draw the line, man. It’s because they were a part of it. They fed into it. They were still on the fringe. It is like they wanted to be here, but they were being pulled into it. I had to let them know things are going to change this year.

Going back to it, I know you can say that because you not only are committed, but you are leveraging your recruiting capacity to say, "You do not have to be here." I am assuming, and I think I have got a pretty good inkling, that they did not just submit their letter and say, "I am super committed." They still might be on the fence, but they just need a couple of months to find their next job. Just have to maybe go off the studies.

What do they say, 35% of your current team is actively looking for work right now as you speak, no matter what they say. I have been in your exact situation before. We cut off the head of the snake, but it was just a matter of time before the other people who were part of that and got the poison left. I know what you are actively doing is not because of them, but you are actively looking for their replacements, not because you are expecting their resignations over time, but you are actively looking for their replacements because that is what you do.

It is what I enjoy doing. I like the chase. I like the recruiting thing.

That was my experience. We cut off the main person, but the other people in time left. I should not say in time, within a few months. They left as well. I know you are in a prime position to replace them because we are looking for it. Not that you are inviting them out the door, but inviting them the other way. "Come join us. The water is warm over here.” There is that out there.

I have never had a negative ROI on higher levels of accountability and standards. It has only been whenever I have lacked accountability or bent or eased the standards that have always come back to get me. Holding a standard is scary. It is scary, but it is also free. It is remarkably freeing, and it will transform. It has always transformed my people. The right ones rally.

These conversations, I know I tell these stories with a lot of passion on the show, but I am not being a jerk to my team. I am trying to be diplomatic and fair and clear, but that is a scary thing for me to do. It takes a lot of courage, and I lose sleep over that stuff. Every time that I show up authentically and I draw a clear line, and I tell them that I will serve them with every ounce that I can, but there is a boundary that they are going to have to fall within, the people who want to be here stay, and they get focused, driven, and directed every time they get realigned.

They get refocused. I feel like that is really critical. I think of somebody like Spencer. I always talk about Spencer, but the way that he moves people with his leadership is really inspiring. That is one thing that he does really well. He has a standard, and he is not afraid to fight for it. He is not afraid to tell people, “This standard is worth fighting for. If you do not like it, you can hit the road." It works.

It actually attracts the aligned people. It not only strengthens your team, but you will start attracting like-minded people. I do not know exactly how that works, but you start getting clear on your values and how that is lived out in your organization. You get better at filtering out those people who do not work. Even during working interviews that we would have, team members would come back and be like, "I am not sure that person is a fit" because they know what a successful person in your organization looks like, acts like, feels like.

They can tell you better than you can sometimes that this person is a good fit or this person is not right. You start attracting those other people. As we started working a lot with the PT students in our area, the ones who worked well in our organization will start talking to their fellow classmates about, "I am in a great place over here." Usually, the ones that they are friends with, birds of a feather flock together, usually worked well in our organization as well. That starts to expand. Your values, your culture, start to get known and start attracting people into the organization.

Tip Of The Spear: Fierce Love And Protecting The "Bus"

The main point is, do not compromise your standards. Do not sacrifice your culture. Do not do it. Your values. I think about my children, my kids. For those who have kids, they find out a whole lot of things in this world that you would let compromise your kids. You would kill for them if you had to. How do we protect our company with that type of tenacity, fierce love, and unapologetic love and commitment towards it? Do not get on your heels with that. Get out in front and be the tip of the spear with that. If it is not a yes for them, get them off the bus. Get them off the bus. If you have got that person in your company that you are on the fence with, it is time for a conversation.

We only had like five owners on the call. Interestingly, this person brought up their issue, and everyone else had gotten through the same issue and could share the same experience. They are just like, "I have had that, suffered them for too long, tolerated them for too long. Once we let them go, things significantly improved." Not just the environment, but the numbers and the efficiencies, and life was just better. That is all we could say to this owner. It is scary, but it is going to be better.

I saw Craig Groeschel. I do not know if you have ever seen his podcast. You should check out Craig Groeschel's podcast. It is a really good podcast. He had a Facebook reel. One of the reels that I saw last night said, "If there is somebody in your organization that is causing a problem and you are not doing anything about it, you're the problem."

The Long Game: Modeling Standards For The Next Generation

I was like, "Ooh," and then I copied it and sent it to that person. I sent it to her, and she was like, "You are damn right." The one other thing that I wanted to share because I think there are a lot of people who are tuning in to this that can learn from my experience. You do not have to make the same mistake that I did. If there is anything, do not do what I did. I did not do it the right way this time.

That is what we are saying to everybody, “Listen to our mistakes so you do not suffer them.”

You can get away with these things when you are in the clinic every day. You can get away with it. You can move things. You have influence, and you can hide it with your energy and your leadership. When you try to open up three clinics, and you have 40 employees, and you are not there as much, you cannot hide it. It is going to be the standard that you set and the expectation that you have with your team that controls that.

I did not do a good job of making that standard known. Now we learned that lesson. That will not happen again. The point is that if you are an owner with a single practice and you have any ambitions, maybe you want to grow your team and take a vacation now and then, maybe open up a second location, or maybe you want to sell to your team one day.

If you ever want to build a business where you can create some distance from it, you have to be able to model that standard and get the right people on the bus and get the wrong people off the bus. You have to train your people how to model that standard as well. It starts with you. This is not even about you, really. It is about who you are being for the next person in line so that you can train them up. There is a longer game for the players, what I am trying to say.

Out of curiosity, did you happen to have any members of your leadership team in on those discussions with this person?

Every single one. All of them.

It’s because you are modeling, right?

Totally.

This is part of your development process as a leader. You are going to sit in on these difficult conversations and watch how we do this at our organization. I think that is vital. We did not share that in our group call, either with the guy who was talking about someone who was not following the process or with the other owner who is dealing with this person. We should have made that recommendation that they have a member of their leadership team in on those conversations so that they can coach them and model what that conversation looks like. I think that is vital.

I think it is also really important because your leadership team is smart, and it is good to work with them because they can give you insights and perspectives that are within your blind spots that you cannot see. It is good to have them counsel you as a leader as well.

They can give you feedback, right?

Correct.

Also, in these disciplinary situations, which is what you are doing, legally, it is good to have a witness. Good stuff, man. I am sorry to hear that you had to go through that, but I am feeling like you guys are better off on the other side of it now.

Dude, Q3 and Q4 are going to be great. We are coming.

Here we go.

Coming back, baby.

Good stuff, man. Good talk. We will talk to you later.

Important Links

Beyond The Treatment Room: Learning The CEO Skill Sets For Profit And Freedom - Nathan Shields' Guest Appearance On Will Humphreys' Willpower Podcast

Mon, 20 Apr 2026 19:00:04 GMT

Most private practice owners think growth comes from doing more…more marketing, more hiring, more effort.

But what if the real leverage comes from seeing what’s already broken — and fixing it fast?

In this episode of the Private Practice Owners Podcast, host Adam Robin sits down with Nathan for a behind-the-scenes conversation on growth, leadership, and what actually moves the needle inside a practice.

From scaling a clinic to selling it… to building a coaching company and launching new offers like a fractional CFO model — Nathan breaks down the evolution of a business owner and the lessons that come with it.

This episode goes deeper than surface-level strategy. It’s about how your role changes as you grow — and why most owners stay stuck doing the wrong things for too long.

In this episode, you’ll learn:

Why growth isn’t about doing more — it’s about fixing what’s leaking in your business
The biggest mindset shift from operator → owner → leader
How small operational fixes can unlock $100K–$200K+ in profit
What most clinic owners miss when looking at their numbers
How audits can quickly identify where time, money, and capacity are being lost
Why “one or two focused changes” often outperform massive overhauls
The real role of a CEO as your business scales
How to think about systems, reporting, and decision-making at a higher level
What a fractional CFO approach looks like inside a private practice

You’ll also hear how Private Practice Owners Club has evolved — from a podcast into a full ecosystem with coaching, workshops, and live events — and what they’re building next.

If you’re feeling stuck, overwhelmed, or unsure where to focus next — this episode will help you zoom out, get clarity, and identify the moves that actually drive profit and scale.

��️ Tune in to learn how to stop guessing in your business — and start fixing the right problems.

�� Want help identifying where your practice is leaking money and capacity?

Book your free audit call: https://calendly.com/ptoclub/discoverycall

�� Join upcoming workshops and events:

https://ppoclubevents.com/04-17-26-workshop

�� Love the show? Subscribe, rate, review, and share!

https://ptoclub.com/

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Listen to the Podcast here

Beyond The Treatment Room: Learning The CEO Skill Sets For Profit And Freedom - Nathan Shields' Guest Appearance On Will Humphreys' Willpower Podcast

Nathan , thank you for being on. I'm so excited to be in another collaboration. How many show episodes do you think we've done together between your show?

On my show? You're probably in the twenties.

Isn't that amazing, how much time you and I have spent?

I feel pretty proud that I was the first guest on Will Power.

The Evolution Of A Leader: From One Clinic To The Stage

You better believe it. Number one and that episode crushed. It gave me all sorts of false hopes for the next ten. I had some great guests, but you were just such a powerhouse. It was a phenomenal introduction. I can't thank you enough for your support. You're at the stage where it's interesting for entrepreneurs to hear because you've gone through the whole lifecycle.

You were PT. You had a practice. You grew the practice. You sold the practice. There was a me in there at some point. There was an initial stage without me. Afterwards, you started doing other things. You've grown and scaled. The story that I wanted you to start with is this idea of what happened at your last event. Tell the audience about your events. Tell me about just what happened.

Me and my partner have Private Practice Owners Club , which is our show that I've been doing since 2020, 2021. Can you believe we've got, I want to say, 350 episodes? It's pretty crazy. It's amazing content for private practice owners.

It's the best show in the industry. It is the best. I'm chasing you. I like having people that chase.

Thank you. That makes me feel good. It's got great stuff. We also have a coaching company that coincides with that. Adam and I have built off of that.

Adam Robin , the great and wonderful.

He's awesome. We have a coaching company, we're obligated. Aren't you obligated a little bit to have conferences? We've been doing in-person conferences. We had our second conference last October 2025. We also decided to do some smaller workshops.

Intimate workshops. How many people?

Instead of 150 people at an event, this is more like 20 or 30 people in a room. We can be a little bit more intimate. Get into the weeds a little bit more. Maybe focus on a particular topic, one singular topic for a day and a half. We had the Annual Strategic Planning Workshop that we did early January 2026 to help owners map out their priorities and goals for the year.

The same exercise that you and I went through multiple times with Scott Fritz. I just tried to expand that to the group and took them through that. What was interesting is I thought it was done. According to our agenda, I was done after doing that. Things happened the next day where all of a sudden, we had two hours of dead space.

People are looking for something and there's just this open space?

It was after our morning break. We came back. There's two hours to work through until lunch. Essentially, that's the agenda. I had to come up with something. “What are we going to do? This is my conference.”

How many people were there?

We had 26 people in this room. They paid for it. They'd done their annual strategic planning. The agenda says that we got two more hours of this and then we've got lunch. That was scary. Interestingly, I felt semi-confident that it was just going to work out. You and I have been in front of enough people and enough groups like that. We've had enough experience. We've done enough things that we could come up with something.

You had this base experience that helped provided a degree of confidence in the face of this recent shift.

An exercise that you and I have done, especially in a small group like that, is like, “What kind of issues are you guys dealing with now?” I'm going to just call them out. I'm going to write them on the board. Moderate that discussion with this group. “Which one do you want to talk about first? Let's go. Who else is having that issue? What is your issue? Give us some context. Has anyone solved that?”

I share from my experience as well if I can. We just cross things off as we go down the list. That covered about an hour and fifteen minutes, and like, “Let's go take a break.” I needed the break. I didn't know what I was going to do next. During that break, I'm looking over some notes and like, “What else can we talk about? How can we make this valuable for the last 45 minutes?”

They came back. We’re like, “There’s three things we're going to talk about regarding your priorities and goals. What can you do to enhance them? Give them more life. Give them more energy. Make them more impactful. Have a greater vision for 2026.” We were able to talk through that for 45 minutes and then went to lunch. Huge hit.

Honestly, afterwards I was proud of myself. I can't say, “Where did that come from?” I know where it came from. I've been through enough of those to have the skill set. To be able to do that is something I could have never imagined in my wildest dreams. I know you've gone through a lot of the same stuff and the skill set you got.

It's important to talk about, though, because it's useful as PTs who are reading this, who are at different stages. We have students, new grads, young business owners, and experienced business owners.

Pediatric clinics and pelvic floor. It doesn't matter. Allied health care and mental health.

All these people who are going through this journey are hearing what most people would consider their own personal hell. “You have a group of people that you have to speak to for two hours that you didn't know you had to. Go. By the way, they paid you. You have to make it amazing.”

Isn't that a Seinfeld joke? To be speaking at the funeral, more people would rather be in the coffin than speaking.

Dying is number two. Public speaking is number one. For you to be able to pop up and knock that out and not have a big pressure. I want to say this, it is scary. It is incredibly hard. Learning how to develop that muscle for all of us, I don't care how good any of us look on stage or in facilitating. To me, that was powerful, Nathan.

It was this idea that that moment, for me, was a reflection of, as I've known you for years, how much you've evolved. I met you after having one location. You had one location. We were looking at expanding a second one together. Your job offer was, “What do you think?” That was the big offer. There was nothing written. We didn't go over any terms.

“What do you think about Florence, Arizona?” Not just what do you think, but what do you think about this desert hellscape called Florence?

It tells you there was divine intervention when what you were selling was the middle-of-nowhere Arizona with eighteen prisons. We drove together for 45 minutes away from my home. You said, without any terms, “What do you think?” I went, “I think it's pretty good. Let's roll.”

“Alright, let's do it.”

Best offer ever heard. I don't know what you're paying me. It turned into this place where you're facilitating owners in a room off-the-cuff. What I wanted is, this is the show. Key lessons learned in your journey of personal evolution in the physical therapy space. Let's go back in time. What were some of the earliest challenges that you had to face as a young business owner? Let's go right into that level of entrepreneurship. What would you say were some of the hardest things you had to endure or figure out when you were starting out?

The Early Grind: Marketing Dreads And TiVo Dreams

Opening the clinic was, of course, a leap of faith. It was scary. Some of my earliest challenges, I do not want to market. Going and starting a conversation with people that don't necessarily want to see me or weren't expecting to see me and somehow ingratiate them?

Have them send you clients?

I would sit outside in my truck and listen to music for ten minutes.

You're like Dwight in the Office, listening to that heavy metal song before you go in.

Not to pump me up, I just didn't want to go in. I don't want to do this. I had a goal. I knew that's what needed to be done. Back in the day, physician referrals, I didn't have anything else. There was no social media. What else am I going to do? Learning that skill set, I still don't feel like I'm the strongest marketer. You know that.

It's something that I had to do, just talk to people. It helps based on our background because you and I were in Boy Scouts. Probably had some leadership positions in Boy Scouts to stand in front of the other boys, as a troop leader or something like that. At church, we have opportunities to speak in front of the congregation from a young age.

In our church, we invite youth up every Sunday.

Being a missionary, talking to strangers all the time who do not want to talk to you.

You're in Japan, by the way, which I have got a new appreciation for you. Going in that language, trying to talk to strangers in a culture that likes to keep to itself. In Guatemala, it was like, “Que paso?” All these people were like, “Nada.” You start talking to them. You're talking to people in a culture that's very formal.

I had that. That didn't change the fact that I didn't want to be there. “I didn't want to be talking to you.” Building on that was extremely difficult. My vision was “If I could have me and another provider and maybe a PTA and a tech or two. If I saw 150 visits a week, I’ve made it.”

You’re killing it.

“I just made it. This is the best.” Whitney's my wife. We told ourselves, “If we can afford a TiVo, then we know we've made it.” I’m dating myself now.

“If I could only get an 8-track.”

It's crazy how your purposes change over the years. Getting to that point was like, “This is cool. Maybe there's more. One clinic's doing all right. Maybe I can do a second one.” The entire time, not building any systems. It’s people dependent. You know. I gave you zero support.

Emotionally, you were great though. I mean this sincerely. Actual processes and mentorship, no. When it comes to feeling like a part of something special and being led by someone who cares about what they're doing. Which, I'm learning in retrospect, is 80% of it. You were fantastic in those ways. Scalable? You couldn't provide that because you didn't know it.

Learning those things along the way was difficult and slow in coming. You and I both would agree. We should have gotten some kind of consulting or coaching earlier.

I don't think we knew about that.

We didn't necessarily know what it was. I don't think there was any. The coaching was nothing.

It was looked down on. Before when you and I first worked together, I will tell you that it was my emotional breakdown. That, for me, led to some effort in coaching. I reached out to that Measurable Solutions company because I was just broken. That's when you and I started together. It was desperation. It wasn't anything other than that.

My explanation to someone of what they were supposed to do in an interview, I literally said these words. “Your job is to do whatever I tell you to do.” That was my level of leadership because I didn't know what else to say or do. I need to treat patients. “Do everything else so I can treat patients.” That was my sole purpose. That was my goal.

That's what all my education led to up until that point, to treat patients. Head down, treat patients. “You guys figure out the rest of it.” Which isn't leadership, that's just being a therapist who happens to own a business. Those were tough lessons. I could see some of the lessons involved people looking at me knowing they had lost respect.

I've had that look many a time, my friend. That glance of like, “You don't know what you're doing.”

“You're a stupid business owner.” I'd be like, “Do what I told you.”

“Don't judge me.”

“I'm going to fire you.” Learning that, it's a hard lesson because you get to a point where you hate your work. You don't enjoy your own company. It's your company and you're just like, “I hate this.”

I started hating my life.

I can't go on vacation because that's when hell's going to break loose at the company, I'm going to go to call.

You're judged as the guy that's living for money.

I have to answer all the calls because no one else has any answers or problem-solving skills. Life just wasn't fun. Waking up at 4:00 AM to do my paper and pencil notes so I can get to work at 6:00 AM, 6:30 AM, coming home at 7:00 PM.

Rinse and repeat.

Financially, I was doing okay. That wasn't the issue. It was just my life sucked. Part of it is I'm a pretty even-keel dude. I wasn't necessarily emotional about it. It was more of, “This is just how we do things. This is how small business owners do things.” I didn't know any other way than to just nose to the grindstone. Those were difficult lessons for sure. Recognizing where I could have led more financial impact, besides that because I didn't know how to hold people accountable, how to track KPIs or how to track my cash. You name it. How many tens of thousands of dollars did we lose?

Millions, you mean? I don't know. I try not to think about it. I say this. I like to look at that as that was us investing in our learning. It's funny.

The Cost Of Doing It All: Moving Beyond The "Hustle" Mindset

That was our small business ownership tuition.

That price tag is going to vary by person-to-person based on their background, support, but ultimately their ability to be coachable and trainable. Since I've coached people, I've met people in their 70s who are still at that stage after 50 or 40 years of running businesses that long. They're learning different lessons. I don't think that we're better off than they are in terms of we're better people. The lessons they've learned are deeper.

We are better off.

Financial, yes. Quality of life, no question. They are learning, but that's the price. What would you tell the audience, the main three or four things that you learned from that timeframe that has everything to do with being able to jump on stage and speak for two hours? Maybe those are disconnected, but what would you say? In that timeframe when you were struggling through all that, what was happening in terms of education for you?

I was learning what it means to be a business owner because you could do the technical therapy very well as a business owner. Otherwise, you don't have the confidence to branch out on your own, to truly be a business owner. On top of that, what it takes to be a business owner is one category. The organization, the meetings, the agendas, the statistics, and all these kinds of stuff. It's another category altogether to learn leadership.

All I learned was the leadership that I had learned in Boy Scouts and through church leadership positions and whatnot. I'm leading a bunch of kids that want to be scouts or don't even want to be there. A church leader position is a bunch of volunteers that have no impact on my financial well-being or anything like that. These are people that I'm paying to be there. How do I get them to move in a certain way, in a certain direction? What it was is, how do I take control of my life?

You were being at the effect of all these things. You're taking control.

The Slave To The Schedule: Lessons In Extreme Ownership

Being therapists, we are at the effect of our schedule. The schedule fills up and that tells us when we're busy and when we're not. Patients either come in or they don't. If I'm going to have free time, it's because someone didn't sign up for that appointment slot.

Which is incentivizing, in that way, for people.

We cede our control to the schedule. We are slaves to the schedule. It took me close to a decade to understand that if this is going to go anywhere, I am fully responsible for getting it there myself. It's not going to go anywhere unless I take control and say, “This is what I'm doing. This is what you're doing. This is what the business will do.” Ultimately, taking control.

This is where it starts to sound maybe more cliche to people. It's so powerful through the lens of what you just shared. That you started letting go of blaming others, started taking full accountability that everything was up to you. Not in a martyrdom like, it's only fully good. It's more like, “I am the captain of my ship.” You're the general of your future or whatever. You're the colonel of your calendar. The idea is that you decided everything, like Jocko Willink with that book Extreme Ownership , you took extreme ownership of your world and said, “This is up to me.”

I had to do something. I had to take control. We, initially, were doing stuff together at the Entrepreneurs' Organization , with EO Accelerator. They were talking about stuff like values and purpose and knowing your metrics and stuff like that. What are you guys talking about?

Different language.

People believe in that? You heard those things, but you're like, “That's for other businesses.”

“Purpose, vision, values is foo-foo.”

What is that going to do? How's that going to make me more money? Eventually, we started getting some coaching and consulting like, “You need to take five hours out of your week and work on your business.” You're like, “What?”

I remember thinking that was insane. It’s like, “I'm going to lose. I'm barely making a profit. Now, I'm going to cut out five to ten visits in those five hours.” I was seeing a lot. How many hundreds of dollars was that?

Per week. It's funny you say that because one of my first coaching clients, Steve, in Vegas. He called me to get some coaching. I don't remember this, but I told him, “I need to meet with you once a month, not during your lunch hour.” He said that blew his mind. He's like, “How could I possibly work that way for one hour a month to sit with my coach?”

It's heartbreaking.

Isn't that crazy? We can say that.

I felt that way myself.

We did feel that way. Taking control in that regard and then learning what it meant to be a business owner. That's an education that we had to have. That we never got from our therapy programs or from our undergraduate programs. We had to pay the tuition either in lost revenue or with coaching. You can do either one.

If you want to lose less money, you get the coach first. If you want to lose more money, don't get the coach. Let life teach you the lesson over a long period of time. It hurts a lot more. That's when I started having fun in my business. I don't know about you. We've had this conversation before. If someone could just take over the business side of things, just let me treat all day. I want to see patients all day. That was the dream.

Something happened. It's funny because if we're not messaging it correctly, it looks like we're stopping treating. What we see is the evolution. We enjoy so much more working on the business because you see the impact on the patients and the employees.

That was the cool part. I can be an influence on more than just this patient that I'm working on. I get value from that. That's what I've learned all these decades, to get to the point. I'm learning this. I'm creating this skill set and these tools to have more than just a musculoskeletal impact. More on leading people, driving their purpose, and coaching them. That being a greater effect on multiples of people outside of myself and that one-on-one interaction that I had with treating. That was you and I. I'm assuming. Not to speak for you, but I find so much more fulfillment and purpose in making that impact that treating patients just doesn't cut it for us.

When we were partners at Rise, you and I both talked about how much people love to trade in our crack. It was almost like we could never find that full fulfillment because of the many hats we had to wear. When we took over the leadership hat and we were able to grow the company in a way that was somewhere fun to work. We were having fun. The physical therapist, PTAs, the front desk, the billers all started loving it.

That was so fulfilling. We created an environment in the industry we love for people to do what they love and not have to feel that stress. They were getting compensated fairly, if not generously. That evolution was so much more satisfying than me trying to just treat my 25 patients in an hour, then somehow, run payroll. You're right. That was such a satisfying experience.

As we invested in them, you could see light bulbs going off in their minds. You could see their growth. They were fulfilling purposes that they hadn't dreamed of either. I'm assuming one of your right-hand women, Michelle, would have been in the same boat. If I could just treat patients, she would have the same path.

Do you remember the girl from Wyoming with whose named Kayla. She was so amazing.

She was awesome.

Where is she?

She has her own business.

How many locations? Probably, she's at three. I stalk her a little. She got to go through that process because we modeled it well. We taught her the way to where our suffering was turned into our knowledge and then turned into edifying others. Not that they had it easy, but they had clarity in a way that you and I never had until we started exploring options for the first time.

They learned from our mistakes.

Minimally, they had a roadmap of what not to do.

It was cool. It was in that space then that we're growing the business. We're growing a leadership team that we're super proud of. People that would stand up and say, “I know I can make more money in other places, but I'd much rather be here because these are my people.”

I love it here. They would cry.

Creating something like that was so fulfilling. We had to learn some skills and tools to get to that point still.

The Courage To Confront: Accelerating Growth Through Clarity

What were the hardest ones for you to learn? For you, personally, what would you say were the hardest ones? Were they certain interpersonal skills? Was it certain leadership elements, like holding someone accountable? Was it firing people, hiring or money? Where would you put, for you, the greatest turnaround was?

It's something that I'm still working on. It's not a strength of mine. It's confrontation. Having clarity in conversations, holding someone accountable, that kind of thing.

That's true for most people, by the way.

Some people have an inclination to get it done more quickly. I'll drag my feet. Most people don't want to do it. For some people, maybe they're the minority. I think about Adam, my partner, if something's rubbing him the wrong way.

He's got to talk about it.

He's like, “Hold on, we need to go talk about this quick.” Whereas I'm like, “Let me think about it.”

His courage to confront, I've never seen it in another person like that ever.

That's directly proportional to his growth. His ability to confront the person or the issue is directly proportional to his growth. He's grown at a speed and a velocity that is significantly different than most. You'll see that in most people. You've coached enough people. You work with enough owners that the ones who make the decisions or have the conversations. Make changes faster are the ones that are opening their 3rd, 5th, 10th, or 15th clinic.

They seem less stressed, ironically. The ones that are like, “Hey, let's hit this head on.” They make more mistakes quicker. They learn from them faster, but they don't stop. They get to these plateaus so much faster. There's a guy, I was on his show, who's Brad Powell. Huge shout out to his show and just him in general. He's a younger guy, younger meaning almost 40, which is so irritating. In his late 30s, he's got this amazing multi-location business going.

He's pivoting the government for change in Utah where he was a lead on helping make a physical therapy considered primary care. They're changing the language to where insurance is half to lower their co-pays because they're not specialties anymore. He's doing that. He's in his late 30s. He's got three locations and more profit. It's interesting to see how some people like Adam and Brad have just got that gift. They can just run.

That's still a tough one for me, but at least, I feel like I have the ability to confront. I can and I have the verbiage behind it. You and I have read enough books that we can understand some of the premises and foundations as to where to start. It's not coming from a place of not knowing this. We have the capacity. That was a tough one to get over. The other is, I feel like I'm even still held back. You and I both have done the rocket fuel that has the visionary.

It was the controller, integrator, and visionary or rocket fuel which is part of the EOS.

I've taken that exam multiple times. I'm equal parts visionary and integrator. The score is 85-82. Where you and Adam offset me in a big regard is you guys are heavily visionary. That holds me back a little bit. It's something that I have to work on. Honestly, if I spend a lot of time in the visionary space, it's draining.

What's your working genius type? What's your two?

I'm towards the end, like D and E or T or something like that.

For those who don't know, Six Working Genius is, by far, the most important test you can take to determine where your energy in a business activity is going to generate from. The coaching and the tenacity, which is the doingness of things. There's not one that's better than the other. There's different strengths around them.

They’re equally important.

There's not one that's more useful than the other. You have to have a balance of a team that does all those things. One person can never be a team ever.

Adam and I have complimentary gifts in that regard. I definitely lean more towards the doing this. If you give me your vision, I'm immediately going down the rabbit hole about, “How are we going to do that?” Coming up with it, no. Recognizing that and having you and having Adam as partners has been so beneficial in the things that we've done together. I've had to have it. It's hard for me to do things by myself.

The reverse is true for me. I struggle on doing the coaching, the one-on-one facilitation with a team member. I had to correct a team member. I don't have that many people underneath me in the org board. This one person slept in. The amount of frustration I have on those discussions. I can have them now just because I'm older and experienced.

The energy drain perpetuated for hours afterwards. I love coach, it’s all about all those discussions, the hard, the good, the positive. Honestly, I don't even like the good ones. I'm serious. I just need a whiteboard. I need a group of people who are going to tell me which ideas suck and how to get it done because all I have are ideas.

Even now, there are struggles. I had a call with a prospective client because I got this new program that I'm doing.

What's it called?

The current name is Profit Intelligence Program. It's where I'd be a fractional CFO.

We talked about this. This is your best one.

Profit Intelligence: Identifying Opportunity Costs

I can come in, look over some of your key metrics, and tell you where you're leaking revenue.

What I love about it is that it's so black and white. There's so many coaching things that matter. It’s like, “Help me build a culture. Let's build your purpose.”

“How do I get leaders?”

How do you draw that to profitability? It is vital, by the way, that you do that. It's harder to see. Whereas if someone comes and says, “You've got a leaky pot right here. Let's patch it and then immediately retain more water.” You're like, “That was a good action.”

“I can help you make $50,000 this year without seeing any more patients.”

Who doesn't want that?

Anyways, I was talking to someone. It was interesting because they are on the journey. There's two owners. They made a lot of money. It's the busiest year ever. They are working 15-hour days and 7 days a week. They don't have any hobbies, don't have time to read a book. I said, “I've got this show.” They're like, “We don't have time to listen to shows.”

That's sad.

It's that kind of thing. Doing their own bookkeeping, running their own payroll. One time I had to be frank with them and tell them, “You're too big. You can't do it all anymore.” I had to follow that up with, “You guys are doing amazing things. You've got an amazing company. This is part of the journey. I don't think you can bypass it. Whether it's for a long time or a short period of time, you have to go through the growing pains if you want to grow.”

They could scale back and just be in a happy space that has a nice 15% to 20% profit margin. Never grow again and see all the patients and do all the fun things. I don't think entrepreneurs start a business to do that most of the time. There might be people who are like that. I have come across a couple of people. One guy was a surgeon. He's like, “The surgical room is my heaven. All I want to do all day long is do surgeries.”

Which is pretty amazing.

We need people like that. I'm sure there's some dentist out there who's like, “If I can just get in as many mouths as possible, then my life's work is complete. I'm sure there are people like that.

Some of them are in prison.

Most entrepreneurs have greater dreams. It seems like even when we were in EO, words that would come to mind as people would tell them that would inspire others, is freedom. Why else do you do your own thing if it's not to have some freedom? When you become a slave to the company, you're recognizing there's no freedom in this.

It's very taxing.

Investment Vs. Expense: The Buy-Back-Your-Time Method

It's the E-Myth Revisited for every small business owner. I shared that book with them. What I had to tell them was, “You guys are doing amazing things. This is all very normal. You are on the path of ownership. There is more to look forward to.” You just have to learn some skill sets. You have to learn to delegate. You have to invest in the business by hiring experts.

It's no more about how much you can do on your own, pulling up your bootstraps, just getting done in the muck and getting it done. It's not like that anymore. You got to act like adults who have a million-dollar business, make million-dollar decisions, and stop looking at things as expenses but as investments. Hire a bookkeeper for health's sake. Let's get serious.

Delegate anything. It's a whole buy-back-your-time method. When you start evaluating your time and you start putting a financial marker to it. You start delegating everything below that marker, and then you start measuring. For me, the big thing was measuring opportunity cost. What does it cost me to not make those changes?

If I don't make these changes, how much money am I going to potentially lose?

What people think is, “I'm going to do my bookkeeping that saves me $300 a month.” What they're not calculating, “I might pay someone $300 a month to do my bookkeeping.” With those three hours a month, what if I was working in my genius? I was bringing in how many more? If I'm treating patients, how many more patients could I do?

If I'm developing the business, how many more therapists could I hire over a year? We're talking about that $300 monthly savings compared to tens or hundreds of thousands of dollars of lost opportunity when we start objectively measuring it. That's why I like that program so much. When you start showing them the buckets. How did they respond to that, by the way? That couple?

Honestly, they weren't a fit for my program because they were so discombobulated. I knew that I could go in and get them the data that they need to make some changes and increase their revenue.

Would they make the change?

They didn't have the bandwidth to make changes. I was just going to be more noise is what I gathered. I directed them honestly. They had in-house billing and that in-house biller needed a ton of support. I'm like, “You're losing money right there now. Let's get this figured out. Come back to me in six months.” I said all that just because that was a most recent experience. They're overwhelmed. They're just like you and I were. That's just part of the journey. You got to go through that lesson. I'm excited to see where those owners are. Where are they going to be in ten years? We were there in the exact same situation.

From Effort To Judgment: Scaling Beyond The $2M Mark

What's interesting too, for me, is that as I've evolved and started to hit new barriers for growth because of my lack of knowledge and my lack of control, I'm learning the same lessons. I'm just learning them at a deeper level. The whole getting someone else to do things for you goes to Benjamin Hardy's book, Who Not How?

As you know, I'm looking to hire someone who's going to be my COO and run my business. It's a huge investment. I was talking to Leila Hormozi, who told me this directly. She's a mentor-type of person. I don't even know if anyone here even knows. Our crowd probably doesn't even know who that is. They're a big deal in our world.

They should know Alex and Leila Hormozi.

Look her up online. She's a big deal. She was talking to me personally. She goes, “There's a major mental transition that happens once your business hits around $2 million or $3 million in revenue. It becomes more of something you have to re-learn every little stage. That is that the value you bring as an owner has little to do with your effort and more to do with your judgment.” Getting to the million mark, it's effort. Beyond that, it's your ability to make decisions accurately.

Leadership team, strategies, and systems. It’s what you do with your time.

All these things. She was saying that if you aren't as sharp as you possibly can, you're not getting the sleep or exercise you need. If you're not doing those things, it feels awkward. It feels weird. As Alex says directly, “Until your world is perfectly quiet, you don't know what the best thing is to do for the business. You have to have almost a state of boredom from a lack of things to do in your own business before you have the space to generate the best judgment to make these 10X decisions for scale.”

It's more of that same lesson that I'm learning over and over again. When I started Virtual Rockstar , I was very quick to hire for every little thing that I was doing. I started doing sales. “Let's hire a salesperson.” I don't like having one person. “Let’s hire multiple.” I started building these systems and people around me to where I was trying to get.

We've hit this stage in our growth where I don't know what to do. I've never built a company beyond the stage where I'm at. It's time to bring in an expert at a different riskier thing. I know I'm making the right decision because it scares me, like there's no other. That's the thing you and I might say to our younger versions of ourselves. The way you know you're doing the right thing is by signing up with that super expensive coaching company. Have you ever regretted any money that you've ever spent with any of the coaches or consultants that we've spent?

Never.

How much do you think we've spent? If you had to put a number on the money we've spent over the years on coaches, how much do you think we put?

Do you think it's $250,000?

Easy.

I would say I never regretted a penny of it. I love what you're saying there. When I'm telling that owner that they need to get a bookkeeper, she has that same fear as you hiring a six-figure CEO. It's the same fear.

The Expert Investment: Overcoming Scarcity And Fear

It's no different. It's the fear that keeps us there because for me, there's a lazy factor at my age. I remember the first time I hired a bookkeeper. It didn't work. The bookkeeper I have is the fifth one. I don't want to go through that process with my right hand. That seems impossible. You're also playing at such a higher level that I would argue. I'm going to put into the universe that I'm also leveraging.

I'm doing it smarter. I am way leveraging better people and expertise. I'm not afraid to pay top dollar anymore because I learned the hard way that usually you pay what you get for. Not always, but the vast majority of the time. If you had to go back in time to a younger Nathan. Let's say, you just opened your doors off of Germann and Alma School. For those of you in Arizona, you're losing your minds. You're like, “He said Alma School?” It’s this funny street name. That's where your first clinic was, Germann and Alma School.

Let's say, he opened his doors. You showed up from a time machine. You just popped out. After you go through the whole, “Is it me? The numbers behind my back?” That kind of thing. You know it's you. What would be the advice you would give them? You only have 60 seconds. That's another thing in this game because that time portal is going to close itself, and then you're stuck in 2003.

It'd be something along the lines of, “Invest in experts who can get you want to get you where you want to go faster. As you do that, you will find greater purpose. You will find a much more expansive vision for what you can do and be beyond this clinic.” That would blow my mind.

That was well said, Nate.

Thanks.

You also hit upon this idea of unlimited potential. I dreamed of the day of having 100 visits per week, another therapist, and be able to take four weeks off a year. That just seemed like an unreal life, a paradise. Make $100,000 a year. Live off that richness until I sail off in my yacht. That's how I dreamed. You look back. You're coaching people with multiple locations you're managing. You've experienced multimillion dollar sales.

You're filling the space on stages and rooms for hours on end without any hesitation. Isn't it true? I don't want to put words in your mouth. Don't you think all those years of struggle, you were digging a well of knowledge that you later pulled from? When in those two hours, maybe the reason you weren't scared was because you had been in so much suffering and learning that you had earned this well of knowledge. When it was time, without preparation, you were able to dip into that well and just pull it out.

Dip in from the pool of wisdom. The learned experience over time. One other thing I would tell myself and we'll get back to that that you brought up. I did have that thought exercise in my mind one time. It was at church. Something along the lines of, “In my current situation, what would my 90-year-old self come back and tell me?” This was in the middle of the struggle. I imagine myself at 90. What would my 90-year-old self tell me? That was more along the lines of, “You don't have to worry about it so much. Don't let fear hold you back.”

That's a big one for me too.

You were so enveloped by fear every week. Depending on the new patient volume and the collections. Move forward boldly in faith and make some decisions that aren't so fear-based. That's another thing that I would have to tell myself. I was ruled by fear. I'm ruled by the scarcity of money. If I could push through that just a little bit, then I will experience a lot more fulfillment and joy. That's another thing I would tell myself.

To go back to what you were talking about, because you and I have gone through that, we can pull from that pool of wisdom. Such that, interestingly in that moment, going back to my original story where I had to fill those two hours. We were talking about things. I remembered this distinctly. One woman shared that she had a provider that needed “more money.” She needed a raise. Yet, she still hadn't met her production expectations, but needed more money. I don't know why.

I was just like, ‘You need to have a conversation with her.” She was like, “Yes, I need to talk to her this next week.” I'm like, “Are you ready to role play it?” She's like, “I'd love to.” As I'm walking over towards her, I'm like, “I don't know how this is going to go. I hope this turns out well so I don't look like a bumbling fool and bring some wisdom to the stage.” We talked through it. She was like, “That's exactly what I need to do.” Thankfully, I watched enough of Will and Adam holding those roleplay conversations that I could mimic it in the moment.

I was early on with you in those rooms at Measurable Solutions. You were down with that. You were so good at those roleplay stuff. It was so hard. It's the only way, by the way. All these big successful companies, they roleplay nonstop. It sounds cheesy, but it is the only way.

The Power Of Roleplay And "Acting Like Owners"

I tell people all the time, “You have to roleplay these.” That's the one thing. Our team initially hated it. They started to recognize the value of it. It's an untapped secret that you could leverage.

It's like a book title. Roleplay to success so that you can take every situation. Practice it with another human being until you find your voice and then go do it.

To go through that with her and then to tell her, “You need to do this with your husband before you have the conversation. Get your words down so that the fear of not saying the right thing has gone away. You can focus on the moment, the response, and the emotion. Keep yourself grounded.” That was a cool experience that, again, I could draw from that pool of wisdom. That the experience that we've had in the past for the benefit of someone else.

That's powerful. I love the idea of the older version of ourselves coming back and giving us advice. I know mine would come back. Same thing, it's the fear. It’s just like, “Enjoy the process.” An older version of me would be like, “You're only going to be young like this once. I know money is a big concern. It's going to be fine. Do your best.” I want my older version to give myself permission to check out at that point.

“At 6:00 PM or whatever it was, 7:00 PM, just come home and be home. On Saturdays, let it go. If someone sends you, don't check your emails ever after.” These little things that we all think we know, but having an older version of me give permission to do that would have been so freeing. I'm sure before he left, he'd turn around and say, “Don't forget to moisturize.” He then would leave. By the way, I'm sure I would have known by looking at him. I'd probably need to start moisturizing. My face looks like a giant pent up of skin.

Mine would have said, “Do more to keep your hair.”

What can you do? “By the way, be four inches taller.” What? I can't do that. What am I going to do?

There's that part of us that just needs to give ourselves a little bit more grace and step back. What I was trying to say to that partnership was like, “You've done some awesome stuff. People want to see you because you're awesome therapists. You've created an environment which is welcoming. Not just welcoming, but generating results. Give yourself some credit. Let's act like owners.” I told them that. “You need to start acting like owners.”

I like that. It's a call of invitation to grow and to be better.

I'm recalling so much stuff as we're talking. My mom was not the wealth of wisdom and catchphrases. She's a beautiful woman and salt of the earth. I remember one time. I was going to graduate from high school in a couple of days. I'm scared about graduating because I've had so much fun. This has been cool. I don't know how it could get any better. I'm worried about the future because I'm going to be adult and stuff like that.

One of her wisdoms was like, “It's different, but it just gets better.” There's blessings and opportunities that you can't experience at your age. You get to have a family and children and a wife. All these cool things and experiences that you can't have when you're in high school. It's just different. You could say that to people, whatever stage they're in. It's scary but it's better. There are better opportunities out there. I remember that. I always think about that.

I love that, Nathan. That's a great way to wrap up our show. Just to remind our audience that it's going to get better. One thing that you and I can both say confidently, and I hope this is okay. If we can get to where we are, anyone can get to where we are. There was no Adam Robbins. That wasn't me. I wasn't the Brad Powell. I was the guy that was years of kicking into that. If I didn't have some of these intense negative things, I would never change. Thank you.

I'm going to keep going. Can you imagine how people see us that we're in that Measurable Solution? We were some of the younger dudes. We were looking up to Brandon, Blaine, Vinash, Chad Elms. How could we ever be like those guys? We're just acting like fools. You're telling lies at the podium about being in fat camp together and stuff like that.

I told everyone that's how we met. You were my counselor at fat camp.

We're the guys now that have the show approaching companies. They're probably looking at us like, “How did those guys do that?”

I don't know. It's funny. Those guys, as we see them, have like a million clinics. It's just funny how I still feel that way with all those guys because they're so freaking amazing.

I still look up to them. You're the one that should be having the show.

Plugging The Leaks: Programs And The Fr actional CFO Pilot

Nathan, thank you for everything. This was such a great show. I appreciate it. I know everyone got a lot out of it. Please plug your program, your show, all the things.

If you haven't read the Private Practice Owners Club Podcast , there's a ton of value. I'm proud of my library. That's not just self-serving. I listen to my episodes once in a while. I'm like, “That was awesome.” Whether it was me or the guest. There's a ton of value there. To go along with it, there's the Private Practice Owners Club Facebook group .

It’s one of the most active serving Facebook groups in the industry, 100%. I love how you guys run that.

We have the coaching program. If you are in one of these stages and you're like, “If someone could just tell me what to do, that would help.” Always reach out to us. Nathan@PPOClub.com or Adam@PPOClub.com . We have PPOClub.com website that has under resources, it has our show library, which you can use a search menu to find the topics you want to learn about. The events page where we're going to have our next webinars and conferences. We have our October conference in San Antonio on October 15th through 17th, 2026.

Go if you haven't been there. It’s amazing.

They're awesome. It'll be our third. They're just getting better. We always have webinars. We'll have more in-person workshops, the more intimate settings. My new program, Fractional CFO program, is in the pilot stages. In early 2026, if you're reading this, it's in the early pilot stages. I'm happy to bring people on because I need to improve my systems.

They get a huge deal. They get this huge program just to be able to work through it with you.

Huge discount to help you find tens of thousands of dollars. I was doing audits on clinics that were just like one-and-done things. I was like, “Give me this data. I will analyze it and give you a report where you can make money.” I was punching out the numbers. There was one company that’s a $2.8 million PT practice to clinics. No joke. They made a few changes. Not easy, but few changes could easily make another $200,000 a year of profit.

Insane. That's money in your pocket. Talk about opportunity cost.

Totally changed their numbers.

Jump on this program while you can. How many people are you able to take?

Hard to say at the time that this comes out. I've got a few people. I can take a couple more.

If you want to be one of the few people, jump on.

This will continue to grow. I'm not just doing the audit at the beginning. Every other week, I'm looking at some of your metrics and telling you to focus over here, give you one or two prescriptions.

Not heavy lifting. It's like, “Go focus on this one step at a time.”

You could have three to five things to work on. I'm just going to say, “This will get you the most money the fastest if you correct it.” Over-the-counter collections or billing or productivity or that kind of stuff. That's the idea. I can come in and show you where you're losing money or leaking money. Plug those holes and make more profit. It's a biweekly thing with monthly reports as well. That's where I'm going with that. I'm excited about it.

Nathan, as always, thanks for being on the show. Thank you PPO readers as welk. Have a great rest of your time. I'm sure we're going to just watch the wonderful growth of that company as it goes. Thanks for all that you do.

Thanks. It was awesome.

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About Nathan Shields

Learn The New Way To Get Patients From Google With Jeremy Dupont

Mon, 13 Apr 2026 19:00:02 GMT

Most private practice owners know they need marketing… but very few understand what’s actually working right now — especially when it comes to getting found online.

In this episode of the Private Practice Owners Podcast, host Adam Robin sits down with Jeremy DuPont, former cash-based clinic owner turned founder of Patch Digital Marketing, to break down what’s driving patient growth in today’s digital-first landscape.

Jeremy shares how he built and scaled a multi-location cash-based clinic in Boston without relying on physician referrals — and why mastering digital marketing became the key to predictable growth. After successfully growing and selling his clinic, he now helps other practice owners do the same through Google Ads, local SEO, and conversion-focused systems.

This conversation dives deep into one of the biggest shifts happening right now: why Google Maps — not your website — is becoming the most important place for your clinic to show up.

Jeremy also walks through a live audit of a real clinic, showing exactly how rankings work, where opportunities are hiding, and what most clinics are doing wrong when it comes to local visibility.

Together, they explore:

Why 70%+ of patients searching for services are using Google Maps — not traditional search
How Google’s AI and search changes are reshaping how patients find clinics
The 3 key drivers of local SEO: Google Business Profile, directories, and website authority
Why most clinics ignore their Google Business profile — and how that hurts rankings
How review volume and consistency directly impact your visibility
The role of local directories and why they build trust with Google and AI tools
How to identify missed opportunities in nearby areas and services (like dry needling or pelvic health)
Why ranking for the wrong keywords brings traffic… but not patients
The difference between “marketing that looks good” vs. marketing that actually converts
When paid ads make sense — and why most clinics start too early or too small

If you’re a practice owner trying to get more patients without relying on referrals — or you’re frustrated that your marketing isn’t translating into real growth — this episode gives you a clear, practical roadmap to start winning locally.

��️ Tune in to learn how to turn Google into your clinic’s most consistent and scalable patient acquisition channel.

�� Want to learn more about Jeremy and his work?

Follow him on Instagram: @_jeremydupont

Visit: https://thepatchsystem.com

�� Want help strengthening your operations and growing your practice?

Book a call with Nathan: https://calendly.com/ptoclub/discoverycall

�� Love the show? Subscribe, rate, review, and share!

https://ptoclub.com/

---

Listen to the Podcast here

Learn The New Way To Get Patients From Google With Jeremy Dupont

We have a new guest, Jeremy Dupont . Jeremy is a Physical Therapist and used to own a cash clinic in Boston. He owned a cash clinic for three years. He knows a little bit about sales, marketing, and business. What's cool is he started a company called Patch Digital Marketing . Jeremy's going to share with us a little more about what he does, how he sees marketing, how he used that marketing strategy to help grow his clinic, and how he's supporting other practice owners with their digital marketing. Jeremy, what's up?

It's good to be here. I'm excited to chat. I know we're going to dive into something that's been the center of my attention. This is what is working the best on the marketing side of things for physical therapists, in local marketing and optimizing for Google Maps. I'm excited to dive into it.

I'm already convinced that you know what you're talking about at this point. For the people who don't know you or why they should even read. Tell us a little more about who you are, a little bit about your background, and what you do. That kind of thing.

As you said, I was working at a clinic and then COVID hit. I got furloughed from that job and went self-employed and started my own practice in Boston. I went cash-based immediately just because it was the easier thing to do to be totally honest with you. I got my schedule busy. That one-on-one, almost concierge-type care took off during COVID, which is interesting.

In 2021, I officially opened a clinic up in downtown Boston. I ran it for three years. We had seven PTs and two locations. As I said, we were a cash-based physical therapy clinic. I couldn't rely on physician referrals or hospitals sending patients our way. We had to figure out the marketing side of things. The local marketing where you go and you do events, injury screens, workshops, and all that can only get you so far. If you want to get to a seven-figure plus clinic, you have to figure out the digital marketing game.

Lucky for me, I hired my first couple of PTs and fell in love with the digital marketing side of all of it. I was like, “I would rather do this than treat patients.” I took myself off of the schedule pretty much immediately and dove into email marketing, developing CRMs, and then Google Ads and SEO, which is the gasoline to growing our clinic.

I did that fairly successfully, and then sold my clinic and run Patch where we help other physical therapy clinics do just that. Our main product of what we do is Google Ads and local SEO. We do some email marketing, CRM building and things like that. We're here to just make getting new patients easy for physical therapy clinics.

I love how you're the guy that's done the thing. You're a PT and done the thing. I'm going to toss it back to you because I'm here to learn. I'd love to hear what you got for us. What do you want to share?

The New Era Of Local Search: Google Maps & Gemini

For anybody reading, if anybody ever wants one of these, I'm basically going to take Adam's clinic through a local SEO audit, which I would do for any clinic that's getting started with us. I always start these with just a couple of stats of 46% of all total searches that happen on Google have local intent to them. Google is where people are finding local service-based businesses.

Within that percentage of searches that are happening on Google, 70% of people that are looking for local service businesses use Google maps to find what they're looking for. Obviously physical therapy, OT, and speech, all of those things fall into that local service bucket. Gone are the days of trying to optimize yourself for page one of Google and just trying to get your blue link website to show up on page one.

What matters is showing up on Google Maps. It's super interesting. This is an article that Google dropped that I was diving into. I figured it was super relevant for our conversation here. They just rolled out the integration of Gemini. Their Google AI summary overview is being plugged directly into Google Maps. People can have a chat-based conversation directly inside of Google Maps, which is going to significantly go into effect how people are looking for a physical therapy clinic.

Right directly in here, you could say, “Does this physical therapy clinic take Blue Cross Blue Shield? Do they do dry needling? Do they have public health included with it?” These are just signs where traditional search is going by the wayside, especially for people looking for service-based businesses. Again, that includes PT, OT, all of the above. When I take a look at this, and obviously, I just showed you that.

The main thing that happened in 2025 and why us at Patch, we started to change the way we were doing SEO is because Google totally changed what page one of Google search looks like. I have on my screen here. I just typed in “Waco, Missouri, Physical Therapy.” You can see at the top of the page and what we call, above the fold. Before you scroll at all, you can see three quarters of the page here are three Google business profiles and a big Google map.

That's why the 70% to 75% of people that are looking for local service-based businesses are going directly to this Google map here because it's what catches the eye. This is where people are going to click. Before we were optimizing for these websites that are down here. It's still important to show up there, don't get me wrong. You can tell that the most important thing I'm not in Wiggins, so ads aren't showing up, but Google Maps is the most important thing.

A couple of things that I don't like. I don't like how my Slidell clinic is the first link right up, right below the map. I wish that was the Wiggins clinic. I don't like how my clinic is, I don't know if you see it on the map. It's not in the center of the map. It's over on the left. I want it to be right in the center. I want it to be big and bold right in the center.

There's different things that you can do. We'll look at your website as we're taking a look at it. It's interesting for you what I pulled up here. This is what we show in most clinics. This is always super helpful for people to visualize. Basically, what I have here is a heat map of where Adam's clinic ranks. Again, this is his Wiggins physical therapy location. Adam, you'll be able to tell me a little bit better. I have a 20-mile radius for you here. It looks like people are probably driving a decent way to find physical therapy. Is that too big, too small? What do you think?

No, that's good. Wiggins is the small rural town.

That’s what I figured.

Super small clinic and people are driving in.

Heat Maps And Proximity-Based Strategy

The way we look at it is clinics that are in a dense city, we usually want a one to three-mile radius of where you're ranking. Suburbs, maybe you're a 5 to 10-mile radius. Places that are fairly rural, we're looking at between a 15 and a 20-mile radius. Basically, what this map here is showing us is that whenever somebody types in physical therapy into Google maps, these pins here. Wherever somebody's located, this is where Adam's physical therapy clinic would show up.

You can tell within a ten-mile radius, you've got this pretty much on lock, which is awesome to see. This is not the case for most physical therapy clinics, unfortunately. Usually, it's dominated by an ATI or Select or something like that. What I always like to look at and what we talk through with some of the clinic owners and part of what our SEO strategy is, is there certain areas where you would want to show up?

We could scroll in and if we wanted to look at Lumberton would be a place where you'd want to show up. It looks like there are some homes there. You can see that where you're ranking there. You don't fall off the map totally. You're in this five to ten-mile range. You may not be showing up in the top three there. Your SEO strategy could be how do we improve our ranking in Lumberton, etc.

The one city that comes to mind is Poplarville. I don't know if you see it, but 1212. Over here, down in the middle, right there. I have some competitors in that area that are pretty strong, little private practice. Bright Steps are right there. It'd be nice to get some of those patients to drive over.

This is what you can start to look at. All of these rankings here do have a lot to do with proximity. As you start getting 30, 40 miles away, it is tougher to rank. What we usually do on a competitor analysis is we always see how many Google reviews do they have. You can see this place. They've only got three Google reviews. This one's only got one. There's not a ton of competition here.

This can be very easy to beat out because Google reviews is one of the easy ways to start taking that over. Where that would come into play is you would want to make sure that on your website, you would have Poplarville optimized for. Again, on your website you can see you have these location-based pages. These are where your three clinics are at. You could have a Poplarville location page on there even though you don't have a clinic there. You can still say “We help residents from Poplarville at our Slidell location.”

This is always something that we look at. Again, for you, I assume you guys are busy because this looks good. We can also do it for other services as well like clinics that have multiple services. I saw one of your guys' services was dry needling. Pelvic floor PT is always one of those. If somebody's works with runners, maybe gait analysis would be another service that we want to look for, pelvic health PT, etc.

What this will do is it helps drive your local SEO strategy because maybe you crush it for physical therapy, but you're not on the map at all for dry needling. People that are looking for StemWave or shockwave or some of those higher ticket services. You can see where you're ranking on the maps for that. People are going to want to find that service on the map. That's where they're going to go for it. The cool part of it and you can create an actual strategy around all of this. You can see where you're deficient, whether it's going to be based on the location or the service. That's your SEO strategy from there.

Optimizing The Google Business Profile

Could you do me a quick favor? Type in pediatrics and tell us where we pop up for pediatrics.

It will take me a second to run it, but I can walk through what the rest of it will look like. I'll run this and then as it's loading for you. The obvious question with all of this is, “How do we improve these rankings?” Say it doesn't look like Adam's map. You can see again. Adam has had some solid SEO services done for him. Say, you're all red here or you’re not on the map.

There's three different things that you can do in order to improve this. The number one thing is updating your Google Business profile. Adam, I'd be interested to hear what you see. Most PT clinics, when they set up their Google Business profile, they just rush through it. They skip and don't fill anything out. They just get it live. They don't ever touch it again.

That's boring work. We don't like to do that stuff.

It's not the sexy stuff. Google puts a white paper out every two to three months. With anything involving Google maps, optimizing your Google Business profile is always the number one thing that's on there and optimizing it. It’s obviously the easy ones where you're adding the location in. You can see here. You have physical therapy. You're tagging your location and your service that you're doing, which is awesome. You want to make sure that that's throughout the description you're creating.

Are you filling out products there? Are you adding services there? Are you updating photos every handful of months? There's an ability to post on your Google Business profile as well. Again, I foresee one of the reasons why you're showing up so high here is this is a super active account. You have a post one day ago, three days ago, six days ago. That's not very common with PT clinics. They're not often updating this or even know it exists, to be honest with you.

You need to make sure that not only is your Google Business profile optimized with all the correct SEO terms on there, but it's active as well. You're consistently updating it. The biggest sign for that is Google reviews. It's super important. I usually tell clinics a 100 Google reviews is the threshold of what you need to get to.

Google tells us this directly. Review velocity is one of the most important things that you can do here. Not only do you have 100 minimum reviews, but are you getting 4 to 6 every single month consistently? That just tells Google, not only you're in business, which is important, but people are happy. People are continuing to come. Google wants to send its traffic to the right place because they want people to come back to Google.

Building Trust Through Local Directories

This is where you'd look at Google Business profile. One of the most important things for optimizing your map ranking. The other is what we call local directories. This is the trust that you build with Google and with any LLM that's out there. I know we're talking about Google maps. If we want to dive into AI SEO and showing up in ChatGPT and getting mentioned in some of those LLMs. This is one of the most important things that you can do.

For you, there's 37 business directories that you're able to be listed in. You can see this audit shows that 27 of them you're missing from. We can scroll down here. We can see it. It breaks down into two different categories. One of them is all of these wellness-based directories that you want to be listed in. These are DocSpot, WebMD, Wellness.com , Doctor.com , Healthgrades. This is not something that we can scan and see just because it's HIPAA-protected. You're not able to see if you're in there. This is more so like you want to make sure that you're listed in here. I saw you guys in here in Healthgrades right here. No, sorry, that's BATS in Physical Therapy that was in there.

I don't like that 2.0 star. That's not me. That's not right.

That's not good for that. They're on there, not for the right reason though. This is again just showing the importance of getting listed here. You can see there's all these other business directories in here. There's Google Business Profile, which is your North Star. There's these random ones of CitySquares and Foursquare and Hours.com and MapQuest.

I always tell people, “Nobody's using MapQuest to find you anymore.” People aren't printing directions out from MapQuest. What AI LLMs do, what Google's AI overview does, what Google Maps does is when somebody searches for “Best physical therapy clinic near me,” it scans all of these directories to see if you're listed or not. If you are listed, it's going to verify that. It's going to trust that you're in business. If you're not there, it doesn't know if you're a legit business.

Even worse, when people move and they don't update their address from a directory. That's a poor trust signal to Google. It makes it hard to show up at the top of LLMs and on Google maps. This is a super easy one that I tell most clinic owners. It will take time. This is part of what we do with our SEO offer for our clinics. We can pull this list and show you where you're not listed. You're going to want to make sure you get yourself listed there. It's an immediate bump.

I would imagine you tackle that one at a time. If you make a little goal where it's like, “We're going to fill out one new profile a week.” If you were going to be limited on manpower. You chip away at this over the long run. It's not like you have to flip it all on its head in one week.

Technical SEO Vs. "PT Flexing"

It's a long game. You can obviously look at them and know which ones are a little bit more important to you. I always scroll down here. The Chamber of Commerce is always a super important one because that's local. Yellow Pages is a super important one. ShowMeLocal because it has that local intent. That's a super important one.

Property Capsule, I wouldn't probably worry about that one too much just because it doesn't have as high of a trust signal. You can pick and choose which ones you want to be in there. Make sure everything is solid. This is the second part. The third thing is diving into your actual website and what are, we call it, technical SEO or the core vitals of your website.

The main thing that I always look at is what's called your Authority Score. This is like your credit score for your clinic’s website. The higher it is, the better off you're going to be. I would say this number is out of 100. You can see Adam’s clinic at 12. PT clinics do not get anywhere close to 100. Between a 20 and a 25 is good for a physical therapy clinic. It's in the range of where you want to be.

There's a number of different things that go into this. The quality of backlinks that you have to your website, what type of pages you have on your website, and what keywords are you optimizing for. What we care about here is this number being high, which will increase this organic traffic number. What I always like to see, especially when we're trying to optimize for Google Business profile, is we want to make sure that you're showing up for keywords like this right here.

The second keyword that has the most website traffic for Adam’s clinic is “Physical therapy Slidell,” which is awesome. That's somebody typing into Google physical therapy Slidell out. His clinic is showing up. He got 100 website visits from that last month. What I often see here is clinics optimize for keywords like, “How do I fix a rib flare or ACL exercises.” That might get them website traffic, which is nice, but it's not somebody in Slidell out looking for physical therapy.

I'm not a marketer like you are. It takes some intention, especially for people who aren't marketers. You're interested in what they're looking for. Not what you think is important. People don't know what rib flare means. It's not important to them. Having a physical therapist in Slidell is important. Making sure you're optimizing for the things that are important for your customer and not to you.

I see it in two different ways. Physical therapists like to flex on other PTs and show how much they know, which is awesome. I think it's good. Flex that clinical knowledge. At the end of the day, you need to market to your patients. As you said, they have no idea what a vasopneumatic device is or something like that.

SEO agencies too, if they don't know anything about physical therapy, they're just going to go after the keyword that gets searched the most. That might be “How do I fix a rib flare?” They show up for that. They can get you tens of thousands of website visits a month. None of that's going to convert into actual patients. Who cares?

That's super important stuff. We always want to make sure that your clinic is showing up for the correct keywords. Again, Adam's site looks awesome there. The other thing is, this is newer. This is the AI search side. We want to just track and measure over time, how often are you showing up in AI? How many, say, the pages do you have? What is your AI visibility? These are all things that you can improve on.

Where we're seeing SEO going is much more conversational-based like, “What is good physical therapy look like?” Versus, “Best physical therapist Boston.” The way people search and interact with search models are just changing because it's just more interactive. You get that feedback from the LLM. Again, SEO is going to continue to evolve over time. As I said, if you're looking to involve some of these map rankings here, the three things you got to do. Optimize your Google Business profile. Make sure you're listed in these local directories. Get your domain authority up and make sure you're showing up for those local basic keywords there.

The Risk And Reward Of Paid Ads

Is there anything that you can add for just a little bit of context around at what point is it appropriate for you to start considering paid ads and that kind of thing? When does that become important to consider?

Paid ads is always a super interesting one. It's about risk tolerance because the worst thing you can do is go into paid ads. You spend $152,000 a month and not go all in on it and try paid advertising. That's important. I always tell people the baseline minimum that you should be spending per month is $1,000 a month.

Once you feel good about that, you're like, “I know my backend systems. I'm going to follow up with these leads properly. I have availability on the schedule. We have the space to bring them in.” You have to get into LTV numbers. How much can you afford to pay for a new patient coming in? There's loads of things that go into it.

The first thing is, are you okay with losing $3,000 in three months? Once you feel good about that like, “I want to try this. I want to scale and grow.” That's when paid ads are a great place to go. In my clinic, we spent $8,000 to $10,000 a month on paid advertising. We ramped it up. We were in downtown Boston. We had the search volume for it for sure. It's a great way to predictably bring patients in the door.

You know what you're doing for sure. Totally cool. For those of you that are reading, Jeremy did share his screen and show all kinds of cool stuff. You can check it out on the YouTube channel. Jeremy, for those who want to find out a little more about what you do, where do they find you?

I'm pretty active on Instagram @_JeremyDupont . I've got a show as well. It's called Jeremy on Marketing . Just dive into the nerdy marketing stuff in the PT world, which is always fun. We're at ThePatchSystem.com . It’s our marketing agency. If you want to learn more about us, check us out there.

Thanks. I appreciate your time.

That's great. Thanks.

Important Links

The Leadership Shift Every Business Owner Must Make To Scale With Spencer Shoemaker

Tue, 07 Apr 2026 10:00:36 GMT

Building a successful business isn’t just about working harder or having the best ideas. At some point, every owner hits a wall where growth stops being about individual effort and starts being about leadership, systems, and the team around you.

In this episode of the Private Practice Owners Podcast, host Adam Robin sits down with entrepreneur and business leader Spencer Shoemaker to talk about the leadership shift every growing business owner must make. Spencer shares lessons from the last year of building and scaling multiple companies, including the realization that trying to be the most important person in the room eventually becomes the biggest bottleneck to growth. Instead of answering every question and solving every problem himself, he explains how stepping back, developing leaders, and empowering the team creates real momentum inside an organization. They also dive into the practical side of leadership: hiring the right people, holding team members accountable, creating clear standards, and building systems that make it easier for teams to win.

Throughout the conversation, Spencer introduces the Momentum Formula, a simple framework that helps leaders diagnose why a team or business might feel stuck and what to fix first.

Together, they explore:

● Why many business owners unknowingly become the biggest bottleneck in their company

● The leadership shift from “doing everything” to building and developing a strong team

● Why allowing team members to make mistakes is critical for real growth

● How hiring for values and alignment matters more than hiring for experience

● Why accountability and clear standards are essential for scaling a company

● The Momentum Formula: Vision, Motivation, Roadmap, and Capability

● How to diagnose whether a team problem is about clarity, motivation, systems, or skill

● Why simple systems and clear processes reduce overwhelm and improve execution

● The leadership mindset required to grow multiple businesses without burning out

If you’re a private practice owner, entrepreneur, or leader trying to scale your business without becoming the bottleneck, this episode will give you practical frameworks and leadership insights you can apply immediately.

��️ Tune in to learn how strong leaders build strong teams—and how the right systems and clarity can unlock real momentum in your business.

�� Want help strengthening your operations, leadership systems, and growth strategy? Book a call with Nathan: https://calendly.com/ptoclub/discoverycall

�� Join the Private Practice Owners community and access resources: https://linktr.ee/ppoclub

�� Love the show? Subscribe, rate, review, and share! https://ptoclub.com/

---

Listen to the Podcast here

The Leadership Shift Every Business Owner Must Make To Scale With Spencer Shoemaker

Our special guest, first time. Spencer , have we done this before?

I did one with Nathan before the Private Practice Owners Club conference in October 2025.

Some of you may have heard me talk about Spencer Shoemaker, I’ll do a quick little recap on who Spencer is to me. We went to PT school together. Sat right behind me. Behind me and to the right. I think you were to the right. You were looking at my right ear for the whole PT school and that's how we met. Right after school, we stayed connected because you started an entrepreneur journey, and we started talking about business, and that grew into what it is now. You're super successful as a business owner and we're partners in a few companies.

I just value the way that you think and that you approach things. I learn a lot from you and I figured people who read this could learn a lot from you too. I thought it would be awesome to just have you on and just pick your brain a little bit, talk a little bit about life, leadership, some of the lessons you're learning and add some value to the audience. Does that sound good?

For sure. I can do that.

What's been new for you. We'll just keep this conversational, but we're approaching the end of Q1, the last sprint at Q1. I’ve been talking to a lot of owners and it seems like this is where momentum usually should start to be kicking in because you're getting through that that one year hump. You should have some plans, a little bit of vision for the year. You should be positioning yourself to for the big push. As you think about where you are in your companies and the lessons maybe that you've brought with you from 2025, I'd love to hear what you're focused on right now and like how you're approaching the problems you're solving.

Shift From Being The "Most Important Person" To Empowering The Team

Yeah, thanks for having me on, first of all. I appreciate it. I repeat what you said. I get a lot of value out of the things just even sitting on one-on-one meetings with you every week, some of the things that you think of and bring up and how your brain operates, it challenges me in a good way to not only in that business but also other businesses. I think of I think the world of you as well.

From 2025, I think that every business owner probably goes into this where you start off and you don't really know what you're doing. You try to learn a little bit about everything and figure out what really fills your cup. I think over the last probably a little bit more than a year, the thing that has continuously filled my cup has been developing a team and developing team.

At some point, you become a business owner and you think you have to be the most important person in the room, you think you have to answer every question. You're not important unless you're the one that people come to. There comes this mountaintop where you start to work down the other side of that where you're like, “I am exhausted every week not only for running my company but also from having to answer every question inside of it.”

Obviously, you start off with your policies and procedures and that gets a lot of questions off your plate but some point in there you realize there's a lot of people around you that are working really hard and you realize it's for you. They're working hard for themselves but they're also working really hard for you because they see the time and effort that you put into it. They see your vision, they want to get behind your vision and they want to grow with you.

So not everybody is in it for themselves. A lot of people value a team approach and the strength of the team is what leads the way. I think over the last twelve months, in each business that I'm in, I took a step back from wanting to be the guy that everybody came to and really start to hone in my team and build them and give them some opportunity to make mistakes.

Honestly, that's when I learn the most, when I make some mistakes. People aren't really going to learn a whole lot of life or business lessons if they're not able to make some of those mistakes on their own. Taking a step back from the PT business I'm in, it was okay, these are the things that I'm good at, these are the things that I'm passionate about and it's not like I'm trying to offload the things that I'm not passionate about.

It's not like this exhausts me, so you can have it. I think the first issue that you can have is when you start delegating task and the and the people know that you're only delegating it because you don't want to do it. I think they feel that and that's not so empowering, in my opinion. People want to feel empowered that you see value in them and how they view business and how they view certain aspects in a different way than you would.

You're empowering them to make that decision and to them it then feels because they're better at it than you are not because it's not something I want to do. It took a lot of self-reflection it took a lot of like swallowing some pride on I don't want to be this guy anymore. I want to develop a team I want to have a strong team I want to have a great work-life balance to then identifying who those teammates are.

It's really not that hard. I know this is conversational so I don't want to take over the whole thing but what are you trying to identify when? You view that as well. If you had to answer every single question inside of your business, you'd never get a work day done. What are you looking for inside of that? What are you looking for in empowering your team?

In the businesses that we're in together, I think I’ve told you this before, it's easy to have the easy conversations and the conversations that you're really good at this and this is why this is why I want you to take it on. It's really hard to have the conversations where you have to tell somebody why they're not meeting the standard. To me, I feel like you have a superpower inside of that to keep it, it's not personable at all. Let's keep it objective let's protect the business. We can go a little bit further into what I'm looking at from ‘25 to ‘26 but I think that the audience would get a lot of value out of how you approach conversations like that.

I love how you mention developing a team. I love doing that too. There are challenges that come with that. I’ve been really thinking a lot about business and practice owners and how to serve them and how to understand them. What I'm learning more recently is how do I make things easier? How do I make things simpler? I used to build systems that were like complicated and like needed to cover every single detail and I ended up overwhelming my team too much and I ended up causing them to be distracted and lose sight of the of the of the main purpose of the thing. I’ve been focusing on like how do I make it easy? How do I make it just like push the button?

Part of the thing that I look for in team members is I think the challenges to building a team really, I think really depends on like the leader that's in the room. For instance, my leadership style is going to be different than yours. Some people are going to gravitate to my approach. It doesn't mean it's right or wrong, just means it is and we can argue if it's effective or not.

You're going to do it a different way. You're going to lead your team a different way with a certain set of values and principles that are important to you. It doesn't mean it's right or wrong. It just means it is and that's going to create its own set of strengths and weaknesses. For me, personally, I look at, number one, are the people are they willing to be led? That's a big thing for me. Are you willing to be led?

Going back, you mentioned you've experienced this transformation from I'm the important person to I'm not the important person and I think that that's important that's a piece of it but also I think I haven't had a ton of success with not being the person who is really clear on what the outcome is needs to be, that understands what the standard is.

It doesn't necessarily mean I have to be important but I do have to be that person that's like, “This is the standard.” I have to be the enforcer of that. Maybe the next question is how do you balance that where it's like I'm not important but I am going to step in whenever the standard is not met? How do you keep that distance that's needed to be effective at that?

Starting With Accountability And Having Tough Conversations

To answer that question, I’ll still lean towards I think there's different levels of leadership, of course. I’ve got my core group of leadership team. For me, it starts with accountability. I have to be willing to hold people accountable. There's a ton of friends and when you're going to hire, typically, there's two types of people you can hire. If I'm trying to start pelvic health per se, I can either go hire somebody that has a ton of experience inside of pelvic health and has done it their way or another company's way for a long time or I can go hire someone with not much experience and I can train them how I would like for it to be done.

A lot of people think that if they hire that first person who has a ton of experience, they can just step back. I think that's a problem because they may be a great pelvic health therapist but that doesn't mean they're following the same standards of your company and they don't have the same values of your company. They have the same personal standards as a treating therapist but they don't have the same approach and all the things that you would want in your business.

It could be argued sometimes it's easier to hire that person with experience and start a program but honestly I think the most important thing is to find somebody that you align with and that your business aligns with the most and grow from there, whether they have experience or they don't. I think to answer your question I’ve got to start with being able to hold my people accountable when they're not willing or they're not reaching that standard that you're talking about. I think that the problem that a lot of business owners will run into is like that's not quite the standard but it's good enough. We're almost getting the job done.

Also, I don't know what the standard is.

We haven't really completed our vision yet to know what success looks like. To talk about a couple of calls that we've had in the businesses that we're together in I like when you end a call with what seems like success to you. There then you really know what they're thinking and then you typically say, “What looks like success to me is this. What is something that we both how do we both win? How does the business win?” When you asked that question just a second ago, the answer that comes to mind is accountability. You have to be willing to have those tough conversations and hold people accountable even when they're your friends.

I’ll speak on a subject that I had. One of the issues that we're running into inside of our therapy company is we went through a little bit of a couple of our providers were not credentialed. When we figured that out, we're like, “Okay, we're going to keep seeing these patients but we're going to get credentialed.” We went through this phase of we were essentially treating a few patients for free.

I'm not saying that's the best policy I'm not saying it's the worst policy but it's what we chose to do. There are certain reports you can run and when you run this one report inside of we use Raintree, it's called an Authorization Exception Report. It basically gives you the total amount of how much we gave away in treatment per se.

We got through the credentialing hiccup and we had a couple of therapists, and he'll listen to this and he'll laugh as I'm talking about it because we talked about it and you know him. He's one of the therapists that went to school with. A lot of patients will come in and they'll have had surgery and we'll treat them for a visit. We'll do the eval. If they have certain insurance, their authorization takes a while.

For a great therapist, you're like, “I need to get them in. I don't need them to scar over. I need to go ahead and start treating them.” There was a certain way inside of Raintree that you can set the note type as different. It was called a P-note. He had figured out how to put them as a placeholder. He could schedule them as a P-note and so they wouldn't get lost in the shuffle but they still had a placeholder on the schedule even when they didn't have auth. He looked up and if we're behind on auths, we've been treating this patient for free for three weeks.

I walked into the office and like, “What are some things that we can do? What are some systems that we can implement that this does not happen again?” He eased around like he knew what I was talking about and I'm like, “How do we stop using the P-note?” He just smiled and he's like, “The only reason I'm using it is because I want the patient to get treatment.”

I'm like, “We don't disagree about that. I also want the patient to get treatment. Insurance is not fair sometimes. I get it, but if you're looking at it from my point of view you're seeing them for free and it's not affecting you you're still getting paid. As the business which we have to protect first, I am now paying you to see a patient for free so I am losing money on this deal. I didn't get in business to make money but I did not get in business to lose money either.” He's one of my best friends that I just had to have an accountability, just a quick two-minute conversation with and I think that if you have a mutual respect for each other, those conversations are not that difficult. It's like, “I see what you're saying.”

I can see his point, he can see mine. We can agree to disagree. We typically don't do that. Typically, there's some silver lining but you have to be able to have the accountability conversation so that they can see your point of view as well. If I'd have just walked in and said, “Stop doing that.” I'm not saying you have to give a why every time but that was an easy two-minute conversation on them understanding from a business perspective why we can't. I think that if you really dial it back to what a lot of issues in business are, it's that. There's a lot of people out there that don't want to hurt their friends' feelings, they don't want to hold people accountable and there's you know certain instances inside of a business and those start stacking up.

If you're not willing to really hold any of them accountable, it's a recipe for disaster. I think that starting off with my core group, I have to be willing to hold them accountable and at some point, that has to drip down from my leadership team to the people that are underneath them. They have to be able to hold their level accountable as well. I think probably one of the most important things inside of business is to be able to and willing to hold people accountable even if the conversations are tough.

I love how you approach that conversation because have you ever read the book Crucial Conversations ?

Yes.

Pretty good book. I don't remember exactly every single part of it but one of the keys to success with those hard conversations is your ability to create to create some type of area of common ground. Usually, that common ground in my experience is the value or the principle in which we're going to choose to operate within. In your case, you were able to define that with some language that was able to be easily understood and agreed upon with this person, which was here's let me let's zoom out. Here's the situation.

Here's what's really happening and how and this is the piece that's the big problem. Let's talk about fixing that. You were able to create that thing that was separate from you and it became a problem that you could attack together. I feel like that is so important to leadership and influence, to be able to create that agreement around that principle. If you can create these principles of operation throughout the business that you're going to hold true to and you can create agreement on those principles, then you got a team that's bought in.

You can distill that down into a value. I'm sure that there's like a core value that was relevant that you could probably put a word to that. I feel like that's really what's the foundation of creating that buy in with the team. To piggyback off that, I think leadership is obviously starts with understanding who you are and the values and principles in which you believe in and you choose to operate within and working on becoming the person who can model that standard.

You can start actually like building some trust with yourself. That unlocks your ability to like hold your team accountable to that standard because you've been the person that can do it. I think leading yourself is key but then I think that maybe goes back to my point in the beginning which was making sure you have a team that's willing to be led. Did you have something to add there?

I think when you strip it down to the bare bones of it, it's important who you hire. They have to know that you're in their corner you want them to succeed and you have to know that they're in your corner and we're collectively working towards the same thing and if is an if it's an insurance issue, that issue's not going to get in between us. That's an issue that we both have to work around.

We both have to work around that to get to our common goal, which is, first and foremost, getting the patient seen with quality care. Second, make sure that we're getting paid from an insurance provider. I think that if you questioned any of the team that's around me, those are our goals. I want the patient to be taken care of, the company to be protected and the employee to be paid and there to be an even exchange.

In your words, I think that you use a good bit there to be an even exchange between the company and the employee like we are all working towards the same thing. We want this to be fair. We want the company to be protected. I think that if they know that deep down and you know that deep down. Everybody's willing to come up with a resolution.

The Importance Of Holding A Clear Standard To Gain Confidence To Let Go

I just had this revelation because I think you just answered my question. My original question was how do you create that distance? How do you become the not important person in the room? In my mind, I thought typically, what we do in the beginning, and I still fall into this trap. I think we all do. We want to get in there and we want to own the thing we want to be the person to solve the problem. We want to own the process and we want to micromanage the whole thing. Especially in the beginning, like we've had some startups recently that have been hard and we've had to be a little more hands on.

The thing that allows you to learn to let go, part of the thing is you being very clear on what the standard is and number two, having the courage to hold that standard no matter what. Nothing can rock that standard because if you can hold that with a level of safety, that is the thing that gives you the confidence to let go of the details.

To add on to that, I think you said it like you're worried about every detail, you overwhelm your team but truly, there's no way that one person can worry about every single detail. You're figuring out what's important for you and what's a win for you. Truly, if you can enlighten your team and you can empower your team, they're going to figure out way more details than we even had capacity to get to in the first place.

Learning how to create those principles that you want and building the language that describes them cleanly and having the courage to be like, “I'm going to stand behind this no matter who believes me or not,” and having the courage to hold tight to that standard will unlock growth, but that's not it because there's more to it than just that. Part of the thing that I get in trouble with is when things go wrong. Everybody's got a plan until you get punched in the face. You know this about me. I tend to worry a little more than you.

I tend to get a little restless and I get antsy when things aren't clicking at the highest level possible. That could be money's tight, that could be somebody on the team's got an attitude and I don't like it or it could be the clients are upset. We’ve got to fix it. We’ve got to get the clients better. I have this compelling urge to jump in and want to just fix it now, which is a problem and that's disruptive. I know that. It's still hard to fight that. My question for you is do you experience a version of that or are there other triggers that make you really want to jump in? How do you make sure that you handle those situations appropriately?

The Struggle Of Taking Team Challenges Personally And The Solution

I think that my struggle is I feel like I take things personally too much. To talk more about that, I think for me, I want to create a standard and I want to create some systems that it's easy to follow. I'd love it if 70% of everybody's daily job was step-by-step this is how we complete it. That last 30% in my brain, I'm like, “As an employee or as a patient, I have taken care of you at every single turn.” Everywhere that I can, if there's a 50/50, you win and I'm going to take the brunt.

There comes a point in time where in that 30% of the things that aren't inside the systems or the policy or procedure you have a standard that you would hope that they would follow. They would fall under that. When the and when there's certain times that people go rogue or they do something more self-serving than beneficial for the company, it really bothers me. I think that the word that you've used in the past is when people challenge certain things. When people challenge me on certain things.

They want to challenge the principle. They want to challenge the whatever framework. The agreement was already made and now we're breaking we're breaking the rules.

For me, maybe this is selfish, but I try to surround myself with people that think like I do or care like I do. I know that everybody's not always going to match that same they're not going to think exactly the same. I'm not saying they care less but they care differently. I feel like my struggle is sometimes I take that personally because then I'm like now I have to step in and I have to be the bad guy. I feel like every single time that something like this has come up, I'm always the good guy. I'm always the one that moves to the side and you win. The moment of time that I ask you to do that for the company, it really bothers me.

I think that's probably my biggest struggle inside of business, trying really hard not to take things personally. At the end of the day everybody works to provide for their family and to provide for themselves. That's why you work. If 100 % of us did not have to work, chances are, nobody would work. I think that you probably get to where you are in ownership and stuff like that because you truly care about your business and the product.

Also, the people around you and you hope and expect that that would be reciprocated most of the time. When it doesn't feel reciprocated whether they didn't mean it personally or not, sometimes I’ll jump to that conclusion. I get defensive. Even when people mean well, sometimes my brain will go to worst case scenario and that's a struggle.

How do you see that disrupting your leadership and what safety nets do you put in place to make sure that that doesn't compromise your judgment?

I think that for me, typically, a conversation pretty quick after because I may sleep on it for the night but I'm we're about to talk about it. I feel like I can get the emotion down and I can have a calm conversation but typically, after a conversation, I can see their point of view and I can explain my point of view and we see each other's side. It's like, “I was really jumping to a conclusion there.” Sometimes I'm not.

Sometimes I don't jump to a conclusion and at that point when I realize that maybe we're not as connected like our leadership team isn't as connected on various things, I feel myself separating just a little bit. I don't quite trust you with everything that I once did as much. Maybe that's not good. I feel like that's my protective mechanism. To answer your question, the things that I put in place is typically follow up with a conversation. Typically, those are not going to be a text conversation. It's going to be I'm going to pick up the phone and call or I'm going to try to hit you in person if I can.

For me, hearing the emotion in someone's voice, hearing the tone in someone's voice, it does a lot for me. You can mistake text all the time like they put a period instead of an exclamation mark. They're mad. I feel like just being able to feel that between them a conversation goes a long way with calming down those triggers or those issues. At the end of the day, once you work through that scenario that you weren't as pleased with, for me, if it's something that could come up again it's time to create a policy. I don't want this to happen again.

Let's operationalize that. My default is fear, worry. Fear and worry makes you irrational. I seek control over the thing and that somehow, if I can control it, I won't have to worry about it. I can put my finger on it, which is not good for scale. I try to systemize my fears. How can I systemize the control around my fears and tighten those things up? Here's the thing, usually, when I do that, it makes things simpler and clearer for my team. I find myself being able to let go a little bit more.

I'm in a season right now where I'm trying to learn how to own that. That is my strategy to basically lead myself a little bit better. Another thing that's really helped me, Spencer, is having some advisor advisors and mentors around me who know you at that level and who know the way you think and know your weaknesses and know your blind spots because we all have them. A lot of times, there are people on your team who who've been with you since the beginning. They know all the good, the bad and ugly.

A lot of times, I’ll sit them down and I’ll just say like, “I'm thinking through this thing and here's the decision I'm considering. Would you be open to giving me some critical feedback around that? What am I missing? Is this me being a good leader or am I missing something?” Create a relationship with at least a handful of people on your team who you give permission to actually give you some critical feedback. I learn a lot from those things.

I learn a lot from those and that helps me too. I love what that mentioned the communication standard. I teach my team this all the time. There are levels of effective communication. Not everything should be an email. In fact, email is probably the lowest level. It's like email then maybe text I don't know if text is they're tied neck and neck.

The next thing is probably phone call. After that, Zoom call. After that, in person. If there are emotional or nonproductive communication within those channels, your job is to move it up the chain to seek the solution. I try to teach my team that like that was not an email thing. That was a call thing. You got to own that. I think that's a lesson that I’ve learned too, creating those communication channels.

Here's another question I have for you. Let's say you have a team member or a group of people around you who are working hard and they want to do good. They want to do a good job. They're just not getting the outcome. It's not good enough. I'm learning this lesson because here's the thing. There's not a lot of people in this world that are going to work as hard as you and I. Fair? My default is always to think, “They're just not working hard enough.” That's my immature default, which sometimes is the case.

Sometimes people need a little motivation but it's not the only thing holding people back. Sometimes they just don't know. They don't have the skill. What's your strategy on being a little bit more diagnostic around underperformance and how do you handle that? I'm the type of person that wants it done now. I have to have patience and understand like this is going to take 30 days, 60 days, 90 days. How do you do that?

I think that for me, one of the qualities that I cling to as a leader the most is to figure out what other people enjoy doing. What they're passionate about, what their strengths are. I feel like I'm always diagnosing that. If there's an issue to be brought up, I'm like, “What is this issue? Is this because this is inside one of their weaknesses? Is this because this is exhausting them because this isn't what they're good at?” I'm trying to look more towards their strengths. Is there some way that I could utilize this person into a different role? Is there some way that I could edit their job roles to add a couple of things that energize them make them happy and take away the things that doesn't fill their cup or it causes exhaustion and allow someone else to help that is good at that?

I think that I'm always like when things aren't going like I would want them to I'm always like going through that in my brain, maybe it was my fault. Maybe I put them in the wrong role to start with. Maybe I need to change some of those things. I think that's where I go to first when something's not going so well. Typically, a conversation goes a long way with that.

If it's something that we've created like a little ladder for growth inside the clinic and I go to them and I'm like, “I put you in this ladder because I feel like these are your strengths.” I go to them three months later and they're like, “I really am not enjoying this. I'm trying to get good at it because you want me to do it I'm not naturally good at that.”

A conversation will allow me to change gears and move them around to something like I was telling you about. Sometimes, you have those conversations and they're just not keeping up. At that point, you've got to decide are they hitting my minimum standard? Are they hitting our minimum standard for our company to still be successful or are they not? Are they a fit for this team long term or are they not?

I guess I'm repeating my answer to the last question but I feel like a conversation piece goes a long way with getting their body language and their emotion and their tone to figure out because chances are if you're not happy with what they're doing on performing, they may not be happy either. They bringing it up to you because they feel like they're letting you down and so having a conversation about it gives them free leeway to air it. It's not complaining, it's not giving up. It's just saying, “I know that you wanted me to do this. I just don't think that I'm the right person for this job. This doesn't fit my wants and desires.”

I'd say that 90% of the time, that's probably the case. You're only talking about a performance issue maybe 10% of the time. At that point, maybe the fit's just not right for you or for them. That's nobody's fault. We just got to find a fit that is. That's still your job as a business owner and as a boss. If that person doesn't align with your growth and with your company's growth, find them somewhere that it is, even if it's with a different company, even if it's in a different role.

I'm still in charge of you. I'm still responsible for you, so even if it's not inside my company, I'm going to make a vow to you. When I hire you that I want what's best for you as well. If this isn't it, I'm going to help you find that. I think that a conversation goes a long way in figuring out the underperformers whether it's that they just don't fit here or I just need to utilize them in a different way.

Using The Momentum Formula To Diagnose Underperformance

I want to share a few things with you and see if you've ever heard of this. Have you ever heard of the momentum formula? I had an executive coach and he shared with me the momentum formula. At the end of the day, you're trying to create momentum through your people. Momentum creates traction and traction creates outcome.

The momentum formula is vision, motivation, roadmap and capability. It's another way of saying that might be like vision, motivation, policy, skill. Vision is they need to understand the goal. They need to clearly understand what the ideal outcome is, why it's important, and what it looks like what it feels like. They need to be able to describe it and see it in their head the way close to the way you do. If I go to your team and I'm like, “What's the goal?” And they don't describe it to me exactly the way I see it, that's on you. That's the owner because what that will look like from your team is confusion.

I'm working real hard, I got the skill but I'm all over the place. I'm not beamed in on that goal. Second one is motivation. Are you and that picks up where you were. Is your team even motivated? Is this person even motivated to do this? Do they want to do it and are they intrinsically motivated to do it? And do they feel like the support and compensation level that they have is enough to inspire motivation to do the thing?

If they're not motivated, that will feel more like resistance from them. They're just not quite willing to sacrifice for the thing, which is different than vision, which is different than confusion. If your team is exhausted because they're working so hard but they're still not hitting the goal, it's probably not a motivation issue. Third thing is roadmap. Roadmap is like do they have a very step-by-step policy and procedure that is easy to follow and creates predictable outcomes? If they don't have that, I just don't know how to do it, that feels like a waste of time like I'm just wasting my time.

Lastly is capability do they have do they actually have the skill? Do they know do they feel like they have the intrinsic skills that will help them experience the result they're looking for? You can create a simple questionnaire for somebody. Just create a simple questionnaire that helps you become more diagnostic on which one of those might be missing for you to be able how for you to be able to understand where can I allocate my energy and resources for this person or this team in a more effective way to support them? It might not be a motivation issue. Might not be a vision issue. Might just mean your sops suck. I have found myself leveraging that momentum formula to help me be more clear as an owner. For those of you that are reading, hopefully that is helpful for you.

I want to add one more thing. One thing that also has helped me, especially with new grads because new grads specifically tend to be a little bit more emotional. When I think about growth in life like think about growth in a career. Growth on a team, growth in as a father, growth in your faith whatever it is. Growth is at some level a series of decisions and tradeoffs. It's like I'm going to sacrifice this thing so that I can get more of this thing. I'm going to sacrifice this thing so I can get more of this thing. I'm going to sacrifice coming off the floor and not treating so many people so that I can focus on working on my business. It's a tradeoff.

I see a lot of younger employees hitting a wall because they're not willing to make the trade or they're not even realizing what trade they're trying to make. I'm going to give you an example. How many times have you worked with a new grad who feels like they have to document an entire freaking essay on their notes because they feel like if I don't do this somehow I'm not a good person or whatever. They end up sacrificing their mental health, their personal health, their bandwidth, all the things. It's like what if we could let that go and decide this is a trade that we're willing to make? At some point, the standard that you have in your head is going to become the bottleneck. If you let this go just a little bit, look at what it opens up for you.

I also found success and breakthrough with team members when I'm able to understand what they're trying to grip and what they would need to let go so that they could grow. That helps me become more diagnostic as well. Hopefully that was valuable. As you’re growing these companies, where do you feel like you need to improve or get better at so that you can actually become a person that grow these companies?

The Goal Of Systematizing 70-80% Of The Workday

I guess we've, we've answered it a little bit, but I feel like what I was talking about earlier when I feel like the policies and procedures make up 70% of the work day, for me that feels like a win because a majority of the day is whether it's treating patients, when you graduate from PT school, you can probably treat a total knee. They know that part. The skill part's there.

Now it's time for me to teach them how to strategically document, how to make sure that I have taught them between the 8 minute versus the midpoint rule. You just work through which patients can I see more than an hour with, which ones do I need to stay one in an hour with? It's my job to create a repeatable policy and procedure that they don't have to do thinking for 100% of the day because that creates exhaustion.

I think for me, in any business, whether it's therapy or whether it's whatever business it is, I need to create policy and procedure that 70% to 80% of their work day is systematic. I'm helping with maybe me or someone right below me is helping with the other 20% to create more systems for that. I think that that can always improve. I think that we could I think that in a lot of businesses or in my therapy clinic, it's called a practice for a reason.

You're always practicing. I think that if you're not fine-tuning your systems and your policies and your procedures, then you're probably going to fall behind because there's every day efficiencies that are being created. Whether it's your EMR, whether it's AI, whether it's virtual assistants, whatever you can utilize to create more efficiency, I absolutely think you should. You've got to create enough alignment with whatever team you have to systematize a lot of their day and then try to create vision that they're thinking similarly to you.

If there's ever an issue that needs to be addressed, you address it right then with love. I think that I can always improve on that. I think that I can always be looking through the businesses that I'm a part of and figure out if there can be some more things that can be systematized and then feeding into my team so even when it's not systematized, they can start thinking like an owner. Even if they're not an owner of a business, they're an owner of that job. They start thinking like the owner of that job.

I’ve learned that boring repetition and systems leads to leadership and vision, not the other way around with people that we're trying to develop. When you're developing your people, it's like, just follow the checklist and shut up for a little while. After a year, once you can breathe this, then we can talk about dreams. If you try to do it the other way around, it gets messy. Awesome conversation. Super deep dive into leadership. I know I had another question, but I'm going to save it for the next episode, a little bit of a teaser. I appreciate your time. We'll circle back like maybe end of Q2 and we'll do another one. We'll catch up.

Sounds good. Thanks.

All right. Be good.

Important Links

Using AI In Your Practice: How To Innovate Without Violating Compliance With Daniel Hirsch

Mon, 30 Mar 2026 19:00:00 GMT

Most therapists are already experimenting with AI. But very few understand the compliance risks that come with it.

In this episode of the Private Practice Owners Podcast, host Adam Robin sits down with compliance expert Daniel Hirsch of Risk and Compliance Analytics to talk about one of the biggest shifts happening in healthcare right now: AI. From documentation automation to billing analysis and scheduling optimization, AI tools are rapidly entering clinical practices. But while these tools can dramatically improve efficiency, they also introduce serious compliance risks if used incorrectly. Daniel breaks down what private practice owners and clinicians need to understand before integrating AI into their workflows.

This conversation is not about hype — it’s about using AI responsibly, ethically, and within regulatory boundaries. If you're curious how AI will impact documentation, compliance, audits, and patient care in the coming years, this episode will give you a practical framework for thinking about it.

In this episode, you’ll learn:

Why AI is becoming one of the biggest operational shifts in healthcare
The difference between using AI as a tool vs. letting AI replace clinical judgment
The compliance risks many therapists overlook when using AI documentation tools
Why HIPAA, security standards, and vendor agreements still apply to AI platforms
What a BAA (Business Associate Agreement) is — and why every AI vendor must have one
Why Medicare doesn’t care if AI wrote your note — they care if it’s medically necessary
The dangers of repetitive AI-generated documentation and why auditors flag it immediately
How AI can actually improve compliance by identifying patterns, billing mistakes, and underbilling
Why AI analytics can help clinic owners detect operational risk earlier
What a scheduling automation and communication tools improve patient adherence
Why therapists must still review and verify everything AI generates
The leadership responsibility owners have when implementing AI tools in their clinic
Why governance, training, and internal auditing are essential when adopting new technology

AI is not replacing therapists. But therapists who understand how to use AI responsibly will outperform those who ignore it. This episode explains how to adopt AI without putting your practice, license, or compliance at risk.

��️ AI is not the risk. Using it incorrectly is.

Show Notes:

Join the upcoming PPO Club workshop: https://ppoclubevents.com/04-17-26-workshop

Want help building a stronger practice model? Book a call with Nathan: https://calendly.com/ptoclub/discoverycall

�� Love the show? Subscribe, rate, review, and share! https://ptoclub.com/ .

99.5% of successful owners interviewed on this podcast have leveraged a business coach at some point in their journey. Private Practice Owners Club is the coach you need — ppoclub.com

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---

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Using AI In Your Practice: How To Innovate Without Violating Compliance With Daniel Hirsch

AI Is Taking Over Healthcare Conversations

I’ve got my guy here, Daniel Hirsch, with Risk and Compliance Analytics and we're going to talk about the one topic everyone wants to hear more about, AI, because it's taken over, Daniel. It's taken over. It's coming. I feel like I have more and more conversations with people about AI and how people are leveraging it, integrating it. Some people are using it in a good way. Some people are not.

I heard that somebody was using ChatGPT to document their plan of care. I just thought about you. I was like, “Daniel would flip upside down if he heard this.” I know other people are doing that. If we're going to leverage AI in our practice, in our business, we want to do it the right way, do it the safe way, and we want to make sure that we leverage it in a way that doesn't put us at a compliance risk. Daniel, I'd love to hear your take on AI and what people need to know about it.

AI As A Powerful Tool—But With Risks

First of all, thank you, Adam. I know this is our last episode in the Compliance Masterclass series, so very exciting. I think you mentioned AI, we're going to talk about probably the one the biggest shifts happening in forget the world. In healthcare right now, AI is everything you need to know is it's a tool. PTs have a tool at their advantage. It can improve documentation, efficiency, and patient care, but there are obvious risks.

I had the privilege of attending the CSM conference from the APTA in Anaheim and I got to tell you, probably 75% of the sessions spoke about AI in some way. The problem is that research is always lagging behind, so a lot of the content was already outdated, meaning that technology was already available, a lot of what they were talking about. I want to answer how to use it responsibly, ethically, and really in a compliant manner.

I think a lot of people, maybe you're hearing this too, they're saying, “AI, is it going to replace therapists and maybe bad therapists?” Just kidding. AI tools could help PTs be better PTs. Let's say you forgot a component in your note, forget the ChatGPT thing you mentioned a second ago, but it reminds you. It provides insight into the coding, how you're billing, the accuracy of it, and obviously, a lot of administrative tasks that should not be so manual anymore.

When Medicare also goes on record to say how long and tedious documentation really could be, the obvious reflex to anyone should be, “Fine, I’ll solve for that. I don't want to deal with this.” Our profession is so heavily regulated that you have to make sure that you're not violating like HIPAA privacy and security rules or billing rules and stuff like that. I don't know if you're a car guy, but think of this like you have emissions tests every year or so.

People, you go and you don't cheat, you follow the rules. I don't know if you remember this, but it stuck with me when Volkswagen got caught with emissions. They got penalized, huge penalties. The point I'm making is that, like when you're using AI, you have to make sure that the vendor has to be reliable, they have to have a really good reputation and this is not a component of let's just figure out a way to cheat the system to be able to use technology to do that. You don't want that.

Compliance Foundations: Privacy, Security, And BAA Requirements

Let me explain that a little bit better. There are really three concepts that you have to understand from a regulatory standpoint. First, patient privacy and security, that's what we're dealing with. The tool that you're using for AI, it has to interact with the patient data but it has to still meet your privacy and security standards. That's under federal law. Department of Human Services, Health and Human Services, you have to be able to secure it in transmission as well as at rest.

Authorized users have to be maintained. You can't just let anybody have access to this. Also, you have to have a BAA in place. If you're thinking about how you're processing notes and intake forms and schedule data, that's all great. That's fantastic. Baas, I know a lot of people complain about, “Do I really have to track it down?” This is probably one of the easiest audits you can do. Having a BAA in place is something that everyone that you do business with, Adam, has to have.

The reason is that it safeguards. It protects you and the business. From a vendor standpoint, you're transferring that responsibility back to them to maintain basic safeguards. Also, for breaches and reportability, you have to have accountability and baas specifically outline who is responsible for what. That's very easy to do. If anyone does not know how to do it, again, this is basic 101 of being in business.

Finally, I think the third component is really for billing and what's medically necessary. Medicare, in my opinion, doesn't care about whether AI was used. They really care about outcomes. As professionals, I think we're being held to the same standards that we've always been held to and that's whether you're providing medically skilled necessary services? Is that taking place? Is the documentation accurate?

Is it individualized? Does it really reflect like the actual care that's being provided? Are you objectively improving your patients throughout the episode of care? If you can't answer that, then A, you probably shouldn't be a therapist, but B, you're just not ready. You're just not ready to be able to be responsible in either outpatient, private practice or not having someone watch over you 24/7.

The Biggest Risk: Repetitive, Unjustified AI Documentation

AI-generated documentation, in my opinion, is not the problem. The issue is when therapists let the AI generate templates and becomes repetitive and it's just not clinically justified anymore. As an auditor, I’ll tell you, it's the indifference problem. You know it right away. When therapists just don't care. AI is also going to reflect that because whatever you put in, you're going to get the same thing back. If you're putting quality in, you're going to just enhance what you're already putting in.

I think that's one of the biggest problems we see in this realm and it's a human problem, but it's going to be exemplified with AI. The safest, highest value I think that people reading will get is probably not a surprise because it's been around for years and that's really from a burnout standpoint. Documentation, I made the joke about Medicare, they don't care if you're using this. They just want to know whether it is still objective?

Is it still meeting their definitions? The manuals didn't change. They're all the same. Yet we get a fantastic technology tool to use now. If you're drafting your notes, you're drafting language, and it suggests clinical phrasing it's going to flag certain things that are missing. That's fantastic. It validates accuracy, it confirms medically necessary language, that's really good. The notes are not really taking away what your clinical judgment should be.

Even if it's AI-assisted, your license, and I think therapists forget this when they're documenting, that your license is still on the line when you're documenting every time. Not just when you're touching the patient but when you're recording what took place. This is just the next chapter to we've done for many years. Now this is just the next chapter that you have a great technology tool to be able to make it faster, quicker, smarter. That's great, but your license is still on the line every time you're signing that off.

From an audit standpoint, I could tell you I love that this is available. Replacing analytics and all those days of calculating KPI, you know how important this is to owners. You need the data. Now, instead, you could just say, “I know where it is, I just need to interpret it and execute on the data.” You got units and coding and utilization outliers and all these things, it's all to your advantage now.

I think also, I’ve said many times before, peer to peer, forget that. Those days are done. Audits can also be accomplished without hiring people like me, which is nice. Obviously, there's a cost of going this route. Technology is going to cost something, but the options are there now. If you could identify risk early on before they become major problems, I think that's the beauty of risk management.

AI Adoption Is The Future—And A Competitive Advantage

If people don't want to take advantage of it, I think that's fine, but they have to realize this is the reality of where everything is going and you should take advantage. I think something where I don't really live a lot, but for marketing and patient engagement with these tools, there's a lot of leverage. All these appointment reminders, I love that. That's great. Scheduling optimization. It helps the whole communication for not just complying, not just getting people to comply with their program, but to keep people on track because we're so distracted nowadays. This does a really nice job.

Finally, obviously, with revenue cycle, when it comes to billing, if you're underbilling, we love doing that. We always hear the bad stories. We always hear the bad stories of people getting caught and making the front headline news, but a lot of us underbill because we're so kind, we're so generous. It could detect denial. If there's a certain pattern, a lot of times, we get stuck in patterns.

I told you, even myself, every three months, you'd be in the same rut of billing the same type of thing, creating the same sentences. Looking at behavior, this takes that human element out of it and says, “By the way, this is what's happening objectively. It's not my opinion, this is just what you're objectively doing.” By the way, it's a great way to measure performance. Those performance evaluations, there's no like awkward, “Let's come in and discuss it.” It's just simply, “Here are the numbers.”

Let's talk about those numbers. To avoid certain mistakes, here's where practices get into trouble. Don't expect perfection. People make mistakes and so do AI models. When you're reviewing your notes, you’ve got to see if it's accurate. You're still going to save like a tremendous amount of time. It's really good. The AI is very good at generating information, but identical notes, I could tell you, Adam, is a huge red flag. Massive.

Just like we're able to make all this fantastic content but if it's repetitive in nature, it's just going to get flagged so quickly. Many AI platforms are not automatically compliant, so you have to check. You do have to ask about what their security standards are, maybe there are contractual protections that you have to do. Even at CSM, everyone's shouting about how AI is going to impact everything and honestly, maybe that's true.

However, if you want to be successful, in my opinion, you have to apply the same standard to AI that you would for any other program or operation, hands down, which is simply it goes with defining the purpose of what you're trying to do. You have to establish governance, you have to train and educate your staff, you got to obviously monitor that, and then you have to audit it on a routine basis. As long as you're doing the same thing you would do for any other operation, you're going to be just fine.

Maybe one day like when you're reading this, maybe it's just my perspective now, but I don't know any therapist who's out there and thinks, “What I know now is all that's needed to help my patients improve. There's nothing better that I could offer possibly. I know the most, nothing ever will be better.” My message that I took home on the plane from CSM was that the profession, it is doing well, even with all the negativity.

I usually stay away from these types of gatherings of tons of students. They're very enthusiastic. Outpatient therapists are really at the tip of the profession and they take on all the necessary risks. When you see it come into play, and when you combine the compliance and the operations and all that clinical decision making that's necessary, you'll see that the growth is really it's possible when you have the right pieces in place.

It was so evident to me after coming out of a couple of days of listening to all the smart people out there and all these hot topic buttons that staff are talking about, burnout and audits and administrative chaos and reimbursements and on and on and how that is directly correlated. I think if you're using AI, you're going to outperform those who are not. It's just that simple.

There are really great ways to do it, there's really great tools out there that have AI embedded in it. It's rapidly advancing and I think it's a shame that people are so hesitant. The upside, in my opinion, there's so many great boundaries that you could stay within. There's no reason not to be taking that on right now.

As I listened to you speak, I thought about my experience with AI, my relationship, I think like most people, I initially had this overdependence on AI and give all the reasoning away. I made the same mistake we all did, like, “It wasn't me, it was AI that did that. I I'm not responsible for that.” I will agree that I had that initial reaction and now I understand. We've rolled out AI in our business and we've had to actually train our therapists like, “This isn't just a tool. This isn't the wild, wild West anymore. You're still responsible for whatever you put in your note.” I think that if you approach AI just like you would with anything, with a level of professionalism and responsibility, then you can use it as a tool.

If you're going to be careless and reckless, then maybe grow up a little bit more first. Don't be like me. Daniel, thank you for your time. I really appreciate it. Thank you for doing these five episodes. For those that are reading, check them out on their YouTube channel. They're going to be posting in our Facebook group. If you need compliance work in your business, check out Daniel Hirsch with Risk and Compliance Analytics. Daniel, see you next time.

Thanks, Adam. Peace.

Important Links

RTM In 2026: What Compliance Will Demand From Your Practice With Daniel Hirsch

Mon, 23 Mar 2026 19:00:00 GMT

Remote Therapeutic Monitoring (RTM) is no longer “the next big thing” — it’s here, it’s evolving fast, and in 2026, it’s becoming one of the most powerful levers for revenue growth, patient engagement, and long-term practice sustainability.

But with opportunity comes responsibility.

In this episode of the Private Practice Owners Podcast, host Adam Robin sits down with Daniel Hirsch , CEO of Risk & Compliance Analytics and one of the most trusted voices in compliance, to break down what RTM actually looks like in 2026 — and what compliance will demand from practice owners who want to do it right and keep the money they earn.

Daniel pulls back the curtain on why RTM struggled early on, how recent rule changes have made it far more flexible (and forgiving), and why the practices winning with RTM are the ones that treat it as a system — not a billing hack. Together, they reframe RTM as a tool for controlling time, improving outcomes, and increasing touchpoints with patients, not just another CPT code to chase.

They dive into:

Why RTM adoption stalled early — and what changed heading into 2026
How new payment rules reduce risk and reward consistency over perfection
What compliance actually requires when billing RTM (and where practices slip up)
Why documentation, timing, and patient communication still matter
How RTM fits into an active plan of care — and where owners get in trouble
The real financial upside of RTM when enrollment reaches scale
How to think about staffing, vendors, and workflows without burning out your team
Why Medicare’s continued investment in RTM signals where the industry is headed

This is a practical, no-hype conversation for practice owners who want to grow smarter — not riskier. If you’ve been sitting on the sidelines with RTM, worried about complexity, compliance, or whether it’s “worth it,” this episode delivers clarity, confidence, and a roadmap forward.

�� Takeaway: RTM in 2026 isn’t about being perfect — it’s about being intentional, compliant, and consistent.

Want to talk about how we can help you implement RTM the right way, strengthen compliance, and protect your revenue?

�� Book a call with Nathan: https://calendly.com/ptoclub/discoverycall

Love the show? Subscribe, rate, review, and share: https://ptoclub.com/

---

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RTM In 2026: What Compliance Will Demand From Your Practice With Daniel Hirsch

Adam, what is going on?

Just another great day to be alive. Wake up every day with a couple of goals on your to-do list, and you just tackle them every day. Having a great day. What about you?

Checking boxes. That is it. That is what having a good day is about.

RTM’s Real Opportunity For Private Practices

The funnest part about the day is RTM. I do not know if you guys have heard about RTM. It is a big thing. It can make a big difference in your practice from a revenue perspective, not just from a revenue perspective, but from a patient engagement perspective, and patient compliance. We can get better outcomes.

There is a lot of research behind it. People have been slow to implement, but it is starting to gain traction. There are some compliance concerns. We have to check ourselves to make sure we are doing it the right way. That way, when we get paid, we can keep the money. We got Daniel Hirsch . The number one compliance guy on the internet. He is going to tell us all about RTM, remote therapeutic monitoring for private practices. Daniel, train us, man. Teach us what we need to know.

Thank you, Adam. Thanks again for having me. I want to start by saying you are totally right. RTM, remote therapeutic monitoring, is not a secret. It has been around for a while now. You probably know there are people who charge for this information, but in this setting, in the PT profession, we need fewer barriers. We do not need more toll collectors to access this information. If you are still paying for this, no excuse. We are on the clock.

We are going to fly through this really fantastic topic, RTM. I love it. For PTs, this is year four. I am proud to say that I have been preaching jumping into RTM. It is finally gaining momentum. Also, if you notice, some of the loudest voices in at least my compliance arena, they only became interested once they had a financial incentive to do so. Take that for what it is worth. RTM 2026 looks very different from the 2022 version.

Thank goodness, the problem with the original rollout was like the kryptonite that affects most PTs, and that is math. I do not know if you experienced this, but we avoid it like it is the plague. Counting monitoring days over a 30-day period versus over a calendar month was just too much for the normal physical therapist. We could not handle it. I want to reframe RTM from what you probably heard to a new perspective.

There has been a lot of talk about RTM to help owners make a stronger decision for the growth of a company. Adam, I went back and reread some of my blogs and watched some of my webinars on RTM over the past couple of years. It was good content. It made sense. Practices were really limited by the poor technology. You need that to be able to bill for this. Think of it this way. When you control the clock, you are able to determine how your schedule looks, what services to include, or what to bill.

Also, you need to relax on vacation. All these important variables impact us in and outside of the clinic. What people need to understand is that RTM allows you to take back your time. You haven't really heard this from an RTM perspective, but I want people to understand that you decide when you send that email, that text, that electronic communication with the patient. You decide who will help you accomplish this on your team is really up to you.

I feel like the perspective needs to change. Maybe it is a staff member looking for extra work, or maybe it is a third-party vendor who will manage everything. It could be a hybrid approach, lots of ways, but ultimately, you need to decide how to control the time for the service. That is why RTM is very unique. We need to really accept this opportunity. It is a gift of clock management, in my opinion. As a coach, I am always telling people, you've got to control the clock. This is not hypothetical.

How RTM Works In Practice And Why 2026 Changes Everything

We also know that Medicare and other payers pay for this. It is a winning formula. You get better outcomes, better retention, and you get all those boxes that you want to check off. This does that for you. I am not saying it is the end all be all. It is not going to make all problems go away, but let me run you through what RTM includes. A few numbers from the 40,000-foot view, RTM has got to be supplied and provided by a qualified device, and the data needs to be transmitted.

That is the whole concept of what this is. Basically, you need to onboard patients. You have to supply them with the device, and then you have to monitor and interpret the progress. This is like the 21st century version of like, remember the VHI stick figures that used to copy, and you would have to hand them out to your patients. I guess that is just me being old, binder that stuff, you have to go find half of them were missing, they were numbered. It was terrible.

This is just a really great version of that. I will give a shout-out. I listened to Stephen Cohen last week. He was at the Graham sessions, I think it was Jimmy McKay interviewing him or some live thing. He basically gave the idea that when you are explaining this to patients, at the onset, it just needs to be routine and part of the PT experience at your practice. Not everybody could participate. Not everyone is appropriate for every treatment option.

When you reframe the benefit as something that is simply necessary to succeed in therapy, that is really the goal. You have a couple of codes. There are not many. Most people are not billing all the codes. We are not respiratory therapists. Basically, you have a couple of codes. You have 98975. That is your setup. You have your 98977 for monitoring. 98980 and 81. Those are the first twenty minutes and then the second twenty minutes of data collection, monitoring, and interpretation.

Stop and think. You control this time of how and when. I guess this was complicated, and it had a really high threshold because you did not capture all sixteen data points within a certain component or the full twenty minutes, so you got nothing. People were kind of ticked off. It was an escalation of commitment, almost where you have to keep investing, and you are like, "I'm relying on someone else for that paycheck."

That is very hard to commit to. In 2026, you now get paid the same exact amount, which I think is fantastic, but you can receive payment if you only obtain 10 to 19 minutes or 2 to 15 days of data collection instead of the all-or-nothing I was talking about. That means you have more flexibility for not being perfect without really carrying the risk of wasting your time. A lot of vendors offer this. They offer creative solutions, integration, and really great things. Each one has a very distinct personality.

You should pick the one that really matches your company and what your culture is all about. Do not go out there and find the biggest. You need to find the one that fits basically how your staff interacts. This whole conversation is really Adam is about taking back control of your time. RTM is a very good answer for it.

Nowadays, you hear a lot of grievances about fee schedules and reimbursement rates, and reports about fatigue and burnout. I understand that, but if you put two and two together, this is a really smart route to take after you have been given a four-year runway. In my opinion, if you are finally starting, congratulations. If you are already doing it, you are probably taking a deep sigh and going, "This is fantastic that I could get more for not being perfect."

I am going to shout out to Stephen Cohen. He owns Cerah Health. He is a sponsor of the PPO club. I got to shout him out. He is also a really cool guy. Super passionate about this topic. Check them out. We actually use them as well. The thing that attracted me to RTM was, obviously, as a business owner, the financial opportunity. We are always measuring the revenue per visit.

How do we squeak that up an extra dollar or two here and there? When you step back, and you do the math, and you zoom out, it is like $40 or $50 per patient per month or something like that. When you step back and do the math and look at man, if we had 30 %or 40% enrolled in this, it makes a real financial difference when you extrapolate it over twelve months.

It is not a small number.

It is a legitimate number. It will offset a lot of expenses.

Even if you are giving a percentage off the top, even if you are outsourcing 100%, it is a very large number.

Financial Impact And Where Practices Commonly Get Stuck

It is some setup energy, some training involved, and obviously, you have to be actively involved in that process, but a lot of things are automated. As you mentioned, that math problem is solved for you with the use of technology now. It is easy to implement from my perspective. It is really cool because you can create bonus programs around that. I do not know if that gets into compliance issues or not, but I have heard of companies building bonus programs around RTM.

That is my limited, ignorant perspective of what RTM is from a business perspective. I would love to hear you tell me where you see people get in trouble. What do you feel might be important to make sure you get these one or two check boxes checked before you start charging people for it? What are some of the things that we need to have in mind from a compliance perspective?

A lot of the vendors, the tools that are available, do the math for you, and they basically prompt you. They tell you what to do. They are like, "Here you go." Where people run into trouble is a universal problem with specific insurances, where there is a copay or deductible. Sometimes you are paying. You are applying things to maybe the wrong date or a non-date visit, and then it is triggering something else. You have to use some thought.

You cannot just randomly start tagging codes because this is a different concept of how you capture billing. Usually, we are very physical. First thing is in front of you, you deliver the service, and then you bill a code. This is not. This is where you finally bank it, and then you apply it. You have to be thoughtful when you are doing this. This is again very rare, but from a documentation standpoint, you have to be able to retrieve that data into your EMR.

When there is a documentation request, it has to live somewhere that is secure, then eventually, if there is a request, you have to be able to extract that and put it into your documentation. It is not really a problem. You just have to be cognizant about that. You were alluding to this is a fantastic thing that we usually hear people complaining about, "How do I charge for reviewing a home exercise program?" This is literally the answer. When you're saying you want continuity of care.

By the way, they have to be actively participating in a plan of care. That is also one of the key components. You cannot discharge a patient and then be like, "Congratulations, you're doing RTM." It does not work that way. They have to be active. The idea is that RTM specifically, there could only be one, so you cannot have your snowbirds up in New Jersey do an RTM, and then they go down to Florida, and they are also doing an RTM. They cannot be simultaneous.

The idea is that it has to be that open plan of care that allows for the billing to take place. The idea is that you really want to make sure that they understand what is involved. You do not want people to be surprised. This is a classic compliance issue where you think you are communicating, but you are not communicating to the patient. As long as you're communicating clearly at the onset, it will absolutely pay dividends. I have seen companies do really well with this over the years.

Adoption Mindset, Patient Communication, And The Future Of RTM

There is real value there. That is important to understand.

Even conservatively, Adam, it is something like 150 per episode of care. Those are conservative numbers.

If you extrapolate that over twelve visits, I do not know what the math is, maybe $13 or whatever that is. I do not know. There is real value financially and also for the patient. Personally, when I think about it, I have a few businesses. The businesses that do well are usually the ones that have higher touch points with their customers. They are more actively involved and engaged at a higher frequency. They feel heard, they feel supported, and you catch little issues a little quicker. You're more responsive.

You're dialed in with the patient.

That usually increases the lifetime value of the patient. They refer people to you. There is real value there for the patient. They are going to get better outcomes, assuming that they actually utilize the service. They're probably going to get better outcomes. Medicare has done its research. They are not just rolling this out to see what happens. There is a reason why they are raising reimbursement rates, or they are making it easier to get paid this year, because it seems obvious they are moving in that direction, because they are seeing costs go down for them, or they see a future where costs might go down.

We know everyone is going to follow whatever Medicare does.

Healthcare, as well, is transformative. That is amazing.

You are not going to be looking back at this going, "You were right, why did we jump on this?" There is no reason not to. Usually, in the first twelve months, people are like, "It's the wild west." You do not know what is going on, but this is proven. We know it works. This is clearly where everyone else is going. It is a shame if you do not. You almost have to feel bad for people who are not jumping into it.

Just do it, man. It is a skill. Take a couple of Saturdays and Sundays off. Read, learn it, and then learn options.

There is no one right way. You've got to look at your staff and say, "What is my staff capable of doing?" You could figure that out.

This is episode 3 or 4. I cannot really remember. We are doing five action-packed fifteen-minute segments on compliance. Do not really remember what the next week's. Actually, we're taking a week off, but the next episode, I am not really sure what it is, but I know it is going to be good.

I forgot what it is. We will make it interesting.

If you're watching on the Facebook group, check out the comments. I am going to have some information about Daniel, what he does, and how he helps people. If you're tuning in to the podcast, check out the show notes. All that information is there, too. Daniel, where can they find you?

At RiskAndComplianceAnalysis.com on our website. It is very easy. We have everything from a compliance perspective. When it comes to outpatient PT, we thought of everything.

Sounds good, man. We'll see you next week.

Thanks, Adam.

Important Links

Choosing The Right CPT Codes: How To Stay Compliant And Audit-Ready With Daniel Hirsch

Fri, 20 Mar 2026 10:00:18 GMT

CPT coding isn’t what therapists went to school for. But it is one of the most common — and costly — areas of compliance risk in private practice.

In this episode of the Compliance Series, Adam Robin sits down with compliance expert Daniel Hirsch from Risk & Compliance Analytics to break down how CPT codes should actually be used — and why most audit problems aren’t caused by fraud… but by bad habits, unclear documentation, and misunderstood workflows.

This is a fast-paced, practical conversation about how to stay audit-ready without drowning your therapists in unnecessary documentation.

They unpack:

Why CPT coding is one of the highest-risk audit triggers
The three questions auditors always ask
Why “medically necessary” and “skilled” must be clearly documented
Why total treatment time doesn’t automatically equal billable time
The biggest mistakes with time-based CPT codes
How lumping treatment together creates audit exposure
Why cloning notes and identical documentation raise red flags
The power of one strong assessment sentence
Why therapists often underbill — not overbill
How AI tools may improve justification clarity
Why chasing higher-paying codes can backfire
The single most important rule when billing time-based codes

Daniel also explains why auditors aren’t trying to “catch” you — they’re simply looking for consistency, progression, and clinical reasoning that supports skilled care.

If you want to protect your clinic, defend your billing, and build documentation that survives scrutiny — without overwhelming your team — this episode is essential listening.

�� Takeaway: CPT codes aren’t about listing tasks. They’re about telling the story of why your clinical brain was necessary.

�� Want help strengthening operations, leadership, and growth strategy?

Book a call with Nathan — https://calendly.com/ptoclub/discoverycall

�� Love the show? Subscribe, rate, review, and share! https://ptoclub.com/ .

99.5% of successful owners interviewed on this podcast have leveraged a business coach at some point in their journey. Private Practice Owners Club is the coach you need — ppoclub.com

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Choosing The Right CPT Codes: How To Stay Compliant And Audit-Ready With Daniel Hirsch

All right, ladies and gentlemen, here we are, the fourth episode of the compliance series. Fifteen minutes of action-packed compliance talk from our favorite compliance expert on the internet, Daniel Hirsch, with Risk and Compliance Analytics . The guy's a genius when it comes to compliance. In this episode, we're going to talk about something that I'm excited about because I don't know exactly what direction we're going to go with it, but I'm sure Daniel has an idea.

We're going to talk about CPT codes, the actual codes that you use to get paid. How do you use them? Which ones should we use? What's the issue? How do we make sure we're doing it right and maybe train our team on the right way to do that so that we can be compliant? Daniel, I'm going to toss it over to you. Tell us where do you want to kick this thing off at?

CPT Coding Risks & Compliance Basics

All right. Thanks again, Adam. It's been a great few back-to-back weeks. It's been great topics. CPT codes, we're not going to go into the weeds because we'll be here literally all week if we're talking about how-tos to code, what exact codes. Also, they're constantly changing. We're going to talk about how to stay compliant and audit-ready. Really going to teach people the basics, and we're going to slam it into fifteen minutes, which is good.

CPT codes, though, when you think about it, it's really one of the least favorite parts of clinical practice. No one really went to school dreaming of "This is going to be one of my favorite things to do." It's one of the most risky areas of why people get audited, though. That's one of the biggest problems. It's not because of fraud or bad intent. It's really because of misunderstanding or maybe bad habits or outdated workflows. That's really what the problem is. We're going to put the pedal down, we're going to go full steam ahead and talk about how to choose correctly, accurately. What does audit-ready actually mean for how to stay compliant and really how to avoid mistakes?

We want people to understand how to avoid mistakes and how to really protect the practice without drowning therapists. I know you talked about this earlier with me. You don't want people to be overburdened. You don't want to drive people crazy and burn them out. You don't want to do that. There's a lot of technology out there to help with this in 2026, and it costs. You've got to be willing to pay for it. Absolutely, there's great technologies to help with CPT coding.

For clarity, you've got to know what does it represent? What do CPT codes represent? Last time, we talked about RTM and how that's really a clock control. You're managing the clock. CPT codes, they're not tasks. They're the representation of what your skilled services are. Auditors are not asking, "Did something happen or did it not happen?"

They're simply saying, "Tell the story." you're trying to tell the story of what was the skilled service that you provided, was it medically necessary, and was clinical judgment used? Those are the big three to say, "By the way, why do I need you, Adam, where I could just go down the street and go get a massage therapist or something like that?" It has to tell the story. From a CPT code, aka your billing becomes valuable.

Even if the treatment itself was you need to know, was it appropriate, was it medically necessary, that we said, was it skilled, and did your clinical judgment right, that's the theme that we're going to be revisiting constantly. It's rare for me to walk into a clinic and see poor treatment by therapists. That's really rare. I'll say probably twice that's ever happened to me.

The therapists fall into the trap of they're very friendly and they're very kind. They want to give away their time and energy and resources. We tell them not to. You have to be professional. I'll also go against the compliance doom and gloom that you hear from all the respected experts out there. I believe most therapists are probably underbilling, or they're simply not trained at a professional level to know how to ethically and accurately bill for their services.

That's what I think because you're not learning that at the DPT level. When you're coming out of school, that's not what they're trying to teach you. They're trying to teach you how to make decisions. We'll shift into areas of CPT coding. You have your time-based codes. Those are definitely your, hands-down, biggest risk. Your time-based codes, the most common problem is when people don't list the time properly, or maybe the minutes don't match the codes.

Sometimes they're lumping treatment together and they're not breaking that down. It's very hard to understand what's actually being provided or maybe it's not being recorded correctly. Total treatment time doesn't always equal billable time. The auditors are saying, "Okay, is there a start time? Is there an end time? What's the total minutes per CPT code?" They're just looking for the simple math. They're not looking for all that other wonderful stuff.

Again, I'm not going to talk about math with pts. I don't want to insult anybody. If you can quickly explain, the math is simply are you performing what you're claiming to perform and was it medically necessary? Does it actually match? Is it accurate? That's what you have to keep asking yourself. Also with modalities, we see this a lot.

When it comes to CPT code, there's a lot of confusion out there where people are billing, like heat or warm up on a bike, and I'm like, "Is that skilled?" You have to describe what you're doing. Don't just bill something for the sake of billing bike as something or neuro. You have to describe how it's medically necessary. Maybe are you educating your patient as they're on the bike? Are you reviewing the plan of care or their home exercise? Whatever you're doing, it has to always answer the same question. Is it medically necessary? Is it skilled?

Documentation O f Skill, Clinical Judgment, & Medical Necessity

You're not looking, Adam, for just an activity list, because then you can go to the gym. If you just need an exercise list, go somewhere else. If you're looking for skilled decision-making, that's what the auditors are saying, "Yes, this should be reimbursed. Why? Because it's clinically appropriate." The worst is when you see an assessment that says, "The patient performed XYZ." I could care less, because I already know they did that. I already know the flowsheet says that or the activity log.

You've got to say what you're observing, what adjustments did you bring to the table. You're not selling yourself, but you really are describing why my brain was needed in this treatment. That's what you're trying to say, not just a list. People get that wrong all the time. Also, for over-documenting, that's one of the biggest areas that I beg people, please stop. If we want to know what took place and it's already there, don't rewrite it. Please.

Templates are good. That's another area where Medicare loves to give therapists a hard time. Medicare contractors are constantly saying, "You can't use templates. EMRs are making things too easy." the truth is identical language, visit after visit, that is a common problem. I give like the three-strike rule. If you're saying that nothing really changed in three visits, you should be worried.

You have to be showing progression, you have to be documenting that. Also, from the coding standpoint, the notes shouldn't just look the same. I'm not going to go into detail about a specific diagnosis or anything like that, but when you are looking at how you progress your average patient in a clinic, it should be a nice curve. It should be a nice graph that you could say, "We're making it more complex, we're using more valuable codes in that regard, we're making it more ING-friendly. We're doing activity-based stuff instead of just reps and sets."

We don't want to have cloned documentation. You definitely don't want that. Obviously, auditors are not trying to trick you. They're looking for consistency, and when it comes to how you're describing so I could tell you, I would get into a really bad habit of probably every 2 to 3 months, I will just be doing the same thing. Maybe I learned something, I took a course, i've seen this many times, where therapists get into the rut of "I'm just billing these four codes," and that's what your billing looks like for months until all of a sudden, you're like, "Maybe I should consider that 97535 or 537,” or something else. Maybe I forgot about the gait training code. Why not? Half our patients are lower extremity, maybe that's the appropriate thing to add.

Something to consider where you don't really want to get into the rut of doing the same thing over and over again to create a red flag for yourself. The gold of any note, though, when it comes to supporting the CPT codes, is by far the assessment. It's only a sentence. It's not hard to do, because no one could do that for you. AI's not doing it for you and that wonderful massage therapist down the street, they're not able to provide that.

Only your critical analysis in that one fantastic sentence on a note, that's what payers want to see. By the way, if you're ever stuck in an external audit or you're trying to argue and trying to prevent recoupment of funds or something like that, that will always win the day. You will always survive with fantastic assessments. It's not your activity list, it's not your really cool app you created. That's nice, but the assessment that one fantastic assessment that is really saying, "By the way, we needed Adam. We didn't need that other source down the street."

I talked about more words, over-documenting, the sets, the reps, all that nice objective data, that should live somewhere. If you're attaching that nicely into your note, that's fantastic, but you need to say why the intervention was skilled. The CPT code has to say, "Well, why was it skilled? What functional deficits did it address? Did my brain, did my clinical judgment did that apply to the service?"

Avoiding Overdocumentation & Cloned Notes

I guess i'll also go out on a limb here. I don't like peer-to-peer. You probably have heard peer-to-peer reviews are part of an audit program for compliance. The truth is they often provide very little value to a practice. A lot of times, people hate doing it, and it's hard to convince people to give up lunch breaks. There's, again, so many affordable options that you could either outsource or bring in-house from a technology solution. I think that's one of the biggest things.

When you have your CPT codes, I know we talked about the time codes, they are all valued differently. You can't just tell your staff, "By the way, I need you to bill top three," because what happens every year? We get a fee schedule, and they're magically always recalibrated. Why does that happen? It's because everyone's playing the same game.

Everyone's using data, I would assume.

They're saying, "Well, why did 97530 get reduced in value,” because all of a sudden, magically, it's being used 50% more this past year because it went up last year, or, “Why is neuro more valuable versus therapeutic exercise?" I like to just simply say, always pick the code that accurately reflects what you're doing as opposed to just chasing a dollar sign. I heard a webinar from an EMR that put out saying they're surprised that people are using group code.

I'm like, "Really? Why are you surprised?" It's a fantastic code. It's not worth very much, but it's not timed. It's something where you could say, "My one minute was worth a few dollars,” but you could extrapolate that to say maybe that was three people sitting there for that one minute. It actually does become pretty valuable. If you document appropriately, it's one of these things where it's a great tool to have to diversify your CPT coding.

I say this all the time, don't just do the top four that everyone else is doing. Don't just keep doing the same exact thing. Don't be like me and every two months catch yourself and say, "I haven't billed gait training in four months. Why haven't I done that?" the answer is because is it reflective of the patient sitting in front of me and does my service actually match what I'm coding? We're not coders. We're not medical coders. We're not medical billers. We're therapists. We're trained therapists who are supposed to, again, be using the clinical judgment and the justification to support these CPT codes.

I had a lot of things that popped in and popped out of my head as I heard you talk, but the one thing that I held on to is you mentioned technology. There's a lot of AI tools now that are helping you formulate the sentence structure that creates that justification. I would assume that that tool, if it's any good, is going to help you have a better assessment.

I think the future, Adam, is going to be the "click here to validate." you can't be a creative writer. We don't want English majors. We want people to be able to simply say, "Yes, that is what I did and my license is going to sign off on that." Yes, that's what I think the future is, just to simply say, "You know what? I read that. That is what happened. Yes, I like that."

I would assume now the audit process have to be a little different because it's going to be harder to catch. It should be consistently decent across the board if AI's writing it.

I think that's where we're finally leveling the playing field. All these years, we are constantly saying, "Well, where did you go to school? Where was your clinical affiliation," and then you were magically supposed to be up to a certain level. We're leveling the playing field and saying everyone should be at least good. I think that's what it's trying to do, and I think personally, as an auditor, I could tell you I love that.

I think it's really great because there's so many other things you need to be worried about. There's so many other things you need to be focusing on. The patient in front of you, you're supposed to be worried about that and that progression and that management, not on how good was that sentence structure.

It's usually like you said. Most therapists are doing a really good job. They're just having a hard time putting it into words that make sense, that actually captures the depth of the skill. I'm guilty of it too. When you see 100 total knee patients over and over, you can normalize that experience so much that it feels like it's unskilled because they're coming in and doing quad sets.

Really, there's a neuromuscular facilitation of the quadriceps muscle to stabilize the patella, which is the truth, but we oversimplify what we're actually doing and sometimes we have a hard time articulating the value there and the skilled care. That's where I think AI really helps with that. Helps you continue to capture the skill.

It's available. Why not take the advantage? I don't understand why people are saying, "It's a tool." Yes, but we have a goniometer too. Why would I want to eyeball it when I could use a tool that does a great job?

Give me the single most important thing that a therapist should focus on to improve their documentation and justification around CPT codes. What's the one most important thing?

Accurate Time-Based Coding & Using AI Tools

The number one thing for CPT coding is it's got to be if you're doing time minutes, the minutes have to add up. Be cognizant of if you need 8 minutes, do not bill 6. That ultrasound setting that for some reason is set to 6, change it to 8 because you're not going to get billed for it. If it's still clinically appropriate, be aware of what it is, because we don't want to just give away our time either. It doesn't make sense. Most of the companies that we work for are not pro bono. This is not just a nonprofit organization. We're there to do a job and we want to be compensated for our time.

The following episode is our last episode, 5 of 5, and I don't even remember what the topic is. We can leave it as a cliffhanger, but it's going to be good. Daniel, thank you for your time and we'll see you next time.

Thank you, Adam. All right, awesome.

Important Links

Is Your 'Therapist Heart' And Aversion To Metrics Killing Your Business? With Adam Robin

Wed, 11 Mar 2026 23:00:00 GMT

Most practice owners think culture problems start with people. But what if culture actually starts with numbers? In this episode of the Private Practice Owners Club podcast, Nathan Shields and Adam Robin have a candid conversation about what really happens when production slips, urgency fades, and leadership loses clarity around business metrics. Adam shares transparently how taking his eye off the numbers last year led to cultural drift, reduced urgency, and low-level anxiety across his clinics. But once he rebuilt his proforma, clarified expectations, and defined hard production targets, everything changed. This episode is about ownership, accountability, and the invisible connection between financial metrics and morale.

They dig into:

● The four types of practice owners when it comes to knowing their numbers

● Why “production is the basis of morale”

● How lack of clarity creates cultural erosion

● The power of defining a weekly visit target per provider

● Why metrics must be red or green — never gray

● How to create urgency without being emotional

● Why every KPI needs a clear owner and battle plan

● How daily scorecards create behavior change

● The difference between knowing your numbers and knowing what to do about them

● Why EOD deadlines force prioritization and eliminate distraction

If you’ve ever felt low-level anxiety about your finances…

If your schedules aren’t as full as they should be…

If you’ve struggled to get buy-in from your team…

This conversation will give you clarity and a tactical reset. Because when you get clear on the numbers, you lead with conviction. And when you lead with conviction, your culture follows.

�� Takeaway: If your schedules aren’t full, that’s not a staffing problem. It’s a clarity problem.

Want help identifying the right metrics for your practice?

Book a call with Nathan:

https://calendly.com/ptoclub/discoverycall

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Is Your 'Therapist Heart' And Aversion To Metrics Killing Your Business? With Adam Robin

Welcome to the show. I have my partner, Adam Robin, with us. How are you doing?

I am turned up.

Is that a good thing or a bad thing? You sounded excited, but everyone knows it is a good thing.

It’s a good thing. I have been super motivated. I am in a season right now where it has been ever since I got that tax bill. It has been like, "I cannot wait to get to work." All the work that I have been doing is coming to fruition. I am really just motivated. I have been really proud of my team.

Good to hear it. Tell me what any wins so far this 2026 were in the first part of February.

The biggest fear that I had this year was how we were going to hire a new therapist. How are we going to find them? I proved myself wrong again. I was like, "How about we try? How about we try harder?" How about we try as if we had to? Whenever I asked myself that question, I sat with that, and I dug into a deep cognitive project to solve that problem.

It is working. We have hired a new PT this year. We have hired a new speech therapist this year. We have hired a new PTA this year, all full-time employees. We have another PT on the hook. We have another OT on the hook. We have two other speech therapists on the hook. Literally within one month. It has been working.

I thought it was hard to hire people.

It is hard, but I am a volume guy. Send more messages. What I did was like, "What if I went up the chain a little bit and I focused on the offer?" Let us make the offer more compelling. That unlocked another level. We are going to talk a lot about that in our webinar coming up. When is that?

February 20th, 2026. When this episode is released, it will probably be released just a few days before that webinar, but it is Friday, February 20th, 2026. People are going to have to register for that to get the proper Zoom room address. You can go to the Facebook group, find our Mastering the Recruiting Process on the Practice Owners Club Facebook Group , or go to the website PPOClub.com under events.

There is going to be a link to the registration page under events, under I think it is under webinars or virtual or something like that. You can just register there. It is going to be you, Brian Widener, Career Tree Recruiting, and also my friend Bart McDonald from Idaho. He has some great insights on recruiting and how to entice people to come and join his practice. You are going to share some of these secrets as well.

Listen, if you cannot make it, just sign up anyway, because you are going to get the recording. You will not get all of the free stuff that we are going to give away live, but you will still get the recording. You will be able to tease out the nuggets.

We are going to have our virtual event in April. What is that date again? April 17th, 2026. Look for information on that coming up. It is going to be a Friday event all about recruiting. The cool thing is you are going to talk about all the things you do, share screen. "This is what I am for email campaigns. This is what I do on LinkedIn." You are going to see content. You are going to see CRMs.

You are going to see step-by-step processes. Look out for that information. It is going to be coming out on the Facebook group here soon. You will have to register for that one as well, but it is going to be an all-day virtual event with recordings as well. I do not know if we are going to have recordings on that one .

We will figure it out. It is our first time doing a full workshop.

A full-day virtual conference. It is going to be an opportunity to apply for CEUs and all that stuff, but that is going to be more in the weeds of recruiting.

This is going to be like a master class. It is going to be unlike any recruiting. I have never seen anything like this done. It is really going to be like share screen. We are going to be opening up the books and walking through the entire process. You do not even have to capture it all, but I am sure there will be a recording. Even if there are not, one or two nuggets from that, I promise, will make a transformative difference in your recruiting efforts this year.

We are going to go high-level on February 20th, and we are going to get deep into the weeds on April 17th. Keep those dates, register for the 20th, look out for the one on April 17th. Huge wins for you so far this year, just in a short amount of time, way to go.

What a relief. Talk about a setup for a really great year. It is exciting.

We just did an episode about a month and a half, two months ago, about how you changed the culture. Things were going the wrong way in the third and fourth quarters last year for your clinics, and you had to change the culture around production. That led to some people opting out. You are okay with it, but that does not mean you stay that way. You've got to find people to replace them.

We've got to go. We have bills to pay.

What Happens When You Take Your Eyes Off The Numbers

Our topic is not so much about recruiting. Of course, we will focus on that on February 20th. We are going to focus on metrics because you have a focus on metrics that you may have let slip a little bit last year. Did you?

A hundred percent.

What made you take your eye off the ball?

Just, honestly lack of discipline. I say lack of discipline. I got busy. We had conferences and in-persons, and we had a lot of stuff going on last year. I took my eye off the ball.

Is it also because between the two of us, I am the numbers guy? You are not so much. Maybe this is the wrong phrase, but you are not so much a numbers dude. That is not your strength, and you get distracted if that’s not what you want to pay attention to.

I can do it, but it takes a lot of energy for me to dive in and look at spreadsheets.

It is easier to let that slip.

It is not fun for me. I would rather recruit or something like that.

I can see that. You saw it for yourself, but it sounds like that bled into your leadership team as well.

It bled into the whole culture, honestly. I heard Nathan Shields talking in my ear the whole time. The numbers really do matter. There is an invisible connection between the numbers and the culture. I do not know what it is, but when the numbers are good, the culture is good. When the culture is good, the numbers are good. I do not know exactly which one comes first, the chicken or the egg, yet. I am still figuring that out, but I know they are both needed. You cannot have one without the other. I know that much.

It was always production as the basis of morale.

It is true.

If production is there, the culture starts coming around, or at least covers a lot of holes.

It has to be there. It is demanded. Culture was down. Numbers were down. We got slower as a company. Everybody was slow. We lacked urgency. We started coddling people. It was scary as an owner because I did not know why. I was not clear on the numbers. I felt really in the dark, which was a very scary place to be.

I was very vulnerable and just in the dark. Now that I have done the work, the work that I was explaining, I really dove in. I rebuilt my pro forma. I rebuilt everything. I feel so much control. I feel so confident in the way that I show up because there is a level of certainty and conviction around my leadership, as I am so clear on the numbers now.

Data does that. When you see the numbers score, it gives you clarity.

It permits you. We all have a therapist heart. We have a hard time asking for more because we do not want to ask for any more than what is fair. When you see the numbers, it is like, "Now I know exactly what I need to ask for and why." It is more objective and not because I feel like it. It becomes less emotional. You feel very grounded. You are okay with whatever people think. If you want to leave, you have to leave because this is what it is. That is a good place to be in, in my opinion.

Four Types Of Practice Owners In How They Approach Their Numbers

I look at owners, and this is my theory. I have not done any tests or trials on this, but I think owners in general in the private practice space fall into one of three categories. One is that they do not know their numbers. They know how many patients they saw last week. They might even know how many new patients they got, but they do not know anything beyond that.

They do not know their financials. They do not know what is going out, what is coming in. They just do not have a beat on it. They just assume, "I provide great care, and I should get compensated for it richly somehow." The other one is that they know their numbers, but they do not know how to affect them or if those numbers are good or bad.

That is a big one.

They can look at their numbers, but they do not know their break-even point. They do not know what a good arrival rate is versus a bad arrival rate. They do not know what a good profit margin is versus a bad profit margin. They are just kind of ruled. They see the numbers, they know what they are, but they do not know how to judge them or assess them.

The third one is that they know all the numbers, but they do not know where to focus. They do not know how to use those numbers to prioritize where to go first and second. They do not know how to prioritize the importance or the urgency of the different numbers. There is the fourth, of course, that are living by their stats, and it drives their decisions.

Nathan Shields.

I wish I were that good. I guess there are four buckets there, and that is where they tend to lie. You can be very confused in each of those states. If you are in those three states and not the fourth, you are kind of driven by a little bit more emotion. You are going to default to compassion because that is the personality of our industry, and fall on the side that less production is okay, with reasonableness behind the numbers.

Maybe you are softer when it comes to what you see in the bank account. That is not great, but it is doing okay, maybe. Maybe you look at the P&Ls from your bookkeeper or CPA, or maybe you do not. You just look at the bottom line. Was it positive or negative? You are not looking at much more than that. That can be really hard to work from.

What I think you saw when you really got into your numbers is that you gained some clarity about the reality of your organization. I know where we are now. We talked about this a little bit before we pushed record, but now you are really able to focus on what the levers are that produce change. Let us start focusing on those. Now you are moving into that fourth bucket.

Let us get really clear about what the things are that can really affect change when we were looking at these numbers. I shared this before as well. You can look at profit margin and say it is 8% or 9%. You are like, "That is no good." What are you going to do about it? It is an important metric to measure, but that does not tell you where to put your action and how to improve it.

To improve that, you have to look at all the other subsets of numbers and see where they are. Maybe you do have a ton of new patients, but they are not coming for their full plan of care. Your episodes per plan of care are down, or the arrival rate is not good.

Maybe your therapists are not billing skilled units at the level that they should be, compared to how much time the patient is in the clinic, or they are using lesser-paying CPT codes that could justifiably be higher-paying CPT. There are so many ways you can look, but if you are not looking at those subsets of numbers, you are just going to hope and pray that maybe more patients lead to a greater profit margin.

I really appreciate you breaking it down like that because I feel like we were in that second and third bucket that you described.

You can see all the stats, but you are not quite sure what is good and what is bad.

What was third?

There is a ton of data. You might even know the benchmarks, and some of them are down, some of them are up, but you do not know where to focus your energy.

That was us. We were there. We did not know where to focus, and we did not know at what intensity to focus.

You said before we pushed record that you would see some down numbers, but you’re like, “Let us just see if they change next week.”

We got to a place where I did not know what we needed to do. If the providers were asking, "How many visits do I need to see?" I was like, "I think 50-ish. I do not know." This was working, but now it is not. I am not really confident anymore. I have to go back and look at the pro forma. My lack of conviction and clarity led to a lack of trust. This guy does not sound like he knows what he is talking about. That bled into my leadership team and led to the cultural erosion.

Sometimes they do not know where to start. If they are averse to numbers to begin with, that’s like, “Dude, you bet.”

There’s a lot of clarity, and your team has to be bought in before it will be bought in. If you do not even know, how are you going to get them to know? The conversation shifted whenever it was like, "Nathan, the business only works whenever you see 55 a week minimum. Your evals will count as two, but I need overall, I need you to be at 55 minimum in order to be employed here. Are we good?" I am going to support the heck out of you to make sure that you get that, but that is something that we cannot wiggle with. Once we reestablished that with everyone, everyone was like, "Let us roll."

Now I know the score. Just for reference. We count evals as 1.5, but missed 2. However, you want to do it.

That is the way it works out for us in our model right now. That might shift over time, but that is the way it works for us. That was the start. Me getting clear on what we needed and then being really explicit with that.

When you say what you needed, you meant financially driving the organization.

I mean to preserve the company financially.

The viability.

To be able to know that we are going to be okay in the event that something happens, or we do not have to worry. We can just focus on treating our patients and growing, and not have this low-level anxiety and scarcity that the ball is about to drop. For people who do not know me, that is just something that I am not going to allow to be in my life. I am going to create some control around my finances, or I will just shut the business down. I have even told my leadership team that if we do not, I would rather just shut the clinic down and step away if we are not going to buy into solving this problem together. That is how committed I am to this.

We need to live so far above the survivability line that anxiousness never becomes an issue. Why not?

That was the start, but then it became, "How do we get there? What are we going to do today to ensure that we are hitting that metric on a regular cadence?” That was the next thing. What I found was we were talking about needing to be at 55, but we would wake up two days later, and we are still not at 55.

A week would go by, and we were still not at 55. My team did not understand, no fault of their own. A lot of this was on me, but my team did not understand how to organize their energy today to actually make the change that we were trying to make. I had to go in and reorient them on how to do that. Now we are on our way.

We have daily scorecards, and we are back on the map, but basically had to reorient them to "How do I make change today? How do I make a change tomorrow? How do I make changes for next week? How do I make changes for next month?" I have to categorize those things by levels of urgency. That is really what I have been focusing on, and it is working. We are starting to turn the ship.

Owing The Metrics And Pushing For Positive Behavior Change

That is way cool. Part of what you are talking about is that you can look at these metrics, but the next step after having the metrics is to decide who owns that metric. If we all own the metric, no one owns the metric. If it is the 55 visits per full-time employee, then for a clinic of three, that is 165 visits a week.

Who is ultimately responsible for that? They need to report in that leadership meeting on their KPIs. You cannot report all the KPIs, but there are primary KPIs. In our organization, the Vice President of Operations, the Vice President of Sales, the Vice President of Administration, and then Will and I, we had our separate KPIs. We could have one to two max.

We made that mistake too. We had too many.

You present one to two max KPIs, and not only do you share the KPI, but we also share graphs. We would graph out our KPIs to know what direction the KPI was going and give a little bit of context to it. After they presented the KPI and the battle plan. "This KPI is in a good place. We are going to keep doing XYZ. This one is not in a great place, so my plan this week to improve that KPI is X.” They have already done the homework beforehand.

It is not, "I am going to go find out where the KPI is lagging," or which individual provider is not performing properly. "I have already figured out that Janice is the one who is a problem. I am going to make sure the clinic director is talking to her specifically and that she understands that she needs to bring things back up.

It is her first offense, so we will track it next week." That battle plan then comes forward so that everyone is on the same page. "Cool. You have it handled. Do you need anything from us? Do you need any help? Do you need any other support? Do you need a resource? Do you need some guidance?"

There would be some version of that battle plan for each KPI that was presented. It would give us some focus, and that helped us because that was towards the beginning of our leadership team meeting. Any discussions about other issues in the clinic happened in the second half of the organization. Those issues could take up the entire hour if you do not set them aside.

We focused on the production. We focused on those KPIs and what you are going to do about them this week to effect change. Because we kept that in our leadership team meeting agenda at the front end, our focus was on production all the time. It did not get left up to chance. That was really helpful for us.

We started implementing a similar flow. We were going to start by doing it daily.

Is that in person, or is that just an email chain or something?

It is going to be a weekly meeting and a daily email exchange. It is due by 9:00 AM every day. We have our battle plan options. You have to pick three a day. My thoughts were that I wanted to create something that drives behavior change today. Not later this week. Not "We will think about it," or "I am going to have lunch with them on Tuesday." No. Today. I want a behavior change today.

I had to break our team of that habit of like, “Let’s think about it,” because I was the one allowing that to happen. When I was creating this out and building this out, I had to really think about how to change behavior. I honestly learned so much. This has all made me a much better owner. Going back to what we were talking about earlier, we have people, we have really successful owners in our program, who still have not defined that weekly target for their team members.

I have started thinking about what it takes to actually change behavior. It has not really been that complicated. Number one is you have to define the target. If I go up to your team member, your favorite physical therapist in your business, and say, "How many visits a week are you supposed to hit in this clinic?" Ask them, and you will find out very quickly if they know. If they do not know, there is only one person to blame, and that is you. I do not know if it is laziness on our part or fear on our part, but for whatever reason, a lot of owners are scared. They avoid that.

You also have to include that lack of knowingness.

Maybe it is a lack of knowing or ignorance, but if you do not give them a target, they are never going to hit it. It is either red or green. It is either you hit it, or you do not. Now I can say, "Your job is to turn that green every day." I can follow that. It is not "Your job is to guess what I want you to do today." You cannot change behavior that way. Number one, you have to define the target.

Number two, the target has to be either red or green. It has to be either good or bad. There is no in-between because the in-between part is where all your dreams go to die. We have to define like if you are one below, you might as well be a hundred below. You are either below or above. We have to create a culture of urgency around being below. There is no below.

The third thing is you must confront the behavior. Whenever they are low, you must be willing to confront them. You must give them barriers and be like, "The path to success is right through here. You can either move through this with me, or you can go somewhere else." It is up to us as owners to create that accountability.

You definitely can have that conversation with anyone on your team. With the provider, it's like, “How many businesses do you get to see a week? What is the expectation?” You can have that at the front desk. A powerful question at the front desk is, what is your main job? You have got so many things going on here at the front desk. You are doing all the things. What is your number one responsibility? If they cannot clearly say, "Fill up the schedule," if that is not the first thing out of their mouth, there is a leadership problem.

Nathan, you say that, we all fall victim to that. I am supposed to be the coach who knows this stuff, and I even let it slip. If you do let it slip, it just means you have to go in and fix it. It does not mean you are a bad person. You hire new people, you have turnover, you get busy, and you have things slip. Ideally, it does not slip very often, but I made the mistake. We had all these stats on the board, where we had visits, visits per evaluation, skilled units per visit, number of evals, number of discharges, all really important.

I had to sit down and ask myself, "Which one of these matters the most?" Remember the priority star? Do a priority star. What I landed on was total visits. I do not care if I have 4.0 or 5.0 skilled units per visit. If I do not have enough volume on the schedule, I am done. If I am trying to teach my providers how to bill and I am trying to teach my front desk how to fill schedules, now my focus is diluted. Let us spend a month just focusing on filling the schedules.

How do we fill the schedules? How do we get so good at filling the schedules? Once that thing is full and humming, then we can start talking about skilled units per visit. Does that make sense? One of the main things is that we try to do them all at the same time. That really diluted our focus and got us distracted. Now we are back to square one, front desk, fill the schedules. Chapter two will be to improve our billing metrics later.

Maintaining Urgency And Stick To Your Deadlines

You also brought up urgency, and this is something that I can default to very easily. Addressing something in the moment may lead me to not think as clearly, and be a little bit more emotional. I have a hard time confronting if I am not clear on the verbiage I am going to use. I will delay to a fault.

There are many times when I should. Most of the time, I probably should collect my thoughts, but give myself a deadline. "I am going to give myself a night to think about this, but I need to address this tomorrow." The urgency behind it, I had a call with an owner, and she has grown in her practice, but last year she lost $40,000.

Some of her providers are not billing enough skilled units per visit. Frankly, I think they do 45-minute visits, and some of them are averaging two point something skilled units a visit. No one is going to be profitable at that. I said, "Cool. When are you going to talk to these people?" She said, "I wanted them to fill out this questionnaire about their annual goals, and I have plans to talk to them next week."

I was like, "Hold on. You are losing money right now. How soon do you want to start making money?" She said, "Yesterday." "We have a few hours left in the business day. How about you talk to every single one of those people today before they go home and help them understand the expectation?"

I do not know why that happens. It happens to me too.

She was really surprised. I think it caught her off guard. She listens to the show. I hope she does not mind. I just shared generalities. She was caught off guard by that, but I was really surprised as well that she was willing to let it slip another week when she lost money last year.

It was still an issue, and she had talked about it many times, but not with any amount of urgency whatsoever. I made that a little bit more common because, as you were talking, the idea came to my mind. It is hard to see the picture when you are in it. If I am in the picture, it is hard to get that perspective. I am distracted.

There are a lot of things going on. I have got things to do. I am not sure where to focus. Once you step back, and a third party like me comes around and says, "Why are you not doing this yesterday?" This sounds like a major issue if you could let it go any longer. It is surprising.

I know why that happens now that I am thinking about it. You have read the book, The Science of Scaling . What a deadline does is it creates a filter. It forces you to prioritize what is most important. We, as humans, are not naturally built for progress. We are not built to grow and be uncomfortable. We are actually built to stay the same. Just survive and get by. Our natural inclination is fight to preserve what feels comfortable.

Discussion Wrap-up And Closing Words

Let us go. Let us make 2026 a completely different year. Thanks for your time. Again, check out our webinar on February 20th, 2026. Go to the Facebook page, check out the recruiting webinar on April 17th, 2026, mark that down on calendars for the full-day virtual conference on the recruiting master class hosted by Adam and me. We can get more people driven into your organization. Check them out, register there. Thanks for your time. It was a good conversation.

See you next time.

Important Links

The Master The Art Of Recruiting Webinar: How To Out-Recruit Hospital Systems Without Matching Their Salaries With Adam Robin, Brian Weidner, And Nathan Shields

Wed, 04 Mar 2026 10:00:38 GMT

Most private practice owners say recruiting is hard. But very few have a real recruiting strategy.

In this episode of the Private Practice Owners Podcast, Nathan Shields and Adam Robin sit down with Brian Weidner of Career Tree Network to break down what’s actually happening in the 2026 hiring market — and why many clinics are struggling to keep up. From clinics closing locations due to staffing shortages to new grads locking in jobs months before graduation, the recruiting landscape has shifted. And if you’re still relying on job boards and hope, you’re already behind. This conversation is a practical, tactical deep dive into what it really takes to attract, convert, and retain clinicians in today’s market — without overpaying, overpromising, or operating from fear.

In this episode, you’ll learn:

Why recruiting in 2026 is not getting easier — and what’s changed
How new grads are securing jobs months before graduation (and why you never see them hit the open market)
Why posting on Indeed alone won’t fix your hiring problem
The difference between optimizing for applications vs. optimizing for inquiries
How to identify and target high-intent candidates instead of spraying cold outreach
Why your offer — not your ad spend — determines your recruiting success
How to extract real value from your clinic’s strengths (culture, mentorship, flexibility, autonomy)
Why you can’t compete with hospitals on salary — and why you shouldn’t try
The dangers of negotiating from fear and bending on compensation
How speed in the hiring process can win (or lose) great candidates
Why building a recruiting engine gives you leverage in leadership conversations
Practical ways to use AI, automation, and systems to remove yourself from daily recruiting
How consistent outbound effort creates predictable hiring results

Adam also shares how his clinic went from hiring 18 therapists in one year… to watching momentum stall… to rebuilding a stronger recruiting engine that produced five hires in two months.

If you’re tired of feeling like your team has more leverage than you do, or you’re anxious about the next resignation letter, this episode will reframe how you think about recruiting — from reactive panic to proactive system.

��️ Recruiting isn’t a luck problem. It’s a systems problem.

�� Ready to build your own recruiting playbook?

Join the Clinician Magnet Intensive Workshop on April 17th and walk away with a step-by-step, plug-and-play recruiting system you can implement immediately: https://ppoclubevents.com/04-17-26-workshop

�� Want help strengthening operations, leadership, and growth strategy?

Book a call with Nathan — https://calendly.com/ptoclub/discoverycall

�� Love the show? Subscribe, rate, review, and share! https://ptoclub.com/ .

99.5% of successful owners interviewed on this podcast have leveraged a business coach at some point in their journey. Private Practice Owners Club is the coach you need — ppoclub.com

Explore upcoming workshops, free resources, and tools to help you scale revenue without burning out your team: https://linktr.ee/ppoclub

---

Listen to the Podcast here

The Master The Art Of Recruiting Webinar: How To Out-Recruit Hospital Systems Without Matching Their Salaries With Adam Robin, Brian Weidner, And Nathan Shields

Introduction Of Speakers & Context Setting

Welcome, everybody, to the Master of the Art of Recruiting in 2026 webinar brought by the Private Practice Owners Club. I’m going to be the host and moderator, Nathan Shields. Welcome to all those who are joining us now and also in the future. With me is my partner within the Private Practice Owners Club, Adam Robin . Adam, go ahead and introduce yourself a little bit.

My name is Adam. I’m a Physical Therapist. For those of you who might have tuned into the show or might have seen me on the Facebook Group , I started my practice in 2019. I started working with Nathan at the end of 2020 or early 2021, one or the other, as a coach. That was a huge transformation for me personally and professionally. I’ve also worked with Brian. Brian has helped us recruit in our practice quite a few times. I’m grateful to be here. Now, I have the pleasure of being a partner with Nathan and helping other practice owners. That’s a little bit about me.

We got Brian Weidner of Career Tree Network . Go ahead and introduce yourself a little bit, Brian.

I’m not a PT by background, but my wife is. I got into this through her. In 2007, we started our company to help PTs research and connect with employers. We’re based in Milwaukee, Wisconsin, and work with clients nationwide. We focus on PT recruitment, helping clinics with hiring, and helping PTs research and explore options. We do a lot of work with new grads. It’s been fun.

It’s good to have you guys. We did advertise that my friend Bart McDonald of Superior Physical Therapy in Idaho is going to be with us as well. Bart had some family physical issues come up and had to drive to Salt Lake City to help out some family members. He’s unfortunately unable to join us. He brings a great perspective to recruiting, especially bringing people onto his team.

Since he’s not going to be with us, I’m going to share prior episodes that he has been a part of. One of them is related to how to help new grads and join your team specifically. Also, I might as well throw this one in there. One thing that he does that is unique and drives people to his practice is that he is certified in musculoskeletal ultrasound. That is a big part of his practices. In fact, all the providers are expected to be trained in musculoskeletal ultrasound. That’s the way their practice operates. It is a recruiting method that he uses to have people join his team. Since he can’t be here, check those episodes out on your own time.

We’ll go ahead and get started. Let’s dive into it right away. The first question I want to start with and ask both Adam and Brian specifically is, how is the state of recruiting in 2026 different from what you’ve experienced over the past couple of years? Is it getting harder? Is it getting easier? What are some of the barriers that maybe you’re seeing in the last few months or the last quarter of 2025 that are relatively new for you? I’ll start with Brian.

The State Of Recruiting In 2026: Challenges & Decreasing Labor Force

The challenges of recruitment in 2026 continue to persist as we’ve seen in the last few years. It’s not getting any easier. If you look at the data, the demand for PT services is very high, yet the labor force is decreasing. There are a few reasons why I think that’s happening. In the last couple of months, I’ve heard of two of our clients who are closing some of their clinic locations, not because of lack of patient interest, but a lack of staff, which is something that I haven’t heard before.

We continue to see candidates having very high leverage in terms of what they’re looking for and the ability to advocate for their career path. With all groups, we recruit for hospitals and skilled nursing facilities. We do a lot of work with private practice as well, but it seems like the private practice setting has seen the most challenge in terms of recruiting.

I’d like to dig deeper on that, but I also want to get Adam’s take on that before we get into any tangents.

I would echo that. Brian probably understands recruiting from a national perspective. You mentioned a little bit more data. I don’t necessarily have that type of perspective. I just know based on my experience. I’m also the person who loves to recruit. It’s one of the things that I enjoy doing. In 2024, I had a great year recruiting. We grew our team exponentially. We hired eighteen therapists in 2024, which was such a huge win for us, but I didn’t feel that momentum carry into 2025. For whatever reason, it slowed down.

You were doing the same things at the same volume, and you weren’t getting the traction that you were before.

Adapting Recruiting Strategy: Shifting From Volume To Value & Offer Enhancement

We weren’t getting the traction. That caused a little bit of concern for me, a little bit of pain, and a little bit of like, “This isn’t going to work.” I started feeling a little worried about, “How are we going to do this? How are we going to continue to keep the company afloat if we can’t hire?” That pain drove me into diving into a lot more about how to get better at recruiting and how to not just hit the volume and the outbound numbers that I need, but how to get better at recruiting. Echoing what Brian mentioned, candidates have more leverage. Finding even better ways to separate ourselves and create valuable, competitive offers that weren’t only tied to money was what we had to learn how to do. I see it as a more and more competitive landscape.

You’re having to change some of the things that you’re doing a little bit compared to what was successful in 2024.

We had to get better.

It’s not necessarily getting easier is what we’re hearing. It’s getting even tighter. We’ve got to approach things differently. I will tease that towards the end of our call, Adam is going to share an opportunity for you to work with us, and especially him, on creating your own recruiting strategy. He’s going to talk a little bit about that later on. Make sure you stick on for the entirety of the call because he’s going to share an opportunity to help you create your own strategy where you walk away with your own recruiting playbook. We’re going to talk about that a little bit later on.

You have, though, been a little bit more successful in 2026. What wasn’t working in 2025, you had to alter in 2026. You’re doing something a little bit different. Do you want to share a little bit about what you’re doing then? Tell me about the process. You figured out, “I need to do something different.” Where did your mind take you after that?

In ‘25, we had several interviews. For the first time in a long time, we had candidates telling us no. We had candidates telling us, “That’s not enough. We need more.” I was like, “What do you mean? We’re awesome. What are you, Crazy? What’s going on?” You can only get so many noes before you start thinking to yourself, “Maybe we can get a little bit better. Maybe there’s something we can do.”

Overall, my strategy in 2024 was to be loud. I was getting in front of as many people as I possibly could, going to all the career day events, sending out emails, and promoting. I was doing as much as I possibly could. I was creating a volume of noise in the marketplace that would make me undeniably present, and that worked.

If you haven’t listened to anything Adam has done, he’s serious when he’s talking about volume. He punches out volume on social media, DM-ing people, and chasing people down. We call it semi-stalking. He is reaching out to people on a volume that you wouldn’t imagine. We’ve talked about it many times on the show, so please reference the show. Look for Adam talking about marketing. It is volume-based. It’s hard not to see Adam if you are an available physical therapist or occupational therapist, or speech therapist that he’s trying to recruit.

The game was volume. As I’m talking through this, I’m good at sales as well. If there’s a candidate that I can get in front of, I usually convince them to at least hear me out. One of the things that I wanted to focus on in 2025 was learning how to remove myself from the process. How do I not have to be in so many interviews? How do I train my team on how to recruit without me being president? I started to see the numbers flatlined.

A lot of it required me to dive in a little bit deeper and play not just the volume game, but get clear on how we’re extracting value from our offer and maximizing the value of our offer. Using very specific language that highlights the value of our offer in our outbound attempts, marketing, and promotion to maximize conversions, and then training our team on how to sell our culture, vision, and values in a strategic way has started to help people convert a lot better going into 2026.

Leveraging Unique Strengths To Create An Irresistible Offer

You dove back into what makes your clinic unique, what makes it special, and what its strengths are. For some people, that can be hard. As I’ve said before, when you’re in the picture, it’s hard to see it from the inside. People talk about how it’s hard to find the strengths within their organization. As an outside party, I can look at their clinics and say, “You’re in an amazing area. You might be in a small town, but there are plenty of people out there that want a small-town atmosphere. You are not in suburbia,” where your clinics are. You can speak to that.

You doubled down on focusing on the strengths and benefits of working in your company. That could be culture, the environment, and the opportunities. You focused on those. It sounds like you doubled down on your ads. You call them your offer. That offer extends past just the ad for it. It also speaks to the verbiage and the things that you’re highlighting in your communications with those people.

I love how you said you can’t see the painting if you’re in the painting. It’s so true. We see this in our teams when we’re building our leaders. A lot of the people on our team don’t understand their own strengths. If it’s a strength, that means you’re good at it. That means you do it all the time, and you’ve normalized it to yourself.

It becomes natural. It’s nothing extraordinary.

You naturally start to devalue your normal strength because it’s normal to you. We normalize it, thinking, “I’m a physical therapist,” but there’s so much you can extract from being a physical therapist. There’s so much value that, for the right person, it is extremely valuable. Part of it is getting excited again about your offer. When I say your offer, it’s what you are offering these candidates. Why should they choose you? Why should they choose you over the hospital, home health, or whatever?

We have to define the why. It’s usually found in the unique strengths and attributes of your company that you have normalized, and are hard to see. It takes a little bit of mindset work to extract that value. It might be worth working with a coach or doing some reflection exercises. Once you start putting some language to it, you’re like, “We’re in a pretty cool place.” That can get you excited about going to the marketplace and sharing that with the world.

Brian, don’t be afraid to jump in anytime here. When someone comes to you, how do you help them do that? How do you help them see what their strengths are? You’re a third party trying to promote these clinics. You’ve got to find out what those strengths are. How do you go about helping them extract those things so they can best promote themselves?

One thing that Adam said that I liked is that focus on areas of strength. A lot of our clients tell me, “I can’t compete with the hospitals. I can’t compete with X, Y, and Z.” You’re probably right. If you’re competing, it’s like, “Where are my areas of strength? Where am I unique? What can I provide as an employer that the big employer can’t?” There are things that you can do better than a larger employer. For example, more flexible work schedules.

We had one client who was offering a Tesla as a sign-on bonus for their company. Another client had a condo in Hawaii. They were offering that as a benefit to join the team and have access to this shared condo. These are examples of things, but there are areas as a small company that you can excel in, versus the larger companies that have to be more strict and uniform in terms of how they approach things. That’s key. It’s to recognize where your strength is and where you’re unique, play into that, and then find your tribe of candidates who are looking for that.

In reality, a lot of PTs and a lot of new grads are gravitating towards the larger companies. I heard some stats from our PT school partners, where a large percentage of PT students are never hitting the open job market. They’re accepting a job from one of their clinical sites. That’s been a change that’s happened. We used to see a big bump in the new grads’ season of new grads hitting the job market. All of a sudden, influx of new grads is all eager to talk to different employers. A lot of students are accepting a job from clinicals and then never hitting the open job market.

Importance Of School/Student Involvement (Clinical Sites, Career Fairs)

That’s important to highlight. That tells me that if part of your recruiting strategy does not include your involvement with the therapy programs that are around you within your state, or maybe your alumni program where you graduated from. You might be out of luck if you’re waiting for me to come around and talk to the graduates. You need to be at the career fairs. You need to be taking interns. You need to be taking students. Otherwise, you’re never going to see them, is what it sounds like.

That’s true. Also, the percentage of students who already have a job at this point is quite high. A lot of PT programs graduate in May of each year. Even in November 2025, we hosted a career fair at a PT school. We had 2 or 3 students there who are graduating in May, but in November, they already had their jobs lined up. They already decided where they were going to go.

It’s faulty thinking to believe that we can go to a career fair in April and hire someone in May. We need to start those relationships super early. The larger companies have whole teams of college outreach professionals who are helping navigate that process. I don’t think you need to necessarily do that as a private practice, but you should have your eyes on the schools for sure and how you can add value and be a resource for students.

The other thing we have to be clear about is you have to accept the fact that you can’t compete with these hospital systems on salary and benefit. If you’re talking about what we traditionally call benefits, such as health insurance and salary. You probably won’t win that game. Adam, you probably accepted that fact.

Brian, I had this visual where you were talking a little bit about competing with hospital systems. If you were trying to compete with a fish in a swimming contest. You’re not going to win. I am never going to win that game, but I can run and get a fishing pole. I can do other things that a fish can’t. The truth is, we overemphasize the significance of money to these candidates.

I’m not saying that it’s not important because it is important. It’s of great importance, but the truth is that there is real value in other areas of your offer that people would be willing to sacrifice if you could explain it to them and tie it to other needs. It’s not about getting every single candidate possible. It’s about getting the right people who find value in the things that you offer.

That can take your pie from 0% to 6%, and that 6% is your lane. You can become good at that 6% every year with every new grad class. That could be enough to keep you going. It is getting clear on where your competition is and then also getting clear on where your competition is not. Your job isn’t to necessarily pull everyone in. Your job is also to push away the people who don’t fit your company.

If somebody comes to you, Brian, as an example, and they’re like, “I’m looking to make $100,000.” My next line is, “You’re not going to make that here. I want to be clear. If that’s your primary thing, you can’t make that.” I’m pushing those people away. I’m disqualifying them. I’m like, “You’re not going to make that here because here are the other pieces of value that we like to emphasize. If you feel like those aren’t important, then you probably are better off at the hospital system.”

Equipping yourself as an owner with that clarity is key because you get to serve that person. That person was never going to work out anyway. Guess what they’re going to do? They’re going to go tell all their friends about the other thing that you have, and they’re going to invite them to interview with you. It’s two things. It is getting clear on what game you are competing on, getting clear on what game you’re not competing on, and being bold and explicit about that.

To provide some social proof, you’ve changed your offer a little bit. You’ve doubled down on what your strengths are at your clinic. Adam, what has been the result of that over the first couple of months of 2026?

Five therapists.

In two months?

In 2 months, 5 therapists. To be clear, one of them is a PT. I didn’t start recruiting on January 1st, 2025. The new rollout started in Q4 of 2025. It took a little while to get the pipeline full. It was a lot of relationships that I had invested in 90 days prior that led to the result. It has given me so much more excitement. I don’t have to worry about recruiting now. I can focus on marketing and getting more patients in the door, or something else. That is a burden that is off my shoulders. It’s very freeing to know that that doesn’t have to be the restraint for me in 2026. That’s what I’m most excited about.

Kevin asked a good question. What was the exact change in your message that took you from 0 to 5 from quarter four to now?

It’s going back to pulling the value out. For me, my business, and my practice, we have PT, OT, and Speech. We have a multidisciplinary practice. That may sound like a normal thing, but wouldn’t you love an opportunity to work alongside in an outpatient clinic with not just PTs? You get to collaborate with OTs and speech therapists who are serving your patients as well. I’m adding value to it. That’s number one.

Not only that, but we have a pediatric team and an adult outpatient team. You get to treat patients from birth to the end of life. You have a dynamic opportunity. We’re going to work with you to build the caseload that you like. You’re not going to get stuck with a bunch of pediatrics. We have options for you. How cool to be able to provide that level of autonomy?

That is another value add. Not only that, but we’ve integrated an AI scribe where you get to walk out every day with notes completed. Evals are done in five minutes because we value work-life balance. That’s what you can get here. Kevin, that’s a little bit of language that a lot of you probably have. Positioning it in a place of value is the only thing.

It sounds like that’s what you’re doing. You’re taking characteristics that your clinic already has. You’re not creating something new. You’re taking what you’re already doing and repackaging it. I think that’s great.

The interesting thing about it is you present that to me and I’m like, “I don’t care about any of that stuff.”

You’re not going to work for me.

I’m not that avatar, but there’s going to be someone who is. There’s got to be someone who would fall in love with that opportunity.

Sometimes, people have a hard time tapping into their value. We have a new grad twelve-month mentorship program where we will meet with you every week to help you clarify your twelve-month goals. You’ll meet with a mentor to work through your first year as a new grad. Highlighting that is another thing. A lot of you guys have very cool programs like that in your business. There’s real value there.

A lot of people who are tuning in have expertise that they are willing to coach and share. I’m pretty certain, Adam, that your “mentorship program” was built out quite significantly with the help of AI, if I’m not mistaken. You put a lot of your language into AI of what you want to see in your mentorship program. It probably built out that twelve-month program for you. I don’t know your answer, but I’m assuming that’s what you do because I know you.

It doesn’t have to be complicated. Here’s the thing. If you meet with a new grad twenty times a year, one-on-one for an hour. Is that worth $5,000? It’s got to be worth $5,000. You’re lowering the gap by $5,000 against the hospital offer. It’s got to be worth $5,000. There’s real value there.

Other benefits that could stand out, especially compared to some of those larger entities, are leadership opportunities, a path to leadership, and growth in the organization. If you can show leadership development program over a period of time and give them examples like, “So-and-so started with us two years ago. Now, they’re a clinic director and are overseeing this many people.”

I wish Bart were on because he has been able to leverage a student loan repayment program, which is super valuable for anybody coming out of school. Under IRS codes, you can pay up to $5,250 per year towards someone’s student loans tax-free to them. You could pay more. You could pay $10,000 or $20,000 on some schedule, but the first $5,250 is tax-free.

There are some stipulations. You have to have some written program, and it has to be available to all providers. You can’t discriminate only to higher paid ones. It has to be available. I know Bart uses that quite a bit as another benefit that anyone could offer. Thinking about things like that, Brian, do you want to add on maybe other benefits that you might see that traditional owners could share with their new hires?

Alternative Benefits Beyond Salary (Stipends, Transparency, Loan Repayment)

A flexible schedule is key. Professional development and CEUs mentorship. A lot of newer grads are interested in a residency program, so that might be something. It seems like there’s a push from some of the PT schools to consider residency as an option for a new grad. If you can explore that and see if that fits in, that would be an area worth exploring. Structured mentorship is key.

We talked about student loan support. You could do anything as a benefit. You could have a wellness stipend where on each paycheck you have an extra $100 that’s earmarked for wellness. We’ve had clients who take money that they would have as regular pay, and then they have the stipends listed out on the paycheck, so that you’re having that as a benefit. There's a technology stipend. You can use this money to pay for your cell phone. It’s regular pay, but when you call it out on the paycheck in these different buckets, it gives you an opportunity to sell that to candidates as a benefit.

Also, it gives you the chance to address where you may be weak. For example, a lot of our smaller clients don’t have their own health insurance or group health plan. They’re like, “We don’t have a health insurance plan.” That’s what they tell me. I’m like, “Would you consider adding a stipend on your paycheck that says Health Wellness Benefit? All of a sudden, you don’t have a group health plan, but you have a health wellness stipend that is on your paycheck. You’re able to check that box.

One other benefit that is possible, but that a lot of larger companies are afraid to do, is transparency and compensation models. This could be an area that we might want to talk further about. A lot of larger companies are very afraid of wage equity and where people are getting job offers. There’s a lot of secrecy in compensation. If you look at jobs that are posted, you often see a wide range. It could be something like, “This PT position pays anywhere from $70,000 to $110,000.” It’s like, “Thank you for sharing that wide range.” What if you looked at doing something different? What if you were more transparent in your compensation?

I had a client with whom I spoke. She pays all of her PTs a flat rate. Every single PT earns the same amount of money, but then there’s incentive pay based on performance. In some ways, I like that model because from a recruiting standpoint, it’s easier if you can be transparent on the compensation side. That could be a huge benefit that would travel throughout your company. It’s like, “We’re going to be the most transparent company that you know of.” A lot of newer grads are especially looking for that.

You’re going to attract those people who aren’t afraid of being busy or productive. To Adam’s point, not everyone needs to be aligned with you. You’re focused on the people who are aligned with you, and you want to talk specifically to them. I could see that. I’d assume there’s plenty of opportunity to maybe have some more flexible bonus systems and whatnot that a larger company couldn’t do. I don’t have much exposure to hospital programs, but I’m assuming that smaller clinics have bonus opportunities that might not be available at the larger facilities.

There’s certainly more creativity as well among the smaller companies.

Adam, in your offer, you brought up leveraging AI for documentation purposes. I saw a post on LinkedIn. They had come back from a combined sections meeting of the APTA in California. That conference tends to have a lot of students and academia present. What one person noticed was that there were a lot of students asking at the different booths about how they are leveraging AI in their companies.

Brian, you talk to a number of people who are coming to you. As you’re trying to connect them with owners, are you seeing that? Are people asking just yet? I’m assuming, with AI being a buzzword, that especially college graduates are going to be looking for places that are a little bit more on the leading edge of leveraging AI for the benefit of their company.

Honestly, that sounds like a good question that a candidate would want to ask an employer, but I haven’t seen that. It almost seems like when you’re interviewing for jobs, and you’re supposed to have a set of questions that you ask the employers. It’s like, “Tell me about your culture. Tell me about X, Y, and Z. Tell me your mission statement.” It sounds like a good buzz question like, “How are you using AI to enhance patient care?” To me, it sounds like a fluff question.

The biggest benefit that I’ve seen, and we’ve had clinicians ask us about this, is the AI documentation. That is taking off quite a bit in terms of time saving. The thing is, with students, they haven’t had the drudgery of doing documentation. They don’t necessarily know why AI documentation is so much better. It could be a selling point, but we haven’t seen it like that.

I could see where not just using AI documentation to support doing those notes, but also leveraging AI to make sure that your notes are compliant. It could be something that people want or appreciate the confidence that that gives them. Their notes aren’t going to be brought under certain scrutiny because they’ve leveraged these kinds of AI programs.

Addressing Productivity Expectations & The Role of AI In Documentation

The biggest concern among new grads is productivity, which we haven’t spoken about yet. Using AI and implementing it for time savings could help with balancing your day and being productive. If it’s positioned in that regard, that’d be helpful.

Tell me about your conversations, maybe not just with new grads, but also with other people. What are they asking about in terms of productivity? Is there fear there? What are they asking? What are they saying?

PTs of all experience levels are looking for quality time with patients. The gold standard for that is one patient per hour. No double bookings, no aids, and no assistance. It’s 8 hours of work, and you have 8 patients a day. That’s what the most comfortable model is, at least what people think it is. On average, we see our clients for an eight-hour day. We usually have 55 patients per week full-time. That’s approximately what we see. We see that from small companies and even large companies. We work with very large employers, and they’re saying that’s what the average is as well.

In reality, with reimbursement and different factors, we have some clients who are seeing a lot more like in California or New York. There is some localization in terms of what candidates are finding acceptable. Ultimately, because of the number of jobs that are out there, PTs have lots of choices, and they can be very specific about what they want and who they’re willing to spend time with within the interview process. If you’re able to share your documentation process, share your expectation for productivity in the job advertisement, and be transparent with that, it can be a big help.

Adam, what has been your experience as you’re talking to people, whether it’s about the leveraging of AI and/or productivity during those conversations?

I’ll piggyback off of Brian. Most of them don’t even realize that AI is a real thing. They’re not fully aware. For instance, I interviewed a new grad, and she was blown away by the AI. She had never heard of it. She was like, “What is that? I’ve never seen that before.” That was a cool experience to be like, “We’re cool.” For most people, that’s not a leading thing, at least from where I’m at.

As far as production goes, we’re right there on the average that Brian mentioned. In our practice, we’re at 55 a week. Most candidates that we talk to feel like that’s fair and appropriate, at least the ones that we attract. We don’t have a ton of pushback. Every now and then, we may have a little bit of pushback. This goes back to having clarity around who belongs in your business and who doesn’t. I love it when I hear people, especially our clients saying, “If you have a problem with that number, then you’re probably not going to be a good fit here because this is what it is.”

When your team tells them that?

When I even hear some of our clients push back against candidates. I think that is needed. That is our way of balancing out the market a little bit. It’s like dropping the low-paying insurance. I don’t mean to make that weird, but you’re not built for everyone. Have clarity around the types of clinicians that do well in your practice, not just from a value perspective, but from a productivity expectation, and be clear on it. Define what that is, and then don’t go below it. It’s either that or help them find somewhere else to go. Maybe they need a move to do a cash pay practice or something like that.

I see a lot of owners get in trouble when they start to make emotional decisions around hiring. They try to bend a little bit on productivity expectations and give them a little bit more money. They’re like, “Hopefully, somebody will work for me,” and they end up getting in financial situations that they can’t dig themselves out of. That’s where the clarity comes in.

We had someone post about that in the Facebook group. It was, “I gave this person what they wanted financially. It was a little bit more than I expected to pay, but I was anxious to bring them in. Lo and behold, after training them for four weeks, they found another place that paid more and left. All the training and time went down the drain.” If it’s going to be about a numbers game, like strictly, “How much money do I make?” You can’t win that game.

You can never satisfy them.

They’re either going to keep coming back to you for more money or they’re going to find another place that’s going to pay them more. You can’t appease everybody.

That is so important. It doesn’t mean you’re mean or a bad person. It means you’re a responsible owner, and you are clear around the finances. To give you guys a quick example, I appreciate candidates who are willing to come in, negotiate, strengthen their position, and try to get the best offer that they possibly can. I love that. Also, there’s a budget for that, and it’s my responsibility to know what that is. I had a PTA that we hired. We made an offer, and she wanted more money. She came back and said, “I want more money.” It was significantly more money.

I simply told her, “No. This is it. I’d like to know within the next 24 hours if this is a good fit. If not, then we have other candidates that we can interview. Please let me know the best way to proceed.” The next day, she was like, “I’ll take it.” She’s awesome. We love her. I’m going to help her try to earn more money with us. It’s important to start that relationship off on a very clear, transparent start. It’s how to build your culture, not to get on a tangent. The clarity around the offer is important.

That’s a good lead. It might be a good time for people who might have to get off at the hour mark to talk about what we’re doing in April 2026. What Adam described is that he’s not afraid to have that conversation with that person because he has this recruiting engine. He has leads and candidates that are always there. It puts you in a position of power to have that conversation with a person that’s coming at you, or have a conversation with someone who’s not aligned with you value-wise. They’re maybe a cancer in the company.

You’re afraid to let them go because you don’t know how you’re going to replace them, or that means that you’re going to have to step in and see patients. You have business things to do, and not see patients. You withhold having those conversations and holding them accountable because you don’t have this bench to pull from. That’s where the power comes from, having a bench and having a recruiting plan and strategy in place. Talk to us quickly before people take off at the hour mark, Adam, about what we’re doing in April 2026 regarding recruiting.

If there’s one thing that you can do to go to work every day and lead your company from a place of insecurity and fear, it’s not knowing when your next candidate is going to come. You need your team more than they need you. That’s hard. It’s not that we don’t value the team, but if you’re in that position and you feel like the next time somebody quits, you’re going to be buried in the business. You want to try to avoid that and I would love to help.

On April 17th, 2026, we’re going to be running a one-day full virtual event. It’s going to be the first time we do a virtual event. It’s going to be called the Clinician Magnet Intensive . This is not going to be another webinar. This is a webinar. This is more of a general conversation. What we want to do is help you walk away with a custom, specific playbook for your practice.

We’re going to help you have a very clear avatar that fits inside your practice and help you build an irresistible offer for them. That’s numbers one and two. Number three is we’re going to show you what it’s like to build that outbound system. How do you get excited about what you’re offering and get it in front of as many people as possible through emails and DMs? How do you automate that process? That’s building the outbound process.

Number three, I’m going to give you some AI tools that you can use to help you build scripts, email campaigns, sequences, and everything you need to plug and play all of your outreach to these candidates. We’re going to give you an interview framework to help you close the deal. We’re going to give you a practice branded playbook that is very specific to you.

All of that to say, the goal is for you to be able to walk away from the webinar with the full playbook. You can go up to your admin team on Monday and say, “Here’s my playbook. Start it.” They should be able to run it internally for you. We’re doing that on April 17th, 2026. There are early bird tickets. Early bird tickets are going to be $397 if you register early. After that, tickets are going to go up to $597. You can also order just the recording. If you don’t want to attend live in person, you can order the recording for $259.

Here’s the guarantee. I’m putting a ton of energy into this. This is exactly what we’re doing in my practice. If you guys can’t tell, I’m super passionate about recruiting. I want to help you guys win. You can solve this problem. I want to make sure that there’s value here. If, during the webinar or by the end of the workshop, you feel like you don’t have a specific playbook that you feel very confident about that you can run internally without blowing up your time. Email me before the end of the workshop. I’ll give you all your money back, and you keep the playbook. I want to make this a no-brainer for you. If you’re interested, we’d love to have you in there and show you how to win the game of recruiting.

We’re excited about it. Not because it’s our first virtual event, but because we’ve done these smaller workshops in the past. If you’ve been a member of those, those have been super valuable. For this, we wanted to provide an opportunity where people didn’t have to travel to get the value out of it. It’s an all-day event. We’re starting at 8:00 AM and going until 3:30 PM. That's probably mountain time, depending on where you’re at time zone-wise.

At the same time, this is going to be a lot of handholding by Adam. It is going to be, “This is what I do. I’m going to open up my computer screen. This is my CRM. This is how I track all my leads. Let’s go to LinkedIn. This is how I message people on LinkedIn. This is how I find people on Facebook.” There’s going to be a ton of handholding because talking about it in this webinar can give you some ideas and some inspiration. Some people still want the like, “How do I do it?” That’s what April 17th is going to be all about.

If your State accepts it, we did get 5.5 contact hours approved by the Louisiana Physical Therapy Board . I’m sorry to my OTs and speech folks out there. I’ve had a hard time getting approval from your other boards, but it’s not for lack of trying. If you have any help that you can give me in getting a continuing education approval for something like this through the speech and OT boards, I’d appreciate your help.

Adam is going to do a lot of handholding. There’s going to be a walk away like, “This is what I need to do as of Monday. Step one, do this.” It’s going to be step by step. We’ll work you through that so you have your individual playbooks. We are excited about it. Brian, I wanted to ask you. Where are you finding candidates. At what scale are you having to promote positions that are available to start generating a lot of leads?

Strategic Sourcing: Optimizing For Inquiries, Resume Databases, & Geotargeting

What we’re doing is trying something different and we’re shifting from optimizing for job applications to optimizing for candidate inquiries. I’m working with my clients to understand the difference there as well. From a recruiting standpoint, it has always been optimizing for job applications from candidates who are submitting their resume and a cover letter. With the shortage of PTs and the challenges with recruitment, we’re looking at how we can optimize for candidate inquiries and have that be the goal. Inquiries are the first stage in having a candidate who’s interested.

From a sourcing standpoint, there are two different sides in terms of where candidates are coming from. One is that they're coming from job ads that we’re posting. When you look at job ads, for better or for worse, Indeed is the primary platform where candidates are coming from. As a secondary source, we see LinkedIn, Google, and ZipRecruiter. Beyond those, Indeed is the primary one. We’re not seeing much with candidate sourcing coming in from ads.

The other side of the coin, and I know Adam has done a lot of this as well. We can post the job and hope that the right people see it or we can get more strategic around figuring out, “Who are the PTs that live near my work location? How do I contact them?” In reality, when you’re posting a job, you’re hoping that those qualified PTs near you see the job ad.

PTs are not typically relocating for jobs. They’re relocating for personal reasons, and then they find a job as a secondary factor. The idea of a PT relocating to your community specifically to work for you, and that’s the main reason why they’re moving, is not something that we typically see. The idea is to figure out who those local PTs are.

We’re doing that based on geotargeting from the licensure data. We have all 50 States. If you’re a PT, we probably already have you in our database. We’re figuring out, “These are the PTs that live near the work location. How do we go about contacting them via phone, email, text message, or social media?” We’re paying a lot of attention to resume databases as well. Candidates with a resume posted are career-minded. Whether or not they posted it yesterday or three months ago, they’re someone who is open to career opportunities. Resume databases have a huge potential as well.

I love that you brought up the fact that they’re out there, but there are a lot of people who are moving positions within their cities and their states. It’s imperative for us to know who those people are. Back in the day, we had our list of all the licensed therapists that were in the State of Arizona. We could get that from the Arizona board.

Depending on the state, you can get the email address or the physical address. Either way, we were leveraging it. We got email addresses. That was part of our recruiting method, to reach out to the state therapy license holders every month or every six weeks. It was part of our recruiting strategy. We wanted everyone in the state to know who we were and that we were around.

The posts weren’t, “We’ve got a position open.” They were usually more valuable, like what we saw happening in the industry, what we see happening in the state, and what we see happening amongst our clientele and our patients that seem to be valuable. Occasionally, at the bottom, it might say, “If you’re interested in working with us, this is our contact information.” I’m imagining, Adam, you probably know all the licensees in your area pretty well. You probably either connected with him on social media or you have their lists and numbers somewhere

You’d be surprised, though. It’s not uncommon for me to find a new person, even locally. I do a lot.

You usually find them on social media.

I wrote down three things when I heard Brian talk. Let’s start there. Number one is job ads. Do you know what makes job ads work? A good offer. At the end of the day, nobody’s going to click on a boring job ad with no value. I know that there’s a large percentage of people on this call who have posted a job ad on Indeed, spent $1,000 on a sponsored ad, and didn’t get a single click on it, and were like, “Indeed is such a scam.” It’s like, “No, your ad sucks.” There’s a skill to that. If you can get good at crafting your offer, not only will you get applicants, you can put some real money behind them and get even more because they’re converting. I wanted to highlight that.

I don’t have any information in front of it, but we posted 4 or 5 job ads between January and mid-February. We probably spent around $2,000 on sponsoring them. We got 12 to 15 applicants between PT, OT, and speech. It was good, which was not what I was doing in 2024. When you get good at the offer, your job ads become much more convertible. That’s number one.

Number two is sourcing. Brian mentioned, “Where do you find these people?” There’s a skill to that as well. Number one is resume databases and your state board list. LinkedIn is huge. You are owners. There’s a cool site called the NPI Registry . Look it up. You are doing it to make sure that people have active licenses. Go to it and type in your state, and there they are. There’s their name. You can start building a database of people to reach out to. List building in itself is a skill that you’ll learn in the workshop on April 17th. There’s a routine and a cadence to that.

Lastly is relocation. I agree with what Brian mentioned. Most people relocate for personal reasons. However, there is a smaller group of people who are drifters. They’re adventurers. They’re single, and they like to go to new places. They’re open to the idea of relocating to a new place that they’d never lived in for the right offer.

We’ve hired several people who were like, “I’ve never been to Picayune, Mississippi. I see you guys are close to New Orleans. I know you guys have Mardi Gras. I’d love to experience that for a couple of years. What do you get?” They’ll hear me out and move to the area. Highlighting the value that’s within your area is important to be able to attract those people to you. I wanted to make sure I covered those three things because those are three big important things that I have learned from experience that have helped me with my recruiting.

I have two examples. I hope I remember the second one after I finish my first one. Someone in our coaching program was desperate to find an experienced therapist in her very small town in Northern Idaho. I believe it was through her social media efforts after working with us that she connected with another therapist in her small town and developed a social media relationship. It was not to say that, “I’ve got an ad. I want to connect, especially with other like-minded therapists in our town.”

That person reached out to her and said, “Do you have something available at your company? I’m not seeing a path for growth at mine. I’m stuck, and I’ve maxed out. Would you happen to have that?” That was exactly what she wanted at the time. It worked out. She brought her over and was able to move her business forward in a way that she couldn’t do before. She never even considered that some other therapist in her small town would be looking for another opportunity that was unique to her clinic. That’s one thing.

The second thing was that I have a friend who started doing a lot of work. He was connecting on LinkedIn and posting on LinkedIn about his clinic and whatnot. After doing that for a year, someone whom he had connected with on LinkedIn reached out to him and said, “I’ve been watching you for the past year, knowing that I’m going to move to Arizona eventually. I would love to come and talk to you when I come into town about the opportunities that you have.”

That’s the power of social media. Those are anecdotal, but I think they represent working locally, knowing all of the licensees, talking amongst them, and also staying on social media for a prolonged period of time to have your presence shown there. That leads to the second part of my question. At what scale are you pushing information out? How often are you trying to reach out on a daily basis? Adam, do you want to start with that?

It depends on the need.

You’re never stopping.

The answer is as many as it takes. There’s no right formula. Maybe Brian can add some. Brian and mine’s recruiting style is a little different. He might have had a different flavor. Assuming that the offer is good enough, at least above average, and your outbound messaging, meaning what you push out to the world, aligns with the offer in some meaningful way. The only parameter at that point that directly correlates to hiring somebody is how many times you do it. That’s the only other thing you can adjust.

If you commit to, “I’m going to reach out to ten people a day,” and do that for a month and still haven’t booked an interview, you probably should double it. If you do that for another month and still haven’t booked an interview, you probably should triple it. I would continue to go up until I started booking interviews. That’s the best answer that I could give. If I’m hiring for multiple clinics and I have multiple roles, it might be 100 a day. I’d be sending 100 a day. As a low-level maintenance, I would say at least 10 to 15 a week, even if you’re not hiring. I don’t know if that’s a good answer, but that’s the way that I think about it.

Scaling Outreach: Automation Tools & The Balance Between Volume & Authenticity

For me, 10 or 15 a week is heavy lifting on social media.

I want to pass it over to Brian because I know him and I are different on this. That doesn’t mean that I’m doing it, number one, because I’m not sending 100 DMs a day. Number two, that doesn’t mean that I’m not using automation. This isn’t about, “How do I add more things to my plate?” This is, “How do I build the system that allows me to hit the outbound requirements without sacrificing my time and my energy?” It’s about building the system of leverage that leads to the result, not about working harder. Getting interviews booked isn’t a hard work problem. It’s a systems problem. Follow the system, and then you’ll start booking interviews.

I’ll pull back the curtain a little bit. What kind of tools are you using to offload your time and energy?

There are levels to that game, too. There’s a tech stack you can use. At a basic level, you can use ChatGPT with some templates and a copy-and-paste framework. You want to make sure that it’s not spammy and that it has some specificity in it. That’s the lowest level. CRM, and copy and paste.

You’re not doing the copy-pasting.

I’m going to approve the offer, the outbound script, and the outbound cadence. I’m going to approve the thing that represents our company. I don’t want to make people mad. I don’t want to irritate them with a bunch of spammy things. I don’t want to irritate the market or burn my list up. That’s basic. There are some automation tools that you can use. There are some tools, such as an example for your LinkedIn profile, to automatically send DMs on your behalf. You can leverage a CRM, MailChimp, or some type of email outbound platform that can help you drip out campaigns.

Are you still using Dripify ?

Dripify is a very common tool that you can hook up on LinkedIn. Look up LinkedIn Automation Tools. That will keep you satisfied for the next month. There are tons of them out there. They’re very available. You can use those to automate some things.

You can hook up your virtual assistant to do that.

You can get a VA. We’re starting to think of this as more of a systems approach and not like a, “I got to work harder,” approach.

What can you add to that, Brian?

I’ve thought about this a lot and tried as much as we can try in terms of different approaches over the years. In general, the response rate from proactive outbound recruitment messaging is on the decline quite a bit. Back when I started in 2007 recruiting PTs, we would be doing the outreach and the calls. We weren’t doing texts in 2007, but we were doing everything else. We would see a decent response rate. In fact, we would have a ratio where we would have to have 300 people on the list, and then we would be able to get a slate of 3 candidates surfacing from the outbound activity.

As times have changed, my thinking is that people are not responding to that outbound messaging but there are some. I’m more in favor of paying attention to those people who are showing signs of interest. If you have a resume posted, you’re someone that I’m going to be following up with quite a bit because you’re showing me, “I’m interested. My resume is posted online.” Your hand is up in the air waving.

If you’re a PT who’s using LinkedIn, why would you use LinkedIn if you’re a staff PT? Maybe you signed up for it in PT school, but why do you keep it active and updated? It tells me that you’re career-minded. You’re looking to advance your career. If you’re a PT on LinkedIn and you’re actively using it somewhat, I’m going to pay attention to you and follow up with you more often. For the vast majority of people who are on these lists, they’re not responding. There’s nothing that we’ve found that works to get a large number of people responding. It is a numbers game, but it’s about where I can spend more of my time.

I am concerned with spam, like sending out unsolicited emails, sending out unsolicited texts, and calling people who haven’t requested to be on a phone list. Those kinds of things are things that I think about, which I didn’t think about a couple of years ago. That quality of the communication and the smaller tribe of people who are high potentials is much more valuable.

You could automate things. You could have your LinkedIn sending out this, that, and the other. Maybe that would be good because there’s a balance between it being a numbers game, but then also having it be authentic and getting through to people. It’s challenging. That’s where the biggest struggle is. I could email you with a list of 100 PTs in your community, and then you’re going to be like, “Where do I go? What do I do?”

That’s the interesting piece. How we go about capturing people’s attention but doing it in a way that is authentic and also provides value is key. Could you invite people to your clinic and have them do a CEU course? Could you host a Happy Hour in your community and be like, “We’re doing a PT Happy Hour. Come on down, and we’ll buy you an appetizer?” That stuff is awesome that you could do and add some value.

One of our clients did a Happy Hour for some of the PT students in their area. She invited a few different classes to come to their clinic for a Happy Hour. She was going to do a presentation about her specific specialty, so it wasn’t all about hors d’oeuvres and drinks. There was also some value there as well. She was able to coordinate that.

In the same vein, you could host continuing education courses at your place, or maybe even an opportunity for people to come and hang out. I know another friend of mine in New York who gets together every month or every two months with other owners in the area. They go to dinner somewhere. They sit down for drinks at a Happy Hour and talk.

It’s not necessarily to recruit, but the point is to get out, socialize, and get your name out. Find other creative ways to get people to know and like your clinic. We’re coming to the end of it. Is there anything you want to share? Are there any final words that you want to share, Brian, like words of encouragement or things that we might not have covered?

Final Recommendations: Speed Of Hiring & The Importance Of Action

We didn’t talk about this. Adam mentioned the emotional side of hiring briefly earlier. Here is one piece of closing thought that I would give. When I look at the difference between a smaller practice and our larger clients, like a hospital system, for example. I look at their hiring process and how they approach it. The people at the larger organizations are not emotionally driven with their recruiting process. They’re not as concerned about making a bad hire. They’re able to move through that process with more confidence because they don’t operate from that same fear.

The fear that a lot of us have is the process moving at a slow pace. That’s slow hiring process. We didn’t talk about interviewing and that kind of stuff. That slow pace of hiring is what’s causing a lot of candidates to go and accept a job somewhere else. We’re missing out on candidates because we can’t move through that process more quickly. That’d be one piece of encouragement. Think about what your interview process is. When you’ve used Adam’s tools, you have everything in place, and you have someone interested. Think like, “How do I move them forward from that point of inquiry to the job offer, and how do I do it as quickly as possible?”

How do you shrink that time? If it’s a week between connection and job offer, they’ve probably received 2 or 3 offers in the meantime. How do you get that down to 24 hours?

We never know what stage the candidate is at when they surface to us. They may already have 2 or 3 companies that are waiting to get back to them.

It’s more than likely. In this environment, you have to expect that they’re getting multiple offers at the same time that you’re talking to them. Speed is imperative. Adam, what do you want to share?

Get in the game. There’s no perfect way to do this. The best way to do it is to start, figure it out, and make some mistakes. Get in the game and start learning because this challenge isn’t going away. It’s just going to get more and more competitive. The people who have real recruiting strategies that work are going to survive, and those that don’t are going to close.

I would recommend learning. It’s a big learning curve, but you’ll be surprised at how fast you can learn if you get in the game and start. That’s my big message. Don’t be so afraid to make a mistake. Spam some people, and then fix it next time and do it a little bit better. Over time, you get better at it. You have to make some mistakes. The next thing is to extract the value from your offer. Focus there. Start there. Get good at your offer.

The last thing that I thought Brian made an incredibly good point about was the difference between cold outreach and high-intent outreach. That’s an incredible idea. Make sure that you’re finding ways to extract high-intent leads, whether that’s from active resumes, active LinkedIn profiles, people in Facebook groups, or whatever that is, so that you can reach out to the right people. Finally, I promise you that if you come to the April workshop, I’ll make it valuable for you. If you want to solve this problem, I would love to help. Hopefully, we’ll see you there. Some of you have already signed up. I appreciate it. I’ll see you there.

I’ll throw this out there. If you’re not part of our Facebook group, where there are a ton of other private practice owners, then you need to join that as well. We don’t have time here to go into your question, Lisa, because you’re asking about credentialing and how long it takes. That can be nuanced between states, and how to pay them when credentialing takes a lot of time.

What I’d recommend is to post that same question on the Facebook group. I’ll make sure to give you my two cents. Adam will as well, I’m sure. You’ll get a lot more feedback from a lot more owners with their experience in the Facebook group. I’ll direct you that way since we don’t have a lot of time left to talk about that.

I highly recommend everyone look into the April workshop. We’ll see you there. If recruiting is an issue for you, then it’s a no-brainer. You’ve got to be there. In fact, we’re going to be doing it virtually from Scottsdale, Arizona. If you are in Arizona, there are seats to be in person. If you want to travel to Arizona and you like Scottsdale, because it is a super cool place, and you probably need to golf there once or twice in your life, there are in-person tickets available there as well.

Reach out to Adam or me if you want to be in person versus virtual, and maybe write it off on the business, which would be a pretty cool idea. Brian and Adam, thanks for joining. It was a great conversation. Hopefully, we can see more of you guys in April at the recruiting conference. I’ll talk to you guys later.

Bye.

Thank you.

Important Links

About Brian Weidner

Before You Offer Cash-Pay Services: What The Law Actually Requires

Tue, 24 Feb 2026 10:00:06 GMT

Building new cash-pay services can be one of the fastest ways to grow a private practice — or one of the fastest ways to create legal, compliance, and licensing risk if it’s done wrong.

In this episode of the Private Practice Owners Podcast, host Adam Robin sits down with Daniel Hirsch , CEO and Founder of Risk & Compliance Analytics , for an action-packed installment of the Compliance Marathon — a series designed to help owners stop fearing compliance and start using it strategically.

Daniel breaks down what most practice owners misunderstand about cash-pay services — including the dangerous assumption that “cash means no rules.” From Medicare landmines to pricing consistency, documentation requirements, and licensing exposure, this conversation gives owners a clear framework for expanding cash services without putting their practice, revenue, or license at risk.

Together, they unpack:

Why cash-pay services are not “rule-free” — and where risk actually increases
The biggest Medicare mistake owners make when offering cash services
How inconsistent pricing, discounts, and “buddy deals” create legal exposure
Why documentation requirements still apply — even when insurance isn’t involved
How to clearly separate cash services from covered therapy to avoid compliance overlap
What must be transparent: pricing, good-faith estimates, refunds, and consent
Why protecting your license should always come before chasing new revenue
Common gray areas where practices get burned — including “free” screenings
The simple steps every owner should take before launching wellness, performance, or specialty cash programs
How to build cash services that are compliant, defensible, and scalable

This is not a lecture on rules — it’s a practical roadmap for owners who want to grow aggressively and responsibly. If you’re thinking about adding wellness programs, memberships, dry needling, laser therapy, women’s health services, or any cash-pay offering, this episode will save you time, money, and future headaches.

�� Takeaway: Cash-pay doesn’t eliminate compliance — it changes it. Build your services with clarity, structure, and transparency so compliance becomes an asset, not a liability.

�� Want access to Daniel’s cash-pay compliance resources and tools?

Check the show notes for his free guides and templates.

�� Want help building scalable services, strengthening operations, or avoiding costly missteps?

Book a call with Nathan: https://calendly.com/ptoclub/discoverycall

❤️ Love the show? Subscribe, rate, review, and share: https://ptoclub.com

�� Join the conversation and access additional resources: https://linktr.ee/ppoclub

---

Listen to the Podcast here

Before You Offer Cash-Pay Services: What The Law Actually Requires

Offensive Compliance: Moving Beyond The "No" Mentality

Welcome to this edition of the Compliance Marathon, fifteen minutes of action-packed compliance talk. It’s not going to be regular compliance, Daniel. It’s going to be the exciting stuff. The stuff that allows us to make some money and to actually, I don’t want to say weaponize compliance, but go on offense with compliance.

Daniel Hirsch, CEO, Founder, is the compliance guy. He’s the owner of Risk and Compliance Analytics , my favorite compliance guy on the internet. In this episode, we’re going to talk about what to consider from a compliance perspective around adding cash-pay services. We’re just going to let Daniel riff off of that and see if we can add some value. Daniel, take it away. What do we need to know about adding cash-pay services to private practices?

All right, awesome. Thank you, Adam. Thank you again for having me. Last time, again, that was a loaded topic and of course, I tried to jam too much detail into a short amount of time. Rookie mistake. I’ll stay on target, though, and let everyone know what’s necessary before you start offering cash in PT private practice. I love the way you said offensive. It’s 100% true. A lot of times, people think historically, what you think of compliance is like, “You can’t do that.” That’s all you hear.

Too many rules. Nobody likes it. It’s terrible.

The truth is, you just have to stay within the boundaries, and there’s a lot of grey area that you have to navigate towards. This is one of the biggest ones. A lot of times, people are like, “I always lose money on compliance and legal fees. It just never gives me anything back.” The truth is, if your compliance is not helping you expand in your practice, then you need to think differently.

Avoiding The Trap: Medicare Red Flags And Pricing Integrity

A lot of practices are adding cash services right now, like wellness, performance memberships and stuff like that. On the surface, it seems simple. Patients pay directly, there’s fewer headaches but compliance really does matter. The biggest misconception, Adam, is that when you have cash pay, there are no rules. The truth is, in reality, legal and compliance obligations don’t disappear. They’re just differently involved.

Some risks actually increase if the program isn’t really structured properly. The whole idea is that you have to build it correctly. Let’s talk about what rules still apply. You still have state practice acts, the professional licensure, and consumer protection laws. You’ll also have maybe advertising standards and also, everyone knows fraud, waste, and abuse.

The gloves are off. Everyone is talking about that with this administration. If you also treat Medicare and Medicaid, then you have to be very careful because obviously they’re fully funded, they know exactly what they’re doing. The biggest trap when it comes to Medicare patients, I’ll start with Medicare. People think you’re billing Medicare patients for cash for services that are otherwise covered.

It’s a huge red flag when you try to switch somebody to a cash-based fee when it’s a covered service. That’s a huge red flag. Unless it’s statutorily not covered, you can’t do that. You can’t opt out. It’s not like you could just hand off that magic ABN form and be like, “Good luck.” I’ll say this again, Medicare beneficiaries simply can’t pay you cash.

If that’s what you want to do, you should stop and figure out first of all, is it allowed, is it a covered service, and where do I go when it comes to this? Let’s talk about, I guess, pricing. Pricing, we see packages all the time. We see creative memberships and discounts. The biggest issue is actually being inconsistent. The reason I say that is because self-pay pricing, if it’s not clearly defined, has to be documented very well. The consistency raises issues because if a discount looks selective, and I think you know where I’m going with this or discretionary or discriminatory, that could be a huge problem.

There are no buddy-buddy deals.

No, we call that the Boston deal. It can’t be. Practices, they need to have real clear policies to explain the pricing, the refunds, and what’s included. This also means for policies to describe exactly how it works without other exceptions. You cannot discriminate, it cannot be selective, and when you are applying discounts, you need to make sure you are giving a good-faith estimate.

I think we alluded to that a little bit last time. Is that on file? Is it transparent? You don’t want it to be your secret. You may be thinking like, “I’m just going to be offering this really great program, but I’m not going to tell anybody. It’s just going to be this quiet hush-hush.” It cannot be. It has to be transparent. I mentioned good faith estimate. There’s actually a really good webinar that I put out already on my website that really breaks down exactly how to do it, what’s needed, what’s necessary. It takes about five minutes to learn this. It’s very short, very easy. Definitely check that out.

There’s no point recreating the wheel on this. It already exists. The content, the guidance, it already exists. I think most providers understand that documentation has nothing to do with insurance. I get this question all the time. “What about my Aetna? What about my United?” The AMA is defining these codes. It doesn’t matter if it’s cash or commercial or federal.

A lot of times, also, owners will forget that the primary goal is to protect their license. You worked very hard to get this license,and you paid a lot of money. CEUs cost a lot of money. This costs nothing to learn and to grow as a practice owner. These things should be readily available. We’ll actually be speaking about this a little bit more and providing guidance on documentation, coding, and billing.

I think that’s for the next episode. We’re going to be talking a little bit about this with RTM. It’s one of my favorite topics to talk about. For years, really, I’ve been listening to a lot of Medicare auditors and speakers about what’s required in notes. You could even listen to this every month if you want. If you have a hard time falling asleep, you could go listen to these webinars. It’s terrible. Adam, 99% of this stuff is the same regurgitated content over and over again. They’re saying the same thing month after month, year after year. I’ll try to be respectful, but it hasn’t changed. Nothing has changed when it comes to the standard for documentation.

It’s not that complicated.

It really isn’t. You’ll hear staff, you’ll hear owners make excuses all the time of like, “They’re a new grad,” or, “They’ve been out for forty years,” and the truth is, it’s the same. The baseline is the same. There is a minimum requirement that everyone should know, regardless if you’ve been practicing for three decades or if you just got out last week.

To be clear, Daniel, not to interrupt, but this documentation requirement, no matter if you’re Medicare, cash, all of these documents, you can’t take off your PT hat.

The "PT Hat": Protecting Your License While Differentiating Scope

You know what an attorney once told me? An attorney once told me that you can never take off your PT hat. Even if you’re a fantastic yoga instructor, this is just a random comment, but let’s say you want to do some yoga at night in your PT clinic. Guess what? You’re still a PT. You need to make sure that your practice act, that your licensure is being protected. Even if you claim and pretend to want to be doing something else, you can’t remove that title from yourself.

If you want to start offering cash services right now, you need to define what the services are clearly. You have to align your pricing, make sure that’s very clear. You also have to draft waivers and consent forms and you also have to designate services that are outside of what traditional therapy is defined as. You have to know, “This is what my therapy treatment is, and this is what my unique service is.”

They can’t be the same, in my opinion. Also, check with your liability insurance. I know that’s one of the things that most people don’t do and it’s usually because it’s often covered under your insurance, but it takes sixty seconds to find out the answer. It’s always worth just calling your carrier if it’s HPSO or CM, whatever it is. You could just say, “This is what I’m doing. Is it covered under my policy?” They’ll say very quickly yes or no.

A little bit of a cheat code. Just grab your policy, throw it into ChatGPT and ask it and it’ll probably tell you. It’ll probably get you pretty close.

It probably will. The truth is, you probably have some insurance agent, some rep that’s supposed to be answering this stuff. The answer is, if you don’t have it, they could easily add it as an addendum or amendment. Very easy to do. That’s one of the specialties that we do. We draft waivers, consent forms, and we make it very simple, very transparent. That’s what people need to be doing if they want to have cash services.

It was rapid fire, but I wrote down make sure that you have your consent forms. Make sure that your pricing is transparent, good faith estimates, and also you’ve got some documentation that shows why these cash-pay services are not the same scope as traditional covered therapy services.

Correct, because you don’t want to start entering that space. Once you start entering that space, now you have to deal with other contracts .it just gets very complicated when you’re trying to do something too similar. It’s always better to just go a separate route and say, “I’m distinct, I’m unique and this is why my services are worth X, Y, and Z.”

Operational Excellence: Documentation And Liability Cheat Codes

The next thing is that documentation guidelines are still going to apply no matter if you’re billing cash. That’s a big one. I’ve never really considered that. I’m glad you said that. It’s too easy. Go to your EMR and create a cash service template, whatever that looks like, and make sure that you’re either using an AI scribe that is Medicare compliant or that you’re following the guidelines. The last thing I have is check with your liability insurance company just to ensure that you’re covered on that side as well. Did I miss anything?

No, that was it. That was really good. I wanted to make sure that we were very succinct and concise with this because it’s not complicated. People think someone down the street is doing this or they heard somebody say some crazy thing on a webinar and the answer is, it’s easy to stay in bounds with this. It’s very easy. Is ChatGPT going to help you a little bit?

Yes, but at the end of the day, you still want another pair of eyes that has expertise in this area. This is something where it could take 10, 15 minutes to do. It’s not a huge commitment if you have your idea already in place. You just want to make sure that at least you’re covering your basis to say, “By the way, I don’t want trouble down the road.”

I don’t want some patient coming back to me and saying, “I thought that was insurance, I thought we were using this and then it switched over to something else.” You don’t want that because I’ve seen many cases where someone is saying, “I thought that was a free service that you were offering me or I thought that was a cash service and then what happened? Now that’s being reimbursed?” You don’t want any confusion. You don’t want to rely on someone saying, “I understand you.” You don’t want that. You want it in writing and saying, “This is exactly what you’re getting from me.”

Yeah, so some of the services that come to mind are like dry needling.

Dry needling, you could have laser, you could have women’s health.

Shockwave stuff?

All of that, yes. Even Hypreice, we've seen that people want to do cash services. These are all great lines of service that people can do. The idea is that they should be standalone and they should be separate and distinct.

The Visionaries And The Knuckleheads: Moving Responsibly

For those who are reading and want me to talk a little bit about this, I’m not a compliance guru. That’s Daniel. I do know entrepreneurs, and how you guys think. You guys are knuckleheads. We don’t ever want to stop and do this stuff. We’re visionaries, we want to go, we want to go to the next thing, we want to get that cash-pay project going, we want to rock and roll. It’s such an easy thing to just skip. It’s such a little easy little step to skip, but it also could be the most expensive simple step that you skip. It’s like we want to make sure that you’re rocking and rolling and that you’re moving aggressively and making money and serving patients, but also do it responsibly.

Make sure you have somebody on your team holding you accountable to making sure you're buttoned up legally. I just wanted to share that perspective because that’s you. If you’re reading this, that’s you because we’re all like that. We’re all wired that way. Daniel, really quickly. I know we only have a few more minutes, but quickly, could you just give me a quick little bullet point of where you see companies blurring the line between traditional covered services versus non-traditional covered services? Where do people get in trouble with that grey area right there?

The Danger Zone: Blurring The Line With Wellness Screenings

I always see it on the front end with wellness screenings, where they think they’re being creative by getting people in the door. They’re like, “It’s free.” No, it’s not free. If you’re touching someone, that could be considered physical therapy. When people are transitioning from certain free screenings, that is a huge area that is very expensive.

People will gladly sue when they feel like they’re being taken advantage of when it’s not clear. I’ve seen that many times. That’s a huge area because again, to your point, these owners, they’re thinking they’re going to be creative and this is just a fifteen-minute pit stop to make sure that no unforced errors. You don’t need to drop the ball here.

This is something that’s very easy to do. You could be as creative as you want. If that’s what you’re doing, it needs to be very clearly delineated. If you’re having that free screening, that’s great, but we’re not touching that individual because once again, once you start mobilizing that person or whatever, it falls under a different scope. Very easy to do, but very easy to mess up.

Thanks for sharing that. Episode 2 of a 5-part series. Next time, we’re going to be talking about something really fun and popular. 2026 RTM, Remote Therapeutic Monitoring. We got a pay increase. If you’re not doing RTM, you’re missing out big time. If you’re going to start implementing RTM, you might want to make sure you’re buttoned up on the compliance side as well. Daniel’s going to share some information next time about that. Daniel, thank you so much. We’ll see you next episode.

Awesome. Thank you, Adam.

Important Links

Navigating The Possibilities Of AI In 2026: Realistic Implementations For Private Practice Owners, With Sharif Zeid Of Empower EMR

Mon, 16 Feb 2026 19:00:07 GMT

Most practice owners feel the pressure to “keep up with AI” — but few have real clarity on what actually works, what’s hype, and what could quietly overwhelm their team.

In this episode of the Private Practice Owners Club Podcast, host Nathan Shields sits down with Sharif Zeid , longtime EMR leader and representative of Empower EMR , for a grounded, practical conversation about where AI is truly delivering value in private practice — and where expectations need a serious reset.

Drawing on years of experience working with hundreds of practices, Sharif breaks down how AI adoption is accelerating faster than any technology wave we’ve seen before — and why documentation, scheduling, compliance, and phone systems are at the center of that shift. They also unpack the hidden risks of chasing tools without systems, and why “AI as the solution” fails without strong operational foundations.

Together, they explore:

Why documentation is still AI’s biggest and safest win for practices
How generative AI (scribes, summaries, chart review) is actually being used in real clinics
Why “perfect” AI is the wrong benchmark — and how partial wins still create massive ROI
The growing AI arms race between providers and insurance companies
Where AI helps with compliance — and why trust-but-verify still matters
Why billing automation is over-promised and under-delivered (for now)
The real cost of stacking tools — and how to evaluate ROI per provider
Why team overwhelm is the biggest risk of fast AI adoption
The rise of AI in phone systems, scheduling, and patient self-service
Why patient portals and foundational systems must come before automation
How AI should support decision-making, not replace leadership

If you’re a practice owner trying to decide where AI actually belongs in your clinic — and how to adopt it without breaking your team, your culture, or your systems — this episode offers clarity without hype.

�� Takeaway: AI isn’t the system — it’s a tool. Practices that win will be the ones that build strong foundations, guide the technology intentionally, and keep humans firmly in the driver’s seat.

�� Learn more about Empower EMR: https://www.empoweremr.com

�� Want help evaluating systems, operations, and growth strategy? Book a call with Nathan — https://calendly.com/ptoclub/discoverycall

❤️ Love the show? Subscribe, rate, review, and share! https://ptoclub.com

�� Join the PPOClub community and access resources: https://linktr.ee/ppoclub

---

Listen to the Podcast here

Navigating The Possibilities Of AI In 2026: Realistic Implementations For Private Practice Owners, With Sharif Zeid Of Empower EMR

I’ve got a returning guest, he's been a frequent flyer, Sharif Zeid of Empower EMR . How are you doing, Sharif?

I'm doing great. How are you doing?

I'm doing great. It's so good to have you on again. I know we check in every so often and we've seen each other at the conference, we saw each other at the workshop in New Orleans for the first annual strategic planning. It's good to see them there but it's also good to connect and maybe talk a little bit more about business for everybody.

Yeah, what a blast. Great job to you guys with the event and hats off to all for the continued success. It's been awesome to be a part of it from our perspective and role and getting to come to these events and talk and share our product but also participate and hopefully add some value along the way.

Definitely, and you do so. I really appreciate that. In our conversations here on the podcast and at the conferences, you are a representative of Empower EMR and I know you're ultimately there to invite people to sign on to Empower EMR, but in all your presentations, you provide a ton of value whether it's like I said here or at the conference, so I appreciate that. Thank you so much.

I think the perspective I bring is getting to work with a lot of practices over a long span of time and I think that's really where one of the most common questions we get, like if you think about clinical stuff like the thing with outcomes is always like, “How am I doing compared to my peers?” That's always the question and the same can be extended to financial questions. “Is this a good profit margin? Is this how much a visit should cost? Is this a good reimbursement?” The theme is always how am I doing compared to my peers?

I feel like and I know you have this perspective, too, you get to talk and work with a lot of practices you just see a lot and you see the good, the bad, the ugly and then you see it longitudinally over time where you're like, “What were we talking about five years ago?” What were we even talking about in 2025, 2024 and now here we are in early ‘26 and it's already like just a lot of stuff happening, the space is moving very fast, some overwhelm maybe happening, so there's just a lot going on.

We did have this conversation and you said that changes that are happening in AI are happening even faster. We had this conversation maybe a year, year and a half ago on the show about what people can expect with AI because it was just coming into play where AI was becoming a thing in terms of especially the dictation services that are out there and maybe some billing components related to AI and what not.

Now there's even more coming forward and it seemed like that at PPS there were like AI dominated a lot of the booths, that was the buzzword and of course there's a lot that they say is possible but not sure how functional. It's good to talk to you now and to see, now we're in 2026, with all the change that's happened in a year and a half, what do we have some clarity on what it can do for us for now that could again change another 6 to 8 months. It's good to have this conversation.

AI In Documentation (Generative AI/Ambient Scribe)

I think the pace is definitely a central part of the conversation in terms of how fast things are moving from a year and a half ago. We're a long way out in terms of innovations that have come out already and obviously what brewing out there. I would start by saying some things maybe haven't changed, so let's start with that. The list is fairly short but there's some things.

One is I think AI is this big topic, big thing, but generative AI, which is what most people experience personally and like on Google search or Gemini or chatgpt or whatever your flavor is and that's the like writing, reading, summarizing, those sorts of things, which is what made it a very natural fit for documentation purposes, long a thorn in everybody's shoe.

I think what hasn't changed is that it's really has shown tremendous value in that arena, in the documentation arena. There are flavors of it. The most common one is ambient scribe. You're recording the visit or you're recording a brain dump and this is seeing widespread, I would say, proliferation, a lot of clinics are using it, a lot are not still. There's a lot of opportunity for some to give it a try if they haven't. The technology curve is always early adopters and then you've got that middle.

The Fast Pace Of AI Adoption

Let me just give you like a little perspective historically. EMR for PT came into the world around ‘06, ’07, just to give you like a rough idea, when a physical therapy specific EMR actually existed versus let me go get some hospital system or something like that. The main adoption wave didn't happen until I would say about 2010, ‘11. You had a lot ramping heavily from ‘07, ‘08, ‘09, ‘10, then you hit this curve and say by 2012, most practices had an EMR and then you were on the back side of that curve.

What's interesting with this stuff is that that curve is happening much faster now. Generative AI, scribe comes out, it's a few years old now from the day it was first released and so many practices have done it and it won't take that many years for adoption to complete, I think, because people are seeing it. It's not for everybody. In some settings and some types of care, it's not providing value, at least to some eyes. My personal view is like, don't let perfect be the enemy of better and we talk about that all the time. If it can do half of your notes, it's half of your notes. I get that all the time like, “It's only helping me with a quarter of my notes.” I'm like, “That sounds pretty awesome, like 25%? That sounds good.”

Sounds like a few minutes every day, at least.

Exactly. It's interesting perspectives or expectations maybe is the right word. If it can't do 100% of my notes for 100% of my providers, is it still good? I would say absolutely. Even if it's 25% for 25% of your providers, that's a serious improvement. Now there are other flavors of it, like we offer another concept with our Empower AI and there's just different takes on it.

Where I'm going with all this is the generative AI, the stuff you really know is kicking butt and it is what it does well, like, “Summarize this chart for me,” or, “Read this thing and tell me what it says,” or, “Let me give you a few pointers and then you write it up for me.” If you're not using that, I certainly think it's like you got to check it out at least and give it a try and again, just expect varying levels of happiness and adoption and try and make a decision that's balanced and reasonable and try and take the win, if you can.

You really have to consider who you're working with as well because I know a number of clinics, maybe they have 5 or 6 providers and 4 of them love it, like they would never use anything else, never go back to anything else, and there are 2 people who just can't either can't figure it out or they're just not tech savvy. If they could do it all over again, they'd go back to paper notes. There's no reason to throw the baby out with bath water. These people are loving it, just let them do it and keep going that way and accommodate for your team.

High Expectations & The "AI Wars" (Provider Vs. Insurance AI)

Isn't that true for everything or should it be true for everything? If you introduce a new clinical methodology or method or system or machine or equipment and some take to it and some don't, you didn't hear a lot of people like, “We're going to return the treadmill because everybody loves it but Nathan and he just won't use it with patients, so why should we have it?”

People have a different mindset with technology, so I think that hasn't changed. What has changed is expectations are sky high for what AI can do, so that is interesting because some of it may be a little dreaming and hoping and that's never a bad thing in technology because that's where things come from. Trying to right size expectations for today's world with what it can do, that's one. Expectations are high. Second one is AI wars, I call them, meaning clearly providers, practices are planning to use or are using AI to take a bite out of insurance and I think insurances are preparing to use AI to take a bite right back. Let me give you an example.

It’s already been done to some extent.

No doubt. It's just amplified. Everything is and they have more resources. What else is interesting is they have more data and that's always a powerful tool in AI right because the more data you have, the more patterns you can draw and that makes you more powerful. A simple example of it is like I'm going to have AI call all these annoying insurances and get auths because insurances don't do things until they have to.

They didn't allow for e-claims until essentially it got overwhelming the paper claims. You want to make it as hard as they can until they're like, “It's costing us too much now. Everybody has to do electronic claims.” This is like 10 or 15 years ago now, whatever. Authorizations is so silly they could have made that accessible and driven off of 1990s technology if they wanted to but they're not in the business of you getting an auth being easy. Providers are ramped up right now, practices like, “Alright, here we go. We're going to have you know Nathan AI call and annoy the insurance for an auth.”

I'm curious. I'm laughing in my own head as to how long it will take before the insurances figure out what a waste of money it is to put a live rep on the phone to talk to an AI and then they're just going to pigeonhole everybody back into a very classic technology like just request an auth through this portal or through this mechanism or through a clearinghouse, whatever, they'll figure it out.

The AI wars are interesting, I think it'll come for claims too. It'll be very interesting to see what happens with documentation because, again, looking longitudinally over a long period of time, compliance was a huge issue several years ago. It's like all you went to conferences every talk was about compliance and Medicare audits and RACs and all those things they used to talk about. It faded out a little bit. Certainly, if you're getting audited, it's a very real thing for you but I'm just talking broadly across the industry.

Cost/Value Of AI Tools & Overwhelm For Team Members

The AI wars are ramping up. Expectations are sky high. AI wars are crazy and the third thing I would say is just really trying to narrow down what you actually need and then having the conversation about cost. I think this just such an interesting thing. I’ve been in the space for a long time, so when you're starting a new business, you're trying to find product market fit and what can you charge for this thing. This is all right now the Wild Wild West, like EMR was years ago.

Nobody knew what to charge for it, it was a testing ground and everybody was just feeling around in the dark until it settled in. In the last couple of years, some are really pushing what you can so what you could pay per provider for your systems and tools. I think one of the great interesting things is like where is this all going? Is it reasonable for a practice to pay $800 a month for tooling let's call it?

EMR of course is part of that, but then there's like what if you get three AI tools and you start breaking down this cost and it per provider which is the most I just think most intelligible way to think about it is like, “We're like pushing $1,000 on this stuff. We're pushing $800, $700. Is that right? Is that okay?” Do they really see an extra five patients a month that somehow justifies that? That becomes the push and pull.

The last thing I'd add is the overwhelm is real, I think. Practice owners are obviously trying to rush to stay competitive and find the right tools and so forth sometimes with expectations a little exceeding, like I said, what's actually out there. Your team is still like, “What is happening? I'm drowning in stuff I'm supposed to know or do. It feels like every couple weeks, we're talking about a new system and I can't keep up and so I think I'm just going to do it the way I always did it.”

“I’ll just wait on hold for 45 minutes to get that auth because even though it's probably not efficient, I know I'm going to get the auth and then I get to check it off my list and I'm done with it.” Maybe human nature is not moving fast enough to keep up with AI, but this team concept is so important. A few years ago, recruiting was such a huge topic, I think. Every conference I went to was recruiting. That's faded out, I don't know if what that means but that's another episode.

It's still there. No, recruiting is still a big thing. I think it's become like we expect it. It's just an expectation.

Yeah, like the pain has set in and we have a base level of pain and we accept that it exists.

Honestly, a lot of the recruiting efforts haven't changed necessarily a whole lot over the past year and a half. There are maybe some nuances to it, but I can just say recruiting is still a thing out there.

Don't get me wrong. I don't mean it's not a thing. I just mean it's not a topic. The conferences I go to, it's not the headline was recruiting constantly, so whatever. That is whole another episode for another day. Anyways, people are still crucial to your practice and so if you are going to blow them out with too many tools or too many things too fast all of those things, that's still a real thing and it's even more of a real thing now with the advent of all of these tools and so forth.

With all that said, it is an exciting time. I think it's an interesting time. That's probably a statement that's bigger than just physical therapy software, but it's just we're in this miniature industrial revolution of our time I guess or maybe how miniature is a debate and we're going to have to find out together where it's going to go. That's going to be a combination of what the tech can really do, how other parties react and what the actual uptake is by practices and people. What can they actually implement and what are they just over their heads?

From what I heard a little bit about what you're saying is if you weren't an early adopter into the documentation utilization of AI and maybe even the compliance then these are safe waters now. It's time to jump in and see what you can do. Are you pretty confident in saying that? Leveraging AI for both compliance and documentation purposes, we've got some good systems out there. You can trust them. It's okay to jump in and try to take advantage of it. Are you safe to say that?

Balancing AI Use (e.g., Compliance, Patient Interaction)

Yeah, I think my only nuance to it would be the nuance is what how comfortable are you to jump out of it entirely and give it all to technology? If you think about compliance, you have one end of the spectrum say 100%. We just rely 100% on the tools. They help us write the good note in the first place or they review the note and tell us it's compliant and then there's the 0% which is we don't use any tools, we do hand chart reviews and that's the classic method.

I'm a conservative technologist so I'd probably say maybe 90% is where you should be. Maybe you should still read a few notes and just see if it's all AI junk and is it really good? There are even some tools out there, maybe not for this purpose for HIPAA but just in general, that you can run something through it and it will tell you the percent chance it was generated by AI.

The question you really have to ask yourself is if this goes in front of a reviewer, what will they think? AI is very good at writing a lot. If you're take these 2 words and write 5,000 words out of it, it will do it. Does not mean it's the highest quality stuff. I still think and we're running a business here too and there are some things you don't want to give 100% over to the technology. I also worry a lot about patient interactions getting too mechanized. People are really excited to have AI do all the phone stuff and that's the soup du jour this month and it is. It is super interesting because there are a percentage of calls that are really just not super interesting.

When was the last time you called an airline and had a great phone experience talking to an AI? There's a reason why. You just have to really think about, alright, maybe that's something where AI can handle some of the calls, but when Nathan's upset and he's calling and he's not feeling well or he's not had a good experience he doesn't need to go through AI phone hell. These are small businesses, so I think there needs to be some balancing of this stuff.

I'm just telling you what I think. We continue to develop and we're like, “Alright, this is what the folks are asking us for. Let's do it.” I'm here to talk about my experiences and what I’ve seen out there and this is how I view it and we try and do again try and do similar things in our own business. It's easy to say, “Let's use AI for all technical support.” That's the obvious one for us and then who likes that?

Just beware that when you give it to the AI, you're cheapening it and that can be good if it's a very mechanical thing and it's a very formulaic thing. It's very bad if it's a special thing and you're upsetting somebody or driving them out from your practice and now what? Now you've got to re-earn a patient and that's really hard. That's probably the hardest thing.

I can see from the documentation compliance standpoint, if you're not leveraging it at all, there is a safe space to jump in and use it. In terms of compliance and in chart audits, I would say there's a number of people that are reading right now that don't do the manual chart audits at all and letting AI do at least some of them is a step in the right direction. Don't just sit back and expect it to be 100%. It's the trust but verify.

No, your point is super well taken. If you're not doing any chart reviews, then anything is an improvement from what you're doing now. I jumped right into the nuance of if you're doing chart reviews how many should you still do manually versus not, so very well taken point. Do something, please.

The "Year Of The Phone" (AI For Phone/Scheduling/Outreach)

You brought up something new that's coming on board that we weren't talking about before, that is AI phone conversations and I'm on the same page as you. They seem to be very good and some people say you can't tell if it's an AI phone conversation. I don't know if I’ve been on an AI phone conversation yet but I would be I'd be hesitant to leave that part of what I consider the sales process up to an AI agent or an AI bot at this point. It's one thing for it to maybe do that on your website, maybe you have an AI bot running on your website to answer basic questions and I and I'm totally cool with that.

I know most of the time when I'm when I'm chatting, it might get to a point where it wants to transfer me over to a real person and I understand that and that's fine. When it's coming to answering the phone, outside of phone number, email address, regular address, where's our location, what are your office hours, that stuff, I don't want to leave that to AI.

That's the great debate. People are even talking about having it do outbound sales if we can use that conversation like calling a patient to reactivate them and do these sorts of things. Really interesting. I don't know what the outcome is going to be of those. I don't know about you.

I wouldn't be an early adopter of that one. That'll be a tough one.

I don't know. You also have to draw on your own personal feelings. I don't really answer the phone for numbers I don't know and even when I do, it's not my first choice. My first choice actually is never a voice call. It's actually always my last choice. Is there a self-service option? Is there a way for me to do this by myself? That's where we go back to some more traditional technologies and we're just like, if you're not using a patient portal and pushing it to its absolute limit of what it can do for your practice, maybe it's something to look at and consider if we're pushing on something new without passing a checkpoint that's so critical.

Nathan, the number one thing with online scheduling, when we say online scheduling, we always study the Zoom video to see if the person's having a heart attack. “Online scheduling, you're going to mess up my schedule. No one else can do it my front desk,” all those things. If you want AI to do it, you have to clear those hurdles anyways. You've got to open up. Here's a fun exercise. Just go search up twenty practice websites and look at the varying quality of the website out there on the space.

Some are gorgeous, they look nice and have good information but offer basically no self-service, nothing. Maybe the one that you see a little bit is the pay a bill, but boy it's all over the place with that and the even that most of the time is dumb, meaning it just says how much do you want to pay? It has no idea how much you owe, it just says, “Nathan, how much do you want to pay?” “I don't know. How about $10?” “Okay, we'll take $10.”

To your point about chart reviews, $10 better than $0. If you don't have any bill pay on your website, it's better than nothing. On the other end of the spectrum, we see websites weekly that are 10, 15 years old. It looks very rudimentary, absolutely no self-service, information's old or out of date like what insurances you accept and hours.

I will say this is finally going away, but some still had COVID information like, “Here's what to do with COVID.” Now we're really showing our age. I'm always trying to encourage people to really leverage good tools and some you probably already have and you're just you're running by them because of the AI fury which is understandable. You can't turn on the radio or TV without hearing about it, but push your tools to the limits if you can and self-service is always a good option. This is a long way to come around to phone conversations. I share your sentiment. It makes me wonder.

You talked about phone conversations which is another tool that's starting to develop in AI. You brought up another AI tool that's out there in terms of the scheduling, using an AI agent to help people schedule because I get your point. The last thing anyone wants to do on their phone is to get on the phone. That's a seldomly used app on your phone. If people can go to the website and schedule the appointment without talking to someone, that would be true for a majority of the people even if you have a large Medicare population.

I think having that opportunity there for them to schedule an appointment online is something that you really need to consider. I'd be more acceptable of letting an AI agent access the EMR scheduler and find a time that works for them and schedule that time and maybe reschedule or cancel and that kind of stuff. I’ve done that in other medical facilities that I go to, that I frequent. It makes it very nice to be able to reschedule cancel in an appropriate time frame and have that opportunity instead of getting on the phone and calling them.

That again is something that we weren't necessarily talking about a whole lot before. There was access to the scheduler and what not online, but you made the point before, people are asking about these AI agents that can help people schedule in the clinic but they don't have a patient portal on their website to begin with. You’ve got to step before you run.

Walk before you can run, exactly. I have to because it makes me think. The Medicare population thing, it's just not true anymore. I used to hear that all the time. I still hear it all the time. “We have a lot of older patients.” I'm like, “They're kicking butt on their phones and you should probably just let them do what they want to do and not fall into that old trap.” I'm sure several years ago, those on Medicare may have been tech challenged, but that was years ago.

You're into a whole another decade forward where all new people are on Medicare now and they not came up in the age of phones, that's obviously not true, but it's been integrated into society now since the iPhone. It's legit and don't fall into that trap. I hear that often. By the way, it's like many things. If you make a tool available, again, it doesn't mean 100% of your patient population will take to it and love it, but if you have the pie and you said, “50% seem to be very willing to book online,” you just knocked down your phone volume by 50%.

That sounds pretty good. Maybe you decreased your payment friction and so now you're getting paid online by everybody because they don't have to call and it's just it's not I'm not this is not rocket science. It's just obvious stuff but I think it's good to hear it and to hear it batted around and think about it. Medicare people can use phones. That's the moral of the story.

The question I have for Empower EMR specifically but for most EMRs that people are looking for in general, should they expect their EMRs at this point to have the capacity to allow for that patient portal to schedule an EMR or I'm schedule an appointment or pay online and it's compatible?

I think it's requisite, personally. We launched patient portal in 2018. We were first out the gate with it. At the time, it had two cornerstones of online intake and online scheduling, but even back then, we were thinking about online booking and again, talk about the tech curve on that one. The adoption curve, it's been pretty slow in some ways because of that reticence to give up that front desk power. It's so vital and it's all the same concept which is you're giving up some control for speed and efficiency.

Unfortunately, you want to have as many of both as you can but there's always a tradeoff. It's a classic thing in technology, security versus convenience. If we make it super easy, let's say you just went to Gmail and all you had to do was type in your first name it let you into your inbox, super convenient, not very secure. Very dumb example. This is the same concept here. You have to balance out.

You implement an online schedule and 5% of your bookings are not exactly what you wanted them to be, patient put themselves in at a spot you didn't quite love and your front desk would have blocked them. Okay, it's 5%. That's a common theme now. It’s just perfect being the enemy of better and good and I think on the whole, people will find that if they use some of these things, it's going to be better on the whole. There will be some things that you don't love about it but such is life. A lot of times, talking and going to conferences PPS there's a lot of talk about not having too much on one person because what if they leave your practice?

This is a great example of that you've got to somehow be able to take your scheduling rules and make them formulaic at least to some degree if you want to automate them. If you're over here thinking about AI but you haven't done that over here on a base level foundation, you won't actually ever get there. It doesn't matter how good I am at my job and my team is at building stuff, we cannot figure out what Nathan wants to do and who he wants to treat and why he wants to treat. That's all stuff you got to have some baseline foundation for.

The Importance Of Foundational Systems Before Adopting AI

It brings up what I said before, which is trust but verify. I think a lot of people see maybe they have a lack of system around scheduling or patient collections or even compliance. We were talking about they don't have the systems to begin with and they think that they can then just incorporate AI and that becomes the system and I still don't have to create a system. That is the grind of most small business owners anyway.

I don't have to create the system, AI is just going to take care of it all. I think what you're saying when you use the term foundation is you just don't have the systems to trust and verify that the AI is doing what you expect it to do because you didn't have a system there to begin with. It's important to incorporate the AI and that's fine, but you still need to have a system of this is how we do things and this is how we verify that the AI did it the way we're supposed to do it. For those people who are just throwing the AI into their company expecting it to be the system is an improper mindset.

I agree. This is how I would think about it. People are like, “AI can be your employee. It can be like somebody who works for you and gets it's another person.” Great, if we carry that analogy forward, if I just hired you to my practice and I'm like, “Nathan, can you put together online booking,” you'd be like, “I just got here. I have no idea what you guys want out of this. Do you want to work on Saturdays? Do you want to treat at 8:00 PM? Do you want an evaluation at 9:30 AM?”

How can you use the analogy of which is usually good, not derogatorily like AI will be an employee for you? That sounds really good. I could have somebody without having somebody without the cost of having somebody, but then have these weird expectations that that somebody is going to build your practice for you and tell you what to do with it.

When you ask an AI to do something, it's called a prompt and you have people who literally study prompt engineering. All their job is to learn how to ask the AI to do things. That just shows you that it's a tool in your toolbox but you need to guide and direct it. Yes, just buying AI from some vendor, whatever that even means and whatever product it is, that would be great. If it was like it's just in a box, it's great, but that's just not a realistic expectation.

Will it become a realistic expectation at some point? Who knows? Obviously, some people argue that AI will become sentient and can do all these things. I would say at the end of the day, the practices that win versus the practices that lose are probably still going to be because of decisions made by humans, just smart competitive decisions that are being made assisted by, augmented by, amplified by AI. Not, “I can beat Nathan because I use Claude and he uses Gemini.” That's probably not how I'm going to beat you at this game or stay competitive with a hospital system in my town or whatever other challenges you're facing. Keep your hands on the wheel, I guess, is the short. Maybe the Tesla example's a bad one but somebody's still got to tell this thing where to go.

AI In Billing (Analytics & Automation Vs. RCM Replacement)

I’ve believe I’ve talked to you, I talked to Will Humphreys about it as well, but the integration of AI into billing. How far has that gone that's pretty acceptable so far and where can it go still?

I think right now, I'm going to be totally honest, I see a lot of high-end claims and little to back up what it's actually doing in the billing realm. I think billing is a natural place for AI to be considered because of the volume of data. Huge amounts of charges, units.

It's an LLM onto itself.

It is, infinite stuff. There's a lot of stuff about it can tell you what codes not to bill together. Honestly, outside of the PT space, Athena Health, if you're familiar with them they're popular in the physician realm, they made that many years ago. It was just by studying the eras of a million practices and coming up and then as soon as they plugged a hole and said, “Don't bill these two together,” the insurance responded by saying, “Here's what we're going to do. Bill them together.”

They just changed the rules to make it harder to keep up with. Where I think it is and where it isn't. In billing, I think there's a lot of applicability to analytics, analyze this data set, give me some insights into it, read it for me. By the way, like everything, trust but verify so you can definitely get weird insights from AI and it has a tendency, in my experience, to focus in on interesting numbers but that are not high volume.

A really simple example was looking at scheduling data and it was like, “This is your number one cancellation slot based on a huge set of data.” When you looked into it, there was only two visits in that slot so it imputed a 50% cancel rate because it was 1 out of 2, but there were other slots that had 10 visits in them and had 1 cancel 10%, but it zeroed in.

That's what it does, so you need to be aware of it. With billing, I think that's an area. I do think, again, analyzing large data sets for coding efficiency opportunities is good. You've got twenty codes and the number of combinations actually isn't as infinite as it may seem. How many visits do we see it's 97530s and 97140s and that's the way life is and that's the way it was. I think there's that. Where I do think it's interesting and growing is probably with automation more so taking continuously occurring tasks or regularly recurring tasks maybe the better way to say it and then mechanizing them.

You just brought that up but something that comes to mind is the denials. Maybe it comes back a denial for this code or whatever, maybe AI has the capacity to understand the denial, get the information that is needed out of the EMR and then send that back out without having a human have to get involved and so it could be quicker, faster potentially. Are you seeing that?

I think that's the dream. My question on that is why are they denying? I think most practices that are doing good systems and process for billing on the front end can achieve a very high percentage of clean stuff. Normally, when it goes sideways, it's a fight or it's an off issue. It's not that the patient's name was spelled incorrectly. That's not the main driver say of denials nowadays in comparison to a few years ago. Can an AI pick up on a denial and then call the insurance itself and talk through it and negotiate with them to pay it? Maybe.

I think this is where I think you're seeing a lot of high-end claims, not insurance claims but claims of product what it can do and we've seen this first hand then you get into it you're like, “It doesn't really do a lot of those things or it's very thin.” We like to be very integrous here and we're not going to tell you it can do something if it really can't. If we're stretching the edge of a technology, we're stretching the edge of it.

It is an interesting area. Are you going to have a time where you don't need a biller or billing company in the next four years? I don't personally think so. Let's just use 2030 as a spot. Are you going to fire your RCM company or dump your biller? I don't personally think so. The other reason I really don't think so not just looking at the technology side but a lot of practices, the difference between true success and profitability versus essentially failure or whatever malaise, is that 10% of claims let's say that didn't go well? Who really chases those down? Is that essentially your profit margin?

If you're going to say, “I'm going to fire somebody who I'm paying X dollars a year to save that money,” because that's the main argument for doing it and then you're cutting your nose off to spite your face because those 10% of claims now become 20% and they start going poorly, congratulations, you traded a person's salary for double that in losses. Is that what you wanted to do?

Are there any other any other tools that you're seeing that are being incorporated or on the near horizon that people should be aware of at this point?

My sense is 2026 is the year of the phone. Whatever that even means. It could be patient facing, it could be insurance facing. That's what I'm hearing a lot of and we're seeing a lot of interest around. I think it'll be interesting to see how that plays out but at least in as of January 2026, and this moves so fast, I could always be wrong in two months but usually it stays.

I think that's everybody's frazzled with the phones which I understand and they want to solve it in some way shape or form and this just seems so promising that I think that's what looking at. I think the scribe is super interesting but it's not new anymore. It's not the leading edge of everything. I definitely think the phone thing seems to be what everybody's talking about and who knows? Maybe by June, it'll be something different.

Something that I'm curious about and we'll probably you've taken a lot of time already so I appreciate your time. The thing I'm thinking about is leveraging AI to manage better. I bring that up because two things. Something that I'm doing and something that I'm hearing about. One is leveraging AI to monitor the phone conversations and then provide data on how well those conversations. Not to do the calling or talking but to monitor the human to human interaction on the phone conversation and truly extrapolate what's the conversion rate.

How are these conversations not just recording them but it's also giving you the analysis. Maybe even some metrics behind it as to percentages of true cancels and reschedules and conversion rates and tone and did they follow the script etc., for training purposes and also monitoring purposes. Secondly, I'm working on building out analyses of operations and financials and providing reports again so that people don't have to go into the report section of any given EMR but be given instead something that's pushed to them an analysis of what those reports are actually telling them. I'm wondering how far AI is going down either of those routes. Do you know?

The first one all day long I would say, it's not common in physical therapy but monitoring phone conversations and now applying a rubric of some kind and having the AI score is fairly common in other industries. Frankly, it's fairly common in in the SaaS software as a service which is our space obviously.

Which is pretty common and we're about ten years behind, normally.

Yeah, you get there when you get there but it's fairly common, software companies running large teams. Nobody has time to go listen to 25 demos that somebody did. To your question, yeah, we do that, for example, but we don't do 100%. We want to also listen to some calls here and there and go in and try and really study. I think that is very much in the realm both of possibility and of availability even now. You may have to go outside of the PT space to find somebody talking about it in those terms and maybe it comes part and parcel with the phone thing. The year of the phone is now let's just add on this let's record it, transcribe it, score it kind of thing. That's totally doable.

On the second one, I always think analytics is always such a challenge from our perspective we feel it's drinking from a firehose because it's a constant desire for some new metric or way to look at things and they're positive things don't get me wrong. We're always open to any tool where can we derive some new metric out of it and this is an area where I think AI is interesting and expansive in its ability.

For us, giving you a data set's much easier than giving you a curated figure and I always tell people you really have to think about what the metric actually is from business perspective because this is a great way to explain why AI is good and why you need to think about it. AI can do you can give it a prompt and say, “Go calculate this,” and it will make assumptions because it has to. If you want to have a metric that's meaningful to you, you start off with what's the business case for this? You back into how to calculate it.

I always use this silly example of cancellations as an example. What was my cancel rate last week? Do you want to count it if it was canceled more than 24 hours in advance? Do you want to count it if the guy's car blew up and he couldn't make it and that's actually a no-show? I just use that simple example how it mushrooms into like how are we going to figure all this stuff out?

The definitions of some of these words can make a huge difference into the metric itself.

I think it is interesting and we're excited to see what you have and work with you if we can and on our end. We're always cooking all this stuff. I don't want anybody to misunderstand my comments. I'm giving you my perspective as a technologist and I think I'm always looking for measured and modest meaningful progress because that's what ends up having enduring value. That's how we run our company here.

How can we make things that help people that last and not just check a box for 24 hours and now we're just collecting money and nobody's really using it? I think people should think the same way and be measured and try and keep your team on onboard with you. Don't drop anybody off the side of the train and the train keeps going. Keep everybody in and see if you can't make your practice a little better every day and not flip out and break everything down all along the way.

Thanks for sharing your insight especially in relation to all these recent changes and whatnot. If people want to reach out to you, how do they do that?

We'd love to welcome you to EmpowerEMR.com where you can check out our product. We've been around for a long time and a cornerstone of the PT tech world starting back when PT tech was a covered wagon and now we have these modern space shuttles. For me personally, if you want to find me on LinkedIn , I'd love to connect with you and be a resource for you if I can.

Obviously, we'd love for you to consider our EMR but more importantly, we just want to contribute to the space and that we find that if and when the time is right for an EMR, we hope that that leads you to give us a chance. Give us an opportunity and we'll show you what we have and talk money and pricing and see if we can make it work. That's it for us.

Awesome. Thanks for being on again. Good to see you.

I hope to see you soon and thank you so much. Always a pleasure to be here.

Thanks, Sharif.

Important Links

About Sharif Zeid

120% Over Medicare: The Work Comp Playbook Every Private Practice Owner Needs With Josh Farley

Tue, 10 Feb 2026 19:00:03 GMT

Most private practice owners know work comp pays better — but very few know how to actually leverage it without blowing up operations, documentation, or staff confidence.

In this episode of the Private Practice Owners Podcast, host Adam Robin sits down with Josh Farley, PT , former state association president, and workers’ compensation consultant, to break down what really drives profitable, sustainable work comp programs — and why so many clinics get it wrong.

Josh pulls back the curtain on why work comp is one of the most misunderstood (and underutilized) revenue streams in private practice. With average reimbursement hovering around 120% over Medicare — and even higher in some states — work comp can dramatically improve margins. But only if you understand the systems, players, and rules that govern it.

This conversation goes far beyond “take more work comp patients.” It’s a practical, operational deep dive into how work comp actually works — from referrals and networks to documentation, communication, and clinical decision-making.

In this episode, you’ll learn:

Why work comp consistently reimburses higher than traditional payers — and how to protect those margins
The biggest mistakes private practices make when trying to “add” work comp
How referrals really work (patient-driven vs. doctor-driven vs. case-manager-driven)
Who actually approves care — and why confusing case managers and adjusters kills revenue
Why being out of network can completely block referrals (even when people say they want to send you patients)
How network pricing strategy impacts volume — and when lower rates unlock bigger opportunity
Documentation landmines that trigger denials and delays (wrong body part, scope creep, poor intake)
How to think strategically about work conditioning, FCEs, and higher-level services without wrecking capacity
Why communication — not notes — is the real driver of trust and referrals in work comp
What realistic timelines look like for seeing financial impact (and why this isn’t a “flip the switch” play)
How a diversified payer mix protects your practice as reimbursements continue to decline

If you’re feeling squeezed by traditional insurance rates, unsure how to grow revenue per visit, or curious whether work comp could be a meaningful lever for your clinic — this episode gives you the clarity, context, and playbook to approach it the right way.

��️Learn how to turn work comp from a confusing headache into a strategic growth engine — without compromising care or compliance.

�� Want to learn more or talk directly with Josh? Reach out at Josh.Farley@LighthouseComp.com or call 601-927-3011

�� Want help building a stronger, more diversified practice model? Book a call with Nathan — https://calendly.com/ptoclub/discoverycall

��Love the show? Subscribe, rate, review, and share! https://ptoclub.com/

---

Listen to the Podcast here

120% Over Medicare: The Work Comp Playbook Every Private Practice Owner Needs With Josh Farley

We have a new guest, a new guy, Joshua Farley . We're going to call him Josh. Joshua is a Physical Therapist and a very seasoned therapist, has a lot of credentials and a very diverse background. Long story short is that Josh, you were the keynote speaker at our white coat ceremony when I graduated physical therapy school. That's where I think I first became aware. You were actually the president of the Mississippi Physical Therapy Association at that time.

Yeah, I think it was my first year in that position. Actually, now I think about it, Adam, we started those payment lectures, and I think your class was the first class I did the payment lecture it was messed up because they did it in the second year, which is very hard because you've had one rotation.

We're just trying to survive at that point.

It got lost. I can't believe it was that long ago, though.

That was 2016 or so. I don't know if you remember, you were working at a small clinic at the time and I came and saw you because I was having some knee pain. I was having some knee pain, I was having some funky stuff going on with my knee, I was trying to figure it out. I went to like 4 or 5 different physical therapists to try mostly to learn and figure it out. For those that are reading, I ran into Josh. As I mentioned, he's got a very decorated career, he's worked with big business, small business, he's worked on the legislation side of things.

He's very passionate about the profession, the physical therapy profession. Now he's doing consulting, specifically around workers' compensation, which I know not a lot about. I don't know a lot about it, I'm sure that there's people in this world that don't know a lot about it either. We're going to learn a little bit more about Josh, what he does, how he helps people and hopefully learn how to grow our businesses. Josh, what's up?

Work Comp As A High-Paying Payer Source (Net Rate vs. Medicare)

Good to be on, Adam. Thank you. I really appreciate you asking me and I'm excited to have a discussion around this. I think it's something that everybody wants, the business that everybody wants because it's such a great payer and it really will increase your net revenue. On average, the fee schedule for work comp, and this was in 2020, so you know what Medicare's done, but work comp hasn't gone down like that. In 2020 or 2021, the average net rate was 120% over Medicare. In Mississippi, it was 160% over Medicare. I know Medicare's low, but if you're controlling your costs, you're still looking at you could have and easily have a $30, $40 margin on a visit, which, as a business owner, that's really robust.

It's a lot better than 6%.

Yes, or 6% or 2%, or giving it away for some of these payers. In the clinics when I was on the operational side with some of these companies, what I really went in and did was I started really focusing on trying to get work comp business and working with our work comp sales force. It was very eye-opening that it was much more complex than working with just directly with physician practices because of numerous things, but how a patient gets into the system is you have to understand how that works from a workflow standpoint.

If somebody gets injured, you've got these entities. There's a bunch of different entities that are involved in that care, and you have to be able to navigate those entities to understand where that where that referral is actually coming from. On top of that, you have to understand what your state statute says and your state law says about where they can come from.

For example, in Mississippi, it's patient-driven until they're under a doctor's care, then it's doctor-driven. In Alabama, it's case management-driven. The case manager, so if you're in Alabama and you're going and talking to the doctors about how you'd like to build your work comp business and these are the things that you do for work comp, you're talking to the wrong person. That's the wrong person. You're just barking up the wrong tree.

The other things that you have to understand is you've got to have your infrastructure set up in your clinic, whether it's through your networks, you have to have the right networks in place. What happens is even when let's say it's doctor-driven, these case managers and adjusters are taking care of these patients. What they're using is some of these companies then go into these networks, so like One Call, Align, all of these different networks that they used for cost containment and savings.

The case managers have to use those, the adjusters have to use those because at the end of the day, while we're treating the patient, the business is the client, which a lot of people misunderstand because they're the one footing the bill. You have to get your networks set up to where they can understand where they can actually then use you. We met with a potential client and we went and talked to this big case management group and they said, “They want to use us and all of these things and then they never send us any patients.”

Our first question was, “What networks are you in?” They're like, “We're not in any networks.” We’re like, “They're not going to send you any patients because you're not saving them any money and you're not able to help them because the client is going to be upset that you're not saving them that money and using the network that they've built.” There are things like that. There's the intake process to where you need certain information even looking at job descriptions and looking at what their job was prior to.

Have they had these injuries before? Was this a chronic injury that was exacerbated? All of these things that from a documentation standpoint is really important and then are you documenting the right body part? For example, if you treat somebody and they come in with shoulder and you know Dr. Jones and he sends you a lot of his patients, and not work comp, just private pay or whatever.

You know his shoulder pain is coming from his neck. It's a radiculopathy or radicular pain. What you would do is probably go ahead and treat the neck. With work comp, you can't do that because it's been documented across there. What happens is when you do something like that, it turns around and kicks the claim out and causes everybody a bunch of headaches. Even understanding the logistics of what you can and cannot do there's just a myriad of things that we come in and help you with to better grow your business because 10% to 12% work comp for your business is a game-changer as far as your revenue goes.

I think I know the answer to this. There are a few questions that I have. The one leading question is where do people get this wrong? What's the big mistake that most small private practices are making around work comp right now?

I think what happens is when you're a private practice owner having a lot of skin in the game. You're probably very attuned to what your net rate is and the networks you want to be in and the insurances that you will take because of the margins that you're going to have to have and you can't really have too many margins that don't work for you. The work comp, you actually have to have some of those networks that may not have the best margin. They're still going to be better than most but you're going to have to get in there because then it becomes a volume game. You're in a volume game where you're going to be in some of these networks that may not pay as well as others, but that's going to open you up to business on these other networks.

The loss leader.

Right, absolutely. It's a little bit of a scary undertaking and that's for a lot of people in our initial conversations of, “We don't want to accept anything below the fee schedule.” That's not the way that they're going to do that. You're going to have to take a hit. Considering the fee schedule's so high, even if you're 110% over Medicare versus 120% or 150%, you're still making money. It's just not as much as you may want to make, but it's going to open you up to those to those other things. That's probably one of the biggest ones. In the PT world, the other big one is communication. They don't understand that those case managers, they get a couple of things confused.

The nurse case managers actually go with those patients to appointments, they actually do that, but they don't approve the money. The adjuster approves the money. A lot of the times, what will happen is somebody will talk to a nurse case manager and the nurse case manager says, “Go for it if you want to do something. I want to dry needle or I want to do BFR,” or something like that. She's like, “Yeah, go for it,” even though it's not in the plan of care or something like that.

The adjuster hadn't approved it. A lot of the times, people will get verbal okay, but it'll be verbal okay from the wrong person, then it's not documented, and then what that does is it messes up the patient plan of care, messes up the ability of that patient to be seen, and then you lose out on revenue because the right person didn't approve it.

Key Players In The Work Comp System (Case Manager Vs. Adjuster)

For somebody as ignorant as me, I don't even know what an adjuster is. I know that this is bad, so let's back up for a second. There's a patient. I know what the patient is. I know what the physician is. Case manager, adjuster. Are there any other players in this or is it just those two?

There may be a risk management person at the company that may be involved. It can be. The physician case manager and adjuster are generally the main players that you're going to have to focus with.

The case manager is just simply somebody that's working alongside the physician group managing that?

They're there as almost as an advocate for that patient.

They're like a work comp specialist for that hospital system or whatever?

Usually, it's contracted out. Adjusters and case managers generally work hand in hand. The adjuster is basically the money. They're watching the dollars. The case manager's actually watching the patient and can be an advocate for the patient. The adjuster is just worried about the dollars and cents. Adjusters may have upwards of 100 cases. Case managers generally aren't going to have more than maybe ten, something like that, but that's a lot for a case manager. They're more on the ground level.

They'll be who you talk to most of the time. In a lot of these big networks like One Call, I think for example, they don't have case managers sometimes. You're just talking to the adjuster. If you're talking to the adjuster and you're getting off in the weeds on these things that you want to do clinically, they don't care.

You need to know who you're talking to. Know the room.

They don't care. If you're talking to the nurse case manager, you're going to have more of a clinical discussion because that person's a clinician.

You have to know what that person's interested in, like what are they motivated by. You can position your interests. You can align your interests, right?

Right. You have to understand what they're looking for. They want to get that patient back to work. They want to get them back to work in a timely fashion at the highest level possible. That's all they want. Minimize risk and then put them back and they want to have that objectified and documented. That's it. There are other things that occur.

I’ve had conversations with nurse case managers where there has been an issue with a patient whether it's transportation or whether it's something then they'll try and help you out and do those sorts of things. It's all pointed towards trying to get that patient back to work at their highest capacity. Whereas the adjuster, they just want to know how much you need to spend and how much you're wanting to spend.

Can we talk about these networks now? I know when you're looking at work comp, like if I look in my AR, I see some work comp companies like MedRisk. Is that a network?

That’s a network. MedRisk, One Call, Align, Streamline. There's so many out there. What we do is help people with the bigger ones to get them in them first and then we can go after little other ones that may be in the area that you're in. You might not even realize they're there. There are a couple big employers that actually do their own. They're direct-to-employer stuff, but they're their own network.

I’ve got a few clients that have been very into that.

The Taylor Group, which is a big manufacturing company somewhere in North Mississippi, I think, they're a worldwide company and they do actually their own work comp. They are their own work comp network. It's all in-house. You have to understand who the players are and where the low-hanging fruit is and your area.

If you're on the coast somewhere, you may want to get into the shipping because maritime is a different world too. Anything that happens on that boat is a work comp injury, sickness, injury, it doesn't matter. I had a stroke, heart attack, that's all covered by the maritime companies. There's a lot of different things that we help people enter into to find the access points for getting the patients in the door.

Once you understand all the players, then I guess after that, it's like how to find them. How to find how to find where they're at, how to get in network with them. Is there some type of contract negotiation with them or is it is it pretty much standard flat thing across the board? How does that work?

It's one of those things. Some of them negotiate more than others based on what numbers they have. It depends on the size of your organization too, obviously, and their need. As you said, it's leverage. What's their need versus your need. Also, they won't talk to you about what everybody else's rate is. It gets complex and one of the things that we do help with is understanding what the average rate from each network is because we've got that that information. Getting in the network is key, but then if you negotiate and they say, “We're going to negotiate it. We want 135% of Medicare.”

They say, “Great.” The clinic next door to you or down the street from you, they took 120% Medicare. They're going to send them to that clinic. You may have priced yourself out. It's not just a process of getting in networks and turning on a switch. You have to then continue track your referrals and then you have to track and then you have to look at three months and every quarter and then go, “Have we received any referrals?”

If we haven't received any referrals, that's when we go back to the networks and go, “We've turned the switch on, we've negotiated the price, we still haven't seen anything. Do we need to drop our rate for 60 days? Do we need to drop our rate for 30 days to see if that turns things back on? You then know your price. There's a strategy to it as well because it's not just like turning on a switch and then the water starts flowing. That's another misconception that people have because you don't know what the person on the street's doing.

You can find out. It might take you a little bit of time, but you'll find out.

If you see that they're doing a whole lot of work comp, then obviously they're probably going to have a rate or they're going to have some other offering that is beneficial to whoever it is that's sending the patients.

Timeline For Work Comp Program Implementation & Financial Impact

How long does that take, you think? Let's say you were to work with my practice and let's say we're like, “All right, come on, let's go to work. Let's get it done. Let's put let's set it all up.” Let's say we have some operational capacity to move things forward. How long does it take to get a network and start getting things humming, get your data set up to where you actually have things moving? Maybe the better question is you're actually seeing a financial impact in the clinic. Is that a three-month thing, a year-long thing? How long does it take?

I think you'll start getting some pretty accurate data if we get everything tweaked within the first quarter or whatever the first 3 months, and then at 6 months, you should have some robust data. If you're looking at it quarterly half a year of data, you should have, “We're moving in the right direction, we're not moving in the right direction.”

It's just one of those things that you have to look at. If we're working with somebody, we generally look at a six-month window and then we can extend if we need to because it is so relational and easy. For example, we had a gentleman that we worked with and he was in a different state. He wanted to do work comp and we helped him and a case manager sent him five patients. Busiest case manager in that state. Sent him five patients. They screwed up three of them.

They documented wrong. They caused her a lot of headaches. They caused her to get basically hand-slapped with the adjuster and all of these different things. We learned a valuable lesson from that. Number one, we weren't doing him a service by not requiring him to have training. He didn't want to do the training and all these things. We generally want to make sure that at six months that everything is good to go and then at that point, we can look at go, “Do we still have some touchpoints?” Six months humming hopefully to where you see a significant volume change in a year. If you get 15% work comp, you're rolling.

How important is it to have FCEs and being able to provide that type of work comp specific interventions? How critical is that?

Here's the issue with FCEs. Yes, it's good to have them. The challenge that I run into with FCEs, and this is speaking from somebody who did a bunch of them and also oversaw people doing them, it's a huge block of time.

Yeah, it's like a half a day or something.

Yes, it's half a day. If you're looking at your billable hours, what happens is a good FCE is going to depend on the ability of the patient. You have to have, number one, a rate that's big enough to cover that time, but not so big that you're scaring away people wanting to use it. There's that critical fee schedule type piece that you have to manage.

Strategic Use Of Work Conditioning (Work Hardening) Programs

The other thing is if somebody comes in and their blood pressure's uncontrolled, you've just lost out. They're not paying that day. You've got somebody sitting on the clock for the four hours. You get 1 or 2 of those a week and it can kill you. I think it's important to do, but I think there has to be a real strategy around it. It can't just be, “We're going to start doing work, we're not start doing FCEs, we're buying $1,000 worth of equipment. Now we got 4 FCEs in the door and 2 of them couldn't perform. Now just half my revenue or loss.”

It's like most things. It's like start with the simple scalable stuff. Get that right. Once you're at capacity and you're cranking and you're looking for operation ways to expand your program, then maybe you can start adding bells and whistles FCEs and work hardening programs and all that.

Now the work hard Now the work hardening program you can do in-house really easily because it is a self-regulated program. Basically all it is, is you set up an exercise program for them. They're there for up to four hours. You don't have to be with them. It's a skilled intervention that you're setting it up, but you get paid every two hours. If they're there for the first two hours, you bill this one code. If they're there past two hours, you build a second code.

It is a them following their own plan of care. You set them up, you walk them through it day one, this is what we're going to do. We're going to do these things. Okay, now you're going to do this circuit. You're going to do this circuit for two and a half hours and they're over there doing it while you're working with patients, which is completely above board. That's actually work conditioning. Work hardening is actually a multidisciplinary team and a different code.

Work conditioning is every two hours. Everybody uses it interchangeably. That's actually something that I don't think we do enough as a profession. One of the biggest challenges that I had when I was doing FCEs, you're looking at their biometrics, you're looking at their the pulse ox, you're looking at are they satch, you're looking at their heart rate, you're looking at all these things while you're having them do really strenuous stuff for almost 4 hours or 2 hours.

You're giving them a rating based on their ability to perform that and you have all these other questionnaires and things to help with the validity and things of you know what you're finding. I had a bunch of them that could actually work at a higher DOT level, like a medium-heavy or a heavy. I really felt that way, but they were deconditioned and they couldn't perform at that level, so I couldn't recommend that level. If we get into work hardening, I think it gives the worker a better shot too to get back to work too.

I think a lot of the times, especially with work comp, we want to go, okay, “They're out of pain, they can bend over, they picked up a few things. If that person works 40 hours a week or more, we've done them a disservice. We haven't loaded them to the capacity that they're actually going to be loaded in a safe environment. I think I would advocate that everybody, if you're treating work comp, you really should look at continuing on with work conditioning. You can recommend that to the case managers. We have to be careful about it.

Do adjusters like that or not?

It depends. You have to be judicious with it like with anything else. You want to do what they need, not just what you want to do. If you've got somebody that had acute low back pain and they're 22-year-old fit kid that has been running or whatever, but and you get him out of pain, you get him moving, he's like, “I ran four miles yesterday, I felt great,” I wouldn't recommend it. However, if you do have somebody that's in the twilight of their career or they've had a chronic injury, they had a serious injury that caused them to get real deconditioned, then it would be a good idea to go in.

When I asked that question, I think about Humana. Humana is the new UnitedHealthcare, in my opinion. They're like if you build too many theracts, then they're they want to come in and they want to audit you and they want documentation. It's a pretty quick trigger, too. That's how it was when I was treating a lot more often. I'm not sure exactly how it is now.

There are some insurances that are like, “You can't build a theract and a manual at the same time.” They've got all these silly rules that they don't like. It’s just interesting to hear it from the work comp perspective. You don't find trends based on maybe it's MedRisk they like behave this, and One Call, they might behave a little bit differently.

It depends on what your negotiated, you know they may pay a per diem rate. It just depends on what the contract says. At the end of the day, the coding really doesn't matter. Now with the work conditioning, it does because it is a matter of time, two hours and that stuff. While there's more regulations as far as the different things you have to do, there's not as much red tape once you get them started and get them in the door and get them moving.

To me, it was easy because you could always go come back to the nurse case manager, come back and go, “I want to do X, Y and Z. They're really progressing here.” That's why communication is so important. They're really progressing to this point. “I really feel we need to start thinking about this, getting them into some real conditioning and maybe some therapeutic activity that's a little bit more robust. We're going to need more time.” That type of communication allows them to see you're actually helping that patient get back to work. I think a lot of people want to send over a note, and I know everybody thinks this, but nobody reads your notes when you send them to people.

I learned that about six months in. Six months into treating.

You write this beautiful, long note and yeah, and it took you twenty minutes or whatever, and then they call you, “What does this mean?” I don't care. If you're doing it judiciously, they're not going to. If everybody gets work conditioning, they just won't send you patients.

I got another question. One is more around some of the clients that you work with. Is it pretty standard that most of the clients that you work with have the same goal? In my mind, the goal is more work comp visits, more money. Is that generally the goal?

It's such a great payer. Most people understand it, but they don't understand how to maximize it. It's clinical people moving them towards a goal that's got to be there. Whereas you know with the total knee replacement, they just want to walk. That's all you're getting them. Whereas this is you're working them towards a specific goal and so you have to have understanding.

It's a whole different motivation, it's a whole different thing. It reminds me, because we do a lot of pediatric, it's not this but there's school-based therapy. There's the outpatient. It's two different perspectives. Two different frames. You have to understand what frame you're in. The next question I have is about legal. I’ve approached my team about this idea in the past and this was when I had a team that was a little bit more skittish, but they’re all like, “I don’t want to go to court.” I don’t think that way but what’s your take on that? Is that irrational?

It’s like anything else. You have to be able to justify it in your documentation. If you’re working within the bounds of the Practice Act and you’re working within the scope of that patient or working within the scope of the diagnosis and you’re documenting those things, then it shouldn’t be one of those things that you’re worried too much about. I’ve been doing patient care and I was full-time treating for fourteen years and I never once got called for a deposition. I will tell you that there were times that things happened.

Sure. We’ve all had that patient fall or hurt themselves.

It happened. You’re right. You’re judging the severity and the intensity of these injuries and your tolerances may be less than you imagined it would be. You maybe overdose them on exercise and they flare up or you’ve done a manipulation or mobilization that was maybe a little bit aggressive. It didn’t hurt them, but those types of things happen. What people need to realize is with anything, you have to be really negligent. Negligence means you’re working outside of the scope of your practice.

Your intentions may be impure, right?

Doing something that is not normal for that patient with the condition. If you’re doing something and something happens, the likelihood is you’re not going to be held liable for that because your intent is not what it is supposed to be. If you’re completely going there and your drawing needle, you’re using a 60 ml needle in the ribcage, you’re going to be held accountable for that. That’s gross negligence on the clinician’s part. I did a lot of FCDs. I did a lot of FCEs. I had a couple that went sideways. You have to be careful. One thing you have to do, especially with FCEs is you can quit. I tell them at the beginning, “You can quit anytime. You can quit and stop this.”

I had a couple of patients and they were doing fine and I won’t tell them after that because I don’t want to skew the results and ask them, “Do you want to quit?” They’ll be like, “He was telling me to quit the whole time.” You have to sit back. I had a couple go that way and then started to get involved, but nothing ever came of it because I did what was within the bounds of that. There are going to be things but the likelihood is as long as you do what you’re supposed to and document, you’ll be fine.

If people want to get in touch with you and maybe want to learn a little bit about, “Maybe this guy can help me,” because here’s the thing. I don’t know if you’ve heard, but reimbursements are going down. It getting harder to make this all work. How do they get in touch with you?

The Business/Legislative Motivation: Profitability Unlocks Possibility

My email is Joshua.Farley@LighthouseComp.com. If you are a texter or just would rather call me, my number is 601-927-3011. I’d be more than happy to talk to you guys about it to help on getting their business up. I’m getting on a soapbox if that’s okay for just a second. What drives me in our business and our profession is we have to punch above our weight legislatively.

One of the things that is a real factor in legislation is your economic impact. Through having a more robust business across the board for our physical therapists, that economic impact is really important. For us to be able to treat patients at a highest level, we have to drive that economic impact not through just money grubbing but through good patient care, taking care of as many patients that we possibly can, doing what they need and billing for those services.

I think if we can do those things and all of our clinics have healthy businesses, we become stronger as a profession. That’s my outward motivation for helping people. At the end of the day, it really does help our profession. It is a cycle. We’re seeing these reimbursements go down and it’s not because we’re not advocating it, we’re not working at it.

It’s because the leverage that we have and the money that we have in the legislative cycle is very small in comparison to the AMA, MSMA, the chiropractors. The money just isn’t there and the economic impact, or at least us not showing it as well as we should across the board. That’s my motivation for getting into this. It’s the strength of the profession through helping others get better.

For the audience of this show, they’re all going to resonate with that. This is a very business-oriented show. This is what we talk about. We talk about business and we talk about money. We all recognize that profitability unlocks possibility. When you’re profitable, you create possibility for the profession, for yourself, for your team, for your community. You’re probably not going to get rich like Jeff Bezos. You’re probably not going to do that but you could make a real impact for yourself and for the people that work for you too. I think it’s going to take a pivot.

I was sitting down, having dinner with my partner and another really smart gentleman several years ago. I graduated PT school in 2017, so my initial big I think it was when the PTA reimbursement started getting cut. It's like, “They're really cutting it.” I said, “How are private practices going to survive?” The guy at the table said, “Those who pivot will survive.” I think things RTM that that's coming out now, things like leveraging cash-based services, leveraging work comp, we have to find ways to be better at business, quite frankly. I don't know how else to explain it.

We've got to diversify our services, we've got to catch different fish, we have we've got to do different things. The old, “I’ve got a clinic and I'm on paper charts and I’ve got a few primary care physicians that send me some referrals every now and then,” that's probably not going to work long term. We've got to look for ways and I think that what you're doing is awesome.

For those that are reading, I’ve never worked with Josh, but I know Josh as a person. He's a very hard worker, extremely passionate, give him a call. It's 2026. You've probably set some revenue goals this year and if you're interested in improving your revenue per visit, reach out to Josh. He's probably got a nugget or two he can share with you. Josh, anything else before we head out?

No, I think this is great. I appreciate what you're doing, appreciate you having me on. I think that if we all help each other and we'll just all get better. The goal that we have as therapists is to help people, and through helping people, then our financial goals are going to be met. We just have to find the ways to do it. We got to stop thinking that it's the ortho patient that's the piece of pie. It's the entire public and we need to start looking at the different ways you said. I couldn't have said it better. I think the more ways we find to help people and give them access to care, the better we're going to be for it and they're going to be for it.

Best of luck to you and maybe we'll have you on again.

I appreciate it.

Peace out.

Important Links

Why Buyers Look At Compliance Before They Buy Your Practice With Daniel Hirsch

Mon, 02 Feb 2026 19:00:02 GMT

Most practice owners think valuation starts with revenue and EBITDA. But when buyers step in, they look somewhere else first — risk. And more often than not, compliance is the silent deal-killer owners never see coming.

In this episode of the Private Practice Owners Club, host Adam Robin sits down with Daniel Hirsch, compliance and risk analytics expert, to unpack what buyers actually evaluate before they write a check — and why strong compliance can increase leverage, speed up deals, and protect your exit value.

Daniel breaks down why compliance isn’t about being “perfect,” avoiding audits, or living in fear — it’s about control, predictability, and trust. When compliance is weak or unclear, buyers don’t just lower the price — they change the entire deal structure… or walk away altogether.

Together, they dig into:

● Why buyers assess risk before growth — and how compliance sets the baseline

● How compliance issues can stop a deal before financials even matter

● Why two practices with identical EBITDA can receive very different valuations

● How weak compliance triggers deeper diligence, longer timelines, and higher deal costs

● The real impact of compliance on deal terms: cash vs. escrow, earnouts, reps & warranties

● What buyers look for beyond policies — and how they test real-world execution

● Common red flags: documentation gaps, supervision issues, credentialing, and unlicensed staff

● Why “unknown risk” scares buyers more than managed risk

● When to start preparing (hint: don’t wait until you’re ready to sell)

● How simple, practical compliance systems can be integrated into daily operations

● Why compliance should add value, not just create overhead

If you’re a practice owner thinking about selling in the next five years — or even just building a business that’s truly durable — this conversation will change how you think about compliance, valuation, and leverage.

�� Takeaway: Compliance doesn’t kill deals — surprises do. Build control, clarity, and predictability now so buyers see your practice as an asset, not a headache.

�� Want to learn more about Daniel’s compliance frameworks and access free resources?

Check the show notes for his lead magnet and tools.

�� Want to talk about how we can help you strengthen operations, value, and exit readiness? Book a call with Nathan — https://calendly.com/ptoclub/discoverycall

❤️ Love the show? Subscribe, rate, review, and share! https://ptoclub.com

�� Join the conversation and access resources: https://linktr.ee/ppoclub

---

Why Buyers Look At Compliance Before They Buy Your Practice With Daniel Hirsch

We have the one, the only Daniel Hirsch, Risk and Compliance Analytics . Daniel, a good friend of mine, has been on the show a few times. He's one of the guys that I like to talk to about compliance because he doesn't try to scare you. He tries to help you make some money. Speaking of money, we're going to talk about something that I think is interesting. It’s how to cash in and make sure that you factor in all of the compliance work before you go to sell your practice. This episode is going to be action-packed compliance talk from Daniel Hirsch. Daniel, take it away. What do we need to know about selling our practice?

All right. Thank you, Adam. Thank you for having me. We could go the scaring route I wasn't planning on doing that but everyone else does it, so we'll let everyone else have that route. We have a really good topic for that we could speak about for many hours, but we're going to highlight details that you could take away and use immediately. We will also clarify and articulate how and why for this topic, regardless. It's obviously for the buyers but if you're the seller too, this is going to be really valuable for you.

Buyers Assess Risk Before Revenue—And Compliance Sets The Baseline

When it comes to compliance, most owners think they start with the revenue. You're always evaluating the company. Don't. Buyers assess risk before growth all the time. They want to make sure and it's not sexy. We know that compliance is one of these things where you got to have it. You got to do it. When it comes to compliance issues, they don't just lower the value, they change the deal terms.

When you're considering how to approach compliance, it really determines the viability. Compliance issues, they could just stop a deal. It could just completely stop the deal before you even look at financials. They're important. The numbers matter, but the compliance components really will ultimately stop any kind of deal from going forward. It also sets the risk baseline. Buyers assess from a regulatory exposure first to understand where are the liabilities. Where are they? If you don't know that ahead of time, you don't want a surprise.

Obviously, Adam, when it comes to like other components, if it's marketing or operations or HR or front desk, there's a lot of wiggle room involved. With compliance, you don't want a surprise during a deal. It also drives the diligence scope and cost. If you have weak compliance, that just triggers a deeper dive, a longer investigation, more expensive due diligence. It just compounds.

You may think, “Maybe I'm just going to squeeze by. I'm not going to get a lot of questions.” All of a sudden, a certain can of worms is opened up and you're not prepared. It could be not just money, but your time and energy. People have to consider that that is what is going to really impact how you survive a deal. If you're not willing to put in the time, if you're not willing to put in those weekends or evenings to actually answer these questions or go through diligence, it's very important that you have that sustainability.

It also signals from an operational discipline standpoint, strong compliance suggests that you have systems and that you have controls. Regardless of how large you are, they want to know is there leadership in place. One of these things you need to know, how fast this is going to happen. The impact of clean compliance could accelerate how a buyer feels from a confidence standpoint, or it could shorten the transaction timeline. I guess, Adam, the main takeaway from this concept overall from entering a transaction is, buyers are not looking for perfection. I say this all the time. I’m not perfect, you’re not perfect. We’re not looking for perfection, but they're looking for control and really predictability. That's what they want.

I love how you said that because buyers are picky. Buyers probably have money. They have money. That’s why they’re buying. Money isn’t necessarily the most important thing to them at this stage. It’s how can I continue to grow my money risk-free? I think about compliance and I think about it’s like this little sliver of awareness in most of our brains. We don’t think about compliance very much. At least I don’t and it’s not that big of a deal. From the way you’ve painted it like, it’s just these very simple routines to keep your practice in order but it can make a big difference for you whenever you’re going to evaluate your practice.

It’s becoming more and more apparent to me that essentially, buyers, when they come in, they want to be able to buy an asset that prints money for them without them having to solve any more problems or have any more headaches because they already have headaches. If you don’t have a good compliance program, then they’re basically buying a headache and that devaluates the business.

Compliance Maturity Directly Impacts Valuation & Deal Structure

It's true. Speaking about headaches, from a valuation standpoint or even like a deal structure standpoint, you could have two companies, my company, your company, we could have the exact same EBITDA, but they'll have very different valuations based on the compliance maturity. You don't want to discount uncertainty. The cleaner compliance profile, it's built into what they're looking for. Your point of they just want to invest. Investors are looking to invest to grow their money. That's very true.

When it comes to really determining how much the purchase price is paid, the compliance strength often decides whether proceeds are either it could be cash, it could be deferred. You could have tighter covenants, you could have long survival periods, you could have broader reps. All these things impact not just a number. It impacts the actual deal. It could drive escrow size or duration. All these things, if you're a seller, you're not really considering. You're just looking, "Am I going to get that multiple?" the answer is, hold on. It really depends on what you've done on the front end that will pay dividends, I think, when you're going through that transaction.

Compliance uncertainty also makes earn-outs really hard to achieve and it's easier for buyers to dispute it. It's all about leverage also. When you're thinking about this, when you're going through that process of how are you leveraging when you're going through a negotiation, the sellers with really strong compliance programs or just an awareness of their compliance, you could push back on assumptions and restrictive terms.

That's your leverage that a lot of times people are thinking, "The numbers don't lie." when you have a process in place and you could prove that, by the way, this is repeatable, this is something that could be sustained and grow because it's protected, that's ultimately what is going to differentiate between you and someone down the street also when you're going through.

That’s exactly where I was going. What a way to easily differentiate yourself. If you’re gearing up for a sale, it’s like you know most of the people that are in this group, they’re 1 to 3 clinics, maybe 5 to 7 clinics is like that mid-tier. We probably don’t have our compliance in order as much as we probably should. Let’s be honest.

That’s okay. The truth is people that have known me for over a decade know it's a process. It's not just the goal to be, "I'm compliant, I'm not compliant." you got to start somewhere. Even with auditing. I could care less what you did. It's what are you doing now? Are you showing something meaningful to say, "I'm identifying this and I'm going to make sure that," again, from what people look at in due diligence, you mentioned documentation maybe, or coding and billing. For consistency or red flags, you have to be able to hold up through scrutiny.

How do you do that? How are you describing your CPT utilization or time-based coding accuracy? Not just coding, but about your time-based coding. Are they accurate? How often are you billing re-evaluations? Are you just doing it on the clock every 30 days? The answer is, I hope not. It really depends, but you have to really be able to describe and defend what you're doing. Even from a documentation integrity standpoint, are they reviewed? How are you going through this? For credentialing, I think HR, I always get nervous credentialing, supervision, licensure not just to rattle off a million things, but supervision rules these really matter.

Are you following? I've seen deals that they were at the eleventh hour, they did not close because of supervision issues where you may think, "Okay, well that's not a big deal," but it depends what state are you in. Are you following your rules? Do you understand what those rules are? When it comes to payor mix and contracts terms, those are really boilerplate. It's not that complicated. Any lawyer could pick that out, but you want to make sure is it sustainable? Is there exposure or a long-term exposure to unfavorable clauses? You want to know. To your point, if you have a small mom-and-pop clinic, you want to know what that is. What are you going into? What are you offering before you actually open that door and say, "Okay, I'm ready."

Buyers also test whether written policies are actually followed and operational. I can tell you I do this often. You'll ask, "Where is it? How does it work and can you explain?" The process of what you say you have, is that reality or is that just, "I asked ChatGPT to quickly create something for me." That's not going to fly because you have to pass the scrutiny of, “By the way, I'm not just going to read it, but I'm going to say, let me interview some staffs. Do they understand? Do they understand how it flows in practice?"

I know I mentioned supervision, but it also goes to unlicensed individuals too. Techs, aides that also is heavily regulated. I can tell you, Adam, the do not get on that list, OIG list, from an investigation standpoint, it is always with aides and techs and it's always with unlicensed individuals either claiming to be or it's from just a dollar standpoint. The penalties are significant for these types of cases where people are abusing certain positions. It's one of these things that, again, goes back to policies. Do you even understand how the workflow is with certain unlicensed individuals? Also, with maybe are you over-relying on a certain payor or a referral source or based on where your location is?

All these things really matter that you should be saying, "Okay, well what is my percentages?" And I'm sure you go over this with some of your clients where you want to know, are you not bulletproof, but are you able to sustain, let's say, your major referral all of a sudden retires? What are you going to do about that? How does that work? How does that impact your value?

When & How To Prepare: Compliance As An Ongoing, Practical Process

The number that I’ve heard is five years. If you’re five years out from thinking about selling. If your thoughts are that you might sell within the next five years, you probably should start working on this stuff now. I never really considered the compliance aspect, but usually, what we look at is like more around the financials and getting your contracts in order and all those things. I would assume compliance is a big part of that, too. That five-year audit process where you’re really just going through your practice, making sure you’re buttoned up on the compliance side. When practices come to you and ask you like, "When should I start thinking about this," what’s the timeline like? Is that the five-year mark what you recommend or do you recommend something different?

I typically don't give an actual year or time. It's almost like when you evaluate your patient. You're automatically thinking, “How am I getting this patient to discharge?” When you're opening up, what does the end look like? It doesn't mean that it can't be 6 years from now or 20 years from now or 6 months from now. The answer is you should have a plan in place. I'm in the compliance world, which is great because I'm able to say, "You know what, this may be meaningful to me, but it may not be meaningful to you or someone down the street."

The answer is, is this appropriate for you? That's the question you always have to ask. You're not being compared to the publicly traded companies. You're being compared to you and what is reasonable for your practice. If you can do that meaningfully, that could be a simple two-year process. That could be six months. It goes back to what I said before. If you're not taking something, a meaningful step now, that's the challenge. That could be simply saying, "I need to open communication lines. I need to be able to have some anonymous reporting." That's going to cost me about $100 a year. Why not just do that?

I need to audit my charts. Let me do that. Or maybe use AI to be doing that. There are great tools right now, there's great technology that can do this for you. It could just simply be a gap analysis or an IT risk assessment. All these things, there are so many great things to leverage that you could apply to operations and traditionally, I think, Adam, a lot of people shied away from compliance to say, “It's annoying. It doesn't really help me. It's not practical for what I'm trying to do.” That was true for the last 20, 30 years. It wasn't effective.

And that's why I'm here talking to you to let people know that it really should be. It should be integrated with operations to say, "Where's my risk? Is this appropriate for me? How do I stay within the boundaries?" This is what I need to do to actually make an impact, to add value. If you could do that from a five-year standpoint, forget EBITDA. You'll be in a really great position to be able to say, “Year-over-year growth, that will speak for itself.”

When it comes to how knowledgeable your staff are, all it takes is one weak link to have a breach. The idea is, are you educating your staff? It's really easy to do that. You could go on MedBridge, you could go on a lot of different platforms to get training, but are you? Are you actually doing it? Are you signing up those employees on basic things for your practice?

I know buyers are really more concerned with that unknown risk than really just the managed risk or last-minute fixes. That just reduces the trust. Compliance doesn't kill the deals, but surprises always will. You don't want that, "By the way, we're closing on Tuesday," and the answer is, "No, we're not. Look what we just found."

I really appreciate the time. We’re going to make these short and action-packed. We’re going to do fi five episodes of this. Next time, we’re going to be talking about cash-pay services. Before you start launching your cash-pay services, what are some of the compliance considerations that you might want to think about? Daniel, thank you for your time. Daniel has a lead magnet here for you like. There are some free resources there. Check out Daniel if you want to have a conversation with him about compliance. Thanks.

Thanks, Adam.

Important Links

Everything Looked Fine… Until It Didn’t: How One Owner Lost 4 Providers And Rebuilt A Stronger Clinic - A PPOClub Workshop Interview With April Atchison, CCC-SLP

Mon, 26 Jan 2026 19:00:01 GMT

Most practice owners assume culture problems show up loud — missed numbers, complaints, chaos. But what if the real danger shows up when everything looks successful?

In this PPOClub Workshop interview, Adam Robin sits down with April Atchison, CCC-SLP , to unpack a real-life leadership story that every growing practice owner needs to hear. April shares how her multi-location practice appeared stable and thriving — strong revenue, expanding staff, leadership in place, and real work-life balance — right up until subtle cultural cracks began to surface.

What followed was one of the most difficult seasons of her career: recognizing leadership misalignment, addressing cultural drift head-on, and ultimately losing four long-term providers — including a clinical director. Instead of avoiding the storm, April chose decisive leadership, values-based clarity, and fast action to protect the future of her organization.

This conversation goes far beyond theory. It’s a behind-the-scenes look at what actually happens when an owner chooses culture over comfort — and how doing so can unlock stronger teams, higher ownership, and renewed momentum.

In this episode, you’ll learn:

● The quiet warning signs of culture breakdown most owners overlook

● Why high productivity can hide serious leadership misalignment

● How to run clarity and alignment conversations without fear

● When acting fast protects your best team members — not just the business

● Why losing people can sometimes strengthen culture and performance

● How proactive recruiting creates leverage before you need it

● What decisive leadership looks like when the stakes are high

● How rebuilding after disruption leads to stronger ownership and accountability

If you’ve ever felt uneasy despite “good numbers,” delayed a hard conversation because things looked fine, or wondered whether holding the line on values is worth the risk — this episode will give you clarity, confidence, and a leadership framework you can apply immediately.

��️ Learn why strong clinics aren’t built by avoiding hard decisions — but by making them early.

�� Want help building an aligned, resilient, high-performing practice? Book a call with Nathan — https://calendly.com/ptoclub/discoverycall

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Everything Looked Fine… Until It Didn’t: How One Owner Lost 4 Providers And Rebuilt A Stronger Clinic - A PPOClub Workshop Interview With April Atchison, CCC-SLP

She presented on the changes that she made in her organization and how much she had grown. At the conference, we had the opportunity to listen to Zach and some of the stuff that he did. He was putting systems in place on a regular basis. I still remember the remote-control system and how we got to like 2000 visits and a year or something. Anyways, I decided to pick out April because she's been pretty amazing, not just in what she's done but also the example that she set as an owner in our program.

Our first Workshop that we ever did was about this time in 2025 in New York City. April flew from Atlanta and came to New York City, all in their lonesome and absorbed everything. She joined the program and made a ton of great changes in the past year, if I can speak for you. What was equally interesting that she shared with me is that she has a lot of changes. She's got through some hard stuff in the last couple of quarters.

I thought it would be cool to have a discussion with her about what to do. If you've read the show, it's going to be like that. We're going to have some questions and whatnot. By all means, if you're open to it, if people want to ask questions during the course of it, raise your hand and ask her a little bit more detail about how she did some of these things, good or bad then feel free to do that. Where I wanted to start was, where were you this time in 2025? Especially as we're looking at what we did. In this workshop, we're talking about what we're going to do next. We also look back at what we accomplished in 2025. This time in 2025, where was your organization as a whole?

Initial Business Status & Comfort Level (Time last year)

This time in 2025, as you indicated before, I met you guys in New York. It wasn't out of a place of being in pain as it relates to my business. I was very comfortable in my business. I had multiple providers during that time. We had about ten presents. We have two offices. One in Fayetteville, Georgia and the other one in Decatur, Georgia. My Fayetteville Clinic was doing very well. I had a clinical director there, multiple providers, OT and speech. I also offer plate therapy services in partnership with other ABA clinics. We were at a good point. I was comfortable in that.

What were you looking for then at that point?

I was curious at that point. During that time, I was pulling away from the office, from being a direct provider myself. I was just on the cusp of that. I wanted to put some more tools in my toolbox to support me with that.

To be a better owner, administrator or CEO if you will.

Mindset shifts as it relates to that.

You felt like you needed that.

I felt like I needed that at that point.

Tell us the progress then towards the middle of the year because you were an all-star recruiter for the first half of the year.

Focus On Growth & Recruitment Success (Mid-Year Transition)

I feel like by attending the training in New York during that time, it struck a fire in me as relates to recruitment. Thank you, Adam, for that. After that particular conference, it took my recruitment to a whole other level. Which was necessary as it relates to what I'm experiencing now.

If I recall, you hired like 6 or 8 providers over the course of a number of months.

I hired approximately ten therapists during that six-month time span. I had a therapist to go into the school district because we had school district contracts. Some for the clinic and another one for an ABA site. We had a lot going on as it relates to recruitment during that time.

You're not only recruiting. What other administrative stuff did you start putting into place as you got some training and coaching?

I also put a VA in place which has been very pivotal.

Do you still have a VA?

I still have a VA.

Do you have one or two or more?

We have one VA and then we also added on another office personnel. That's been good as well as a billing consultant who I meet with weekly.

You've been working on a lot of the back-end administrators stuff, how to step out of your role and move up in the organization like you're supposed to do. You're acting more like a CEO at this point.

I've also taken on mentoring a few other practice owners as it relates to putting stronger systems in place, building as well as recruitment.

You have the two locations. Do you have an office manager or some clinic director at both locations?

I have an office manager who oversees both locations. I had a clinical director at the Fayetteville office, but we no longer have one now at the office.

Things were going on pretty smoothly. When I saw your pictures from Cabo, was that a good time?

That was a great time.

Was that a good time for your business as well?

It was a great time for a business then as well.

We're talking like July, then what happened?

Around August. We ended up going through some major adjustments in the office, which is a pain that I had never experienced.

Tell me about it.

As we've indicated already, I was very comfortable and confident with my staff, my systems and managing both offices. I had leadership in place of which she was getting ready to transition.

At this point, were you thinking you were pretty close to achieving a lot of your goals for 2025?

Right there on that cusp as it relates to me allowing myself to experience that work-life balance that I've been striving so hard for. Not just financially, but still having that work-life balance that we all want.

As evidenced by the trip to Cabo for a week. You were right there.

Several trips.

What happens then?

Identifying The Cultural Shift & Warning Signs

I noticed in the midst of all the recruitment and hiring that the culture of one of my offices started changing a little bit.

How did you see that?

I noticed little signs. I would speak to my mentors about it like, “Is this in my mind or is it something that I need to monitor?”

Were they acting up or were they losing productivity?

The productivity will still be very high, which could distract you in the midst of that but I dig deeper than just looking at the surface, the numbers and all of that because as we've indicated earlier on in this session, what's your why? The revenue is important but it's not my ultimate why. The changes that I noticed was the leadership becoming weaker. By that, I mean it was a lot more congregating going on than collaborating.

Tell me about that.

Although I wasn't there every day, I had different little signs that things were going on. I would go in the office outside of hours to look over everything. I would notice something simple like the sensory gym being in disarray after hours. Why would that be in disarray? You're not putting things away. I said okay. I would pop in every now and then to say, “I want to just observe what's going on.” I would go and look into the sensory gym and everybody is in there. The multiple providers are with their laptops and children doing their thing.

They're paying more attention to the laptops than therapy and each other.

I put up a sign there limiting the number of providers as well as clients in the sensory gym at one time. That was concerning to me since I have a full-time on-site supervisor there.

Something's happening under her watch and it's not being addressed. There's a standard of expectation that’s being blinded to.

I address that and moving on, we've all always had very high client satisfaction and family satisfaction. All of a sudden, I get a phone call from a parent indicating that she had a concern as it relates to collaboration. The therapist collaborated with most of her and her husband during therapy. She didn't feel like it was as strong as it should be, and she was accustomed to it. I'm like, “That's different.” I had another meeting about that. There were different things going on.

Little but big in my eyesight because I'm like, “Something is going on here.” Even after hours when I would come. My clinical director had a huge office with windows, materials, galore, and full autonomy over our schedule because I trusted her. I would come in and see that she set up an office in one of the other therapist’s rooms.

Not in her own office?

I knew she had set something up because I would see her coffee mug and her jacket. Personal items being left over an extended period of time in that space. Why would you need to do that when you have your own space? These were all little signs that I said, “I need to pull together something tighter as it relates to leadership development.” I was in the process of having more regular meetings, instead of once every two weeks or weekly check-ins and so forth. I still wasn't getting the data and the information that was expected from her.

They're supposed to report KPIs to you.

All of that.

She’s giving you all the excuses.

Other than just doing that. With that being said, I did reflect on myself. I said, “April, maybe you didn't put stronger systems in place from the beginning.”

Is that what you guys tend to do is like, “Maybe I didn't train them well enough?”

I did that. She and I sat down and developed the plan and so forth. I noticed that the energy was off with that. We ended up having an alignment meeting to see where we were as it relates to the position and so forth.

The Clarity/Alignment Meeting & Staff Transition

Tell me about your alignment meetings. I'm assuming these are triggered after having, “I've had a few sit-downs with you and I'm not getting what I want,” then you decide to have your alignment meeting alignment. Adam calls them your clarity conversation. Is that what we're talking about?

It prompted one of the providers who was not collaborating with the families. I wanted to have a conversation about that and she ended up resigning.

Was that after your conversation or after your alignment?

That provider did the collaborative piece. She wanted to point out to me that she feels that she gets 50/50 support from me, but more support from the clinical director, which was fine. I said, “She's on site. That's normal and natural. I'm glad she's performing.” She said even with the way things are thrown at her. I said, “That's good information to know as well. That's awesome. She performs well under pressure. That's great.” Anyways, we ended up having that big alignment meeting because there were just too many things going on.

When you have a big alignment, are there more people now?

There were more people, specifically the providers who I knew had some involvement with the culture shift.

This is a team meeting, so this is pretty bold of you. You have an alignment meeting with the whole team. What are you saying?

I don’t want to take for granted that you guys are on the same page as it relates to alignment because I understand that life changes. Your desires and needs change and so forth. With that being said, we're going to take a moment, pause and review core values, as well as the vision of this office to determine which direction we need to go in as it relates to your position here.

I don't want to speak for you. You're like, “We're going to have a value conversation as a group with the expectation that after this if you need to come talk to me, you come talk to me.”

You're welcome to come talk to me. I did that and that didn't sit well with them with the ones that weren't aligned. The ones who were aligned showed up the next day at the office and indicated, “I'm not having a conversation with you. I'm showing up and I'm here. I want to continue on because I'm definitely in alignment.” They were very much outspoken about it.

Were you surprised by that?

I was very surprised.

Was it a good surprise?

A very good surprise because to me it revealed who was in alignment and truly supportive of the vision of my office. That spoke volume.

At this time, how many providers are you talking to?

At one time, who transitioned?

During the big alignment.

Four providers.

At this time in total, how many did you have?

At this time, we had seventeen.

Ten to 17, but there were four that you needed to talk.

That ended up transitioning.

Four transitioned out but did you have this conversation through all seventeen?

I gave this conversation to eight at that office.

Did the four of them taped out? Were you surprised?

At that point, I had dealt with so many surprises. I wasn't focusing on the surprise.

Were you surprised that it was those four?

I think because I had already started observing the sign. I knew.

Were they all new providers or were they existing team members?

They were existing team members. The team members who had been with me for up to five years.

You can't blame it on all the recruiting that you do.

I can't blame it on the recruiting at all, but out of those providers, one had been there for a year. The clinical director had been there for over five years and the other two had been there for approximately 2 to 3 years.

Out of curiosity. Was there a ringleader?

There was. It was the provider. I identified that it was the provider.

Did you identify that quite a while before?

I had identified it over the last several months. It was something that stirred up over the course of the last quarter. That was interesting to me. My thing is a lot of times when you feel most comfortable is probably time to challenge yourself and challenge them as well.

Especially when they're comfortable.

It's interesting because I was right on the verge of presenting a challenge to that group. One of them in particular. One of them was the clinical director. I was getting ready to transition her into a regional position to help me manage both offices. The other one who was a part of this already had a lot of dialogue in the office about opening up her own practice. What I wanted to do is offer free mentorship for a year to help support her with her transition.

You were supportive of her opening her own place and you were going to offer her that.

That happened approximately two weeks before I was supposed to offer it to her. She was one of the ringers.

I just wanted to highlight that a little bit because you get a lot of providers in one place and things start going South. Usually, there's a person and they tend to poison others that are close to them. This is what I've seen. You lost four providers. Did this become a domino effect? Did you start losing other people as well?

Positive Team Response & Leadership Rise Post-Transition

After those four transitioned out, I was able to observe leadership rise to another occasion with some other providers.

The people who were left behind started doing better. Is this the clinic where you're cuddling a little bit?

Now I'm cuddling.

We won't get into that too much just yet but they started rising up in terms of taking on other responsibilities.

Productivity went up even more and asked me how they can support me more. Being very supportive on a whole other level. It's been pretty amazing, even to the point of getting random messages like, “I know it's been a very difficult time, but I want you to know that I truly look up to you as my boss. You inspire me with everything that's going on. I have not seen you sweat not once but jump in, get your hands dirty, support and build us up again. We appreciate it.”

This was what time of year? When did this happen?

This happened in August.

That took you from, I'm going to Cabo and doing all these trips and now you're in it. You're not going anywhere.

I'm in it. I'm going places but it's on a different scale now. I can say that it was a very hard time. It was a hard time but I'm very grateful.

Did you have to recruit to replace those other four or did you just keep it as it is?

I did recruit in the midst of that. Now, we have a bilingual team and a virtual therapy team. We've also incorporated Saturday clinics of which any provider who wants to come in and provide services on Saturdays, they are welcome to do so to help drive the revenue as well as to sustain the session numbers. They've been excited to do it, willing to do it, and wanting to do it. They are also asking me if they could do it. That's been amazing to the point that I'm hands off on Saturday clinic. Even my admins are like, “I'll do it this Saturday. You don't worry about it. Turn off your phone. We got it 100%.”

It's cool what you see when people are aligned in the clinic. Doing some of those things is no big deal. Coming in on Saturday? I’d like to. You’re like, “I didn’t ask you to but you’re coming. That’s great.” Your productivity goes boom. I have seen that so many times where to hold on and tolerate some of those other people because of numbers or who I’m going to replace them with. You let them go but production increases after that.

It increases in a different way and it's so interesting which directly ties into the previous conversation we had regarding responding very quickly. That's one thing I can say I'm very grateful for with this particular experience. I didn't sit on it. Once I had confirmed evidence that culture was shifting, I immediately had the hard conversation and took care of it like that.

What would you have done differently?

In this situation, I'll be honest. I feel like it may have appeared to be very abrupt and sudden, but I don't think it was at all. I responded the way that it needed to or I needed to respond to protect the culture and the vision.

Also, your values.

Your team saw that too. My experience has been that teams want to be led by decisive leaders. They are okay but it's not always the right decision but they want directions. They want a clear decisive direction. That’s nice.

I can agree. I can see in my own experience when I took too long to make a decision. Especially about an individual that was out of alignment with my organization and I finally let them go. It was the conversations that I had with the rest of the team afterwards that showed to me without using those words that they had lost some respect for me because I kept that person on too long.

It has been known to talk about how it's important to have those conversations faster for the sake of the other people in your organization who are aligned. It's more important to have those conversations to protect the values, the mission and the vision of the company. When we think we're doing the right thing by being compassionate, maybe giving them some grace. Maybe they'll turn around. Maybe I'll do a little bit more training. The other people in our organization notice that we're just dragging our feet. It brings them down. It brings down the organization. This was around August. How long did it take you to feel like you got to the other side of that?

I started feeling like I was getting over that hump around not long ago. It took many months. I'm starting now to feel like, “I'm getting my bearings again.”

They're on some good footing. Did you have to find another clinic director?

I'm in the process of doing that now.

She was one of them.

I have not found a new clinic director just yet. I'm being slow to hire.

It’s because you are quick to find it.

That's what we are with that piece.

I'm going to keep asking. Do you folks have any questions and to learn what she went through? Adam?

For those of you that don't know April, she's like this little social butterfly. She’s got so much energy and this center of attention. She lights up. I'd love to hear about your secret sauce to recruiting. What were your top 3 or 4 that I committed to X, Y, and Z actions that led to the biggest results? There's a lot of people here.

One of the big recruiting pieces was the fact that I incorporated warm outreach which is casually connecting with friends, families and colleagues in my network because that was comfortable. The next one was more of a cold outreach approach which incorporated various platforms on social media, Facebook, LinkedIn, Indeed and so forth.

Did you have a target like, “I want to say these many outreaches a day?”

Yes. I had a target but I would always exceed the target.

LinkedIn allows you, what?

It might allow you 100 each a day.

I would get 100 each a day.

You’re inviting your connections?

Yes. It was quite a bit. Now with everything going on at the office, one of my admins is rising to the occasion again. She said, “I know a lot of your time where you weren’t in the office as much. It was spent on vetting therapists and so forth. Why don't you allow me to help you with that?” She helped me with that.

Did you get a lot of, “Leave me alone. You're being weird?”

What I got was a lot of knowledge, a lot of ignorance and some who were curious. When they were curious, I went all the way in with it. If they gave me a little inch, I took them out. There’s a lot of discovery calls and a lot of discovery meetings took place. It was interesting because I went in with the mindset of, “I'm going to get a therapist.” For some it was just, “I just want to get to know you. Even if we don't end up connecting with you being a provider in my office, let me figure out another way to support you or connect you with someone who can support you.” My mindset shifted in regards to that being the top objective and the end goal.

You're doing awesome and you're still doing it I assume.

I am.

You never stopped hiring. That's right. What did you want to ask, Ellie?

First of all, you said you observed an energy shift. Describe the things you picked up on that were making you feel like there was a shift. Secondly, it sounds like during your alignment meeting, you structured it in a way that they realized they were not aligned. How did you structure that?

It was definitely that. The energy shift I observed was the providers who were displaying a high level of excitement and enthusiasm. It shifted.

At one time, they were higher energy but then you saw a shift in them.

I observed it slightly. It wasn't like 100%, but it was enough for me to observe it. I'm very observant in any way. I’m very detail oriented. I'm sure that allowed me to be more mindful of things that we're taking place and with the alignment meeting. My intent when I went in for the meeting, in my gut I knew what the outcome would be but, in my heart, I was hoping for something different.

Were you scared?

I wasn't scared. Interesting enough because that is a question that comes up quite often and even they posed it. They're like, “This is interesting for you to be able to have this meeting considering this office is one of your highest revenue yielding offices.” I said, “I'm glad you observed that but I know who my source is and where all this is coming from so that doesn't concern me.”

What did you say, April, that once you decide that losing people is not as important to maintaining the culture that the fear goes away?

It was that for me.

You’re like, “I’m okay if you leave. I want you to leave. I’ve already decided that you're here isn’t the right way.”

Exactly. How many universities these led out speak pathologists, occupational therapists and physical therapists annually. Not even annually, but every semester. My thing is the originator of this vision knows what's going to happen before I do.

You stacked so many wins with recruiting.

That was key that I put in a lot of legwork, a lot of study time and a lot of workshops prior to and invested into that bucket to know eventually I was going to have to pull from it. I didn't know when. I was hoping that wouldn't be my win but it was.

You mentioned that on our phone call that you felt like all the work that you had done for that first 6 or 7 months put you in a prime position to handle this pretty well. Would you say that?

Exactly.

You didn't start working on this in August. You were working on it from January when things were good.

When things were great.

You said, “I'm doing the work when things are good and not knowing when it would come around, but it came around when you didn't expect it.

I did not expect it at all. That will be something that I would encourage each of you guys to do. Whether it's recruitment or leadership development or monitoring your revenue, KPIs, session numbers, the referrals and your systems in general. Try your best to invest a lot of time on the front end to be able to pull from when you need it the most because you don't know when it's going to happen.

Part of the core trait of a good administrator or CEO is observation. It's one thing to be objective. We all run off our statistics and we have our numbers. We know when things are going down but I experienced the same thing with one of our most productive clinics. What I observed was I walked in as the owner. I'm not there very often.

We had four clinics at the time and I go there maybe once a month. It's a cold reception to me. It was cordial, but it was cold. My partner and I knew it. Unlike you, we turned a blind eye because the productivity was good. The money was good. They were all there. They were producing but we're like, “That place sucks.” It's our clinic and we hate going there.

That was my fear. I didn't want that to happen because I did have a conversation like that with someone else. She was like, “April, the revenue is high. You're making it.’ I said, “Yes, but I don't want that.” I've always tried from the very beginning when I started my own practice to make this a place where you would want to come to every day and me personally.

If I want to come into a nice and clean place, you make this a place where you would want to come into every day. If you want the materials to be well stocked and on point, you make it a place where you would want to come into every day. If you want a supervisor who's cordial and someone you can talk to and be open with. You be that person, and that was my motto. You always make it what you would want it to be.

I get it, but you started just observing things. It wasn't just the KPIs. I wanted to stress that because we observed it but we didn't act on it. It bit us in the butt pretty hard comparatively. I know I've shared it on the show but we turned a blind eye toward it for long enough that it ended up ruining that clinic. It would have been more worth it for us to shut it down for a year than what we went through to turn it back around. It took a couple years to turn back around. It wasn't for four months. That's for sure. Kudos to you. Any other questions?

How did you deal with the practical problem of four providers leaving at the same time? You patients on the schedule.

Full schedules.

How did you deal with that transition?

Proactive Crisis Management & Family Communication

What I did with that is I was transparent with the families in a way not to shut anyone down, but just let them know, “We so appreciate you giving us the opportunity first of all to be a part of your team to support your little ones. However, we're going through some transitions now. What I can offer you is that you can come to our other location. Our Decatur office. We have virtual providers. We have a Saturday Clinic. These are our options. If these options do not fit with your lifestyle or for your family now, this is a list of other providers who can provide you with support.” I wasn't scared to release it. I wasn't scared.

That might be a limiting question. It's like, “What am I going to do with all these patients if I let go of all these providers? I better not do anything because where are these patients going to go?”

They will come back when I'm ready to open my doors again.

They will come back when I get another provider. That can be a scary situation. To Adam's point, was your purpose strong enough to overcome that fear? It was your commitment to the purpose and the vision and the value of your organization is strong enough to work past that.

It’s a bigger game than that. You had built a business at this point where if you lost, let's say fifteen patients. It's normal but it's not any of your business. You're going to hire some new therapist and make sure you're going to recruit. You play a longer game and it sounds like you played the longer game, which I feel like is always usually the right play.

It could be a little intimidating and scary. Especially when you have others whispering in your ear like, “All that money. What are you going to do?” You have to get into your zone. It's happened to your whys and ripping off anything.

You were talking about the warm outreach versus the cold. Which one had a better outcome?

I would say equally.

The cold outreach takes a lot more work.

I've been pretty successful with the cold outreach ironically as well. It’s because of the way that I was targeted. I don't make it so that it's so cold in the sense of my interaction with it, if that makes sense. You are going to have to put more legwork in the cold outreach. You are.

When there's an opening at your clinic, everyone's going to know about it. Both within your circle and on social media. There's no lack of promotion. I understand. You’re going to let everyone know. Does that help? What were you going to ask, Allison?

This is backing up. You and I have talked about recruiting. I don’t want to put those words into your mouth, but along the lines for the cold outreach about how you were fortunate. That dynamic was very impactful in how I was replying to messages. If you could speak to that. Could you also look back at a period of time where those four great leaders started an incident? Were you able to go back and identify the issue?

There was an incident of which I addressed with the ring leader directly, but she avoided the question.

There was an incident in the office and you addressed her.

It was regarding patient care. She felt like she wanted to transition a client off her case low, which I was fine with, but we have to have a systematic approach. Not only because the child isn't jiving with you. We have to look at other ways to tap into that. I think she felt as though I didn't support her as a therapist. That conversation came out. She said, “I feel like you're 50/50. Sometimes, you side with us and sometimes you side with the clients.” I let her know. I said, “I side of what's right in your paycheck.”

She also held her to the system. We have a system for that. You need to follow the system. There is some commitment to the system over the people involved. There's some strength in that as well.

You said speaking to the cold outreach, the courting aspect of it. We did have dialogue about stimulating interaction as it relates to cold outreach. I did speak to you about that. I advise her to look at it in a way of getting to know someone. You don't immediately go in. If you're trying to date someone and ask them to marry you on the first date. You have to court them and get to know them. Identify what their pain points are and what their area of need is at this point in the process and see if you could tap into that and how it would tie into your business.

When you’ve got those leads, though, of 1 out of 100, you said you’ve got deep into that. What was the dialogue there?

Once I send out, for instance on LinkedIn, Facebook, or what have you, a message for them to allow me to be in their network. One of the key things is I respond immediately. If they allow me to connect with them, they're going to get a message within probably an hour. It doesn’t matter what time it is. I'm not waiting all day. I immediately reach out and I may just initiate conversation.

You have to tailor it based upon your personality. That's going to require you to dig deep into how you interact with people. I could tell you a way how I interact, but it's probably only going to allow you to have 2 or 3 turns. You need to be authentic because I could say “What's going on? What's new?” If that's not your personality, what are you going to say after that?

Authentic conversation, bringing up where they're working, what are you dealing with, what do you notice in the industry, what do you not like about it nowadays and things like that.

“Are you working towards anything new? I have an interest in that as well. This is what I've discovered,” and going back and forth.

Do you always end up with a question?

I do. It was one of the strategies that Adam pointed out. It was like a hook. I ended up in a hooky fashion with some questions. There was one there who I was engaging with about her interests and what it is that she’s working towards or working on or anything in particular. She was like, “I have an interest in feeling therapy. I said, “So do I. I'm taking a team of therapists to become SLS certified. Have you explored this training before or what have you? Does your current place of employment sponsor these kinds of conferences to further your knowledge and development in these areas?”

Very cool. I already asked what you would have done differently and you shared a little bit already. If you're looking at that part of your business, what’s your big takeaway?

The Biggest Takeaway: Running Towards The Storm

Don't be a cattle but be a bull. Run towards the storm and not away from it because I had to dive head on into it.

That's one thing about the bulls that go into the storm. They tend to get through the storm faster instead of trying to run away from it. As Adam said, it hovers over them for the entire year. The bulls tend to run towards it and end up getting through the other side faster.

I did give myself about 30 to 60 days because I think I had a conversation with Adam on that during that time. He said, “April, what are you going to do?” I said, “I shut the office down for like 30 days. I'm doing full renovations because I don't want to walk in and feel the same. I want to feel totally different. I'm going on a vacation.”

What does 2026 look like for you?

I'm ready to jump back in again. We're recruiting. I've established a strong relationship with many of the universities. We have many interns coming in set up on a rotation. I'm excited about that and we're just going to win.

You are. I don't doubt that. Can you just share what are maybe 1 or 3 of your top priorities for 2026?

My top priority is to get recruiting going on at the Fayetteville office. I’m going to put a directors of operations in place and leadership development. Those are the main focus points. Those are the big two.

If you can get those two, it's been a pretty good year?

Yes.

Thanks for sharing.

Thank you.

Thank you so much.

Important Links

About April Atchison

No One Is Coming To Save You: Leadership, Identity, And Building A Business That Can’t Be Taken Away With Regie Tiu

Mon, 19 Jan 2026 19:00:04 GMT

Building a successful practice isn’t just about systems, metrics, or clinical skill — it’s about people. And the leaders who get that right don’t just build clinics… they build raving fans.

In this episode of the Private Practice Owners Podcast, host Adam Robin sits down with Regie Tiu — physical therapist, Queens-based practice owner, keynote speaker, and expert in creating unforgettable client and team experiences.

Reggie shares his remarkable journey from growing up in poverty in the Philippines to immigrating to the U.S. with just $50 in his pocket — collecting cans to survive, working multiple jobs, and eventually building a thriving physical therapy clinic in one of the most competitive markets in the country. Along the way, he opens up about being fired after 10 years, losing his identity, rebuilding from rock bottom, and discovering the leadership lessons that changed everything.

They dig into:

What “raving fans” really means — and why your team comes before your patients
How personal growth and emotional intelligence directly impact retention, culture, and referrals
The leadership mistakes Reggie made early on — and the mindset shifts that transformed his clinic
Why self-awareness, humility, and consistency matter more than charisma
How creating a great experience allows clinics to grow without relying on proximity or price
The habits, routines, and books that helped Reggie become a better leader and business owner

This is a raw, honest conversation about resilience, leadership, and what it actually takes to build a business people love — from the inside out.

If you’re a practice owner, service-based entrepreneur, or leader who wants stronger teams, better culture, and clients who can’t stop talking about you, this episode is a must-listen.

��️ Tune in and learn how to build raving fans — starting with yourself.

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Listen to the Podcast here

No One Is Coming To Save You: Leadership, Identity, And Building A Business That Can’t Be Taken Away With Regie Tiu

Welcome to the show. Our guest is a friend of mine. His name is Regie Tiu. Reggie is a physical therapist. He is a practice owner out of Queens, New York, and has an incredible story. This guy was born in the Philippines and made his way over to America to open up his own practice, and he is successful. Now he is a keynote speaker, and he helps not just private practice owners but service-based businesses build raving fans inside their companies.

I am catching up with Reggie. We are just having a casual chat. We had a live Facebook event where we talked about Reggie's story and how he approaches building raving fans. He has an incredible story, a very unique story, one that is really valuable. I learned a lot, and hopefully you do too. Sit back, enjoy the episode, and we will see you soon.

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What is up, Regie? How are you?

I am doing great. Trying to keep warm here. We are in New York, and it is cold now.

What is the temperature over there?

We are in the 30s, but we expect heavy rain. I just got a text alert from Con Edison, our electric supplier, to be on the lookout for downed power lines and power outages. That is not good.

No, it is not good. I am in the South. I am on the opposite end of the world. We just went through a little bit of a cold spell, but we are in the 70s.

Good for you.

The summers are miserable, man. I am going to be honest. The summers are miserable. We are not known for our weather. We have good food, but we are not known for our weather. It is great to have you here. We are live in the group right now. We will also post this as an episode, but I wanted to just introduce you to our audience. I know that you hang out in the Facebook group a lot. I know we have been knowing each other for it has probably 5 or 6 years now?

Yeah, around several years.

Something like that. For those who do not know Reggie, I am just going to do a quick introduction. Reggie is a physical therapist. What I love about Reggie is that he is from the Philippines, which I think is awesome. That is like my second home, even though I have never been there yet. He is a practice owner. We will get into more of his journey from the Philippines in a little bit. He owns a clinic in Queens, New York called Restore Plus. He has been there for thirteen years. Does that sound right, Reggie?

Yes, almost thirteen years now.

Also, now he is a keynote speaker, and what he is really known for is helping service-based businesses build raving fans inside their companies. If you guys have not checked out Reggie, you can find him on Facebook and social media. He posts some really cool content. I watch it all the time. I am like, there is real value. What I love about what you talk about is how you like to talk a lot about mindset, leadership, personal humility, and building that connection with your team and your people. I was like, "Reggie, let us go live and let us talk about what you do, man." I am so glad to have you here.

Great to be here, Adam. Thank you for having me.

How Regie Moved To The United States

If it is cool, I would love to start with tapping into the story of you coming over from the Philippines because that is super unique. I do not even know what the story is going to be, but I know it is probably going to be a lot harder than most people's. If you can come from the Philippines, which is a poor country, right?

Yes, compared to America.

I am assuming you did not come here with full pockets. You came here with some struggles, and you were able to integrate into the US and learn the system and learn the culture and the language, and build a business in a very challenging market in New York. It is not very easy to build a successful practice in New York. I am looking forward to just hearing about the struggle, man. Let us start from the beginning. Talk to us about how you got here. What was the thing that inspired you and your family to move to the US?

Just like most people you have met from the Philippines, you have met a few already. They are still overseas, and some may be here. The Philippines is a poor country compared to America. Although there are in the city, some people argue that it is not a poor country because the malls there are bigger than the malls here. That is just because of the cultural differences. Mostly, it is that culture where they like nice stuff, things like that.

If you are outside of the city, it is very different. From where I grew up outside the city. To give you an idea, my neighbors were drug addicts and drug dealers. It is what we call a low socioeconomic neighborhood. Basically, it is a poor neighborhood. I grew up with that environment. I went through a lot of bullying because I was 1 of 2 Chinese kids in the neighborhood. Even though I was born there, I was different.

People treat you differently still. I learned the language very well. If you do not see me and I talk in Tagalog, which is the Filipino language, you will not know that I am Chinese. A lot of times, when I tell people I am from the Philippines, they tell me, "You do not look Filipino." It’s because I am not. I am 100% Chinese. I was born there, so I can talk and curse with the best of them.

That is how you avoid getting bullied even more. Because life is so tough, most people in the Philippines have this mindset already that, since they were little, they want to study hard. That is why you are going to meet a lot of Filipinos who are nurses, who are physical therapists, or occupational therapists, because the goal is for you to do something to get a ticket out of the country, which is to come to America to get a green card and earn the almighty dollars.

Be it through education. I have some friends who married Americans. There are different kinds. I do not judge people. Everybody has their own thing. They have families to take care of. That is the mindset since you are young. For me, my mom always told me, "You have to study hard so that someday you can get to America."

Since I was young, I heard either friends, families, or relatives, they go there, and they tell how great life is in America. You always have this big dream, like, "Money grows on trees in America. There is plenty of food, and money is easy." That is what they tell you over there. When I came here, though, you are in for a rude awakening.

When I got to college, keeping my mom's words in my mind, I have always been top of my class. I said, "This might take us out of the country." I learned early enough that I do not want to grow up and raise a family in that neighborhood where one wrong decision can land you either in jail or you are dead. I just realized I just do not want to be there for a long time. I studied hard, top of the class all the time until I got to college.

You get to college, and you are thinking, "What do I take up?" Somebody told my mom that at that time, physical therapy was in demand in America. Guess what I became? I became a physical therapist. I knew nothing about physical therapy at that time. I did not know what physical therapy does. All I knew at that time was that they said, "What does PT stand for?" For some members in your group who are from the Philippines, they would understand this word. They said that PT is Puto Titi. In English, it means circumcision. That is all I know.

A little bit of a curveball.

Leave it to your crazy idiot friends from the street to tell you what the physical therapist does. All I know is if that is something that is going to give me a chance to get to America, I am in for it, whatever they do. It was just fortunate that when I got into the field and did my internship, I fell in love with the profession. I stuck with the profession.

I have had classmates who one of them is in IT, one of them is a cartoonist, and different fields. Some of them went to med school. After I graduated, I worked there for a few years because I was thinking about how to get to America. Finally, I was able to get the papers, come over here, and go through sponsorship, which some clinic owners might be very familiar with.

I am very familiar with that, going through the process and helping others also have the same chance for that American dream. That is how I got to America. Now I came here, though, I wish I had a lot more money, because if I had, I probably would not be in America. I tell you that. I have friends whose parents own businesses in the Philippines.

That was not the case for me. I came to America with $50 in my pocket. That was it. That was the last money that I had after I basically saved all my life, thinking that at some point I was going to use that. Use it for credentialing, use it for the exam, plane ticket, and everything. After all is said and done, I have $50 in my pocket. I still remember going to the airport.

When you have that money, that is the thing that is left. You are so afraid that you will lose it, because if you lose it, that is it. Fifty bucks is not really a lot. You hid it in your pants' secret pocket back then. The jeans that I had, my mom stitched a secret pocket inside the jeans. That is how much you protect that because you just cannot afford to lose it.

When I came here, there was a time when I had to collect cans and recycle them. I remember five cents for each can. You collect them enough, you know a small plastic bag will land you a buck. A bigger one can get you $2 or $3. That is what I would use to buy my groceries until I was able to find a company that was willing to sponsor me, and then I could get some work. That is how everything started for me.

How old are you at this point? You are collecting cans, and you have some work. How old are you then?

When I came here in 2002. I was 24 or 25 around then.

Are you by yourself?

At that time, when I came here, at the beginning, I lived with my aunt, my dad's sister.

Was she already here?

Yes, she was already here. She was one of the people who told us in the Philippines, "Life is great there. Food is so plentiful and cheap." When I came here, I told you, things change. I was there less than a year, and I said, "I cannot do it." To give you an idea, this one evening, we had dinner with her friends. Everybody was asking about me because I am the new guy. They were like, "Who's this new guy?"

All of a sudden, she just yelled out in front of everybody. She was like, "He eats too much." I was shocked. I was so humiliated because you never thought that was going to come out to relatives. That is why some of my friends and I were talking to each other. We said, "Sometimes it's better to live with friends than with your relatives."

You do not expect that. I was working, cleaning the house, mowing the lawn, shoveling snow, everything. In my way of thinking, and my parents told me, "You've got to do all these things in exchange for having a roof over your head." After a while, I said, "I cannot do this." When I started working, I saved up little by little. Even at that time, I used to hang out in Best Buy. I just go home basically to sleep.

I used to hang out in Best Buy. In Best Buy, they have those big TVs, and then you have the couch. You see me sitting there on the couch reading some journals and stuff, just to be up to date with the knowledge and technique here. Thank God that people in Best Buy were cool enough that they did not throw me out. I was just basically there every day until I was able to save enough, and I was able to get my own apartment.

You are in New York at this time, right?

Yes.

You saved up some money. What are you doing for work? Are you a physical therapist working for a clinic somewhere? What are you doing for work, or are you still just collecting cans?

When I came here, I already had everything planned out. I said, "One week, get rid of my jet lag, I'm taking the exam." I said, "There's no ifs and buts about it. I'm not going to fail." I do not even entertain that. I took it, thank God I passed it, and that is when I started calling companies. At that time, we had the phone book, the yellow pages.

I called every company that is under physical therapy until I found someone who was willing to sponsor. Here is the thing. There is something in return in exchange for those papers for the sponsorship. I got paid way less than every sort that I do not share with many people. I got paid way less than everybody else because you need that paper.

For me, "If this is what it's going to take, then I've got to do it." At one point, I was working three jobs because I was working full-time in one job, 40 hours. I structured that two days there. I have half a day that I will be working and filling from the per diem work there. On the weekend, my girlfriend at that time was in Jersey, so on weekends I go to Jersey and do coverage work on a Saturday.

You were hustling.

You have to because you have to pay rent and the bills. Remember, at that time, I counted my money so much because you have to make sure you count every penny. After everything with groceries, I have $200 for my groceries every month. I cannot eat more than that. I used to buy Chinese takeout. At that time, it was three-something for chicken wings with pork fried rice. I would split that into two. I have lunch and dinner, so you can have like $5 for a whole day's meal. At the end of the month, I usually get $50 if I really save, $50 left every month. If you splurge more, then that goes away.

How Regie Decided To Start His Own PT Practice

You are working, you are hustling, you are paying your rent. At what point did you start thinking like, "Maybe I want to open up my own practice?" When did that start?

It was a few years into it. I said at the beginning, I knew how to speak in English, but coming from the Philippines, I am very conscious about it. People treat me differently here, too. The bullying did not really just stop in the Philippines. You come here, and you are bullied by Americans. I feel like I had a stupid stamp on my forehead when I was walking around there in certain areas. In Queens, it is more diverse, but not as much. It still did before. When you go to certain parts of New York or other states, you are different.

People talk to you very differently until you start opening up your mouth. They realize, "He can." Just a quick story. When I first came here, aside from reading journals to be more up to date with the techniques, I felt like I was inferior in my knowledge, which, later on, you realize is not really that. We just have to be confident in expressing ourselves. One of the first shows I used to watch on TV at that time, believe it or not, was Maury and Jerry Springer. Are you familiar with those?

Yes.

The reason why I was watching those is that it is not like you learn physical therapy from those.

No, you do not.

I want to be able to, same as in the Philippines, talk and curse with the best of them. I feel like here I have to be able to express myself. I was in martial arts when I was younger. I took that up again. That helped me build some confidence that I can stand my own and hold my ground if I have to. Funny enough, when people see how the way you stand, it gets them to back off immediately.

Also, the way you talk. When I start talking more slang, the way more Americans will talk, then they start treating you differently also. I am not saying that is right, but sometimes you've got to do what you've got to do. At that point, I just started learning more and more about the field. The culture is a big thing. I worked in that clinic for more than ten years.

After a few years, I said I got more confident, and I saw the things that we were doing there. I was like, "I do not agree with this. I know I can do this better to provide a better experience for the patients." For me, it is about that connection with people serving the neighborhood. That is what I love about the physical therapy field. It is the most fulfilling job in the world because you get to have a patient coming in who cannot walk.

By the end of their sessions, they can walk, run, and return to sports. They get their lives back. What other profession can do that? I really love the service part of it. When I saw that there were things that could be done, but I could not do anything much, I basically ran the place for many years, but I could not make the decisions because the boss would say no.

I started thinking to myself, "I want to create something in the future that can provide a different experience for the patient." One night, I still remember that the boss came to the clinic, which I felt was odd because, since I ran the place for many years, we had grown it to twice the size. I even designed the location, the different layout for the new location, because the boss did not want to hire an architect or a designer.

He came, and I thought something was weird because he is usually not there when I am there. At the end of the shift, he called me to the kitchen. That is our staff room. In one sentence, he fired me. I remember that. He said, "You're fired." I was shocked. After more than ten years, all I could say at that time was, "That's it?" He said, "Yeah." I asked him, "Can I come back tomorrow?" because it was nighttime and I had stuff there.

That was home to me for more than ten years. You have extra shoes, you have extra socks. He said, "No, you cannot come back here anymore." I had to bring everything that I could with my two hands and go home. I still have stuff that I left there. The worst part is that I had to go home to my new wife because that was the first working day after I got married. I had to break the news to my new wife that I had just been fired.

The financial stress took its toll on my family, and later on, we separated and ended up in divorce. I have to admit, I got depressed at that time because you start feeling sorry for yourself. I felt like I lost everything. I lost my identity. You feel like you lost your manhood. You lost your money, and then you lost your family.

You lost your relationships. Later on, I said, "Who's coming to save me?" Nobody will. I stopped the pity party. I got up, and I said, "Only I can save myself. What do I do now? Either I work for somebody else, or I build something that no one can take away from me because I am not going to get fired again."

That is when I started the clinic. I felt like that was the push that, when I got fired, was the push that I needed because I was thinking about starting a practice. "I cannot, but maybe next time." When I got fired, there was no more next time. It is either then or now. I said, even if I do not make it, then I know I can work with somebody else. Thank God, knocking on wood, thirteen years later, I’m still in business.

It’s good for you. You have been an entrepreneur your whole life.

Chinese culture has a lot of entrepreneurial qualities. You are going to see a lot of Chinese people who are entrepreneurs.

When I think about it, it is a hardship. It is a lot of struggle and a lot of risk-taking. You are taking risks. I think you learned the skill of being very efficient, and you learn how to count your money very early. You counted every penny, and you allocated your resources responsibly. You learned that skill.

The last skill, which I do not think was the one that you learned later in life, but you just learned that nobody is coming to save you. It is on you. You took 100% ownership of it. It is like you can either blame the world or you can take full responsibility and ownership, and you can control what you can control and move forward. I feel like that is being an entrepreneur your whole life. You mentioned it, was it your mother or was it your aunt who spoke that into you at an early age?

It was my mom. She always drilled that into me since we were young. "We're going to America. We're going to America because we want a better life." It is no fun being broke. There were times when we had no electricity. You are going to study with candlelight. You split the food on your table with your siblings. Sometimes you do not have enough food. You go to sleep hungry.

That is not the life you want. I feel like the part that made me learn that no one is coming to save me started early on when I was young. When I was being bullied, I was hoping, or at that time, I was thinking my dad would back me up as a man. My parents always told me, "You don't fight." I get punished if I fight.

Here’s the thing. That did not make things get better. That actually made things worse. Let me be clear, especially when people hear this on social media, I am not condoning violence. I am not saying that. At some point, you have to stand up for yourself because people are not going to stop coming if you do not stand up for yourself. I am not saying you fight all the time. For me, in my experience, that helped me get the peace that I wanted. I realized, "No one's coming to save me. My own dad didn't come and save me. Who will?" I got to handle things on my own. I got to stand up for myself.

You started the clinic?

Yes.

I am assuming you started all the same way most of us start. You just started, got a small place, signed a lease, and then started knocking on doors, I would assume, right?

That is the crazy part. I would not have done it now, knowing what I know now. I probably would not have started the same way. When I started, I said, "I'm going to borrow some money." I used some money that I had left behind and borrowed from the bank for the equipment. Instead of starting a small place, I was this little kid with big dreams, and I had a lot of confidence in myself.

I got a 2,200 square foot facility at that time to start. I did that because I envisioned it, like, I saw the place, and I said, "I like this." Transportation-wise, it connects the trains. We are right across the street from the train station, so I said, "It's great." The area was being developed, so it was not the way it is now. The rent back then was not anywhere near what it is now.

I envisioned myself, and I said, "I'm going to fill this place up." I was a cocky little kid at 2,200 square feet. I only had two beds to start off in the whole place. My strategy at that time was that the whole place looked empty. I got big pieces of equipment from the gym to fill up the place. It looks fuller. That is how we did it. We start knocking on doctors' doors, people I know from the neighborhood, because it is in the same neighborhood where I worked for more than ten years. I know people in the neighborhood.

I was at one point board of directors of the Chamber of Commerce and knew some of the doctors. It is different when you are doing it on your own. You start knocking on people's doors, going to the church, people in the supermarket, anywhere. You invite people to come in. I was able to develop a strategy that, when we have patients coming in, we are going to give them an awesome experience that they are going to love, and they are going to tell other people about it. That is how we grew.

The Impact Of Building Your Own Raving Fans

I know because we were a mastermind together in a similar coaching partnership. I know you invested in yourself and in different coaching programs. One of the things that you always talk about is this idea of creating raving fans. You alluded to it just now. You talk about that with your customers or your patients, but these are my words, not yours.

I feel like there is a similar approach with your team. Your team becomes these raving fans as well. At least that is what I get from some of your content. I would love to dive into that a little bit. How do you do that? How do you think about creating these raving fans, and what are some of the principles that you follow to create that outcome for your company?

It is a great question, Adam. You are correct because when you tell a business owner that they should think about the customers, but raving fans is not only about the customer. You do not have raving fans. The bigger the raving fans, it is about your team. If your team is not raving about you or your company, then that is a big problem because why would your patients rave about you if people who work for you do not even like you?

I went through a part of that at the beginning of my entrepreneurship journey. I went through a lot of changes and a lot of challenges with hiring. That made me learn that very important lesson. How that started with my clinic is because of where my location is. We are not exactly where people live. This area is really building up.

Long Island City is crazy here. We used to see the Manhattan skyline. Now I see buildings from Long Island City. It is just different. At that time, I had a challenge. I said, "How can I get people from the location where they live?" It is eleven blocks away from my clinic. How can I get them to come to me if they have a clinic close to where they live? You know the struggle.

We are treating patients in pain. We are treating patients who cannot walk. Here I am asking them to walk eleven blocks to come to see us. I realized that we have to create a great enough experience that they will come and choose us over a place that is closer or a place that is cheaper. That experience has to be great enough. We started that right from the beginning with our patients, and then with the staff that developed a little later.

The turning point for me was one year, a few years into the practice. At the beginning, it was myself and a receptionist. It was easy to manage that. When I started growing my team, the patient load started growing. I remembered that I had one year that I had 27 people left my company, and I had a team of six at that time.

The environment and atmosphere were toxic. It was very stressful. At the beginning, I kept thinking, or I kept saying, "I don't have much luck in hiring. I always get bad people." Some business owners may relate to that. That is what we are thinking. Later on, I realized that it is not really true that they are all bad. Do not get me wrong; some of them deserve to get fired.

A lot of it, I have to take responsibility for. It made me go into personal development. I realized that there is a lot of realization. You hear me say that word a lot. I learned that when I go into personal development and become a better person, I can be a better father. I can be a better partner for somebody in the future. I want to meet somebody someday. Also, I can be a better leader for my team and a better business owner.

I focus a lot on that. I invested in myself and learned all these different things. As I grew, as I developed, and as I improved, everything followed. That is what made me start creating raving fans amongst the staff, also. If I am the only one producing that result, then I am going to get trapped. If my team can help me produce that result, then I can get away. Also, that will multiply the number of people that we can help.

How many years in business were you in when you had all those people quit? What year were you on, roughly?

It was 3 or 4 years into it. That is when you start really growing. For the first couple of years, I worked Monday to Saturday from 8:00 to 7:00 almost every day. You treat hundreds of patients because you work 50 or 60 hours. At some point, I started, I cannot sustain this anymore. I brought in that when you had the aide, then you had the biller, then you had your PTA, and you grew your team. I know I can treat patients, but I was not a good leader.

Build Raving Fans Through Self-Awareness And Personal Development

I did the same thing. I would like to say that most people have a similar experience. I did not really lose a lot. I did not lose 27, but I did lose probably 5 or 6 in a year because of me. Nothing really changed. The turning point for me was whenever I realized that I was being a jerk. I use the word jerk, but I was really being a little bit more than that.

Driven by ego. We do not realize it sometimes because we are in this fight or flight mode all day, every day, trying to juggle all the balls in the air. We end up becoming somebody that we do not want to be. We ended up losing some good relationships because of that. I did the same thing. I went about a year where I just detached from my friends. I detached myself from the noise in the world.

I just read all the books on leadership that I could. I started diving into meditation and journaling, and deep breathing, and just learning a little bit more about my emotions and capturing the way that I was thinking and feeling during those intense moments, and choosing to control those moments instead of letting my emotions control me. That was the turning point for me as well. I want to back up just a little bit.

My issue was with my front desk. I had this really great front desk person, probably was not going to turn out great long-term, but she was very talented. She wanted to do things her own way. She did not want to do them the way that I wanted them to be done. I did not know how to navigate that, but with just more anger. She ended up quitting me and gave me a day's notice.

I had another person join who was another rock star, and she is still with me. Her name was Angel. I guess about 3 or 4 months into her employment, she pulled me aside. She said, "I want to have a meeting with you." She said, "I am about to quit. You are driving me crazy." In my head, I was just thinking, "I am just trying to help."

I am not trying to drive you crazy. I am driving myself crazy. The best thing that I ever did was I said, "Obviously, what I am doing is not working. I am permitting you to hold me accountable. I need you to teach me. I am going to continue to do my thing, but anytime that I make you feel overwhelmed or if I make you feel uncomfortable, or make you feel like you are about to quit, I want you to stop me and tell me right there.

You have permission. I am not going to get mad. Whatever you say, I am not going to get mad, just tell me." She started doing it. She was like, "Adam, you are doing the thing." That was the greatest teacher for me because what I started to realize was that every time I started feeling overwhelmed, that is when she started feeling overwhelmed. I started learning that the way I was controlling myself internally was the same emotion I was delivering to them.

I was like, "I am anxious. That means they are anxious. When I am mad, they get mad. When I get crazy, they get crazy." It became a game of I need to control myself so that I can invite them to be calm and composed with their work. I am in debt forever. Eternally, I am in debt to Angel because of that lesson that she taught me. That was my experience. I do not know if you have something similar.

That is great. You came to the realization. That is great self-realization or self-awareness. Some people, when they call you out, you might still not listen to them. You might still reject them. I am stubborn to a fault. The first few times, I did not listen very well. I still go with the same habit. It is just your brain rationalizes things until it really gets bad. You have labor investigating things like that. It really got bad.

That is when you start realizing, "Let me start chilling a little bit and then see what's going on." I think that is why it got to that point. Same experience as you. The reception or the front desk was the biggest turnover for us at that time. When I started improving my emotional awareness because, since being a kid, I knew my IQ was always high, because I was trained, and when I was younger, before I had all my surgeries, I remember things very quickly.

I look at my book once time and I remember the information. My fourth surgery changed things. It still got me through school, though. I knew that was not a problem, but at the beginning, I was thinking, "If you are smart, then you can make a successful business." That cannot be further from the truth. You have to start working with people. I improved my EQ. That is when I feel like everything changed for me. Not only with the companies, even with my personal relationships, everything improved at that point.

That is, whenever I started allowing myself to be calmer and composed and grounded. It invited my team to be calm and composed, and grounded. That was the gift that I gave. I learned how to give that gift. Whenever I started learning how to give that gift, that is when my team started becoming fans of me. They started telling me, "I love working with you. You are an amazing boss."

Not because of anything more than that. It was just me being composed, choosing to have more grace and choosing to listen more than I talk, especially through the hard things. That was the gift. That built a lot of trust, and that also allowed my team to give that gift to the patients, because we started learning about that. I can remember maybe 3 to 5 years into business, I still have some people on my team that are still with me from those times, from the early days.

They tell me all the time, especially people who joined the team, "Adam is not the same person he used to be." You do not know the old Adam. That guy was crazy. We have conversations about how, actually, I am the same person. I just have different habits. These are the habits and skills that I learned.

That actually becomes the foundation of our leadership development training. When we put language to those skills like EQ or emotional intelligence, that is the language that my team starts to use with each other. They start teaching each other that, and that is the language that the patients have as well. There are many times when patients in our clinic will stop me, and they say, "Adam, I want you to know that when I came here, I just came here to get my knee better. I feel like I got a little more than that. I feel more grounded when I am here. I feel more present when I am here."

I have gotten that message from my patients. I truly believe it is from the work that I did. Not that it was all on me, but it was from the gift that Angel gave me that helped build that culture. As I am reflecting on that experience, maybe that is how we have developed raving fans. I am wondering if that is a little bit of your framework.

In the way we show up as leaders, you mentioned it, when you are upset, they get upset. The way we show up passes on to them. If we are not clear about how we communicate that, they will not be able to understand. They are not in our minds, and they will not be able to read our minds. When we start changing, and people say, "It's a different you," it is the same us.

We just know how to manage situations better. This is version 3.0 of me through the years. The way you said it is correct. When we started having the team respect us, we all shared the same values. That is one key thing in my hiring process. Through the years, we have developed a solid hiring process already.

One key thing is that we have to have alignment in my values, and we have ways that we do that. When you are all aligned, then you understand each other, you share the same goals, and you share the same vision. That is when they enjoy working. When they enjoy working for you, the patients can feel that, versus somebody who is just there to clock in and clock out.

People, when they work they just do not have to go over, above, and beyond. When they love what they do, that just comes naturally. When patients come in, they feel that. When I come in, and the patients see me, they would stop me, same as you, and they would tell me, "Your staff are awesome. They did this. They did that."

I did not ask them, and the staff did not ask them to tell me. I feel very proud when they do that. It is not because of how good I am. No. I am just proud of how my staff are showing up and how they are serving people, which is one of our core values, service. We are serving our community to the best of our they can and people are happy. That is how you create those raving fans because they bring other people.

We have strategies on how we do that, but that starts with that experience. If you do not have your staff as raving fans, they are not going to be able to produce that great experience for the patients because they are going to be forced. Also, you do not know what people say behind your back. If they are not happy, what is stopping them from telling their patients that their old boss is an a-hole? Those two are very closely connected. You cannot have a practice where you can not be in the practice day to day in the day-to-day things if you do not have your staff as your raving fans as well.

What I took from this, and correct me if I’m wrong, but it sounds like building raving fans really starts with you as the leader. It really starts with your self-awareness and personal leadership. It starts with you learning how to be somebody that people like.

People like to be able to handle those tough conversations with either their staff or patients. Sometimes, the patients who are not your friendliest patients at the beginning turn out to be your biggest advocates.

It is more manageable to maintain a positive culture when you are by yourself. If it is just you and one person, you can grind through an eight-hour day and put a smile on your face and make your patients feel like you are happy, even if you are stressed. It becomes exponentially more difficult to do that whenever you are building something outside of yourself, whenever you start having 3, 4, 5, 6, 7 therapists in a building, and you are trying to create that outside of you. It is a whole different game.

It is not only the staff now, because we have a virtual staff. It is a hybrid. We have in-person, and then you have virtual staff. How are you going to make everybody happy or have that great experience with your company?

Book Recommendations From Regie

I know we are getting closer to the hour, but if you can share a little bit about what some of the books that you have read, or what some of the things that you committed to that really helped you develop that sense of leadership and personal self-awareness?

The book that really helped me with my emotional and self-awareness is Emotional Intelligence 2.0. I read it many years ago. That started something in me and started changing things. That has been monumental for me. I know it is not a business-related book, but that has been the fundamental thing for me. For the business side, Atomic Habits has been very important for me because I want to make changes.

The quote from Maya Angelou says, “People forget about what you say, people forget about what you did, but they will never forget how you made them feel.” I always make people feel great. They feel heard. They feel seen. You put in the process of how they can grow that exponentially. If any business out there is struggling with that or wants to get that result, especially if they want their team involved, I would love to be able to help them out.

We are live right now in the Facebook group. I will comment below. I will tag you in there. I will drop your email address in there, and then I will also drop Chris Williamson's stuff in there, too. This will also be a podcast. For you guys that are tuning in, check out the show notes. You will have Reggie's website and all his social media stuff. If you want to get in touch with him, I am a big fan of what he does. He has the PPO club stamp of approval.

Thank you, I appreciate that, Adam.

Thank you so much. I really enjoyed the conversation. Maybe we could do this again, maybe sometime next year. I love to tap into people like you just to learn how you are growing as a leader and just watch your evolution over your career. Maybe we can redo this sometime next year.

I love that.

Brother, be good. Merry Christmas. Happy holidays. I will see you later.

Thank you. Merry Christmas. Happy and healthy New Year.

Important Links

Build A Movement, Not Just A Clinic: Why Giving Back Pays Off With Will Humphreys

Mon, 12 Jan 2026 19:00:02 GMT

Most practice owners think charity is something you do after the business is successful — once there’s more time, more margin, or less stress. But what if giving back isn’t the reward for success… what if it’s the catalyst?

In this episode of the Private Practice Owners Club Podcast, Nathan Shields sits down with longtime friend and entrepreneur Will Humphreys to unpack one of the most overlooked drivers of sustainable growth, culture, and fulfillment: building meaningful partnerships with charitable organizations.

Drawing from deeply personal experiences — from local community initiatives to life-changing work in Africa — Will shares how aligning business purpose with charitable impact transformed not just his companies, but his leadership, his team culture, and his perspective on success itself.

Together, they explore how generosity creates momentum inside organizations, why charitable partnerships improve recruiting and retention, and how purpose-driven businesses outperform those built purely around profit.

They dive deep into:

Why charitable giving isn’t a “nice-to-have,” but a powerful leadership lever
How partnering with charities strengthens culture, retention, and recruiting
The connection between profit, purpose, and long-term sustainability
How even small, local initiatives can create outsized impact
Why giving back reshapes mindset, reduces burnout, and restores perspective
How involving your team in charitable efforts turns values into lived behavior
What practice owners can learn about leadership, resilience, and gratitude from global communities

If you’ve ever felt burned out, disconnected, or stuck chasing growth without fulfillment, this conversation will challenge how you think about leadership, success, and the true role your business can play in the world.

��️ Learn why the strongest clinics don’t just grow businesses — they build movements.

�� Learn more about supporting Care for Life and global impact initiatives (links in show notes)

Want to talk about how we can help you grow a purpose-driven, profitable PT business?

Book a call with Nathan — https://calendly.com/ptoclub/discoverycall

�� Love the show? Subscribe, rate, review, and share! https://ptoclub.com/

99.5% of successful owners interviewed on this podcast have leveraged a business coach at some point in their journey. Private Practice Owners Club is the coach you need — ppoclub.com

Explore upcoming workshops, free resources, and tools to help you build a practice that supports both your life and your mission:

https://linktr.ee/ppoclub

---

Listen to the Podcast here

Build A Movement, Not Just A Clinic: Why Giving Back Pays Off With Will Humphreys

I’m here with my long-time buddy, friend, partner, co-worker, you name it, Will Humphreys . I was going to say something else.

Does it begin with a letter L?

I was going to be a reference to big spoon, little spoon, and you can pick which one is which.

I was literally going to say something in that same vein. I love this because everyone's imaginations are running wild, like they have their own thing, and you're all right. All of you are correct with what you were saying.

It feels like it's been a long time since I’ve had you on.

I was just thinking that. That's really funny. By the way, since you’re now in Arizona, we have to do some shows together in person.

We need to do more of them together, but I will say, it is totally dependent on Mr. Will’s schedule, who is a busy-pants all the time.

That is actually my official name. I’ve changed it to Mr. Busy-pants, and I don't love it but it’s a badge of honor. We’re all busy. I just got to this point where I was just like, “I have executive assistants, maybe I should let them control my calendar.” It’s amazing how they don’t let me abuse my time the way I do. It’s crazy.

Good. I think last time, we talked about either AI or the virtual assistant stuff. Super valuable, whatever it was.

We will have to make space for us getting together. I think that would be great because I know if the audience doesn't care, I know we would love it. That's all that matters.

I just want to sit in your studio. You actually have a studio, which I have never been to. I’ve never been in a podcast studio. To be somehow formal in the appropriate setting would feel very nice to me.

That is so ironic. You have the most impactful show in our space, which is funny because I also have a podcast in our space. You have the most impactful, and you don’t actually have a studio. I think you would love it.

You’re talking to a guy, if you recall, that used to do it out of his closet. I look at those videos now and look at the clothes hanging up behind me, and I'm like, “What was I thinking?”

Is that a trench coat? What is that behind Nathan?

“You’re in Arizona, why do you have a trench coat?” I’ve got ideas. At least we had fun listening to that. Hopefully, everyone else got through it the last few minutes.

I know, everyone else is like, "Are we going to have a show today? Is this going to be what it is?"

“Are you guys going to talk about anything significant whatsoever?”

I don't know. Maybe they're lonely and they’re like, "I need some friends," because that's how I feel all the time. You're welcome to join Nathan and I's chaotic discussion over nothing.

Impactful Reasons To Support Or Partner With A Charity

What we're talking about in this episode, and I know this is near and dear to your heart because a lot of what you, Mr. Busy-pants, are doing has to do with charity and giving back. Not just in your professional life, but also in your personal life. We did a bit of this in our organization, and considering where you’re at and what you’re doing personally and professionally with charities, I thought maybe there is a way we can do an episode as to how people can leverage their businesses to have a greater impact in their community, if not the world, by collaborating with charitable organizations.

Speaking to that, why don't you share initially just a little bit about what you’re doing and then we’ll tie it back to some of the things. We weren't super charity-focused most of the time during our ownership, but towards the end, we got a lot more. Talk to the people a little bit about what you’re doing both personally and professionally, highlight those, and then we can tie it back into business.

To frame this for everyone who’s reading, this is incredibly impactful. This is one of the single greatest secrets in terms of developing our business that there is, which is supporting and partnering with charities. It’s the thing that on paper you don't see the connection. As I go through this, I want you to recognize that first and foremost, this was a journey. When you read about what I’m doing, this has just been an evolution over time. As a result of spending time in this space, it’s been bizarre to me to see the benefits of how much I put into these charities and how much we grow as a result of these things.

Let me just add, if I could. You talked about the product of what this does for people, but you’re not seeing the benefits of it on paper as you say, but I think I can speak for you that you feel so much more fulfilled and living out your personal purpose by combining your work with these organizations.

Exactly. That's a great way to frame it, Nathan. For everyone who’s reading, I thought it would be useful because I like to get to the point. I’ll go into it more in detail, but here are just a handful of the most impactful reasons why partnering with a charity are good for you. The first thing is what Nathan mentioned, which is this thing called perspective and creating meaning and purpose.

The heartset and the mindset that working with charities creates is a game-changer that actually results in greater growth in business, and we'll talk about that in detail. Number two, and this is where it seems more tactical, is that you also build the culture of your company to the same degree because then you have people who are aware and collaborating and helping support this, which makes them feel like where they work matters more.

They’re part of a bigger purpose. They’re part of a bigger thing.

The whole point of culture is to turn our company’s existence into a movement. The specific byproduct of a well-created culture is that people feel like they’re going somewhere to work that it's going to make a difference in the world. Every healthcare provider, in particular, feels super grounded on that concept. When you create this charitable partnership, you retain better, you recruit better, all these things. These are measurable things that if people start doing, it creates these impacts. The purpose of partnering with charities can't be about that product, but it is the natural consequence of you focusing on it.

Number two would be the cultural shift within the company. Number three is the community shift and how they experience you. This is what helps us get clients, whether it’s patients, or in my case, people who are looking to hire vas. When they understand that partnering with you as a customer drives these, again, this isn't the reason why we do it. The reason we do it is because we want to help other people. It’s just the natural product of what happens when we do it right.

There’s the fourth product, which is a full circle, which is that the people you’re serving that have nothing to do with your business, like we're going to talk about Africa here in a second, but these people that you’re going to, they get better or supported or whatever it is that they need because of these efforts.

Think about it in terms of impact, starting internally with your soul, outward to your closest group which is your team, then you go to the public that you’re serving and then the world at large, the people you’re actually doing charity for. Of course, you get those benefits of being a father or a mother who have if you have kids or a spouse, that they see this and it changes how they view your professional world, but that’s a bonus feature. That would be the overview in terms of why they care about this before we even get into it, because that’s the end result.

Why Businesses Should Focus On Charitable Efforts

I’m imagining an owner reading this and they’re like, "Yeah, cool. I’m working 60 to 80 hours a week already in my business. How am I how do I ever fit this? How do I ever make those kinds of collaborations? What the time suck that it could be. I need to get my next therapist first.” Of course you do, but I think what we're saying is it doesn't take a lot of time. Have you found?

No. It’s like eating an elephant. It’s one small bite at a time. What we prioritize has everything to do with the way that we grow our companies. If we prioritize giving to others in a charitable format, we are in a position where we do end up creating better space. I’ve learned that by focusing on charitable efforts, the mindset shifts of the owner and the employees to allow for it, which allows for other growth as well.

Now, one caveat. There are people reading this who are driving into work burned out with no energy left, who have zero profits or very little profit so they’re upside down. For you guys who are reading, this isn’t another thing you should feel bad about not doing. What you should hear is that it’s the reason why it’s worth going through what you’re going through.

I want everyone to know that if you’re in that lower level of suffering and you’re reading this, I want you to really understand this, that just by having a desire, a heart that wants to do that will eventually create the space for it when it’s time. You’ll look back and thank the you of today for struggling through these things and reading Nathan’s show and doing the work so that later you can make the impact because I wouldn’t do what I did today without a younger version of me struggling through it as well.

From our experience, we had people on our team that were more than willing to take that off our plate.

When it was that.

When we were struggling with the day-to-day. We weren't struggling financially, but we had plenty of things on our plates. It was so uplifting to me to reach out to my team and say, "Who would like to lead out on finding our next charity?” Maybe it's not like we're going to do a year-long effort, but who wants to find a charity that we and the patients and involved the patients in it? What can we do? What can we give?

I remember this was back when, in my first clinic, a few years being open, I think one of the people on my team found a crisis center or a house where women who were abused were living. They had this laundry list of items that were needed, especially items for their children. All we did was put a big bin off to the side of the waiting room or in the treatment room, I don't remember where, and someone decorated it with wrapping paper and we made this list of items that were needed by this local crisis center.

We would hand it out to patients and they’d bring their things in and we’d tell them we’re donating on this date so make sure you get these items any of these items in into the bin by this date. It was something simple that just felt good. You were supporting the community in that way. Such a minor thing. There's so much more that you can do that ends up being calendared and just an ongoing relationship with a particular charity, but that was an easy place to start for me that didn't take a lot of time.

I agree. Charity is like water, it fills every vessel. It doesn't matter how big the vessel is, and think of your vessel as your time or your knowledge or your capability. Anything we do at any time to help anyone blesses the lives of everyone associated with it or even hears about it. Maybe it's a small project, or maybe it’s a huge initiative, but it all starts with one bite at a time, as my East Texas grandmother would say about eating the elephant. We have to just take one bite at a time.

Maybe we could talk about where those good first bites could be if you want, but I just think it’s important for everyone to know that we can't approach it like a tactic, and it’s the most incredible tactic there is. If we do this the right way with the right heartset, very few things we can do as business owners can dramatically improve every element of our business more than partnering with a charity.

Charities Supported By Will And What You Can Do To Help

Tell everyone a little bit about what the charities you're working with right now. I'm sure they’d be intrigued.

This is not something to feel overwhelmed by as you’re reading this. The end in mind, this is where I’m living now, is first I’m on the board of directors of a company called Care for Life that specializes in developing tribes in the poorest countries of Africa, which are the poorest countries in the world. Mozambique is their primary target right now, where they are teaching community members seven different principles of leadership that have to do with sustaining life.

These are villages where greater than 40 percent of the children are dying from malaria. Simple, easy-to-control things that they don't have access to. This group doesn't bring people in from America to be the saviors. What they do is they have educational groups in Africa, Africans Mozambicans in particular that go to the tribes and they are employed and on the payroll of the charity and then go into the tribes and teach leadership in those villages. They’ve been around for many years. They have completely hacked and systematized how to bring villages out of poverty and into sustainable growth states, which by the way, are based in entrepreneurship, which is a fun thing I always get to see.

I was going to say, they teach leadership and entrepreneurship, don't they?

Yes. I think, again, these owners that are reading your show are thinking about as they’re driving to work, they don’t realize how much capability they have in helping others as they struggle through the challenges of owning their own business, because that’s very much what they do at Care for Life. I’m on the board of directors of that charity. We go down to Africa for that group roughly once a year. We might be going back, by the way, to where we go down there more to just train the employees and then the employees help the villages. That's one element.

The second thing that we do is that we’re starting to create our own initiatives in different countries in Africa. My wife and I were in Kenya. This wasn’t an organization. I have a friend, now that I’m in that world, who just goes there to help different orphanages. There’s so much need for help that this woman just started organizing, “I’m going to go there. Who would like to come with me? Let’s raise some money.”

I have a religious podcast that you know of that raised over $8,000 and we went down there and started buying new land for an orphanage that got washed away with a flood. We went down there and spent time with the children and looked for places for this orphanage to go and those types of things. That’s the extreme side of it but those are the two main efforts that I’m currently connected to.

Through my company Virtual Rockstar , we have also built a fund where we are putting money in to help provide a relief fund for Filipinos when the typhoons wipe out their houses, which happens on a regular basis. For our employees, we’re developing a charitable fund that they can contribute to with their American counterparts that will serve as a fund so that if ever someone loses everything, we can actually rebuild that with them.

It's cool. Nathan, here's the vision right now, this global impact. This is, by the way, not a tactic, this is the reason I own what I own. I’ve come to realize this is my purpose personally. I am leveraging my company, Virtual Rockstar, and the and the Americans to help benefit the Filipinos and their virtual assistants. It’s the owners and the Filipinos that contribute towards the African charities. Filipinos aren't the recipients of charity alone, they’re getting to create their own efforts to help people who are worse off than they are in the poorest countries in the world.

That’s what was so cool when you shared with me about that. These Filipinos are not anywhere near American standards in terms of standards of living, but they want to give to these African communities as well, and so you’re providing them an opportunity to bless African lives.

Philippines is about Guatemala level. That’s where I served my mission for my church Jesus Christ of Latter-day Saints. I was in that Guatemala area, so that's the charitable level that they're at, and I can't remember the exact placement, but honestly, it's almost exactly halfway between the developed countries and these five countries in Africa. It’s funny because they’re like directly in the middle. There is a need to help them, but they are way better off than these poor people in Africa. They all help each other.

Here’s the key thing. I don't want to leave this episode like we’re finished, but the key thing I want people to walk away from is that we need to be in touch with those people overseas who are struggling as much as they need to be in touch with us. They are in financial poverty, we are in social poverty. When we go over to these places where people have nothing and they have found a way to be peaceful and happy, it changes us forever. It’s not a one-way cycle of charitable giving. It literally changes us. As I told you when we met, I got on the plane coming home, first of all, never feeling happier and being like, "I don't have any problems." I got on the plane going over there going, "What am I doing? I’m taking a week and a half to go to Africa."

“I’ve got so many things to do.”

Yeah. "I’ve got four kids,” then I get on the plane coming back, and you would think I was high because I’m just sitting there like, "It’s all good," because it is all good. We’re going to come back. If those people who are suffering can find joy and peace, I have no excuse. Guess what happens? I come back and I have all these ideas for my company because I’m in this outward mindset that I wouldn’t have been if I hadn’t been served charitably by this little boy named Victor. I'm going to get emotional, but next to my computer, I have this note that he wrote me.

It just says, "Dear Will, always know that God loves you and that you are a great man in this world. Victor.” Victor lost both of his parents, suffered abuse of every kind, and now he’s safe in this orphanage. At the time that I was visiting Victor while we were looking for their new orphanage, Nathan, there were 72 kids living in a 3,000 square foot home with 2 beds and 2 baths with big open floors. Everyone slept on the floor. This 24-year-old woman named Vanessa was raising them by herself. You just come back like, "We all need each other equally."

You shared that same experience with me. You’re like, "I have nothing to complain about.” You also said the same thing, "I wish some of these people in America,” whether in terms of anxiety, stress, you name it, which are legitimate, “could see what how blessed they are compared to what is out there in the world.” It’s transformative.

Absolutely. To be really clear, audience, at the end of this, I’m going to have some calls to action to support these charities that I don't benefit personally at all. It’s all for you helping them. There is a call to action I wanted to shout out right now. As you are sitting there reading this, if this is calling to you, I’m going back and I’m bringing people with me. I want to hear from you. People have all sorts of questions before they get into charitable worlds like, “Aren’t there bad charities out there? I don’t want to waste my time and money and those kinds of things.”

"How much of this money is going towards the non-profit executives and what percentage of every dollar is going to the actual people in need?" There are always those questions.

I’d love to have those conversations with you because, at the end of the day, those are the things I think that hold us back when we’re so busy that we don't know if there's space. Remember, we only go through very short amounts of time with high levels of motivation. When you are feeling motivated to do something like this, this is something to act on. Reach out to me.

How do they reach out to you?

My email, Will@UnlockHBA.com . Just email me. Honestly, my virtual assistant will be the first person to respond to you because she controls my world. Just say that you were on you read Nathan's show, that you want to learn more about how you can go to Africa and I’ll have other calls to action later in the show about what else you can do if you're like, "There's no way I’m going to build time to go to Africa or anywhere else." Remember that charities don't have to be that far away. Our first charity, Nathan, was Feed My Starving Children in Arizona.

I was going to ask you to explain that a little bit about how we got together with them and what that looked like because I think I was in Alaska during that time.

You were doing things before you left for the Parkinsonian charities that exist. Very similar to what you said regarding the Parkinson's charity that you guys were sponsoring at Pinnacle, I got together with the team and just it was one of those where it's like, "We should support a charity." It wasn't coming from this like, "I'm a good guy and I want to help others." It was like, "We have a business, we should probably do something with charity." That’s how the whole thing started, that was the first bite.

What we did that was smart was ask the team what they wanted to do. Of course, they had lots of ideas, but someone suggested this thing called Feed My Starving Children here in Arizona. It’s a great charity where it’s not just about feeding hungry children around the world, which everyone can get behind. They have a packing experience where you go down with your team and then you pack for the charity. All.

You actually pack the food.

You actually pack the food. You have a team bonding experience. It’s perfectly systematized to where by the time an hour hits and you're just getting physically tired, you’re done, you get to see on a scoreboard how many kids you fed, you walk away closer to your friends. There's a great spirit in that packing experience. This is what it was at the end before we sold. At the end, the way it turned out was that it involved to where Nathan and I had these four clinics and they knew on January 1st that by the end of that year, we were going to make donations based on their ability to promote the company's purpose.

Our company's purpose was to be the light and hope in the lives of others. Every clinic director was given these sticky notes and any time anyone saw anyone do anything that they thought provided light, maybe it was a patient's attitude or maybe it was the guy who brought in the water, they would write it on a sticky note and stick it on the wall. At the end of the year, every sticky note represented a dollar that would be in a check that we would give to Feed My Starving Children at the end of the last packing event.

It was this big packing event where they’d rent out the downtown Phoenix convention center and Chase Bank would be there, so there were thousands of people packing food. We’d all attend that in December and we at that time we’d take we’d hand a check over to the director and take a picture and put it in our promotions. What was funny, Nathan, is how it evolved.

Every clinic started getting specialized sticky notes, they started getting their patients involved, and the sticky notes started taking shape on the walls. Maricopa Clinic had a giant dinosaur one year where it was just like this T-Rex all out of sticky notes of people showing the light and hope, patients were coming in, they were writing it down. Think about how the charity tied to the purpose for all people, and again, I didn't create this. This was the team's evolution of it.

Literally, the patient walks in, they know the company's purpose, be the light and hope. They're like, "My therapist was my light today." They stick it on the wall, that therapist sees it, they feel touched, they look for someone else, they put it on a sticky note. Pretty soon, their contributions are being meshed into these beautiful shapes and at the end of the year, we walk and hand over this check that was in the thousands of dollars after a full day of packing together. I have a picture on my desk that I got when we sold our company and in it is one of the packing days of Rise Rehab.

It was so special. I keep this next to my desk. It’s been over eight years since we exited. That’s the stuff. We look backwards and it’s like all the stuff that we suffer through, it's the people that we get to work with and those types of moments that you’re like, "I just said one day maybe we should do some charity, we should probably do something,” it turned into the thing that I remember most about that experience.

When has a few-thousand-dollar check ever been more impactful or that you even remember?

How many times do we drop $5,000 on a service or product and it does something for us? I don’t even remember how much we spent but it was like whatever it was wasn’t enough. Should we have done more?

Bringing People Together For Charitable Work

Totally worth it. Did you find that it also brought the team members together as you were doing some of this stuff?

I believe there was nothing more impactful to our team’s culture other than defining and communicating our purpose, vision and values than the charity.

That was living it out. That was living out our purpose, values.

That’s a great perspective. I never thought of it like that. The defining of it and talking about it, the charity was the living it out. I never thought of that.

We put the words to action. The cool thing, you tied it back to culture, of course, but it’s those kinds of things that attract value-aligned people. We're not here to talk about recruiting and retention and all that stuff, but we definitely saw that in that the people who aligned with us, they were with us until the end. They were hardcore Risers. It attracts other like-minded and like-valued individuals.

It really did. It changed recruiting completely because it’s like, "This is who we are." first of all, very few practices really incorporate charities because being in healthcare, you're already in a service, and in a way, a charity. I want to say that’s true for me. When people own donut-making companies, it's not the same thing as healthcare providers provide impactful charity every day when they love their patients. That's not the same thing as a company of people coming together and picking something that’s not in the vein of what we're doing day in and day out.

Something that we can look outward that takes our heartset almost externally from the things that we're struggling with within their company to go, "That’s why we're here.” Yeah, they go and they make a difference in the lives of their patients, but what was best was when we could tie all three. Our company's purpose with the individual's purpose to a greater expression of that purpose outside of the company.

When we talked about profits, again I never meant this as a tactic, but it was always like, "One of the reasons we want to have a high profit margin is so that we can give more to this charity.” We were very transparent. That wasn't a tactic. If you guys want raises, if we’re going to give more to Feed My Starving Children, we’ve got to make this work. This isn't about making a profit machine, it’s about making an impact machine. It needs profits to do that. People can get behind that very easily versus like, "Well, why would I make your pockets fat?" that is how they see it.

You could imagine, they have a different perspective about when it comes to productivity conversations, if they see you living out this charitable experience with the whole company, if they’re witnessing the charity, it’s hard for them to say, "You’re all about the money,” because they do default to that, unfortunately, many times. However, when you show such a strong charitable backbone to the organization, living out your purpose, you could say, "Yeah, you could think that. I could see where you’re coming from, but were you there when we gave that $6,000 check to the charity last week?"

I think if someone on the team saw a very organized and focused effort to give back from a charity perspective, if they still push on you for being about the money, that is your greatest indication, what a blessing to know that you should fire that person immediately. They are a bump to your company's culture and it's not that they're bad people, they just need to go somewhere else and be happy. If your company is actually engaged in that and they still think you’re about the money, especially if they criticize it like, "He’s using this." Goodbye. Thank you for making it evident that you are literally the reason I’m not succeeding, and goodbye.

Will’s Calls To Action

You have some calls to action. What are your calls to action? You already expressed some.

The big one was if this is calling to someone to go to Africa, come. You don't have to commit if you reach out. If you reach out to me and you’re like, "Will, I'm interested in learning more," I’m not going to be like, "You're coming." you are, but I’m not going to force it on you. This is why I’m so intentful about this, Nathan. It’s because they need it. It is so hard to me.

We’re raising money for my organization, the Care for Life charity that I'm on the board for. That's 100% outbound cold sales. I’ll get on a call and talk to people, my wife will, who’s really good at it by the way, big shocker for me. It’s one of those where I know people. I have one friend who I think is making $30 million a year, and really good guy. This is not a criticism of him. I just said, "Can we get a donation from you?” I was looking for like $500, $1,000. In my mind, I was hoping he'd give like a $10,000 or something. He turned to me and goes, " Will, I'm in the earning stage of my life, not the giving stage.”

I just went, "You haven't met Victor or we went to one rehab center overseas that is completely run on the charitable giving of the Kenyans who are already poor themselves, and these kids have the worst equipment and they’re screaming in pain. They're being fed four times a day and all their clothes are being washed by these women who are just volunteering, they're not getting paid. If you saw that, you'd realize like that how silly of a comment that is."

It's like, "I’m going to give later when I have a certain level of “financial security,”" which is a load of crap, is only something we adopt mindset-wise if we haven't seen it firsthand. The people need that not because they'll give, it's because when you go over there, it's what you get by giving that time and space. It’s like there's a healing that these individuals who are born in the humblest and most horrific circumstances can give us just by existing.

One orphanage we visited, and I shared this with you, the hardest one we visited was this rescue center for girls who were rescued from sex trafficking. These 1, 3, 5, 8-year-old girls would stand up and tell their horrific stories of going through what only can be described as hell. For people who believe in a heaven and a hell, there is no hell after this life worse than what these girls have experienced.

To sit with them after earning their trust as a man, which took some time, and to hear them talk about love and forgiveness and happiness and the choice that it is. There’s a lesson to be learned at the feet of these angels that can only be experienced in person. You need them. Heather and I made a commitment that our goal is to get as many people over there as possible. You’ll be spending the money you spend just to get there. There’s no expedition fee, in some cases. If you go to Care for Life, there is because there are different options I can go over with people, but there’s just that piece of it.

The other call to action is just to make financial donations. The main one I’m going to promote is Care for Life. That is such a vetted experience, proven charity that every single red cent that is going to that charity is going to make a difference in someone’s life. I can’t promote that one enough as a board of directors.

The beauty of that one is that it’s tied to our small business ownership, so we can totally relate with the leadership and entrepreneurship skills that they're teaching. What I also really appreciated and respected about them as they expect to go into the village, teach them those things for however many years and then pull out.

Yes. They're in there for three years and then they pull out and they thrive after they leave.

They expect them to go. They teach them how to fish and then let them fish and they thrive. That's so cool that they don't have to set up a center and put down roots like, “We're here for the next century.” They make their impact, they teach their people, and then they leave. That's amazing.

We were there. Honestly, the reason that started, by the way, was because my sister came back from Africa from doing a safari vacation and I love to travel and I'm like, “We should go to Africa.” It's such a long trip. I was like, “Let's stay there for some time,” and Heather and I are like, “We should do like the old Rise days. We should do some charity,” as a tack on. We're in Africa, there's got to be an opportunity for us to do something charitable. I did tons of research because I'm super weird about research and I found Care for Life. I was like, “This is my company.”

I set up to go to an in-person expedition and the expeditions usually cost $2,000 to $3,000 per person in addition to your travel and we were already going. I thought we'll do four days of that. It turned into like a full week. I was dreading it. I had four boys with me and I just thought they were going to hate that week. We had two weeks of really cool vacation and when we could charity, giving with this thing.

We go to the village, the we spent all week, digging holes, and helping create latrines for this family that had earned the right to develop a latrine. The last day, they took us to the villages that they were pulling out of and it was it was black and white in terms of the difference, you would not believe how different it was to go into these villages where people had been graduating from Care for Life.

There was all these businesses. First of all, everyone's smiling. I don't want to pay paint a picture of Utopia, but it was just joy. They were just like thriving. The kids were in school and had uniforms on. There was a thickness to their physical physique of being healthy because they had clean water because the first thing that they put in is a well, and so you see that that difference. You're like, “This is so useful.”

This is a true story you probably heard me say, but one of the days, we were digging this hole in my youngest son, Van. He's my fourth son. Admittedly, I didn't put a lot of effort into teaching how to work hard. We're in the African sun. He's just digging away and he gets out of the hole that he's digging, literally, and he starts crying. My assumption is, “You're learning how to work hard. I'm sorry. I didn't really prepare you for this.”

I go over and put my arm around. I'm like, “Buddy, how are you doing? What's going on?” He goes, “I just never have been happier. I never want to leave.” My twelve-year-old son said that, and I didn't think he was even going on. I don't think we can appreciate, especially taking kids or grandkids to these experiences, how it immediately helps them come out of their social poverty. I'm not trying to compare these things. It's just literal. There's a financial poverty and then there's a social poverty that developing countries are experiencing through social media.

If you don't think that's a real problem, go look at the suicide rates of the youth nowadays that have tripled in the last ten years. If you don't think that those are actual diseases, go look at those numbers. I'm not trying to compare. I'm just saying, we need them. We need them as much as they need us. This is all part of God's plan. By helping each other, we can grow and thrive and find peace as a global family. If this is calling to you, please, every donation matters. I’ll say this. Every person who's reading who makes a donation, I’ll match it. That comes through the show.

Episode Wrap-up And Closing Words

That's awesome. Thanks. You’re doing great stuff. It is inspiring. It’s so cool to hear your stories and see the work that you’re doing. That’s so cool. Thanks for sharing.

You’re welcome. Thanks for letting me talk about it, and let me just say that I appreciate that and it just doesn't feel enough. I feel this urgency. The one thing I’ll warn people about is that once you start getting into this world, it changes your perspective so much that it's just like you never feel like you can do enough. It’s just so warming and life is joyful but as we’re talking about it, I'm just thinking, “What else can I do?”

It has nothing to do with me being a good guy. It's because I believe everyone who reads the show has a heartset that if they were just exposed to this, they'd be in the same vein in a way that would bless them. It's such a shift in perspective and I hope all of you guys who are reading just know that wherever you are in this journey, how much I appreciate what you’re doing. Nathan and I are so grateful for you reading this episode and getting to this part, for sure.

Thanks for joining me. I appreciate it, as always.

Yeah, such a gift. Thank you, Nathan, for having me.

Important Links

About Will Humphreys

Is Hiring Impossible? Build A Retention Machine Of A-Players, New Grads, And Leadership Development With Adam Robin

Mon, 05 Jan 2026 19:00:12 GMT

If hiring feels impossible and retention feels fragile, you’re not alone — and you’re not crazy. In this episode of the Private Practice Owners Podcast, Nathan Shields and Adam Robin break down why recruiting is harder than ever right now, and why the real solution isn’t “more applicants” — it’s building a retention machine that compounds.

Drawing directly from real-world clinic experience, Nathan shares how shifting focus from reactive hiring to intentional retention, leadership development, and new-grad pipelines allowed his organization to stabilize staffing, protect culture, and sleep better at night — even in one of the most competitive labor markets physical therapy has ever seen.

Together, they unpack what practice owners must do as we head into 2026 to stop bleeding talent, stop overpaying for lateral hires, and start developing leaders from within.

You’ll learn:

● Why “hiring is impossible” is a signal to fix retention first — not panic recruit

● How to identify and lock in your true A-players before competitors do

● The exact conversations owners should be having with key team members to secure 12-month commitments

● Why new grads are the most overlooked (and highest-upside) recruiting strategy right now

● How to turn student placements into long-term leaders inside your organization

● What a real leadership development pathway looks like — from new grad → leader → clinic director

● How delegation, ownership, and development directly impact retention and recruiting outcomes

● The mindset shifts owners must make to stop being the bottleneck and start building a scalable team

If you’re a clinic owner, hiring manager, or leader who feels stuck between burnout, turnover, and constant recruiting pressure, this episode will help you rethink how you build teams — and show you how to create a system where great people want to stay, grow, and recruit others for you.

�� Takeaway: Hiring isn’t broken — retention, development, and leadership pipelines are. Fix those, and recruiting becomes easier, cheaper, and more predictable.

�� Want to go deeper with Nathan? Book a call — https://calendly.com/ptoclub/discoverycall

❤️ Love the show? Subscribe, rate, review, and share! https://ptoclub.com

�� Join the conversation: If you haven’t already, find the Private Practice Owners Club Facebook Group and connect with owners who are building resilient, high-performing teams.

Annual Strategic Planning ensures your next year stays focused, aligned, and profitable. Visit ppoclub.com to talk with Adam about building clarity and momentum for 2026.

99.5% of successful owners interviewed on this podcast have leveraged a business coach at some point. Private Practice Owners Club is the coach you need — ppoclub.com

Blog Post URL:

https://www.ppoclub.com/is-hiring-impossible-build-a-retention-machine-of-a-players-new-grads-and-leadership-development

---

Listen to the Podcast here

Is Hiring Impossible? Build A Retention Machine Of A-Players, New Grads, And Leadership Development With Adam Robin

Welcome to the show. I’m your host, Nathan Shields. I got my good friend, Adam Robin , with me. How are you doing?

Busy. I’m learning a lot. A lot of good things are happening in my world right now. How about you?

Things are good. You don’t have to sugarcoat it. I know you just got your tax bill, and you’re not so happy.

It’s incredible, though. I would have never thought that I would ever make that kind of money. Planning for taxes is tough.

Leveraging The Facebook Poll: The #1 Hiring Hurdle For Practice Owners

It is never fun. Coming into this episode, we were talking about what we wanted to talk about. We had some plans and ideas, but I wanted to leverage the poll that you put in the Facebook group. In the early part of December, you would put out a poll in the Facebook group. If you haven’t joined the Facebook group, make sure you do. It’s @PrivatePracticeOwnersClub . You said, “What is the one thing?” Didn’t you list it out? Something like that. “What’s the one thing that is a major hurdle for you right now?” Is that how it was worded?

I don’t remember exactly how it was worded, but I can tell you where it came from. Me and my partner, ChatGPT, my life partner, my business partner, and my financial advisor. We were having a conversation. I was studying about practice owners. I’m like, “How can we help more? How can we serve more? How can we understand more?” It was something like, “What do practice owners need right now? What are their biggest challenges? Give me the top five biggest challenges.” It gave me the top five. I didn’t alter it. I copied it. I was like, “I’m wondering how accurate this is. Of these top five, I wonder which one’s the most important.” I copied it, pasted it inside Facebook, and pressed go. We had a pretty good response.

A good response, but overwhelmingly in one area. There were a couple of people in a different category, but it’s overwhelmingly in one area, and zero votes in three areas.

Three of the five.

Maybe a little bit in one of the areas. What were the results?

If I can remember correctly, number one was not treating enough patients or not finding enough of the right patients. That was an option. Number two was that my schedule is chaotic. I have a lot of cancellations on the schedule. I can’t figure out how to keep patients on schedule. No votes there. The third option was that recruiting is impossible, and I can’t find anybody to hire. That was the clear winner. I think 90% of people voted for that one. The next one was that my team would not take ownership of the thing. They won’t do the hard thing. Maybe we had a few votes there, but I don’t think it was very many that surprised me a lot. The last one is, I’m overwhelmed with admin and bogged down with busy work. We had about 15% or 20% of the votes on that one as well.

I’m looking at it now.

It surprised me. Everybody knows that recruiting is tough, especially right now. I knew it was going to be a top contender, but I didn’t think it was going to be that much of a top contender. I figured admin would be way more. I figured we would have at least a few people vote for, “My team won’t take ownership. I’m having a hard time building leaders,” but that’s not what anybody is thinking about right now, apparently, in our Facebook group.

I’m looking at the poll now, 45 votes, 66%. It is exactly 2/3. Hiring is impossible. Can’t find good people. The second one was at 17%. I’m overwhelmed with admin work that I don’t have time for, which is exactly why you need coaching. You need to reach out to Adam or me about getting some coaching on how to figure that out.

There are ways.

The third one is at 7%, not enough patients or not enough of the right patients. The other two were at 5%, maybe a couple of votes on each one. Their schedule is unpredictable and full of cancellations, or their team won’t take ownership.

I love those polls. Thank you, guys, for participating in those polls because it’s eye-opening for me as an owner. As somebody who serves the industry and who wants to understand the needs of the profession, it’s so nice to have that group. We can just get that feedback. Thank you, guys, for that. That’s very helpful.

The Reality Of Recruiting: Adam's Hypothesis On $100K+ Therapist Salaries

Tell me about your experience. You are one of the best recruiters that I know in our space. Tell me what your experience has been with recruiting people in 2025.

It has been tough, man.

Has it?

2024 was an incredible year for us. We hired eighteen people, eighteen therapists.

That’s crazy.

That’s a mixture of part-time PRM. We had eighteen. We made eighteen offers that were accepted. It’s like I got this thing figured out. Was it the case this year? We interviewed three or four PTs total, but all of them were tough to get an interview with. It took a lot of work. I had to meet them on their terms. I needed them more than they needed me, and they knew it. They all wanted over $100,000 a year. I told them, “I can’t get you that. I am not in South Mississippi. My reimbursement was $84 a visit. I can’t afford it.” That never panned out. I interviewed several speech therapists. I had a speech therapist to whom we extended an offer. She wants $80 an hour in Louisiana.

It doesn’t compute.

I’ve heard a lot of owners complain enough about these therapists wanting too much money and all that. I used to not subscribe to that as much, but in 2025, I’m fully subscribed to it. I understand what’s happening. This is Adam’s hypothesis. What’s happening is it’s not necessarily new grads. It’s more seasoned therapists. When I say seasoned, maybe 3 to 5 years out of school. They are younger therapists, but they’re coming out of school. They started their careers years ago when Medicare was paying about 20% higher, and they were getting offers that were nicer. Now, they’re making, and this is in my area, $80,000 to $85,000, maybe even $90,000, closer to $100,000. That wasn’t unreasonable when reimbursements were for over $100 a visit.

It was on the high end.

It wasn’t unreasonable if you had a busy clinic and you saw enough volume. You could get somebody there, and now they’re trying to upscale. They’re stuck in their home. Remember when the housing market crashed, and everybody was stuck in their home? Now, they’re stuck in their job. We can’t match the salary. That’s what it felt like to me. It felt like a bad market.

If they’re going to move on from that first location, this isn’t going to be a lateral move.

I can’t take a pay cut. I definitely can’t take a lateral move.

It’s got to be significantly more if I’m going to move off where I am.

They’ve developed a lifestyle around their salary. They might’ve got married and had a few kids. I got bills. They can’t move. That’s at least how it has been for me. The name of the game is you've got to get the new grads. You've got to get them while they’re out of school right now. It’s going to be hard to hire a staff therapist and compete with whatever they’re getting paid right now.

It’s not that you’re necessarily changing your focus from recruiting at all. You’re still recruiting. You still have energy in that, but it sounds like from what you shared with me, maybe you’re just taking some attention off of recruiting at 100% all the time to focus more on your team. Would you say that’s right?

The Recruiting Pivot: Shifting To Retention And Focusing On Your Team

Yes. Everybody recruits in a different way. Anybody who knows anything about me knows that I’m a very aggressive, outbound type of guy. If you’re tuning into this, you probably got an email or a DM from me at some point trying to get you on a call. Recruiting is no different. What I’m finding is that that strategy isn’t as lucrative as it used to be. The market is a lot more crowded. There are a lot more people doing the outreach. In the world of AI and ChatGPT, people are throwing content everywhere. People are distracted. It’s harder to get people to listen and have an actual conversation with you. That’s been more of a challenge. As I’m thinking about 2026, what are we going to do? How are we going to solve this problem?

For us, it’s more about two primary levers. Number one, we’ve got to focus on retaining the people that matter the most in our company, defining who those people are. Essentially, you have to get clear on what they want and what’s going to solidify their commitment to your organization for at least the next twelve months. Make the deal. If you don’t feel like there needs to be a deal made, they’re making a deal with someone else. Make the deal. Think about this over the holidays and the first week of January. Define who those top key people are who are critical to the longevity of your clinic. Sit down with them. Ask them what they want. Make that deal every year with your key people. That’s number one.

What do they want financially? That could be part of the conversation, but what do they need? What is their ideal scene? What does it look like if we’re sitting here? This is a Dan Sullivan tactic. We’re sitting here at the end of 2026. What has to be true for you to say that this has been an incredible year and you’ve achieved all your goals? How do we help you get there? It’s that kind of conversation.

Pick up the phone, send a voice memo or a video to your clinic director at your clinic, and say, “We’re going to schedule a lunch in two weeks. We’re going to schedule off an hour. I want you to think about your one-year and five-year goals, what’s most important to you, and what would excite you in your career. I want to have a conversation with you about that.” Sit down. Most of the time, it’s not unreasonable if you give them permission to dream a little bit. If you ask people that question, you’re already going to be somebody that people want to work for more than most.

You’re doing a favor in their eyes.

Correct because you care about what they want. Most people are not thinking about that. They’re thinking about putting more patients in front of them.

Identifying Your A-Players: Who Would You "Enthusiastically Rehire"?

I can see where you’re coming from with this tactic. We can continue to recruit, recruit, recruit, but we can’t exchange one viable provider for a new recruit. You have to be building your team on top of what you’ve already established. You can’t just be swapping pieces in and out and going one for one because eventually, you’re going to get stuck. Someone is going to leave, and you’re not able to fill that recruiting hole. You want to build this foundation of solid people who are committed to you for the upcoming twelve months. As you recruit, you can build on top of that and build other future leaders.

You’ve got to be your foundation. Let me tell you how I came up with this list. I don’t know the size of the practices that are tuning in. We have three clinics. My journal prompt was like, “If I were to sell my clinics, who would I sell them to? Make that list of people.” That’s your nucleus. It’s your leadership team.

Who within your organization would you sell it to? It is not external to the organization.

Who would be critical to carrying this boat without you if you had to pick that squad? Those are probably the people you want to sit down and have a conversation with.

We had a similar question that we would ask. Who would we enthusiastically rehire again if we had the opportunity? Enthusiastically is the bolded underlined word, not just “Who would we hire again?” We’d rehire all of them because we need them all. No. Who would you enthusiastically rehire again? Those are your A-players. Those are the people you want to get commitments from.

That’s where it starts. People who tune in to this show, I think it’s the last episode. We talked about all the hard things that we did in 2025. Our team is solid. We’ve got a squad on our team. I’ll put them up against anyone. We’re not as big as we were earlier in the year, but I’m sleeping better at night.

It means a lot.

I’ll pay almost anything for that. I feel good. I don’t know if we’ll hire eighteen again in 2026, but if we can hire three or four new grads and build off of the people that we have, I feel excited about what the future looks like for 2026.

I cut you off. You said number one. It sounded like you had some follow-up to the number two or number three. Number one was making sure you get those foundational people set in place for the next twelve months.

Lock them in.

What was your follow-up to that?

New Grad Strategy: Using Student Programs And Free Housing To Hire Top Talent

Number two is that I would be focusing on new grads. May is coming. Depending on when they graduate, if you were trying to hire the ones in December who graduate in the fall, you probably missed them. You’re going to have to go for May.

Get tight with your colleges.

You need to be at all the career day events. You need to get the lists. Teach your team how to sell and recruit at those events. Have a policy and procedure on what success looks like at those events and how to separate yourself at those events. Do the guest lectures. Get the new grad names. It’s critical.

Getting mock interviews at those, I know, is not something that you’ve done, but it’s something we would do. It’s like, “If you guys want to practice your interview skills, I’m going to be at the office on a Saturday. Come on by. Every 30 minutes, I’ll do a mock interview with you and give you my feedback on how you came out. How did you look? How did you present yourself? I’ll give you some feedback. People took them up on that.

Get in with the new grads. A lot of the new grads want free housing during their clinical rotations. For those of you who have a little bit of money, if you could afford a home, a small apartment, or something like that, it’s a great recruiting tool. You can get a small apartment for $600 or $800 a month. I don’t know about Alaska, but in the South, you can have a one-bedroom, something small. It’s worth it. That’s what we’re doing. The two best PTs that I hired were both students. They did their last clinical rotation on site with us. One of them is now my clinic director. One of them is now my director of recruiting. They’re killers. It’s such a good strategy. That’s the best people you can hire.

There are pros and cons there. You’re taking someone who might be, or is green, in terms of how to treat patients and get real results, but they’re also malleable because you say, “This is the way we do things.” They have no preconceived ideas of how things ‘should be.’ You can train them right up into your systems.

There is a performing student placement program. Student placement programs shouldn’t be “I’ll just take anybody with a license.” No. In order to qualify for our student placement, you must be interviewed. That person must be interested in working in the area in which you treat.

Also, where you have clinics.

They must be open to the idea of accepting a position with you. You must ask that during the interview. That’s part of the process. They have to be interviewed around your values, your culture, their work ethic, and all of those things. Interview your people and only accept those people into your clinic.

I’ve never thought about that. We took whoever came.

No, never do that.

I’m sharing that. We would take whoever came because we didn’t get that many. We’re just happy to get them. I can see looking back, and I’m like, “I wish we didn’t have that person. That was an additional waste of time.”

If you do that, get a home that you can put some money in, and market your free housing to the university, you might get a few. Go to a couple of career day events. You might get two or three students every year.

Get the real estate tax write-offs and all good things.

I would say focus on the students because it’s going to be harder to afford the other guys right now.

I see it. As you’re looking at pouring into them, what are some of the things that you’re doing in terms of development? How did you develop these new grads? I’m assuming you’ve given them opportunities to do things that they probably didn’t get other places. You’re building loyalty. You’re committing to them, but they are, in return, committing to you and stepping up into leadership positions. What are some of those things? I know you have a leadership development program. How soon are you looking to put some of these new grads into a development program?

Structuring Your New Grad Mentorship Program For Loyalty

We have a three-stage process. The first program that we have is the new grad mentorship program. That’s a one-year program that’s documented. It’s got checkpoints. That’s phase one.

Can you give us maybe two or three bullet points that make up your new grad mentorship program?

It’s going to be regular recurring meetings with a mentor.

It is a designated mentor.

They’ll have a booklet with homework that has to be completed. Leave an open blank. You have to forgive me because I didn't even make the program. Catherine did.

I’m pretty sure Catherine did all that.

Brushed it. It’s got our logo on the top of it and everything. We learn about light leadership. It’s more of a beefed-up onboarding process. We talk about our purpose, our values, our vision, our KPIs, how to set goals, how to juggle a busy schedule, and how to choose your priorities with time management. It’s light leadership and professional development.

A little bit is focused on the job description and building them into a full-fledged team therapist that knows their metrics, how to get their documentation done on time, how to get good results from the patients, how to bill appropriately, and that kind of stuff. I’m sure they're meeting on a routine basis to discuss difficult patients. Maybe you talk a little bit about anatomy, treatment techniques, and that kind of stuff as well.

Hold some space for them to bring what they’re interested in and what they’re struggling with. They just want to be great clinicians. I don’t know if you remember when you graduated from school because it was so long ago, ages and ages.

It was in a different century.

Back then, you wanted to be a good PT.

Every eval was like, “They’re going to figure me out.”

“I’m going to crush this.”

No, that’s exactly not how I was. I was like, “Someone is going to figure out that I’m a fraud.”

“I don’t know what I’m doing.”

It’s total imposter syndrome. I had that for years. Having some kind of mentorship would have been amazing. That can make up for someone paying me $100,000 and someone offering $94,000. As a mentorship program, that’s pretty valuable.

It is very valuable, especially when you’re making the offer. It’s like, “By the way, here’s a copy of our mentorship program that you can look at before you start,” a nice little hook to hook them in.

Not everybody is focused on the money. It’s nice. Some people are, but some people are like, “I want to get the letters after my name. I want to have continued education opportunities. I want to learn how to become a great therapist and treat patients super well.” If you can provide that opportunity and a pathway for that, that’s when you’re going to rope them in.

It still takes a lot of work because everybody’s desperate. We’ve been going to the career day events, all of them. The number of practices that are at these events in 2025 is unreal. All of them are there. They’re all desperate. They’re all hurting for therapists right now. It’s competitive out there.

I get it. Let’s look at it after that year. People who have been in your program for two or three years are starting to become much better therapists in and of themselves. They don’t need mentorship as much, maybe occasionally. “I’ve got this tough case.” Outside of that, what is your path for them? You talked a little bit about having the one-on-one and seeing what they need from you over the next twelve months. Is there more to it than that? What else are you doing for them?

We’ll do a leadership development program. Not everybody gets invited to that or is a good fit for that.

Is that something that they opt into or something you invite them to?

It’s a little bit of both.

You’re talking to them. If they are a candidate, you’re going to probably invite, but also, if they are a candidate and you ask them what they want, then some of them are going to say, “I want a leadership path or a progression.” You’re like, “We align. Let’s get you into that program then.” Right?

Building Your Leadership Pipeline: Theory Vs. Application Tracks

Correct. We invite and get them into the club. We’ll do monthly mentorship calls where we go through an agenda. We touch on all the leadership principles within our company that have helped us become who we are, the beliefs, the mindsets, and the identity that we’ve adopted together. We introduce them to that and help them put language to that and adopt it into their life, the way that makes sense for them.

Is there another workbook on this one?

Yes. We got a whole workbook.

Thanks to Catherine again.

No, I did this one.

Watch out. Adam is stepping up.

Getting them involved in that is important. That usually takes about six months. That’s fun. We have a full clinic director training, which is probably another six months.

It sounds like the leadership development program is more generalized, with some books to read. This is how we do things. This is how we hold people accountable. This is our purpose, vision, and all that kind of stuff. That could be for anyone in the organization. That could be a front desk person. That could be a practitioner. It could be a biller or anyone who wants to go into leadership, but then you have tracked specific leadership development for clinic director, office manager, and that kind of stuff.

The way that I like to think about it is that our leadership development program is a lot of theory. The specific tracks are more applicable to that theory. We talked about stats. We talked about clinics. Here’s the problem. Here’s the blueprint on how to solve that. Let’s go do it. It’s a little bit more application.

It’s a little bit more specific to the job description again.

Correct. It’s applied to the job description.

I get it. Interesting. As you’re talking to owners out there, what are you seeing? Do many of the owners have paths like this? I know you’re talking to dozens and dozens, hundreds of owners by now. What is their typical pathway for developing their teams?

The Stephen Covey Principle: Prioritizing The Non-Urgent (Sharpening The Saw)

They usually don’t have one. If they do have one, it’s not well-documented. I’m not saying that the way we do it is the perfect way to do it. I’m just saying this is what we see. It’s not well-documented and not prioritized. It’s like, “We do that at lunch.” We meet every now and then and talk, but it’s not like, “No, we’re going to remove the patient from the schedule and put the mentorship meeting there, and it’s there.”

Every second Wednesday at 1:00 PM.

We’re not going to answer the phone. They don't want to prioritize it because other urgent things come up. Funny that we talk about that. I don’t remember exactly where it was, but google it. One of the success habits of companies is that they prioritize the nonurgent but important things as a company. When people block off the urgent thing and do the important thing, that’s a good success habit. Sometimes it’s not a great ROI and immediate ROI, but it’s more of a long-term stability and long-term play, building the base of that pyramid.

In the book, Scaling Up by Verne Harnish, I want to say it’s chapter 10. It was all about meetings and the benefits of them. They gave the example of a large construction company that decided they were going to do quarterly management meetings. The initial kick pushback was, “You can’t pull us off the job sites. We’re not going to get stuff done. You’re going to pull us off for a half day, a day, or whatever it was, quarterly to get stuff done.” They’re like, “We don't see why either, but we feel like we should. We need to.”

What happened? Everyone got an alignment. The management team knew exactly what they needed to work on. Subtracting that day ended up making them more productive throughout the entire quarter. All the other days were spent in alignment, doing what they know they’re supposed to be doing, focused on the most productive things and not the distractions. We initially went overboard and hyper calendared our meetings. We wrote it out or calculated it out. We had a ton of hours. I want to say upwards of 60 hours a month for our multiple clinics in meetings.

We’re like, “We need to scale this back. Dialed it in a little bit.” We got to an efficient schedule of meetings. That led to our company being one of the more profitable in terms of percentages, one of the more profitable clinics that sold when we sold, because we sold a few other groups. I attribute it to the focus that we put on those meetings and the training that we gave to these people, so that we were all in alignment. These leadership team members were reading the same books that Will and I read. We were giving them opportunities to come up with solutions to problems in the organization.

We were figuring your stuff out together. As a leadership team and as an organization, we had clear-cut goals that we were working towards. It wasn’t a question for anybody what we were focused on. Taking the time to develop your team into those situations is huge and does turn out to be a greater ROI, even though it’s not the immediate ROI that we can put to treating a patient. I know if I treat a patient, I’m going to get $90 back. It’s not that kind of thing. It’s investing in your team so that they can be more productive and aligned with your goals. When you do that, then the ROI multiplies.

Stephen Covey says, “Give me six hours to chop down a tree, and I’ll spend four hours sharpening the saw.” Most owners spend their time chopping the tree with a dull blade. Stepping off the hamster wheel occasionally is sharpening the saw because you’re working on the thing on the saw and becoming more efficient with it. It’s one of those things. It’s a life principle. He even talks about the idea of principles in The 7 Habits book. It’s true, so do it. That principle is a lot older and wiser than you are. Just follow.

Employee Retention Is Recruiting: The Power Of Giving Team Members Ownership

Retention is recruiting because you’re recruiting them to stay. It’s still a piece. It’s sometimes the thing that we neglect until we get the resignation letter. That’s why it’s so important to be clear on what they want and work on aligning your goals to theirs. What I found that has worked for me is that you have to give them something to do.

A responsibility?

Yes. Give them something to do.

Roll them into the organization.

Give your team something to do. Ideally, the thing that they do is the thing that will either help you make more money or help you get your time back. It’s also usually a thing that either you or somebody else on your team needs to learn how to let go of and delegate. For me, the big thing has been recruiting. Adam, the recruiter, had to learn how to let go of recruiting. That was freaking hard. It’s still hard. It’s still something I’m working on. What is the thing that used to be the big thing that’s now the medium thing that I can get rid of? That’s a little scary to get rid of. It’s a little uncomfortable. It’s a little bit of a risk, but it’s no longer the most important thing in the world. Maybe it’s not the thing that I love doing anymore.

You’re still clinging onto it.

You’re still clinging onto it from a place of I need to, I have to, or I should. It’s a limiting belief. It’s the same trash that’s in all of our ways. Give your team something to do. Maybe it’s a promotion to clinic director. Maybe it’s a promotion to managing the team. Let them lead out on a team meeting, market, recruit, help you help them rebuild the website, build the mentorship program, or build the leadership.

Take over the birthday acknowledgements.

What can they own? How many times have you talked to great people, now great entrepreneurs, maybe, who say, “I was working with a company. I built that department from scratch. That was my baby.” How many times have you heard people say that? They still talk about it today. They didn’t even own it. Give them something to do. Their attention will be occupied because they will build the thing. They will be interested in a thing. They will invest in the thing.

They will more than likely do it better than you. That’s what I've noticed. It was like, “I don’t want to do this thing anymore. Who else wants to do it?” You get people who raise their hands. You’re like, “There are people out there that want to do this stuff?” “Yes, I want to do that stuff.” Give them the opportunity to do it. Let them live into their genius.

Overcoming Delegation: Defeating The "I Can Do It Better" Owner's Ego

I love talking about this stuff. Why don’t people do it? Why don’t people delegate? Why don’t people give away the big thing?

I have my answer. Do you want to hear it?

What’s your answer?

In my family, it’s a common belief. It’s not vocalized all the time. I can do it better than anyone else can. It will take less time for me to get it done myself than to train somebody else to do it. I’ll get it done better because I care more.

You’re way more talented.

I’m so caring and talented. No one else could do that.

There’s only a handful of common stories like that. I don’t have them all written down. “I can do it better myself” is one, or “It’s easier to do it better myself.” One is going to be “It’s too expensive.”

“I don’t have the money.”

“It’s too risky.”

“I couldn’t ask them to do it outside of work hours.”

“I don’t want to burden them. I don’t want to push.” There are all these limiting beliefs around why we don’t let the thing go, which impacts employee retention, their growth, and all the things. What’s the new story that you have to learn to become the person who lets the thing go? You have to learn how not to have an ego and stop overvaluing your hard work. You’re massively overvaluing your hard work. Your hard work and your care aren’t as valuable as you think. You’ve got a little bit of an ego around it. I’m not talking to you, Nathan. I’m talking to all of us who have that story.

That doesn’t pertain to me. My work is super valuable.

Me, too. It is for everybody tuning in, except for us.

This pertains to everyone else.

Delegation As A Growth Strategy: Learn New Skills To Make More Money

We’re the good guys here. They’re the bad guys. 1) You can’t afford not to. 2) Go learn a new skill and make some more money. It is one of the best things. If you’ve listened to this for this long, you’ve heard about the unexpected tax bill that I got. I made a lot of money in 2025 because I started more companies, learned more skills, and delegated the recruiting. I found other things to do and make more money. It’s not all about making money, but if money is the pain point, know that you can learn new skills and make more money.

All you have to do is reach out and start talking to people. Learn some new skills. Hire a coach. Learn how to market. Learn how to sell. Learn how to recruit. Learn how to build an EMR. There are so many things you could do. Write a book. You’re undervaluing your time, and you’re overvaluing the money that you have in your pocket, because with time, you can create endless amounts of money.

Story number three is you think that challenging people is mean when actually challenging people is love. You have to learn those stories. You have to adopt those beliefs. Become that person. When you do that, you’re going to retain a team. You’re going to step into the next chapter for you. You’re going to grow. Those are the reasons why I see people having a hard time letting go of the big thing.

Regarding number three, we often talk about the challenge support matrix. Support is on the X axis, and challenge is on the Y axis. We want to be a place that is high challenge, high support. We’re going to push you to do more than you’ve ever done before. We’re also going to support you along the way to become a better person, personally, professionally, you name it. When we keep that matrix in mind, there are great opportunities for us and for them to grow and develop.

I have to share a story. I had a client once. She had a very successful clinic. I’m like, “Why aren’t you pulling out a patient care? You can’t keep using that as an excuse for not getting things done in your organization. You’re very successful. You’re profitable.” She’s like, “No one treats the patients better than I do.” I said, “How would your team feel if you said that to them as to why you’re still treating? How do you think they would take that? You would never say that. Do you think any of your actions are saying that but not vocally? Do you think some of your attitude is coming across that way? Is it true? Could you be better served by teaching your magic skills to other people instead of keeping it to yourself?” She was a little bit surprised that I challenged her on that one.

We think that way. Honestly, I came from that. I can understand why I thought that is because my household was depending on me to be an awesome therapist with an awesome organization to financially survive. I am going to care quite a bit more. I’m going to figure out ways to retain patients better, to bill optimally, to collect every penny that’s owed, and to collect at the front desk.

We’re going to establish efficient productivity standards, optimal productivity standards, and hold people accountable to them. I’m going to do all those things, but we have to recognize that we’re stunting the growth of other people if we have that mindset. If we can be okay with them at a minimum doing 80% of what we could do production-wise, then we ought to be satisfied. As you said, we’re getting our time back so we can focus our efforts on moneymaking projects.

There’s part of that that’s probably true. You are going to be the most productive person in the building. If you’re the only owner, for sure. The problem with that is that there’s only an ROI in that up to a certain point.

It’s because you’re limited.

When you’re the only therapist, yes, big ROI there because you’re the only person treating. When you have two, your ROI goes down a little bit. When you get three, it goes down a little bit more. When you have this skillset, where you can go make more money over here in real estate or something else, your ROI is even less. Eventually, the priority of your energy shifts over time based on who you are, the opportunities that you have around you, and the size of your organization.

You focus on them becoming the best therapists. How powerful does that become? I noticed a little bit of a shift in my conversations when I had sent off enough of my foundational people to continuing education, did enough training with them, and knew they were aligned. It was so nice when people came to see me as the therapist. I said, “You’ve got a condition that Stacy is an expert in and is much better at than I am. I’m going to put you on her schedule because I know she can treat you the best.”

They were like, “Yes, if you’re not as good as she is, then I want to be on her schedule.” To be able to get to that point was a pretty awesome feeling that I could have confidence enough in my team to say, “You’re going to get better care with other people. Not me. I need to focus on the business. I’m distracted.” That was a cool feeling.

There’s a powerful thing that happens when the owner starts to finally believe in their business, when they start to trust it, which is a choice. You have to choose to trust. It’s never going to feel not risky. It’s always going to feel risky, but you have to choose not to let your amygdala, or whatever it is, lie to you and tell you that the whole world’s going to fall apart if one patient gets upset.

Avoid the fight or flight.

You have to choose to be present through that.

The Final Mindset: How To Define Your Secret Sauce & Build Loyalty

What do you tell people who don’t have a lot of these development things in place? Where do they start?

It depends on the size of your company because not everybody needs to focus on that. If you just opened your doors, I would be out there marketing. I wouldn’t be worried about leadership development right now. I would be worried about developing yourself as the owner. Invest in yourself. Listen to this show. Buy books. Go off the grid for twelve months. Read every business book that you can. Listen to every episode that we have. Hire a business coach.

That’s what I would do for the first year. You’re going to come out as a new person. You’re going to be evolved into the next version of yourself. You’re going to do some cool stuff. That’s what I would do then. You have to live that story first to share that story with others. You have to build the business. You have to do the hard thing, read all the books, and adopt all the things. You become the person. You’re version 2.0. Now, you can write about version 1.0.

You can write about the books that you’ve read. You can write about the lessons that you learned, the stories that you had, the fears that you overcame, the challenges, and all. That’s what you give to your team. You go to 3.0, and then you tell them about 2.0. You’re always learning, and then you’re teaching. That’s the big zoomed-out visionary version of it. It starts with recognizing that you can’t offer anybody anything until you’ve done some stuff for yourself.

Once you’ve done some things, you have to then recognize that you do have some valuable information that you can share. Recognize that you can actually offer something. Start writing that stuff down. What is your secret sauce to success? Nathan, you’ve got your secret sauce. You’re more analytical than I am. You’re more calculated with your approach. That’s served you well. You’ve got a skillset. That’s cool. I learned that from you. You’ve probably taught a lot of people that.

When they hang out with me, they probably learn a little bit more about recruiting, sales, marketing, leadership, and more of the visionary style of things. That’s my secret sauce. I like VAs, time management, and execution. Those are what I like. We talk a lot about time management, systems, and KPIs in our leadership development program. Once you define that secret sauce, you can start writing it down and start giving your team that.

Let them read some of the books. Let them listen to some of the podcasts. For whatever reason, offering that to your team will push away the people who aren’t with you, not in a bad way, but it’ll create a little bit of “I’m not willing to go there with you” wall. “We’re still friends, but we’re not that good of friends.” The people who crave that next level of growth will draw in super tight. I had the best compliment in the world. I have goosebumps thinking about this.

I asked my team, Joe and Catherine, one time. I said, “What do you guys want to do when you grow up?” They both said, “I want to do exactly what you do.” How freaking awesome is that? What an honor. That’s how much we love each other. They want to do what I do. I’m like, “Done, you can have it. How can I help you get there?” Investing in myself has allowed me to build that with Joe, Catherine, and other members of my team. That is so awesome. It’s what it’s all about for me. The money is great and all that. I’d rather go broke than lose that. Hopefully, that answers your question.

The Align Leader Program: Investing In External Coaching & Development

You have the program, but for those people who are tuning in to starting from scratch, we gave you some ideas for sure about what to do to develop your team, either as a team therapist or as a future leader in the organization. We can always help you with coaching as well, if that’s something that you need. We also have a newer program called the Aligned Leader Program. You can sign up for our program and send your leaders and to-be leaders with the program.

We will do a monthly call with them and coach them. We will give them access to resources to do their jobs better and give them opportunities to come with questions. Also, we’ll do some training with them. That’s a very reasonable program to invest in your team. If you don’t know where to start or what to do next with them, you can let us do it. Let us and some of our coaches do some of that.

It’s awesome. When I get on a call with these owners, the CEO, and the three key leaders who are thinking about joining the program, I’m like, “What do you think?” Their team, the director, and everyone are like, “I am fired up, ready to go. Tell me when the next meeting is.” They crave it. They’re so excited about that. It’s fun to see people get that excited about getting better and improving their leadership.

I was this type. I underestimate the desire that the owners have, especially the ones that are aligned, to learn more of what you know. They’re like, as you said, “I want to know what you know.”

I want to do what you do.

We had the same situation. Will and I had a business coach who would meet with us as a team and also individually. We opened her up to our leadership team to get one-on-one coaching with her. They absolutely loved it. Their commitment and their loyalty after those one-on-one meetings were worlds different. Also, your investment in your team cannot be understated or overstated. It cannot be overstated. We undervalue the opportunities that we have to give our team leadership training to build them. They want it.

This was the hesitation for me. You know how, when you become a PT, you talk about rotator cuffs every day? As we talk about rotator cuffs over and over, we start to devalue our knowledge because it's so normal. It’s habituated. I remember there have been several times when I would not thoroughly educate the patient because it was like, “You know what I’m talking about, the rotator cuff.” I would assume they knew what they taught. They’ve got YouTube.

Even though they were calling it a rotor cup.

They were calling it a rotary cup, which is a mistake on my part. Leadership development was the same experience for me. We talk about billing, finance, accounting, payroll, and all the things so much. We assume that everybody knows that stuff, but your team doesn’t. They don’t know that stuff. They don’t tune in to these shows. All that to say, don’t undervalue what you have. You have something so special to offer your team. They’ll stick with you if you build them up.

You get a few people like that on your team. Back to the recruiting point that we had in the beginning section of the show, they start promoting on your behalf. “I love where I work. You guys need to come work with me.” They have networks. They have an alumni group. They’re like, “We’ve got an opening. This place is awesome. You should join us.” That’s different coming from them than it is coming from you, the owner. That land is totally different. That’s huge. That’s when you start building a strong culture.

At the end of the day, if all of my B-players and C-players quit tomorrow, I know I still have my A-players. I still got it. We can still make it work. There’s a sense of security there that is nice to have.

Good talk. We spent a long time on this one.

It was good. If you’re tuning in, Annual Strategic Planning, January 9th and 10th, in New Orleans at the Riverfront Hotel. Food is covered. It’s in New Orleans. Have you ever been to New Orleans and had some Creole and some Cajun seafood? It’s delicious. We have a lot of butter and spices in that food.

Hopefully, people catch it in time to sign up and come on January 9th and 10th.

Annual Strategic Planning & The Align Leader Program

If you don’t make it, call Nathan. He’ll come to your place. He’ll do a full annual strategic planning session with you and your team. If you made it this far, you care about your team. You care about your company. You’re our type of people. We love you. We’re giving you a platform. We would love to connect with you in New Orleans. If you don’t decide to work with us, we still love you. You'd better be doing an annual strategic planning session in your company, or next time I see you, we’re going to box one-on-one.

Bring it. If you have questions about the Aligned Leader Program, reach out to us at Adam@PPOClub.com or Nathan@PPOClub.com . We can give you details regarding the Aligned Leader Program for your team members to give them the support and development that they need and that you want for them. Check it out. Thanks, man. Good talk.

Important Links

End The Year Strong, Start The Year Smarter - Financial Clarity For Private Practice Owners: A PPOClub Expert Webinar Series With Eric Miller And Sean Healy

Mon, 29 Dec 2025 19:00:00 GMT

Most practice owners treat finances like a fire drill: frantic at year-end, reactive at tax time, and surprised when cash flow hiccups wreck payroll. What if money management wasn’t a crisis to survive, but a repeatable system you lead on purpose?

In this episode of the Private Practice Owners Club, host Nathan Shields sits down with financial strategist Eric Miller (Econologics) and bookkeeping & vCFO expert Sean Healy (AccountedFor). Together they deliver an operational playbook for wrapping up 2025, protecting cash flow in Q1, and building the disciplined systems that let owners actually plan for retirement — not just keep the lights on.

They dig into:

● Why proactive tax planning beats last-minute spending sprees (and how to actually execute it with your CPA)

● The three financial skills every owner needs: acquire it, control it, invest it — and how to institutionalize them in your practice

● Practical year-end moves that protect cash flow (retirement catch-ups, HSA contributions, beneficiary checks, and smarter equipment buys)

● How to build a financial team that works together — CPA, bookkeeper, and advisor aligned to your goals (and when it’s time to fire an advisor who isn’t)

● Forecasting and proforma basics: reverse-engineer the profit you need to reach your personal goals, then map the operational steps to get there

● Cash-first tactics for Q1 (expect a tight January — plan the line of credit, manage payroll cadence, and pre-talk client deductibles)

● Money discipline that scales: automated savings buckets, routine scorecards, and the operational cadence that produces real wealth

If you’ve ever been blindsided by tax bills, drifted through another year without a cash plan, or felt like your practice owns you — this episode gives you the financial clarity and tactical next steps to run your business like an asset, not an anxiety.

�� Takeaway: Financial success is intentional. Stop reacting and start engineering predictable profit, cash flow resilience, and long-term wealth by building simple systems and a proactive financial team.

�� Connect with Eric & learn more: wealthforpts.com

�� Want bookkeeping or vCFO help? Learn about AccountedFor and schedule a complimentary checkup via their site (search AccountedFor Bookkeeping / Virtual CFO).

�� Want to go deeper with Nathan? Book a call — https://calendly.com/ptoclub/discoverycall

❤️ Love the session? Subscribe, rate, review, and share! https://ptoclub.com

�� Join the conversation and access tools: https://linktr.ee/ppoclub

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Listen to the Podcast here

End The Year Strong, Start The Year Smarter - Financial Clarity For Private Practice Owners: A PPOClub Expert Webinar Series With Eric Miller And Sean Healy

End the Year Strong, Start The Year Smarter (Private Practice Owners Club)

We’re talking about financial strategies for 2025 and 2026 as we’re looking forward. We’ve got Eric Miller of Econologics and Sean Healy of Accounted4 . If you’ve seen the show before, you know Eric has been a long-time guest on there over twenty times. I am excited to have him back. Sean Healy and Keith Campagna have been present at other workshops that we’ve done in the past. We’re excited to have them both on here.

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Welcome to the Private Practice Owners Club final webinar of the year 2025. We’re going to talk about all things money with our friends, Eric Miller of Econologics and Sean Healy of Accounted4 Bookkeeping. We’re here to focus on how we wrap up 2025. What do we need to do to prepare for 2026 properly? We’ve got some great experts to talk about that with us. Before I get started, you can always offer up your questions in the chat at any time over the next hour and a half as we speak.

For the calendar item, if you haven’t seen it on social media or gotten any texts or emails, January 9th and 10th, Adam Robin and I are going to be in New Orleans, Louisiana, doing an in-person workshop on strategic planning and goal setting for 2026. It’s going to be a small, intimate 20 to 30-person meeting in New Orleans at the Riverfront Hotel. We’re going to be helping you and guiding you through how to set your priorities for 2026 and how to set your goals appropriately for 2026, so you are totally clear on what your top priorities are and what you need to get done in that year, so you can get unstuck.

A lot of times, I wake up on Monday morning, and it’s not totally clear what I need to do. The idea behind this is to make sure you know exactly what you need to do and what your top priorities are as you attack the week. I will put the registration or landing page in the chat for you to go and register for that. I found out that we have continuing education credits that you can get for joining as well, approved through the Louisiana Physical Therapy Board. I will put those in the chat now.

As I’m posting it, I would also say for those people who are on the call right now, I’m also going to post the discount code so you can get 20% off the registration fee for the first ten people who sign up during this call. After this call, we’re going to put that discount code PPOCLUB20 out to everybody who registered for the call. This is only available for the first ten people who take advantage of it. I highly recommend you take advantage of it now during the webinar. Eric, why don’t you first start and give a short bio of who you are, where you’re from, and what people need to know about you?

I’m in sunny Clearwater, Florida. Everywhere else in the world is probably cold. Not here. It’s 75 degrees. I’m actually sweating a little bit, but I’m going to rub it a little bit more. We’ve been helping healthcare owners with their personal finances since 2008. It’s been a labor of love for us because I come from a healthcare background. My family was in healthcare. We saw the results of bad financial advice for people who were trying to help patients get well.

I didn’t see the monetary benefits that I thought they deserved to have. Our focus is on making sure that your household is financially strong and stable, that you’re utilizing your practice as an investment and treating it like an investment, and that you’re able to harness the power of your practice to build personal wealth and then eventually go out at the top of your game.

Sean, share a little bit about yourself, please.

My name is Sean Healy. I’m in not really sunny Philadelphia right now. Once again, thanks for rubbing that in, Eric.

It’s always sunny in Philadelphia.

I’m the founder of Accounted4. We provide everything from bookkeeping to virtual CFO support, small, mid-sized companies. We’ve had a focus on everything in private practice. We work with clinics in 30-plus states, something along those lines. It has given us a unique view into a lot of the problems that end of the day, we see a lot of issues that land on your P&L. We see a lot of the issues that impact profitability, but also, we see all the issues that impact cashflow.

One of the big things that we try to preach and we try to touch on is that there’s always a big difference between making a profit, making money. There’s always a little bit of a translation gap in there. We try to help companies be able to take a look, build plans, and then, most importantly, execute on plans that are going to allow you to take home extra money, ideally, so that you can then give to Eric to invest in and build more of a personal financial future for yourself.

Sean, just to be clear, you are not a CPA, right?

No. We don’t do tax or compliance work, but we do partner with a lot of CPAs. We do see a lot of different strategies that other companies are using. A lot of times, we try to make sure that all the data is being managed in a way that everything is beyond prepped and ready to go for a tax preparer to come in and file that for you.

Same thing with you, Eric. You’re not a CPA. You are a financial advisor, however, right?

We are not CPAs. We’re what’s called a registered investment advisor. More simply, you’ve probably heard the term fiduciary advisor. We’re definitely classified as that. As I said, our target is making sure that your household is financially strong. Honestly, if your business isn’t profitable and it isn’t running well, then it’s going to be difficult for you guys to recognize the fruits of your labor. It’s important that you integrate the two. Too many people try to separate them. You have to integrate the two. That’s a successful action that a lot of people have done.

That’s why I love having both of you on. I personally don’t feel like we need a certified CPA out there talking to us right now. If we had one, it would be great. I don’t think it’s totally necessary because what we get from you, Sean, is boots on the ground. This is how the numbers work. This is what you need to do to make the numbers work and be profitable. Eric is coming from now that you’re profitable and you made some money, this is what you should do with it. I’m excited to have both of your perspectives on there, but I wanted to throw that out there.

Your 2025 Financial Checklist: Tax Strategies & Intentional Spending

If at any time you guys have questions, as I said, go ahead and throw them in the chat. I’ve already put the registration for our January 9th and 10th workshop in there, along with the discount code for the first twenty people who use it. Let’s get started. We’re in December of 2025. What are some things that practice owners could or should be doing towards the end of the year to wrap up their 2025 well financially? What are some general ideas that they should be doing? Are there 1, 2, 3, 4, 5 things that they need to do? What do you recommend? I’ll start with Sean and then go over to Eric.

The first thing is that you should be communicating with your CPA if you haven't already. You should 100% be meeting with your CPA if you have not already by the end of the year. What we have found with a lot of CPA firms, because they get so many different clients sending them information, sometimes partial information, is that if you reach out to them proactively and say, “This is where I'm at as of a certain date. This is how I’m projecting to do for the rest of the year”, you can at least put an end of the year plan together. Number one, talk to your CPA. Make sure you have some form of a strategy in place.

The second thing you want to do in that conversation is ask them what your tax strategy is. Ask them what tax strategies could be implemented for your company. One of the biggest things that most people tend not to do is they don’t shoot for a particular profit number. If you’re any type of pass-through entity, so if you’re an LLC filing as a sole member, if you are an S corporation, if you are a partnership, anything that you are getting in profit, there’s a way to get a 20% tax deduction if you are under a certain threshold.

It’s something that came out with some of the laws that have been passed over the last several years. I actually did look up the deduction amount. If you are a single filer, if you are making over $197,000 in taxable income, that 20% deduction starts to go away. If you are married, filing jointly, it’s up to $394,600. If your family has a total income of that dollar amount or over, you might be missing out on some of the deductions. If your profits are close, a good strategy would be to make sure we’re intentionally spending some money before the year ends to be able to get us underneath that threshold if possible.

This is not a tax strategy that everybody should be implementing. It’s always something to bring up to the CPA and see how they respond. One thing we also notice is that if you are looking to sell in the next 2 to 3 years, it might not be advantageous to save a bunch of money on taxes and show no profit. One thing I always recommend when meeting with your CPA, let them know where you are as of now, where you’re projecting to be, whether we should try to aim for this threshold, and what we can do to get to that threshold, but also let them know what your long-term goals are.

Once again, if you’re looking to sell, it might not be the best idea to show no profit. There are a couple of conversations we always recommend having. In a perfect world, you want to do it at least 2 to 3 months ahead of time. We still have a little bit of time, though. What we want to try to avoid is that conversation where your CPA reaches out to you in the last week and tells you to go buy a new car. We want to try to avoid that. If you’re going to spend money, we want to make sure that you’re spending money on things that are intentional and things that can be deducted in the year. We will lean on your CPA to identify that.

How often do you recommend people meet with their CPA?

At an absolute minimum, twice a year. In a perfect world, quarterly. One of the big problems we find is that most companies, their bookkeeping is usually in arrears by 30, 60, or 90 days. There are usually no good double checks to be able to tell them where they’re at. The other big problem that we tend to see is that most companies, when we first start working with them, don’t have any projections. If you can’t see into the future, it’s hard to plan for the future.

The analogy we always use is that if you’re only looking at your bookkeeping data, it’s like driving a car, staring in the rear-view mirror. You’re only looking backwards. You’re bound to crash. We always recommend that if you can get projections put together, if you can tie that to where you are, if you have real-time data, most CPAs don’t have access to that. Being able to present that to a CPA, give them as much information as you can for them to build the best possible strategy for your current situation. Once again, make sure they know your goals.

I love you sharing that. I had to force my CPA to meet with me on a monthly basis initially to get an idea of where I was and understand what all these reports were that I should know as an owner. It was helpful to at least talk about it quarterly, “This is how much you made. This is how much you need to set aside for taxes.” It is because I got bitten a few times by coming up to April 15th of a given year, and the CPA calls me and says, “Nathan, you had a great year. Do you need to send $75,000 to the IRS today?”

No problem. Do they take cash?

Boost Your Personal Wealth: Retirement Plans, HSA, And Beneficiary Review

Unfortunately, I had to experience that once or twice before I learned my lesson, and then I forced my CPA to meet with me and talk to me about what I should prepare for ahead of time. I highly recommend the same thing. Meet with your CPA at least quarterly or semi-annually. Talk about the financials. Go over all that stuff. What do I need to prepare for? What are you looking at? What do you see, Mr. CPA, Mrs. CPA? How do I need to prepare better? What can I do better? Where should I be looking at things? How does this compare to what we have in terms of pro forma projections and all those things? We will talk a little bit more about looking forward here a little bit further on in the hour, but I love all the recommendations you made, Sean. Eric, your turn. What are some things from the financial advisor perspective that people can do or should be taking advantage of as they wrap up 2025?

I do want to say the last thing on that because I can’t emphasize that point enough in terms of developing a meeting cadence with not just your CPA, but with your whole financial team. It’s imperative to do that. I’m trying to remember the other point that Sean made. It’s a great idea to make sure that you do that. On the household side, there’s certainly not a shortage of things to do. There’s always a good time to put financial order into your household. It’s always a good time to do it.

There are a couple of things that you should be looking at. Obviously, looking at your contributions to your retirement plans. There were a couple of things that changed with the Secure Act 2.0 that I know. If you’re between the ages of 60 and 63, they actually provide what’s called a super catch-up. Not only do they have a catch-up, but now they have a super catch-up. If you’re 60 to 63, in your 401(k), you can put an additional $11,500 in there. If you have a simple plan, I believe it is right around $8,000. You have to be between those two ages. Most people have a retirement plan. We would all agree that it is a great way to reduce some of your taxable income. Making sure that you’re making those contributions to those would always be beneficial as well.

They can make those up until April, can they not? Do they have to make them in this calendar year?

You’re right, up until April.

It might be the tax return. If you have an extension on your tax return, at least on the corporate side, you might be able to do that as well.

Another thing, too, if you have a high deductible health insurance plan and you have the ability to contribute to a health savings account, that would be, for a family, pretty close to $8,000 that you can defer there. That’s going to be pre-tax. You won’t have to pay any tax on that. If you use it for medical services, you won’t have to pay any tax on it at all. Those two things are pretty basic, but a lot of people don’t do them, especially the HSA. I would certainly recommend people to do that as well.

Another one, too, in case you haven’t done this in a long time, check the beneficiaries of some of your accounts, especially your retirement accounts, your IRAs, and your 401(k)s. People go through divorces. They go through all kinds of life issues and everything like that. Unfortunately, we’ve had some cases where people forgot to change the beneficiary designations on their accounts. Sorry, I’m laughing. All of a sudden, money goes to people you don’t necessarily want it to go to. It’s always a good exercise to check your beneficiary designations.

That would upset people if the beneficiary was an ex of some kind or something like that. For some people, the common thing is you’ve got to buy your car by the end of the year for tax purposes, that kind of stuff. What do you say to big purchases, equipment purchases, and stuff like that?

That’s what Sean said. I agree with him on that. I don’t want to spend money on something just because there’s going to be a “tax benefit” to it. The whole purpose of money is so that you can multiply it and expand it. You don’t want to be buying things that are going to depreciate to that degree. If you can invest in something, whether it’s investing in your staff, training, or something that’s going to allow you to appreciate, and you get a tax benefit for it, or it’s going to improve the overall organization or the practice, then great. You should certainly do that. If it’s to buy something just to get a tax break, I’m not sure that’s the wisest use of money. I agree with Sean on that point.

Unlocking Hidden Tax Advantages (Augusta Rule, Payroll) And When To Fire Your CPA

Is there anything they can do tax-wise that maybe you see on a regular basis that practice owners aren’t taking advantage of that maybe they should consider? This could bleed into 2026 as well. I’ll bring up the Augusta rule or something like that. Are there things like that that you could explain or share for people to consider in terms of tax advantage?

A far as that is concerned, yes. A lot of these things you have to be proactive about. You can’t sit around and think that your tax liability is going to go down all by itself because it’s not. Minimizing your taxes takes effort, energy, willingness, and documentation to be able to minimize your tax liability. All these things are great. Having an office meeting at your house and being able to offset that expense to the business, absolutely. Putting your kids on payroll who are actually going to perform a function that you’re going to be able to document, absolutely. Those are all things that are beneficial to do.

Those are a couple we’ve mentioned. Buying real estate and being able to use depreciation is always beneficial as well. This is the point I wanted to make. Hopefully, this doesn’t rub people the wrong way. Don’t be afraid to fire your CPAs if you’re not getting what you need. I say that not because I want you to go out and fire your whole financial team. I want you guys to understand that not all CPAs are built for you. If they’re not calling you back, if they’re giving you lazy tax planning, or if they’re not doing planning for you, it may be time for an upgrade.

I’m sorry. That’s going to happen. It probably happened to many of you. You can’t be afraid to replace them. It’s not hard to find a good CPA. They don’t have to be down the street from you to work with them. None of us does. We can do everything remotely right now. Make sure that your financial team is in alignment, as Sean said, with your goals and what your purposes are, and that they’re there to help you. They’re not telling you what to do.

As people ask about CPAs and what they should look for, you and I have done an episode about this, Eric, in the past. The one thing I tell people all the time is communication. I would always recommend a CPA who is willing to communicate with me on a regular basis. As you said, timely responses to emails, a willingness to sit down in person and review things in person or virtually, whatever it is, but sit down and review reports, and calling me back after I leave a message are vitally important. Surprisingly, not all of them are very willing to do that on a regular basis, especially. Finding people who will be willing to do that is vitally important.

It is tough to find them sometimes, though.

Did you want to add to that, Sean?

When our clients are not happy with their CPA, the first thing I always recommend before jumping ship and finding a new one, which sometimes is the move, like with any vendor, is to make sure that you level set and set some good expectations. What I find is that a lot of times, CPAs fall into the trap of getting the info from you, filling out a tax return, and just filling out a document. They have the ability to provide a lot of insight.

A lot of times, what we hear from our CPA partners is, “I didn’t have enough information to be able to give that insight.” Sometimes, it takes, unfortunately, yourself or somebody to almost project manage it and say, “I want to have a sit-down. This is what I want to talk about. What are the strategies we’re implementing? What are the strategies we can implement? What are the things we’re not doing?” Mind you, if they turn around and say, “We’ll do the Augusta rule. Put your kids on payroll,” and that’s the end of the strategy, then you are probably at a point where you need a CPA that can be more of a tax strategist.

Those are things that I 1,000% agree with Eric. Those are things that you can and should be doing if you’re not. If you are just learning what the Augusta rule is, or just finding out you can put your kids on payroll, that might be a red flag there with your current firm. At the same time, there are a lot of different options and different strategies that we see people implementing, things as simple as, “Is my entity the right entity type?” There are different tax advantages to changing your entity type. I’m changing my entity type in 2025.

There are a lot of different things that you can do. What we found, though, is that you have to go and ask the appropriate questions to get the appropriate insight. If they’re not giving you good answers, then go find somebody proactive. Go find somebody who’ll give you a good cadence. Go find somebody who responds. If your CPA reaches out to you in the last week of the year and tells you to buy a car, no. Maybe go find another firm.

Upgrade Your Financial Team: Finding A Proactive Tax Strategist (Not Just A CPA)

Eric, I don’t know if it was you guys at Econologics who told me you were totally fond of leaning on the CPAs for all of the tax strategy advice. Is that totally appropriate? Where should someone look for tax strategy advice?

The state of Utah always has the best tax strategies that come out of that state for some reason.

He’s making a joke.

Define who they are. There are CPAs who are tax planners. Those are definitely people that you would want to vet and make sure that, “You’re a CPA, good. You’re going to do all the filing, good.” We also do tax planning. We meet, and we try to minimize your tax liability. You’re trying to measure everything. What is my overall tax liability? That would be the total amount of tax that you’re paying compared to how much income you made. All you’re trying to do is minimize that down every single year. If you’re trying to find someone to do that, that’s advantageous. There are tax strategists out there as well. You can google tax strategists who find something in the tax code that they specialize in.

You have to be careful about this because none of you wants to get in trouble with the IRS, and I don’t want any of you to get in trouble with the IRS. There are firms out there that specialize in certain types of tax strategies. They know how to implement them. They know all the rules. They have attorneys and everything like that. Until you get to a point where you have probably $800,000 to $1 million of EBITDA, I would start looking at something like that. That’s something we would call a tax strategist. They specialize in a particular section of the tax code. They find what I don’t want to call loopholes. They take advantage of the tax code.

Alison posted a good question. She’s not sure what types of questions to ask her CPA or where she can find these types of questions. “What kind of questions would you ask if you were ‘interviewing CPAs’ to find out if you should work with them or not?”

The two that I always use are, “What’s an appropriate cadence that we should be meeting?” and I always follow up with, “Are you going to be reaching out to schedule those meetings, or do I need to reach out to schedule those?” You can figure out from that question alone one very important thing. Is this firm going to be proactive or reactive? If they don’t reach out, how are they going to remedy that? Whose responsibility is it to create that cadence? The other thing is, what’s the typical strategy that you provide? I like to keep questions open-ended because they might turn around to you.

If they start giving you an answer, they are probably not the greatest firm to work with. If they start asking you a lot of questions, they are probably a good firm to work with. They turn around and say, We’ll put your kids on payroll.” I don’t have children. “We’ll do something called cost segregation for your building,” but I don’t have a building. We’ve always found that good advisors tend to come with answers. Good coaches and good consultants come with good questions. There are questions that you want to ask because you want good answers from them, and you want that insight, but how they answer it also goes a long way.

Eric, I don’t know if you have any insights around that.

I can’t top that. That was perfect. That was great. That’s exactly right.

That goes to the heart of it. What kind of communication are you willing to share or be on with me? Are you going to learn a little bit more about me before you start giving your advice? I love it.

It goes back to finding people who are interested in you, not trying to be interesting.

I’ll quote you one of these days, Eric. I like that.

That’s pretty good, isn't it?

You might want to.

Philosopher Eric Miller. There you go.

Future-Proof Your Practice: Setting 2026 Profit Goals (Begin With The End In Mind)

As people look forward to 2026, let’s talk about preparing for the next year. What are some things that you would recommend as people look forward into 2026 to best set themselves up financially? We’ll start with you again, Sean.

It all starts with beginning with the end in mind. You need to have a goal. One of the hard parts that we find, especially when people are looking at the next year, is this. I’m going to use some random numbers. I made $1 million in revenue this year. I’m going to add 20% to that and make that my goal. A lot of times, that’s an arbitrary number. We’re shooting blind. I always tell people, whenever you’re planning for the next year, start with a forecast based on the resources you have today, the people you have today, how you’ve been performing, and the spend that you’ve been spending.

If nothing else were to change and you kept that going through 2026, where would you land? What would that profit number be? Ask yourself. Out of that profit, am I making enough profit to get myself to my goals? Can I compensate myself enough through distributions and draws in a way that gets me to my retirement goal? Do I have enough money to pay down my debt? Do I have enough money to save for my taxes? Do I have enough money to put savings away for a rainy day? Usually, you want to come up with cash flow buckets of, “I want to put one payroll away in savings by the end of the year,” because what’s our biggest fear as business owners?

I want to put one payroll away. I want to pay down that one line of credit. I want to pay myself $100,000. I know that out of that profit, I should probably save 30% of it. Am I making enough profit to get me to these goals? If the answer is yes, at least you’re on the right path. The goal is not to backtrack, or maybe you’re not shooting high enough. If you’re not making enough profit to get you to some of these goals, then you’ve got to sit back and figure out, “What do I need to do with my business algorithm?” I think J.B. Schreier has called it a business algorithm before. I like that term. What do I need to do to adjust either my current income or current expenses to get me to that profit number?

Sometimes, we’re spending too much money. We have too much overhead. We’re paying our people too much for the results that we’re getting. Other times, we need to open up our capacity. We need to increase our incomes. We need to go and hire three people. We have this beautiful location, but it’s only half-filled. We need to go and find more people. I always recommend starting with the end in mind. How much money do you need to be making? How much profit do you need to be making to be successful, which means to get you to that goal? Work your way back and figure out what changes you need to make in 2026 to be able to bridge that gap, if there is one.

Translating Profit Goals: Working With Your Financial Team For A 2026 Proforma

Is this a conversation that you can work through with your CPA, or recommend working through your CPA or bookkeeper? That is, “Listen, I have this goal of this take-home profit number by the end of 2026. Can you help me figure out the calculations of how many visits that entails? What is my expense ratio looking like?” Is that an appropriate question or exercise to with someone else?

You certainly can. Mind you, there are a lot of good CPAs, a lot of good bookkeepers, and a lot of good CFO consultants who can help get back into it. Part of the reason why we started this company is that we realized there was a big lack of tools and resources to have a conversation around cashflow. Most accounting professionals talk about profit, profit, profit. We find that cashflow is not something that they’re very good at communicating or translating.

I would say it doesn’t hurt to try to have that conversation. Not every CPA is going to be equipped to be able to communicate it, at least in your language. We always say that the language of business owners is cashflow. A lot of times, we find that CPAs tend to struggle to communicate and translate from that profit number to that cashflow number. It doesn’t hurt to have that conversation, though.

I talk about building out your pro forma for the upcoming year. Budget could be another word you use for pro forma. Is that something you can expect from a bookkeeper or your CPA to say, “I at least want to make this much more in revenue. I want a 20% growth, 10% growth, or whatever it is, by the end of 2026. Can you build out the month-by-month pro forma of what that would look like?” Is that an appropriate ask as well?

It depends on your team. As a shameless plug, those are the conversations that we tend to have with our clients.

I was going to say it was a great time to promote yourself. My experience is that most of them don’t do any of that at all. What he said was perfect. You need to set your life up. How do you want your life to look in the next twelve months? The struggle that most owners seem to have is that they’re only making enough just to get by. That’s what most of them do. They don’t set up the financial system from the practice, as Sean said, to be able to set aside money into retirement, to be able to set aside money for your taxes, or for business reserves, and all those things. That is the vital part of going into 2026. That’s not something that you can just hope.

You have to do it. You've got to do it now. You have to attack that because that will allow you to change. The inertia does set in for a lot of practice owners, and how they handle money. It’s an inertia. “I’ve been doing this for so long.” You have to change the inertia of how you handle the money, especially going into 2026, where it’s seemingly getting harder. I’m sure you guys have heard all of the reimbursements, finding people, and all these things. It’s getting harder. Your ability to handle money is going to be paramount to your having financial success in 2026.

When we say financial success, it’s not just, “I have a couple of bucks left over in my bank account.” It is that, “My retirement for my next ten years is being handled. My business has enough money to handle emergencies. We can expand. I can take care of other things.” It’s a necessity to do what we're telling. If your financial team is not doing that for you right now, then you've got to get with people who are going to push you to do that. I hope that didn’t come across too hard.

I was thinking the same thing. As Sean was talking, I was thinking that what some of us lack as business owners is simply intentionality about the business. We get caught up in the doingness of the therapy or whatever service we're providing. We’re not thinking about, “I need to get to a certain dollar.” Let’s be honest. We’re in this to get a nut, to make this certain amount of money so that we can retire at a certain age and not be worried about our financials at that time when we can no longer provide that therapy or that service.

We may forget that part of it, but what you’re talking about, Eric and Sean, is being intentional about not just 2026. Let’s look at ten years from now, or whatever that retirement age is. What’s that number I’m trying to get to? What do I need to do this year, revenue-wise and profit-wise, to know that I’m on the path to getting to that end goal? Sometimes, we lose track of that end goal and get too busy with what I might call distractions, in this case, around us, about running the business.

It is getting intentional, as you said, Sean, with your CPA and your bookkeeper, and saying, “These are my goals. This is what I want to achieve. Help me understand how I get there. What do I need to do to get there?” I feel bad that you’re saying that there are a lot of financial teams that don’t do that because I know that I can email my bookkeeper right now and say, “I need a pro forma for the next 8 to 12 months. These are our goals. These are some of the expense ratios that I’m expecting. Show me what that’s going to look like and what we have to do.” That’s unfortunate that not a lot of people can do that.

They should be able to. Most are not able to. It’s one of those things where it’s common sense, but it’s not common practice.

I see that for sure.

It doesn’t hurt to ask them. Start by asking to see if they can.

Planning For Retirement: How Practice Goals Impact Your Long-Term Financial Future

To push that out a little bit further, Eric, talk to us a little bit about setting up 2026 so that it helps out with your end goal of retirement or where you are financially.

It’s good to start with having targets and a plan. We often talk about what your ideal financial scene looks like for your household, whatever that is. Most people have that missing, or they’re not very precise on exactly what that looks like. Everyone should have that. They should know, “Exactly in 7, 10, 12, 15 years, I want to have X amount of dollars. I want to have X amount of income coming in. I want to have no debt. I want to at least have control over my financial situation. I’m not 100% dependent upon the practice now to be able to run my household.”

Start with that. From there, start gradiently putting in, “What are the actions that I can start setting up that are trackable now, so that I can measure along the way that I’m getting to that point?” That’s where a personal financial plan comes into play, making sure that you have a roadmap of something that you can measure that allows you to see that you’re making progress. Most people just want to see that they’re making progress towards something. If you can see it, great. The best stories I always see from people that we’re working with or my advisers are that someone saved an extra $150,000 this year.

They’re like, “I’ve never saved that much money in my entire life.” I’m like, “I know.” You set up the system so that the money could be captured, and it didn’t get spent anywhere else. You multiply that by seven years at a 6% interest rate. You’re talking over $1 million all of a sudden in doing that. It’s setting those things up and having someone be able to push you, run you, and hold you accountable for those things. That to me is important. Going back to what we talked about, your money doesn’t take time off.

I always use this analogy. Anybody who has had kids who never went out to a store, you take your attention off them for a second, and they’re 7 miles away, it seems like. That’s what happens with your money, too. You take your attention off your money, and you don’t know where it’s going to go. I can promise you it’s going to go somewhere. I’m not saying that you have to look at your bank accounts every hour on the hour.

Don’t do that.

It is probably not a good idea. Make sure that you have the ability to look at your finances, or hire someone who can help you decipher this and do that. It’s all for the end goal, the purpose that it serves your household at the end of the day.

The Simplest Step: Setting Up Your 10% Profit Savings Account

The simplest action that we can recommend to people is to have that separate savings account set aside for that top 10% of revenue that comes in the door. Establish a break-even point. Establish a line item in your expenses that says this top 10% goes over here to the savings account that I don’t touch. It happens on a regular basis. That’s one of the easiest ways to start.

Does anybody ever have a grandparent who used to put money in envelopes? Do that. Put X amount in this envelope. That works. It did because one of the natural laws of money is that if you have to physically remove money from a place, if you ever expect to have reserves or emergency funds, meaning that you have to physically remove it. Now, we don’t physically remove the money. You have a bank to do an electronic transfer to a specific account. That to me is so important.

If you have an account that has a purpose to it, say a business savings account, what is the purpose of that account? Business savings, emergencies, or an old crap fund. Does it take a little extra work to set up the account and have it? Yes, but you run into a situation where all of a sudden, you have a drop in patient visits. How are you going to make payroll? I got $150,000 sitting right there for that purpose. When we talk about setting aside money for you personally, you have to physically remove the money to get it into an account that you can use for future investments. That to me is the important action. It is to be able to do that.

Your thoughts on that, Sean?

I agree with all points.

A good book on that is Profit First by Mike Michalowicz. He talks all about it. If you’re uncomfortable with starting at 10% of your revenue, going over to a savings account, start with 1% or 2%, and then build up once a month. Add another percentage as you go, or every quarter. Click that up a percentage or two until you do get to 10%. The people who have routinely done it, and you guys tell me if you have different stories, are usually like, “I’ve got $40,000 there. I had no clue that I could get there. It wasn’t that hard,” especially if you do it on a frequent basis, like every week or once a month.

We have a lot of clients who will move to a weekly cadence for savings. I do enjoy that book, by the way. That’s a good book reference. If you haven’t read it, a lot of good nuggets in that book. One of the hard parts, though, is that you have to make sure you’re making enough profit to put away towards savings. There are a few things in that book that are like the rules of thumb. We take some different approaches personally, but one of the biggest ones is a concept called mental accounting, where we put different values on money based on what it is.

Like your retirement plan, it’s out of sight, out of mind. You want to be able to do that with savings. You need to be very intentional about what you are saving, because if you’re not making any profit and you’re like, “I’m going to go save money now,” you’re just going to end up taking that money out. You have to be intentional. It has to be based on profit. It can’t be based on what’s in your bank account on that particular day. There needs to be some intentionality. The number of people I’ve seen that save a bunch of money because they have money in their account, and then they have three payrolls the next month, take a wild guess where that money’s coming from. It is that savings account that you put into play.

We always recommend that if you have a good forecast and know where those ebbs and flows are coming from, you can plan around them proactively. There are goals that you’re not taken by surprise. You’re shooting for a goal, but also, they say SMART goals. One of them is that it has to be attainable. If you don’t make enough profit to put that savings in the savings account, it’s not going to stay there very long. It’s having that plan and then making sure you’re executing on it.

The ROI Of Expertise: Can You Afford A Bookkeeper For Financial Insight?

Alison did ask, “What if you can’t afford a fancy or expensive bookkeeper to do some of the things that we’re talking about?” Tell us about that. What can people expect to pay to have bookkeepers to help them out? Does it cost a lot to have a bookkeeper on your team to build out a pro forma? Give us some reality on that, Sean.

Never heard the words fancy and bookkeeper in the same sentence before, so I thank you for that. It comes down to ROI. There are a lot of companies that I’ve heard say that. Sometimes you can’t afford not to have somebody giving you that financial insight. If you're not getting that financial insight from somebody and you don’t have a forecast or a plan moving forward, you need to do something. Doing nothing is not going to be an option. If your business is not thriving and you’re not hitting your goals, it’s because something probably needs to change.

There’s probably an issue somewhere in that business algorithm that you’re not aware of. There might be a significant ROI with one conversation with somebody who can take a look at your numbers and be like, “You’re not making enough off of this particular employee,” or “You have two employees that are actually losing you money.” It’s not that things are tight. It’s not that the business is not going well. You have a couple of problems in your business that you’re probably not aware of. I always say it never hurts to have a conversation with anybody. It never hurts. You never know what you’re going to learn.

Thriving businesses have a little more cash flow to be able to take risks for some of these different services. No matter what, you need something or somebody who is giving you guidance because it’s hard to cross a specific threshold if you don’t have those people in your corner. I’m sure you’ve heard that you are the five people you surround yourself with. Businesses are the same. Six months into me starting my company, I realized I had never had any mentors professionally in my life who had a positive influence. I went out to a group of people who knew things that I didn’t and asked them to be advisors.

That was probably one of the smartest decisions I made because I started getting other insights. It wasn’t just what I thought was a best practice or the best thing to do. I had people to challenge me to think differently, look at stuff, and give guidance. You need those people, regardless of cost, because at the end of the day, the price of what somebody is going to cost is just the meeting point between the value and cost. If you’re not getting value from it, then you can’t afford it. If you can get more value than what the price is, then it’s a no-brainer.

The hard part with many owners is that they are high-achieving individuals. A lot of things they feel they can get done by working a little bit harder and putting their nose to the grindstone. We do have to recognize that we are not experts in these other fields. Learning QuickBooks alone isn’t enough for us to be very savvy regarding our finances. We need to talk to other people who are experts, get on the webinars, read the books, and watch the YouTube videos. Ultimately, you need someone who is personally involved in your financials to help you understand your financials a little bit better and where you are making mistakes.

It might feel like a stretch, but it’s vital to have a CPA. You might as well spend a little bit more to either meet with them or spend a little bit less to meet with a bookkeeper to go over some of those financials and give you some ideas on what could be going wrong. If they find something, it might not only pay off in that month in which you’re looking, but if you continue that practice, it’s going to pay off year over year over year as long as you own the business.

They tell you, “You’re in a great financial scenario. You can’t get much better. You just need to hire one or two more people.” Maybe you're in a great scenario as is, and you don't need somebody.

Q1 Survival Guide: Proactively Navigating Rough January Cash Flow

We talked about how to wrap things up and then look to the end of 2026 and where we want to be. Is there anything in the first quarter that you recommend, especially as you’re considering that April 15th is looming? That’s tax deadlines and that kind of stuff. What initial steps at the beginning of the year do you recommend that owners follow?

Prepare for a rough January?

What do you mean by that?

No matter what I project every January, almost across the board, every state, every size, everybody always lands around 85% of what’s projected in January because of illness, because of weather, or because of beginning-of-the-year authorizations. However you think you’re going to do in January, assume that January is always tight for eight out of ten private practice owners. Also, this January, half the people who do bi-weekly are going to have three payrolls. Cashflow is going to be a little tight by the end of January for a lot of people.

I was going to say everybody’s coming off the sugar high of the holidays. There is something to speed. Money loves speed. We say this around our practice all the time. Try to take time out of the equation. You know how people are sometimes. You get a given task. They allow too much time for the task, and it takes longer. You’re always looking for ways in which you can take time out of the equation because time is the enemy of money. Money loves speed. You could do things quickly, but competently at the same time.

As an owner and as the executives of your practices, try to get your people to move a little bit faster than they are. That’s going to start from the top, that you’re showing them that. You need to move a little bit faster. Whatever the action is, I can promise you that the timeframe can be cut down somehow to get that action accomplished. As Sean said, going into the first quarter when everyone is like, “Money is slow,” and whatever the excuses are, you guys are going to have to increase the speed at which you operate. Hopefully, that has some impact on your cashflow.

By the way, if you know that you’re going to have a rough month coming up, try to get a line of credit now. If you don’t have a line of credit, go get a line of credit. It is so much easier to get access to money when you do not need it first than when you do. I can tell you my big goal going into January. I’m increasing my line of credit. It’s one of the first things I’m doing when I wake up on January 2nd.

It’s definitely easier to get access to money when you don’t need it as opposed to when you do need it. The banks will say no. People get lines of credit against their houses or lines of credit against any assets that they have. If you have a brokerage account, you can get a securities-backed line of credit to be able to access the money. Are the interest rates awesome? Not really. We’re still 6.5%, around that percentage rate. If it’s between that and not being able to make payroll or not being able to sustain the business, I’ll pay the interest rate all day long, but you have to have access to the money first and foremost.

Most clinics, at least therapy clinics, know that January can be a tough month altogether. As you said, Sean, because of authorizations and deductibles restarting, people are hesitant to continue on with their care or start care. Those are conversations that a lot of owners need to have in December with their patients, I believe. It’s like, “January is coming. You’re not done with therapy. You need to continue. The deductible I know is going to reset. How are we going to manage this? This is the recommended plan of care. This is what you need to do.”

Beyond January: Q1 Financial Planning And Getting Rid Of Excuses

Let’s start talking about and having those conversations in December. When January rolls around, owners and therapists aren’t thinking, “Where is everybody?” The deductible got reset, and they decided not to keep coming. Let’s have that conversation now instead of in January, trying to catch them on the phone. Is there anything else in quarter one that you might consider outside of January, preparing for the best 2026? We talked a little bit about performance budgets and preparing ahead by having a line of credit. Anything else that you think we’re missing to set yourselves up financially?

It is going to go back to having good targets, trying to follow through on those targets, and not being reasonable about it as well. It is not, “It’s this, or it’s that,” or taking the reasonability out of it. When I say reasonability, it’s things that we use to explain away a bad condition. That’s what I mean by that. We all do it all the time. It was this. It was that. It was the weather. It was that person, or whatever it is.

It was deductibles. It was always like this in January.

If it’s always like that, then what could you do in November or December to make sure it’s not like that again? It is getting rid of some of those things. Maybe a mental checklist that would allow us to have more money is to clear the road of all the objections or whatever viewpoints that we have, so that we can have money. It’s okay to have money. It’s okay to have a lot of money. It’s okay to have gobs of money. It’s okay. I’m giving everyone permission to have tons of money in their accounts.

What do you want to add to that, Sean?

There are two things. Number one, whatever goals you end up setting, I always recommend doing them before the year comes to a close, especially the week between Christmas and New Year’s. It’s a great time to take a little time for yourself and put on paper what you want to accomplish for the company.

Join us in New Orleans. Another plug there.

Communicate those goals with your team. Communicate expectations for your employees with your team. It is probably the most simplistic way to change your business overnight. A good seven out of ten companies that I speak with, that maybe we’re not working with, if I ask them, “Do your employees know what a good day looks like? It ties into your goal,” most will go, “Yes, I think so.” I ask, “Will it match up with what you think a good day looks like for them?” I got to tell you, 7, 8, 9 out of ten times, the answer is no.

Once you have these goals, figure out how do I break that down into good bite-sized expectations for my employees? Am I communicating it over? Do my employees actually know what success looks like in their role? It goes a very long way. The second thing is you’re going to have all these different goals. January is going to hit. Let’s talk through a scenario. My CPA calls me a week before the end of the year and tells me to buy a car. I go and do it. I already have three, but what’s a fourth? All of a sudden, I don’t realize that in January, I have three payrolls.

On top of that, all the metrics that we thought we were going to hit, we didn’t hit from an income perspective. I spent all this money at the end of the year. All of a sudden, I have this huge loss that I didn’t see coming, even though it was pretty much right there in front of us. I can’t sleep at night. I’m struggling to make payroll, and credit cards are rising. I’m freaking out. I had all these goals that I set the last week of the year that I wanted to hit.

What you’ll notice in business is that there are always goals and tasks that are extremely urgent, like making payroll, and then there are goals and tasks that are very important. If you’ve ever read The 7 Habits of Highly Effective People or ever heard of the Eisenhower Matrix or the Important-Urgent Matrix, in Q1, if you have big goals, make sure that you are blocking specific time out in Q1 in that first month where you are stepping away from the business to work on your business, like your conference, Nathan.

Take that time and be very intentional. They say that things that are important but not urgent tend to go by the wayside because of things that are not important but urgent. You have to plan them out. You have to do it well ahead of time. If it’s not in your calendar, it’s probably not going to happen. Block that time out proactively. Know when a good time of the month is because you’re going to get stressed. Things are not going to go according to plan. They never do. Put that time aside now to work on the most important piece that’s going to get you to that goal.

I love what you said about sharing your goals with the team. January is a great time to say, “Guys, beginning of the new year, this is what we’re looking at. These are our top priorities. This is where we’re going. Here’s the flag I'm putting in the ground. This is where we’re headed. This is what that vision looks like. This is how we’re going to get there. Who’s on board with me?” As you said, let everybody know this is what we’re all about. This is where we’re headed. Join us on the team, and let’s go there together.

The biggest fault of most families is that they don’t talk about money. It’s deadly not to talk about money with your kids and with your family. Your money should be an open book. The same thing in your business. It’s okay to show people. You don’t have to show them everything, but they do need to know, “This is the financial reality of this organization.” That’s good, because it does create the demand. It creates necessity.

Most of the people who are on board with your organization want it to do well. If they see that this is what we need to do for us to do well and get paid well, they get raises, and they get bonuses, and for the owner to do fun things for everybody, then everyone must do it. I never understood why owners never talk about money with their staff. Why are you not? Why are you doing that? Let them know.

You’ll weed out the ones and find out pretty quickly, which ones are all about the money, and which ones are actually about the purpose. You can slowly or more quickly start to remove those people who are not going to be part of the problem. I’ve said this before. If you want to see your income rise by 20% or 25%, get rid of the one person that you know is trying to counterintend the organization, because there’s generally just one. Most of you guys already intuitively know who it is. It will skyrocket your stats.

I’ve seen that personally before. The thing I always talk about when talking money with the team is to always tie it back to the purpose of the organization. If you talk about money for the sake of “You guys need to do this for us to make more money,” that doesn’t always land well. It is tying it back to, “This is how we further live out our purpose as an organization. This is how we live out our values. This is how it benefits the patients. This is how it benefits you.”

When we know what this break-even point is and where our goal is, which is well above that, and if we do that, to your point, guys, there are greater opportunities for you as a team to grow and develop to get bonuses and raises. We can do more as a company for the community. These are all the things that we can do for our patients now that we are well above our break-even point, things are flowing well, and everyone is productive and on board. If you can tie it to all of those things and the benefits that come to the patients and to the team members, then they buy into some of those numbers and metrics. That’s what I’ve seen.

Ask them what you should be doing differently. What should we be investing in? You would be amazed. They always say the boots on the ground are the ones who see all the issues in your company. As an owner, it’s our job to ask for that feedback and to listen.

Final Thoughts & Resources: Acquire, Control, And Invest Your Money

It’s a great opportunity to take advantage of this at the beginning of the year, especially. We’ve shared a lot of information about how to wrap up 2025 and what to look forward to in 2026. Before we go into any final comments, Sean, quickly, how do people get in touch with you if they want to reach out to Accounted4 and talk about bookkeeping services?

I’ll put an email address in. My sales director is probably the best person to speak with. We always do a complimentary analysis. If anybody is interested in “What’s the story my numbers are telling me? Are there any good insights or any changes that my current bookkeeper can go and make?”, we always offer a free analysis to give as much insight as we can. It’s like a little QuickBooks checkup, if you will.

I will put in a plug. I’ve been doing high-level audits on organizations where I ask for some high-level data on your financials, your operations, billing, and your collections teams, to see where you’re leaking money. Frankly, of the audits that I’ve done, I’m usually finding opportunities to capture well over six figures in most of these organizations. If not six figures, stuff that you can implement in the next week or two could net you $25,000 over the course of the next year.

There are opportunities to shore up your current systems and operations to make more top-line revenue, with all things being equal, which goes into your pocket. It’s called the Get Paid What You’re Worth audit. I’m happy to share that information with anyone who is on the call. Reach out to me, Nathan@PPOClub.com . I’ll share with you the details on that. I’ll frankly tell you there’s a money-back guarantee. If I can’t find $10,000 in your organization, you’ll get your money back from the cost of the audit. Reach out to me individually on that. Eric, what do you want to share?

The biggest problem most people have is the financial “I don’t knows.” I don’t know when my debt is going to be paid off. I don’t know if I’m going to have enough for retirement. I don’t know how I’m going to send my kids to school. I don’t know how much I should be making. You guys need to eliminate as many financial “I don’t knows” as you possibly can from your life. They are killers. They take your attention. They create anxiety and all those things.

I would encourage everyone to go to WealthForPTs.com . That’ll take you to a landing page, and we can get started. We have a financial scorecard. After about 20 to 25 minutes of answering some questions, you can get a financial scorecard. We’ll show you exactly where you stand in some critical areas. What are you going to do about it after that? That’s where I would start.

Is there anything else you want to share to wrap this up, Sean, in terms of people looking at their financial situations and how to best wrap this year up and look for next year?

I would say probably the number one thing as a business owner that you can be doing, and I know we’ve brought it up a number of times, is to make sure that you’re blocking time out to set some good goals. I can’t say that enough. The number of times we talk with people who don’t have any concrete goals, if you’re not sure of a good way to set a goal, there are a couple of things I always recommend looking into. Look into SMART goals. I know that’s always an easy one. You can just google that.

There’s also a great book called The 4 Disciplines of Execution . The 7 Habits of Highly Effective People and The 4 Disciplines of Execution, I read both of every single year between Christmas and New Year’s. One of the big things that they talk about in The 4 Disciplines is when you are setting a goal, I want to go from X to Y by Z, meaning I want to go from $1 million to a $1.2 million company by 12-31-2024.

By starting with that mentality, it forces you to, number one, figure out where you are today. It helps you come up with what the difference is in the goal, from to. The most important thing is that it makes it more timely by putting it into that simple format, just having those goals and then communicating them to your team. If you do those two things differently this year, I can guarantee you’ll see a big difference in your company. They cost nothing, by the way.

Eric, how do you want to wrap this up?

There are three very important skills that everyone needs to have to be successful with money. You need to know how to acquire it. You need to know how to control it. You need to know how to invest it. Nathan, with what you guys have done in the PPO Club , you guys show practice owners how to better acquire money, market, promote, sell, and deliver. Sean, you guys show people how to control money so that when money is made, it is controlled and it is going in the right places. I would say we show people how to then invest that money. If you can do those three things and you can do those things for blood, then you will have success. It just so happens that both of you guys fit those other two skill sets. That’s why it all aligned perfectly.

Great information you both shared. I appreciate you being on here again. It’s a great mic drop moment. The only thing I’ll add to it is that what came up for me that hit was being intentional about our finances. Instead of using a bookkeeper, a CPA, or a financial advisor to tell you what’s happening, and you’re rather passive and at the effect of everything else that’s going on around you, you’re not going to get to where you want to be if you’re in that situation.

Instead, be intentional and say, “Wait. I want this much revenue so that I can generate this much profit, or I need this much profit in order to subsidize my family and my retirement. Therefore, I need to get this much revenue.” Now, you can start asking questions. How do I get there? What do I need to do? How do I manage my expenses? What pieces of equipment can I get ROI on? Who do I need to invest in to know how to do XYZ?

Being intentional about the end in mind, like you brought up, Sean, and is in The 7 Habits of Highly Effective People, gives us the power to look forward to, “How do I get there? What do I need to do?” Get experts on your team to give you some guidance so you’re not trying to go it alone. I consider what you invest in a financial advisor, a bookkeeper, and a CPA is like tuition. If you could do it yourself, you would have gone through university to learn all these things. You didn’t, so that the experts could do what they do, and you do what you do.

You’re paying tuition to have that additional information on your team and have those experts on your team. They pay off. Otherwise, they wouldn’t be there for you. Being intentional and taking control of your finances was a big takeaway for me as well. Thank you all so much. I have posted in the chat the registration link for our workshop for strategic planning, January 9th and 10th, in New Orleans. PPOCLUB20 is a discount for the first ten people who use it. Look forward to that. Sean and Eric, thank you again for joining us on the call. I appreciate it. I’m looking forward to talking to you again.

Thank you for having us.

Thanks, Nate.

Have a great day. Have a great holiday. Take care.

Important Links

About Eric Miller

Stop The Leaks: How To Increase Cash Flow Without Seeing More Patients With Jerry Durham

Tue, 16 Dec 2025 17:50:44 GMT

If you’ve ever looked at your schedule and thought, “We’re slammed…so why is my bank account not moving?” — this episode is going to feel like oxygen. In this PPS 2025 recap conversation, Jerry Durham sits down with Nathan Shields, founder of the Private Practice Owners Club, to break down the real reasons clinics bleed profit — and why the solution isn’t more new patients.

Across this episode, Nathan pulls back the curtain on the cash-flow killers hiding inside most clinics: weak collections, underperforming billing systems, inconsistent documentation, and a front desk that’s unsupported (not unskilled). He also explains why AI won’t fix broken processes — and why owners who skip the fundamentals end up scaling their problems, not their profit.

In this episode you’ll learn:

● The four internal “leaks” that cost clinics $100K–$300K per year — and how to close them fast.

● Why chasing more new patients is the wrong move when your systems are broken.

● The exact numbers every owner must know (and what they actually mean).

● How to tighten front-desk operations so patients arrive, pay, and stay.

● Why underbilling — not overbilling — is silently draining your margins.

● How AI can support your systems… but can’t save you from bad processes.

● What PPS 2025 revealed about the future of private practice — and what owners need to fix BEFORE adding tech, growth, or new services.

What you’ll walk away with:

● A Cash-Flow Leak Audit you can run in 30 minutes.

● A simple 4-phase roadmap to increase revenue without increasing visits.

● Clarity on the 3–5 KPIs that actually drive your business (and which ones don’t matter).

● Scripts for improving front-desk collections and reducing cancellations.

● A new lens for evaluating tech, platforms, and AI — so you stop wasting money and start moving the needle.

�� Quick takeaway: Revenue grows when systems grow — not when schedules get fuller. Patch the leaks first. Then scale with confidence.

�� Want to learn the systems Nathan teaches owners one-on-one? Join the Strategic Planning Workshop on January 9–10, 2026 in New Orleans — or book a private planning session here: https://calendly.com/ptoclub/discoverycall

�� Explore upcoming events and resources: https://ptoclub.com

❤️ Love the conversation? Subscribe, rate, review, and share!

Blog Post URL: https://www.ppoclub.com/stop-the-leaks-increase-cash-flow-without-more-patients

---

Listen to the Podcast here

Stop The Leaks: How To Increase Cash Flow Without Seeing More Patients With Jerry Durham

Welcome back to the show. What is best for the patient is best for business. I am going to timestamp this. It is November 2025. Everything tends to be at least probably through January. I am going to put a subtitle of PPS 2025 recap. I did see Nathan at PPS. We spoke for at least two minutes. I told him, "I am going to send you a podcast invite. Please say yes." I love people who jump on it. I am glad to see you this week. I am glad to talk to you this soon. I have been on your podcast. You have been on mine before, so you are not a first timer. Nathan, why don’t you just fill in a little bit of context of who you are, what you are doing? We can go on to the discussion of where we are in 2025.

Currently, people might know me, or what I am doing, is all related to the Private Practice Owners Club. It is a podcast that I started back in 2018. It has over 300 episodes. Jerry has been on there a couple of times. We also do coaching and consulting for Private Practice Owners, PT, OT, speech, and pelvic floor. We even got a mental health practitioner and an acupuncturist in there, which is cool.

It is great that you said that. I am glad you did because I want people to hear how everything is more alike. We all claim. I spent the first twenty years telling myself how different we were. I had to go, "We are absolutely like everybody else." I am glad you said that. Thank you.

That really hit me. Within the first couple of years that I did the podcast, I had a nurse practitioner that I went and see. I told her what I was doing. The next time I went and saw her, which was 4 or 6 months later, she is like, "Dude, I have listened to all of your episodes. I listened to them on the plane. I take notes."

This is a nurse practitioner, nothing to do with physical therapy, but she recognizes that so much of what we are doing is simply just small business concepts, issues, that kind of stuff, put it into a healthcare situation. Of course, we are niche down to the allied health professions. Even this nurse practitioner, and one of our clients, is frankly an MD as well. A lot of these things can apply. Another person that we have, I just have to say this, owns a daycare.

We are coaching her on improving her business. Much of it is all about business. It is nothing about treating patients. It is how owners can make more money, have a more fulfilling life, and transform their lives so they are not run by the business. They can actually go on vacation and not get a ton of calls. They can spend time with their family. They may get a lot of fulfillment from seeing leaders within their program grow up, develop, take on greater responsibilities, and grow as individuals and people.

There is so much fulfillment in that for me that went beyond treating patients. I do not know if you were like me, Jerry, but back in the day, within those first few years, I recognized how hard it was to run a business when I opened up my own clinic. I thought, "Man, if someone could just take all the business crap off my hands," I would tell my family this at parties.

"If they could take all the business crap off my hands so I can just see patients, I would be so happy." I was hoping that some white knight in shining armor would come, take all the business off my hands. Not recognizing that that was my responsibility altogether. Once I finally figured that out, this is, I do not know about you, Jerry, but this is like twelve years into my ownership.

The Mindset Shift: From Physical Therapist To Business Owner

By the way, I finally found someone, so I cannot claim this. I tell everybody I make these broad sweeping statements until proven otherwise. I have now found someone who actually will own that it took them longer than I did. I say it about my first eight years, so I am going to give Nathan credit now for being the twelve-year guy. I said, "Yes, it was not until about eight years in that I was like, I am going to say this out loud so we can get out of the way. What am I doing here?"

Yes, for me it was like, "I have to do something different. This s***." When I finally figured that out, I decided to focus on my business, and I found out that I loved business stuff. I got a lot of fulfillment from it. I would have never guessed I would be in this situation now that I am so many years later. We sold our clinics in 2018. We did the podcast. Now we are coaching clients. We have conferences. We just had our second conference in October of this year in Destin, Florida. It was great. I got to speak for the first time at PPS.

Between you and me, Jerry, I never went to PPS while I owned clinics. I did not see the value. I have only been to PPS since I sold my clinics, but I got to speak this last time on increasing cash flow and how to do that without seeing more patients. It has been really fulfilling to have to be on this side of it, thinking totally differently than I was fifteen years ago. I was all about the patients. Whatever I can do to see more patients, that is great. Now I had dipped my toe into seeing patients. That does not bring the joy anymore, man. It is just totally different.

If you are listening to this, there is a video version. You have to pull up the picture cause Nathan and I look a lot alike right now. It looks like we go to the same bar. It looks like he is about five years behind the color of my beard. It is so funny because you are going to watch me aggressively nodding my head yes to everything Nathan said. I went through the same journey as you did. “I will never do this. I want someone to do this. I only want to see patients. If I do not learn how to run a business, I am going to kill myself in the sense that I cannot.”

Scaling Your Impact: How To Affect More Patients After Selling Your Practice

You just cannot keep. I was forced into it when I went out of network because we could not keep doing things the way we were doing them. Literally, we could not. I hit a wall there and went, "We'd better figure it out." What I did not realize was that I then got the business education I should have brought in 5 to 8 years earlier. Yet the same thing. I then found out, "I like this. I can impact more people," which is interesting, Nathan, because I know you get this.

I am not even going to ask you if you get this. You talk to someone. They are thinking, you tell them what you do, and they go, "You have your own practice." You go, "No." They pause. They look at you like, "Should I trust you?" You are like, "Are you kidding me?" I am like, "I have impacted more physical therapy patients since I left my business than I ever impacted in my business because I understood about scalability and the scale of the work being done."

By doing the front-end work I am doing, by connecting it to the providers, I could actually go into clinics that were 10, 20 times larger than mine, do some work. Go, "I just impacted everybody who calls that place." It is interesting that people do not ask, "How did you get there?" I would rather people go, "How far did you get?" I would go, "Cool, good question."

"Do you still own your practice?" I am like, "Who cares?" I am putting that out there because I want people to hear that, because the value is not people still in it. It is the people like Nathan and I, I am going to say Nathan and I, who own the fact that we sucked, found a way to learn it. Now we are helping others to learn it, bringing all the resources that we bring to people.

I am so jealous of some of those owners that I talked to, some of them we coach that are just 2 and 3 years into it. They are light-years ahead of where I was at that point. They are becoming leaders. That is a mindset that so many initial owners have is that, which I talk about frequently, but I can see it in my clients when they get to that point. They recognized that when they opened their clinic, they were physical therapists who owned a clinic.

The mindset shift has to become, "Now I am a business owner. I just happen to be a physical therapist at the same time." When they make that mindset shift, it is usually when they tell me that when they are treating patients, they are spending more time thinking about what they have to do for their business than they are about the patient. At that time, I can come in. Say, "At that point, do not you think you are doing a disservice to the patients to keep treating them?

That is not fair to them." They are like, "Yes, right.” That is when they recognize, "I need to step away. I can have a greater impact if I work on the business more." It is counterintuitive, Jerry, because you and I know all these people have spent 25 years spending their whole life journey, all of their education came to this degree as a physical therapist. They passed the licensing exam. "I am a physical therapist," that defines them.

Many times in coaching, now we are telling them, "Yes, you should not be a physical therapist anymore." They are like, "If I am not a physical therapist, what am I doing? That is what I spent the last 25 years preparing myself to be." Yes, it can be really hard for them at that point. That is when it took me twelve years to figure that out. I wish I had taken 4 or 5, like some of these clients that we have. That would have been really nice. I probably would have saved a few hundred thousand dollars.

That was one of the things about PPS I will bring up. I will say by name, really, the ones I saw there. There were others there, but the High Def guys were out of Seattle. I met Zach originally when he was like two months out of school. Where I see where he is today, it's just like, "Dude, high five all the time." I am like, "Tell me what has been going on." We stay connected, but we have always connected with PPS. I say, "Tell me about the last year. Tell me what is going on."

It is like a huge high five because I am like, "These are the people that I am like, damn, I wish I had." Trying to magnify them, getting people to engage with them, follow them, and see what they are posting. Josh Funk, another one. Just you guys, like, I just posted this. Another guy I met, Carlson Pro Care Physical Therapy, is out of the Northeast. I got on a call with him. He is growing. He comes from outside physical therapy.

He took it over from his father, who was a physical therapist. He is doing it right. He is doing it well. I posted coming out of PPS, "It might be time to reevaluate who your heroes are in the profession. Start looking for the people that did not get you here, but are going to get you beyond here." I am like, the Josh Funk, the Carlsons, the High Defs. I ran into that problem. You probably did too. We were always asking for help.

I realized the person we when we got to a certain point, I cannot forget it. It probably was not even a million bucks. We said, "Cool. We are there." We high-fived the business coach. We went on. We must have been closer to a million or over a million. Said, "We need more help." We went back to the same person. They could not help us. I am not going to say it was a waste of time, money, and energy. It was on our part not to ask better questions. I always say, whenever anybody asks me questions about who to work with, "Find people who are where you want to get to."

If you want to get to 500,000, cool. Pick the people who are at 500,000. They might be easier to relate to. Once you hit $5,000, I am like, "If that is all that you are hanging out with, it is time to bump up to the next level." Again, back to this idea of the people who got us here, including me, I have to own this. The people who got us here are not always the person you need to be following, engaging with, to get you to that next step.

I went through many coaches. I never stayed with one. It always makes me sad when someone steps out of the program. They decided they do not work with us anymore. I would be happier if they left us to go to a different coach than to just drop off altogether, not get any coaching. They think, "I have arrived. I am there. This is it." We are talking about people who maybe have a clinic. They got to five providers.

You and I both know that like 4 or 5 providers in that 2,500 square foot space is a sweet spot. That is when you are maximizing profit. Things are good. You have maybe a clinic director underneath you. You have a solid front desk. Man, that is the honeypot. That is when things are really going well. They still have aspirations to expand, grow, a second location, a third location. They think, "I have made it. I have learned everything I need to know."

The Growth Trap: Why A Second Location Is A Disaster Without The Right Foundation

"Just wait until the doors open on that second place. You thought, wait."

Yes, exactly. I talked about this at my conference. It was more about leadership in the sense of leadership being when you look at it in a Traction by Gino Wickman, it is visionary, integrator, all the departments down below. If you look at a true org chart from a large corporation, there is something above visionary and integrator, which is the board of directors.

Board of directors, then the CEO, you could put your integrator and your VPs. We lose sight of the, that all of us owners, wherever we are, need to have some board of directors. That is, there is no emotion behind it. It is all about the numbers. Either you are doing what you are supposed to be doing, hitting the goals you are supposed to be doing, running the programs that we all agreed to, or you are not.

If you are not, you have to explain.

You have to explain yourself. If you do not have a board of directors, you can get stuck with some of the emotional day-to-day stuff. You get caught up in the excuses, the reasonableness, all that kind of stuff. We need to step out and be leaders as if we are board directors, or at least have that person by you, which is a coach or a mastermind group, or someone that you are reporting to, who holds you accountable.

You can step into a leadership role and not just the day-to-day management role that comes with CEO ship, if you will, you know what I mean? I am big with you on that. There needs to be that person to guide you, direct you, and not have that person or accountability, that board of directors, if you will. It is hard to hold yourself accountable when you are at the peak of the organization. There is no one else above you.

I am just going to agree with you. Accountability, what a great word. When I discovered it better in my business, for me, for the rest of the team, it was as if I was going to hold other people accountable, which meant I knew what my accountability was to the business. If I were sitting across from someone, I would say, "What do you need my help with?" or "Why are you not hitting these numbers?" I knew whether I was doing my role in the company to make sure they were moving forward.

Accountability and responsibility are two separate words. We confuse those being responsible for something does not mean you are held accountable for it. We all know that. We have all been in those where you have not been held accountable. You start to slide. It is not a bad thing. It is just a check-in thing. Are we on the right track? Whether it is working out, whether it is diet, or exercise. Whatever sleep, it does not matter. Something to hold you accountable to say, "Yes, I am doing it, or no, I am not." Own it.

That is exactly it.

The PPS Talk: The 4 Stages To Stop Cash Flow Leaks Now

It is huge. Tell me about your talk at PPS 2025.

All about increasing cash flow. I have given it a number of times. We know some of the statistics, you probably shared with people here, the 30% decrease in reimbursement rates, and inflation-adjusted. Some of the publicly held physical therapy organizations are in the single digits. ATI had a horrendous 2024, with even negative profit numbers for them. We are seeing issues with Select Physical Therapy now and stuff like that.

What is the answer to that, the declining reimbursement rate? I think the tendency, at least for me, maybe some of the younger owners back in the day, was, there is no problem that more new patients can fix. If I could just see more patients, get busier, that would increase the revenue, obviously, and add more profit. I am just like, "Hold on, you have got to have some kind of bucket analogy." You like to think that your organization is this bucket.

If I just pour more water into it, there is going to be more water in the bucket. Inevitably, when I do some high-level audits with people, I am seeing leaks of like $100, $150, $200, $300,000 annually because things are tightened up. There are holes in your bucket simply because of poor operations, poor systems, and poor management. Before you complain about declining reimbursement rates, your revenue, or profit margin, if you will, maybe you need to look at some of your internal operations first, especially before you are going to grow, expand.

Before you even consider a second location, let us tighten up those systems really well. Make sure we are capturing everything that we can, all of that revenue, and eliminate those holes as much as possible. The talk was all about what parts of your organization are commonly seen that you are profit? Revenue and thus profit. It was the four stages. It was like your financial numbers inside and out. Make sure you are really strong at the front desk with over-the-counter collections.

Make sure you are managing your billing collections team, which is a really weak spot for a lot of owners. They just do not know how. They do not know what they are looking at. Same thing with their financials. A young owner does not know what a profit and loss statement is versus a balance sheet. I was that way. Fourth was managing your billing for your charges. Every therapy graduate who comes out of school is going to be billing according to CMS guidelines. That is just not how it goes.

They’re billing because they have had the fear of God put into them about the organization. I never in eighteen years caught a PT over-billing, my friends.

They are under-billing. I like to call it compassionate billing. They do not know what CPT codes to use. They just default to therapeutic exercises and manual therapy, which are the lowest reimbursements. It is that stuff. We went through those four phases, what to look for, what to expect, how to manage things better, and how to train your teams better on billing charges. By doing that, you make more revenue. All things being equal, that all goes straight down into your pocket. It increases cash flow, increases profits. Everyone is happier.

The AI & Tech Trap: Why Process Must Come Before Automation And Software

The sub-perfect tie-in to some posts I did this week, some thoughts I left PPS with, is that your talk is what is needed in November of 2025. This is just getting bolstered more and more every day, the more calls I get in, in order for someone to move into a system where there is technology involved. You just talked about understanding your people. Your people are getting tired of me saying this, but I have said this term more in the last six months than I probably said it in the previous 34 years. You just talked about how to understand what the people and the process are.

I see all these people running towards these technology-enabled billing platforms. I am like, "If you do not understand the process, how is this going to help you?" What I am seeing is AI. Even on the front end with AI voice agents, people definitely have a misunderstanding of the role of AI in general. It does not create the process. It just does what you tell it to. If you put a process, AI will learn, "Cool, from your process you put into it."

Again, that is how you want to do it. Hold on to that process.

That is what it does. Where I learned this, Nathan, was by listening to front-end phone calls. Put a good process in. Ninety days later, I got to hear this thing delivering like none other. I heard the process. I am like, "How is it going to improve that thing?" There is no improvement to be made. By the way, I heard AI hang up on someone recently. Same platform. I keep telling people that in November of 2025, the billing, the voice agent, all of it needs our wisdom put into it, so it knows where to start learning from.

What you just said, I love it because even though you said it was your first time, it is probably the best time, in my opinion, for you to show up, put that out there for people. Go, "I have got to figure this out." Again, they can make better, not only can they make better business decisions, but you and I both know everybody is going to be running towards the tech like the huge light at the end of the tunnel. It is going to be a huge disappointment to them if they are not doing like what you laid out in your course. I am so glad you shared that because it fits perfectly.

A majority of owners out there, I can safely say a majority of owners out there, number one, do not know what to measure other than the main total visits, new patients, and arrival rate.

By the way, I would say the majority of owners. Practice size does not matter. It is not all the newer owners. "All the younger owners." I am like, "I can share some horror stories, man." I see people, this whole idea. Sorry to cut you off, but I want people to understand we are not talking about young owners, small clinic owners.

This is one of those small clinic owners who know that they do get it.

Again, these are the things people need to be thinking about as they start wondering who I should emulate, who I should follow, and who I should engage with.

Number one, I do not think they know what KPIs drive their clinics.

That is a great point. KPIs drive your clinic.

You can really leverage change to make a significant impact. Number one, they do not know them. Number two, if they know what the KPI is, they do not know what industry benchmarks are for some of them. They do not know what is good, what is bad. You can give them a number. They are like, "I do not know, is that good or that bad? I do not know." Number three, even if they find out that their KPI is bad, they do not know what to do about it.

That is, I am with you. There is room for AI to provide better support in that regard, in terms of, "Private practice owner, here are the KPIs you need to know. You do not have to go fishing for them in your EMR. Here are the ones you need to know. Here is that line in the sand where if that number dips below that, then that is what turns red. That tells you that it is bad.” Lastly, not just that it turns red. This is what you need to do.

It will, Nathan. I equate that cause I have spent so much time on the front end. The next thing I want to do is create that AI that sits on your desktop. When someone is on an intake phone call, it helps to, let us call it, direct the flow of the conversation based on what they are hearing because you are asking questions, you are taking a lot of info, you are typing. I want to make sure that it is like, "I am really doubling down on their problem being solved, so that problem being solved just keeps rotating down the screen, so you do not have to guess.”

I have had people on secret callers ask me my name up to 3 to 4 times on the same call. Again, let us just make these simple names flow through the problems we solved. Now they tell us their expectations so we can keep going. I can continue a conversation that AI is driving you to make sure. It is not telling you what to say, but it is giving you all the prompts.

It is a reverse AI thing where, instead of you prompting it, it is prompting you. Again, that real-time feedback, like you said, "Jerry, here is this KPI." You open it up. You are like, "Cool. It is above the line." By the way, do not wait for it to drop below the line to figure out what you have to do, but it will prompt you if it drops below the line.

If owners could get those reports pushed to them instead of going into their EMRs to find, navigate, pull out data, that stuff, that would be game-changing. That would help owners so much in this day and age to really learn how to manage their clinics better.

I want to echo. Nathan did not say more data, more metrics. He said the right metrics. That is where I think, I am going to say this out loud, where most of the EMRs go wrong. I will never forget when we first signed up with our EMR. They were proud to show you all this stuff they could gather, but no one ever told us what was important. By the way, I had a list. I will never forget. We lived and died by it. We had our list of metrics and KPIs, but I could not tell you which ones really drove the business, which ones mattered. The day we finally flipped that, it was down to like three that I looked at every day. If I needed to dive down into any one of them, then I did.

Focusing On The Right Metrics: The 3-4 KPIs That Truly Drive Revenue

Do you remember which ones they were?

I am going to be biased because I am like, "If I could only measure three things," my whole thing is looking at. Let me just give a little context. Your KPIs should be like a blood panel. Normal, not normal. Let us look deeper. I always looked at things like leads, arrivals, drop offs. Probably, there was another revenue type number in there. I do not remember if it was revenue per visit or monthly revenue, or what it was.

Probably about those four things. I am not an expense guy. People still call me, “Jerry, I am looking to cut some expenses on my front desk." I am like, "Nathan, can I ask you a question? What would happen if you just drove more revenue through your front desk? That might solve more problems." I was always more of a revenue mining guy. Let us face it, all of those can tell us the health of the revenue side of the business.

There are those high-level ones, like new patients, visits, and arrival rate. A couple of those, if you do not know your average reimbursement rate per visit.

Down to the penny, I have got to know it. Again, you can take a deeper dive, but at the end of the day, I knew we had a 65% conversion. If you told me the number of leads, I did not have to go any deeper. Let us put it this way. I knew how many new patients we needed on the schedule every 30 days. I knew our conversion rate was 65%. All I had to see on the sheet was leads. I know if we run. You know what I mean?

That tells me about your organization, is you have the other systems dialed in so well. Your front desk team knew how to get them in. Your provider team knew how to keep them in. You guys knew how to do that. If you can get those all dialed in, yes, you can look at those front-end metrics and know exactly what your revenue is going to be at the end of the month, within a reasonable range. You can expect a certain profit margin. I can see a really experienced owner getting that dialed in because their systems are nice and tight.

If you came to me as a provider, because you were not responsible for marketing in my business, I was. If you came to me. You knew your accountability was X amount of completed courses of care, or whatever it was. You were not hitting it. I said, "Nathan, what do you need my help with?" You said, "Nothing." I would say, "Hey, Nathan, can we talk about this complete course care number? It is down.” “What is going on?"

You go, "Everybody did this at least 1 or 2 times until I called bullshit.” "I did not have enough leads." I was the guy responsible for it. I guarantee you, I knew if you had enough leads before you walked into the meeting. I am like, “There was no way.” I would be like, "Nathan, no, let us try the next one.” I am like, “How can I help you?" Again, this is back to when we said accountability. If I am going to hold you accountable, I have got to know, "Am I delivering?"

By the way, if you told me your completed courses are carried out, I would go, "Nathan, I know they probably are. I am going to tell you, you have not had the number of new patients put on your schedule this month. I get it." I would be like, "Nathan, let me tell you what we are doing to make sure we get the lead." It flips the whole. The accountability was on me to make sure you knew where the leads were coming next. It did not give me the right to say, "You are wrong every time."

That is what I really liked about understanding the business that way, because I did not need to know a bunch, but I knew our conversion rate. I knew how many numbers and new patients. I would just look at the lead log every day. That is the only place I had to look. How many leads flow in? "We are 25% of the way through the month. We have 25% of the leads we need." I was like, "Cool, we are on track." I would not live and die. Even though I did at the beginning, I would not live and die by the day or the week, but I would look for the trends. Go from there.

You are better than me, man.

When I was answering the new patient calls real quick, I had to say this because at the front end, someone would say no, and I would hang up. I would have to take a deep breath. Go take a walk around the block, dude.

There was that stage. I was a clinic owner in Arizona. Numbers are always down in the summer because no one is going to go out and get hurt. After all, it is too hot. No sports are going on, nothing. Every summer, I do not know how, how well I always get over it, but we would have a down week. I would be like, "This is the beginning of the end. I guess I am going to have to go find another staffing job, close the doors. This is it." That roller coaster sucked so bad. That was rough.

I was like you. I had an idea, even though I did not know my metrics well, I knew if I had so many patients per week, I had a general idea of how many visits I would have in the following week. If that did not start matching up, I knew where to start looking. I just wish I had known my metrics better ahead of time, tracked things better, and recognized that the grind and small business ownership are all in developing these systems, holding people accountable. I just abdicated that responsibility all the time.

Assigning Responsibility: Using Metrics To Pinpoint The Problem

By the way, so did I big time. I want to add one more thing on top of what you are saying because I think you have made some good points back to where we are talking about. If you know the right metrics, you will assign them to the right responsibilities because you said the thing that we have all done. We all do. You and I now try to get people to stop doing it. It's quite cramming the leaky bucket from the top. "All I need are more new patients." The beauty of understanding the value of the metrics, like this example we had from leads to conversion to new patients, is that you can assign.

If you know leads are down, there is nowhere to go but to marketing. If conversions are down, you've got a couple of places to look, but you have to know. I always tell people, mind you, you would have to be an established business, that the flow is going. "If I could only look at one metric in my business, it would be drop-offs," because I was like, "Drop-offs would tell me the health of my business." If I knew leads were flowing in, we were putting people on the schedule, drop-offs would be the canary in the coal mine.

I see that.

Yet, only after understanding leads as marketing, sales is here, drop-offs, and retention. Again, I want to go back to what you were saying, that if we understand the key metrics, what they are telling us about the business, and the phase of the business that they tie to. By the way, you and I both know revenue per visit could be tied to a lot of things.

Is it collection rate over? Again, you know where these metrics are coming from, so you can make better business decisions. I really want to know that because I think you said that perfectly. That is what is jumping out at me. I do not have to measure thirteen things because I know the four things that tell me about the health of my business every single day.

What it sounds like from this conversation is that I am getting is that I would measure four different things than you. We would still come to the same conclusion.

I have a feeling we come to the same conclusions because we understand the interconnectedness of how the business flows.

It is just understanding what some of those expectations are, what some of the benchmarks are. What should it be? Yes, I shared that in my talk. I did a really bad job as an owner in many things, but one of those things that stuck out was simply the visits per week. Letting my team know where the line was for break-even. "This is our line. This is what we need to."

That is a whole other podcast right there. I love you said break even. I find many owners will tell people what it takes to get a bonus, but they will not tell them what it takes to get their paycheck every two weeks.

What is the minimum expectation? What is it?

We do a poor job of telling people at the interview, "Here is the minimal expectation, Nathan, if you show up every day and you deliver this, you are going to get your paycheck every two weeks."

I would say most of the owners do not know what that is.

I know. By the way, I was one of those. I was not doing that, so people know.

This one time, as I said, I did a poor job at sharing that. That was on me. My lead therapist, ton of experience, was like, "We are going to be at so many visits this next week. I am really scared." I did not say anything. I just said, "We are going to be at so-and-so's visit this next week." She looked at me during the headlights because I could tell she did not know how to respond. Like, "Is that good or is that bad?"

She did not know how to take it because I had given her no context. I was like, "Yes, you need to know that your job is on the line when our numbers hit that number regularly.” I did a poor job at that. That is simply me not being a good leader, and telling the team, "This is our goal. This is where we are heading. This is what needs to be met.

This is how the ship is going to go west if we are heading west. This is what it takes to get there." I just kept that all to myself, acting like the martyr, "I am going to go down with the ship. No one else can help me." It is also naivety. Once I figured out that people needed to know the numbers, needed to know what their expectations were, then people could live up to those expectations.

Front Desk Goldmine: Unlocking 'Arrive, Pay, And Stay' With Patient Value

Heaven forbid, we tell them. By the way, I learned this through my front desk first and foremost. All of a sudden, I started giving them. I will tell you one of the huge tipping points of my front desk journey was telling my front desk how much a new patient was worth to the company. I saw the conversion, I saw the arrival rate change in like 30 days.

I did the same thing. I noticed when I said, "Because you have not collected these copays, we are probably going to lose about $500," because he did not do that. That is when they were like, "Oh." They were ready to get fired at that point. I was not ready to fire them because, unfortunately, I had been very reasonable about losing $500 here and there all the time.

Just skip a paycheck here or there. Just skip something. That is always interesting.

Whereas I should have been hard-nosed about it. That was my fault for not having that system, that expectation in place.

Telling the front desk how much a new patient was worth because they all said the visit value. I said, "No, because when they arrived, they stayed for twelve. They are actually worth $2,400." Everybody's eyes lit up. I went, "When you pick the phone up, that is a $2,400 call."

I will never forget that.

I do not know what I was expecting from it. Most of my stuff was felt, I am not going to lie, was, "I think I need to do this. I do not know why." They started doing it. I saw the impact. That was a big one. The other one was making sure the front desk saw. I wanted them to understand the bills being paid every two weeks by the copay collection. I actually showed them, "All these things get paid through what you are collecting. If you do not collect it, we have trouble paying that."

That is a good one.

By the way, your accountability was to collect it, not pay it. Nathan, like we are saying, "What is the end result of that?" If I put a new patient on the schedule, what is the end result I want? I want them to arrive, pay, and stay. How do I hold people accountable? Make sure that I want the front desk person to know the ultimate goal is to get that person to agree, complete a plan of care, you start that journey. That ultimate result, how your role plays into that ultimate result. Just as an example.

Some of these metrics showed their value to me when I started talking that way. I went, "Getting people scheduled is useless because scheduled people do not pay the bills, nor do they complete a course of care." I was like, "We have got to talk about getting people to show up." Again, things started to change. Same people, same everything. It was on me, not on them. The same people who started to deliver once they understood a little more because I understood the metrics and their role, that metric's role in achieving that bigger metric, which was a complete course of care.

I love that because the front desk does not get told enough exactly what they are responsible for.

Yet, they know every step better than anybody else. I am going to say this. I have said this a lot this week. They know it better than anybody else, but nobody else ever asks them, or goes, "Let us break this down together." It took me again, 8 to 10 years, to do that in the business.

They have misconstrued ideas exactly what they are responsible for because you give them so much. They are responsible for so much. They have all these things going through their head, but as you said, they need every patient to arrive, pay, and stay. They need to fill the schedule, get everyone to come in, pay their copay, co-insurance, and stay on the schedule. Come in at the frequency, and finish their plan of care.

Modern Revenue Goldmine: Strategies For Keeping Credit Cards On File

If your front desk person can do that on a regular basis, you have a gold mine. If they are good at that. We can say, "They are amazing.” I am jealous. I do not plan on going back into clinic ownership at all. One thing I wish we had back in the day was what I am seeing as a big trend in and that is keeping credit cards on file.

Someone brought that up in something I was in. I was like, "Man, dude, we used to have to write stuff down. We had a credit card."

I got pilfered by so many sticky fingers taking the cash.

I do not think people understand how valuable that is today. The ability to keep it on file as opposed to what you and I were having to do.

The AR aging for patient balances should be zero nowadays because you can keep all the credit cards on file. At the end of the month, after the insurance has processed the claims, "Mr. So-and-so, this is a text.” “Mr. So-and-so, yes, you owe $74.37 after the insurance has paid its portion. We are going to charge your card in five days. If you have any questions, call our billing collections team at this number." People I talked to, no one calls. The patients appreciate it. They are like, "You mean I do not have to open an envelope, write a check, go to the post office, and mail it back to you?

My wife is currently going through it. She joined a new provider group, loves them. She is about ready to end the relationship because of how difficult it is. "Just pay through the portal." She is like, "Do you know how many times I have tried to pay through your portal?" They make it so difficult to pay. “Just charge my card.” They make it so hard. She is literally gone. She was like, "Maybe I'll go," and it is down the street. I go, "Why don't you just walk in there, pay it?" I know she loves them. I am like, "Do not quit them. I will walk down there, pay it for you. Let them know that their portal is not what they think it is."

Isn't that crazy that they could have a six-star experience out of five stars? Just because she is having a hard time paying her bill.

She is ready to quit it.

Isn't that crazy? Could be a miracle worker.

People underestimate that.

There are always older people in the room. They are going to be like, "I am going to get a lot of pushback," "No one wants to leave their credit card on file." Like, "Let us put this in perspective. Everyone who is coming through that door has bought something online 2 or 3 times with that same credit card. They have left their credit card on file with Netflix and Hulu, and Amazon Prime, and you name it." They are going to draw a line at their physical therapy provider. Come on.

By the way, again, I am going to pat myself on the back because I excel in setting up. After all, what everybody is missing is, "Nathan, let us get your credit card on file." I am like, "Will you tell them what you are going to do with it, please?" I am going to argue. I am not going to argue with you. I am going to jump on top of what you said. Everybody knows what they are committing to with Amazon and everybody else, as opposed to this physical therapy place, where they just met you.

"What do you do with my card? Scripting that out increases the acceptance rate?” All I am going to say to people is that there is a lot of uncertainty with going, "Let us put your credit card on file." Just give people a reason to. I always say all I default to, Nathan, is give them a reason to leave it. "Nathan, by the way, here is my favorite line. Nathan, let me tell you what all our most successful patients do here at ABC Physiotherapy when it comes to payment. Do you not want to be the most successful patient, Nathan?"

What a great way to start a conversation. Again, then tell them. I make my clients say this, “Decide, are you going to collect copays at the beginning or the end? I want it. Nathan, by the way, when you arrive," I am going to keep going with this. If I take your credit card on file, I am going to tell you, "Nathan, here is how it is going to work going forward. When you arrive for your visits, we will log you in. You will not be charged until you log out."

Again, something like that, just, but you have got to come up with the system. Stick with it. If you tell Nathan, "Yes, here is my card." If you just go, "Can we get your credit card on file?" "No, I will just pay at the time of service," I say. I guarantee you, you will increase that acceptance astronomically.

Again, just looking at these things, how to do this, it is not rocket science. Here we are back to the metrics. What metrics tell me the story I need today? We tell people we want their credit cards on file. I am like, "Cool, do you tell what you are going to do with it once you get it on file?" Let us face it, by the time I get to Amazon. I got three things. I see what I am buying. I see what the delivery date is. The exact amount. Again, yes.

Another big fear is that people are going well. "I am not going to go down that rabbit hole." All I am going to say is people are bringing their past health care experiences to your physical therapy office. Do not assume anything. They have probably been burned by a surprise bill. If you just say we are going to hold your card, charge you, they are going to think about that $2,000 surprise bill they got. I am done.

I love it. I have not gone down that road. I need to add that. Just this conversation. It is like 2 or 3 sentences. It is not a lot.

It really is not. We used to have a sign. When I started answering the first phone call, I sat in the back with my benefits team, my billing team. We had a bunch of signs in the back. All it said was, “Nathan, were no surprises.” If someone's card was going to get charged, I wanted them to know when. If they were going to get asked to pay it, I wanted them to know when. By the way, because my thing was, "We will collect your copay at the end of service."

That is what we always said. Now people would walk in, pay before, I get it. If you were headed out the door, I said, "Nathan, can I collect that copay?" You would go, "Yes, sorry, I forgot." It was not, "I will get you next time." You knew that it was going to happen. No surprises, decreasing that uncertainty with all of this will go a long way to drive some of those metrics we brought up.

I can promise you that anyone tuning in, if you have the credit card on file and you have the system like you are talking about, you are going to add tens of thousands of dollars to your revenue. Just by doing that one thing, you do not have to see an extra patient. You are going to add thousands of dollars.

Rather than go pay some AI bot to chase down people to pay their bills. How about you just collect it over the front desk, and we call it a day?

Hundred percent of the time.

There is another AI tool out there. I know the founder. We have had this conversation. They take your wait list. They will move it down when there is a cancel. I am like, "That is cool. How about we just prevent the cancellations?" Again, back to my point of collecting copays. How about we prevent the cancellations? We still use the AI tool, but how about we do not let it fill the slots? Pretend like that is a victory. How about we prevent the council? Let us change the right questions.

Let us put the light on something else just for a moment. Let us keep that plan B.

Systems Over Solutions: Why Foundation Is Key Before New Programs Or Tech

By the way, you pay per fill. I am like, "What an awesome tool, but that should not be your largest expense every month." I just want to throw that out there. We do not need to go. Again, I want to double back on your talk. It's in November of 2025. I am going to say it is always timely. Yet as we move forward, information like yours that you are sharing is going to be most valuable because it is going to help people make better decisions on how they want to build out their systems and processes if they understand the process.

I take it for granted because I have been giving that talk for a year and a half.

I hear you talking. I am like, "That is valuable today."

I am assuming that I am speaking to the choir. Everyone knows this already, but the feedback after my talk was like, "These people know this. They need to know it. There needs to be more people in this room who hear it." Even if people are doing parts of each one of those things very well, something sticks out. There is, "Yes, I could improve on that."

That one improvement could increase my revenue $10,000, $20,000, $30,000, $40,000 in the next four months. It is timely. It is going to continue to be timely because I do not know if there is a microphone or a speaker loud enough to get through to all the owners that are out there. You just do what you can. Spread it out as much as you can. It is really interesting feedback that I got.

Nathan, if I understand that process, we institute other programs or products or anything. The front desk and the team are used to owning revenue. I am not going to call it cycle revenue management. Instituting all this stuff, like collecting at the time of service for a wellness program, is not going to be a big deal. Again, it grows into something even bigger. Again, if you have this process in place. Your people know we have a program around money, collecting money, tracking money, and then it really does not matter where the money is coming from.

They are going to understand that it is important to do that work. I would say it is the foundational work that has to be done, you are talking about. Again, to add tech, to add other programs. “Bringing cash programs into a network clinic that barely collects co-pays is a disaster,” because no one wants to collect the money. You just tell the front desk, "Collect the money." It is like, "Wait, where is all the money?" It is like, "That is not the way it works."

It is just the opposite with another owner that I met there. We had coached her back in the day. She went through this profit program. During the program, she got rid of her front desk. She had a great front desk person. She was getting the patients to come in. She tells me, "Yes, I have got this issue with a provider. Our average skilled units per visit is at 2.8." I am like, "You know, you are not going to make any profit at 2.8 units per visit.

You cannot complain to me about your profit margin if you know that your current skilled units per visit are 2.8. You and I both know.” She is like, "Yes, I have got to work with this provider. See what I can do to get them up, you know, maybe by March." I am like, “Maybe there is a sense of urgency here that needs to get put into place.

If I could inject you with anything, it would be just some urgency. This needs to be collected tomorrow. This needs to be figured out next week, or this person is not on board with us at the end of the month." "Why are we waiting till March to figure this out, or hope that he comes around?" That is part of our compassion that works against us in the industry.

Compassionate Under-Billing: Allowing Staff To Lose You Money

We are a very compassionate group of people. We always want to sacrifice ourselves for someone else. We always want to be liked by others. That collective personality is something that bites us in the butt every time. She is willing to be less profitable so that this guy is more comfortable in his clinic and in her clinic. It is so interesting. It is a pain in the. It is so, it is so literally allowing someone to lose my money right in front of me.

Be okay with it when you can coach. If this person liked you, they are working there, then you can probably have a conversation with them about how to do what is best for their patients. They are already doing what is best for the patients. This is that whole thing. They are just not billing for it properly.

Again, I ran into this. Our ops person was on top of this. Probably was rotating through every person. Probably about every 60 to 90 days, we're checking this stuff out because we understand that. We put together a model where people could have their time. I was like, "If you bill for it, you can have your time." Constantly going back, questioning, "Why is this person on the schedule for this long when you are only?"

It was never, "You did it wrong." I loved it. Our ops person was not a PT, which was cool. He could manage the conversations very objectively. "Why was this person on the schedule for so long if you only billed for this amount of time?" Now you had to own something there. It was one or the other. Either one would have fixed it. It is like, "Short the visit or bill more when they are here that long."

Here is an owner who knew the four phases. She had been through the program. She knew her financials. She was collecting well at the front desk. She has probably had a good hold of her billing collections team. That fourth phase, like getting your providers to bill appropriately, is getting the maximum out of the visit that you can do ethically. If we are complaining that we are not getting paid what we are worth, we should probably be charging the maximum amount we can ethically charge for the service we provide.

If that is not happening, that fourth phase is sinking her. The three phases are going to find that fourth phase of getting the providers to bill according to AMA versus CMS guidelines. Maximized CPT code utilization. Making sure that the skilled units per visit match the amount of time that they are in the clinic. You are good. She can easily turn this around into a hyper-profitable organization if she fixes that one phase.

We are back to where we started, that you have got to understand all this before you can plug in something that is going to tell you what to bill, and I believe this is why PTs are fearful of these platforms is because they do not truly understand what you just said. Before I am going to let something tell me, I sign off on it, because remember, the key here is really what I am talking about is I sign off on it.

I have to be comfortable with understanding what the standards are, so I can catch things. You and I both know it is going to need the feedback. This is the other thing we forget. I said this already, it is learning. From the beginning, you do not teach it. It is going to continue to facilitate and build on, I do not know, we could call it erroneous information, or less inaccurate information.

If you understand everything you just said, you go into it with that. This was the thing when I was doing the QA for the voice agent very early on, we were catching things, correcting them within the first week, within the first month, within the first 60 days. That thing was catching up quickly, doing a good job. If we had let it flow, it would have just kept making the same mistakes. Doing the same process. I do not want to make mistakes. It would not have been optimized.

I got you. We can get into a default where AI is going to take care of everything.

It is interesting. We think it already knows. That is the biggest thing is the voice agent, all of it, "It knows what to do." I am like, "No, it is waiting for you to put something in there so it can start." It is like we think it is already halfway through the race. I am like, "It has not started the race. It is waiting for you to shoot the starting gun." Maybe that is a good analogy. I do not know.

You can see that as well, because if you put in the wrong prompt on anything, everybody is going to it.

It is going to. "I was so clear."

You are like, "I thought I put in a clear prompt, but I missed certain words." It gave me an answer that was, I do not know where it came from. I said, "That had nothing to do with what I said in the prompt. Maybe consider this." They are like, "Yes, that changes it entirely." Part of it was still stuck on that old answer. It still threw out some of that stuff. You have to coach it. You cannot just expect it.

Therefore, back to that documentation and billing, if you do not know that, you are signing off on stuff. Unfortunately, the insurance and billing side is leveraging AI there. I am like, "It is like a battle of the bots right now." I am like, "How far ahead?" You are never going to get ahead of it. They have more money, more leverage to stay ahead of you. Again, how do we make sure all these things are in alignment? How do we make sure that we are doing things?

I am like, "Let us just do the work properly. Do not have to worry about AI catching it, freaking doing this." It is like shooting for a 100% arrival rate. I am like, "That is stupid." Zero percent cancels. I am like, "Totally unacceptable." We have got to readjust a little bit. What should be the copay collection rate? What should our AR be? Again, we have to have this basic understanding before we can start shooting all this stuff, implementing all this stuff. We are back to the value of this information.

What was interesting after the talk that I gave, I have not been to a lot of PPS. Frankly, I have not sat through a lot of the presentations, the breakouts, but they said, "This was the most positive presentation that I have listened to all day." I heard that a few times. I am like, "Really? What are they talking about out there? Is it all doom and gloom, or is it just pie in the sky, weird alternative answers to how to improve your clinic?”

I was equally disappointed. I have to say this. Hopefully, it is not too much of a tangent, but I started my presentation with a question like, "I am here to talk about increasing cash flow. Does everyone want to do that?" I got some "Yes" from the audience. I was the last speaker of the day. This is like 4:30 in the afternoon. I was like, "What have you guys learned today or yesterday about increasing cash flow in your clinics?" Crickets. I was like, "What?"

I wanted to get on a soapbox at that point. I was like, "Why are you here if it is not to figure out how to make more money? If it is not in like how to improve your business so they can be more profitable, so you can grow. Is that the fault of the attendees? Is that the fault of the PPS nominating committee for presentations?" I was blown away that no one had anything to say about that particular topic on how to increase cash flow besides me. I was really upset about that.

Motivation Vs. Opportunity: Why 80% Drop-Off Os Actually A HUGE Upside

There is a lot of good content. It is drinking from the fire hose. A lot of people need to go home and process. I really do. God is truth. My talk was about arriving, solving all business problems. Again, if people show up, you have done your due diligence, and you can get paid. Plain and simple meaning, again, you and I could argue we were given the same talk. You were just coming from a different angle, like we said, with the metrics. It is interesting because the first slide I pull up is from 2024.

There are only ten percent of people who need physical therapy who find physical therapy. The second data point I put on the same page is 80% of the people who start a plan of care drop off and do not complete their plan of care. I put that up. I said, "Look, this is the context we are going to work from." If anybody saw that as, I looked at that as motivation. It would be interesting and goes, “Is that negative? Do you take that as a negative?” You should take that as, "My upside is ginormous. Do the work."

There is a lot of opportunity out there.

That is what I said. "This should tell you there is so much opportunity. You actually do not have the capacity to even manage it. Why not just take care of what you need to take care of?" The other thing trying to get people off is to quit fighting for the ten percent, man. "My competition." I am like, "Competition, dude, you have got to look in the mirror. No competition.” I am not going to say this. I am not even going to allow you to say anything after, but the hinges and the swords are not competition, my friends. That is, I say it over and over and over.

If you are getting pissed off about that, you do not understand. If you believe the only value is hands-on, face-to-face, all that, that is your issue, too. That is for another day. I want this. You alluded to this because you were concerned about, "What did you learn about cash flow?" I was going to ask you, "What was your biggest takeaway?" I will put that as your number one without knowing I was going to go that direction. What is your biggest takeaway from PPS 2025, added to the fact that at the end of that, when you said, "What else have you heard about increasing cash flow?" Nobody responded.

I did not want to act like that. That was PPS's fault, necessarily. Maybe there is something to it.

It is the people in the room, dude. They have to take accountability.

That is exactly what I was going to say. I fall into this trap too. When you come into the conference, you need to go to a conference, and I say, "I need to learn X, Y, Z."

I do not think people do this. I probably go with the agenda more over the last 5 or 6 years than I ever did.

I have just learned that myself over the last six years or so. I was like, "I need to go to a conference. Even if I am a presenter. Just being altruistic, wanting to share this information with as many people as possible." “That is nice. What am I doing there? Why did I spend this time, money to come here? What am I going to do on Monday to change my business entirely for the better?"

That is funny. I did start the talk. I go, "If you do not walk out of here with something to do on Monday, you have got to come up and talk to me because my goal is to make sure you have one thing out of all this stuff. You have got to be taking one thing that you can." I constantly went back to, "This is something you could do on Monday." We know that. I do not think enough people do that, Nathan. I am going to jump on this real quick. Maybe a lot of people come in there, talk on a high level. Talk whatever. Go, "Cool. You got everything you need." I learned this at the front desk. We do a poor job of telling people what the next step is. I am just going to leave that there.

I’ve been thinking about that way, I could have definitely referenced back to like, I probably did say that a couple of times. "If you are not doing this, you need to do this now." I probably did say that a few times. What did I take away from PPS? Number one, there are a lot more EMRs out there than I ever remember being there at the conference. I do not know if that is a good or a bad thing. The competition, sharp iron sharpens iron, maybe one of those things, maybe it improves things altogether.

That is great. A lot of AI connectivity to whatever the product was, whether it is the scribes or the EMRs or the billing collections, that kind of stuff. That is a catchy thing to use if you are promoting anything is how we are going to leverage AI. I was impressed with the number of people, frankly, but even so, what are they? Jerry, maybe you know better, something like 30,000 clinics out there, PT outpatient ortho PT clinics.

There has got to be at least 30,000 plus. The majority. That men's market group is the largest by far. I just saw some stats on that, but I believed it would always be true. If you take like the four largest, you named a couple. We throw a couple more in there. They have like 25% of the market, 30% of the market max.

You have got 1400 of those owners at PPS. There is something in me that is like, something is not clicking. There needs to be more people. Why are there not more people there? This was an all-time high. This was an all-time high, from what I heard, for attendance. Yes, 1400 is really good for them. I am like, "Why aren't there any more?"

Addressing The "Why Aren't More People Here?": The Need For Year-Round Value

Do you know what else I like and am involved with? I want to tag onto that, the admin side. I am going to throw this in there because this pertains to what you said. I am on a committee right now, revamping the admin education. It was solid. It needed updating. It needed more structure. It is getting both with steroids. This product that this committee is putting together for us to then go to the experts to create the content, I truly believe, will add membership. What I see back to everything you said, I love everything you brought up.

"Why are there not more people?" My journey has shown me that the team is right. The providers are just there to bear me out or are just part of a team. They are no valuable than anybody else on the team. I would just say you could have Jeffrey Maitland, Stanley Paris, and you know, whoever else, standing in the back room. If there are no patients on the schedule, then who cares? If there are no patients on the schedule, how are we getting paid? Again, the value of the front desk team, the value of the back office admin team that has to do with the billing and collections, as you spoke to, then tight in with the providers.

My takeaway this year was a more positive vibe above the line, asking better questions. Positive vibe, asking better questions. Instead of just complaining about lower reimbursement payments, and all the other downward pressures on business. There is more than that. People are leading with, "I got to do this. I am here to learn this." Again, tying in that no business on the face of the earth does not understand their patient's journey within their patient's journey. No business on the face of the earth does not understand its client's journey in their business, then understand the experience they want to create.

Building out the systems and processes, except for healthcare. Healthcare is so fragmented and so disjointed, including physio. I believe it is finally catching up to us. Again, that is why we see these point solutions in the exhibit hall and not solutions. I am going to go out on a limb and say, “The EMR industry has created this vibe. I am not saying they did it on purpose.” I did the same thing.

I expected a lot more from my EMR without asking the right questions on the front end. Again, back to the people there, why aren't more people there? After my experience of going to many, I believe not just PPS, if we can show more value in what we are delivering to your team, the sales team, the provider team, and the billing team in one place, attendance will grow. I believe people are ready for that.

If you had asked me that five years ago, I would have said the same thing. I would go, "No one is ready for this. They are just going to show up. Go to the billing and compliance talks and go home." I want to see this for the right reasons. My room has increased in size for the last three years in a row. I attribute it to one thing and one thing only. People know they have to do something different. I do not attribute it to me. I attribute it to people knowing what they have to do.

Come on, Jerry.

You know what I am saying.

You have got the brand. You have got the name and the brand. Look how pretty you are.

You know what I’m saying. I know it’s in my haircut and everything before I go. Do you know what I mean?

Yes, I do.

They know I was really surprised. Here is the most surprising thing. I put this talk together as a series. If you were at the first two, you were going to drive more value from this talk. The room was going to be greater than 50% people who had been in my other talks. It was like 75% first-timers. I was like, "If you had been in my other talks, you would get value.” I am like, “I have been building this stuff.

No one talks in one hour is going to grow your business.” Again, the fact that 75% of that room was new was a huge tell to me, Nathan, that again, everybody is coming back on, "I have got to figure this out. It is not just the billing talk. It is not just the finance talk. It is not just adding more services. You have got to figure out the systems to get people." My marketing and not just marketing talks because it was a lot of marketing talk.

I just have a question for you. You have been to enough of them. You are working with the PBS. Do you think there is room for another association if it were started?

If this association, if it does what I just said, there is no reason why I cannot do what. I am not sure of the answer to that question in the context of what I just shared.

I guess why I am asking is because I admitted I did not go to a lot of PPS at all until I sold. I remember myself as an owner being like, "What are they going to teach me? I do not understand."

Let me answer this.

Just really quickly. Let me just finish this is as I did not recognise the benefit of PPS in between the conferences. There is the magazine, like you have got to get it to me somehow. I was not necessarily reaching out either, but I did not know what was out there. I did not see the benefit to me between conferences. I guess that is where I asked the question. The PPS can be, in and of itself, a great motivator, and can provide a ton of value. Now, what is happening in the next twelve months to keep some?

That is a great question. You know what? I can speak to the administrator side way better. I can speak to the owner's side. That administrator content is going to be available to owners year-round. I am going to make the next thing up. The next thing is my idea. Nobody else is. It has not been approved for anything. What I am hoping is that the build will get to conference, get the updates, like get an AI update, get it right.

You always need billing and compliance. There will be motivation to get the practice managers, but back to your point, Nathan, the value is not going to be the conference. I said it is going to the extension. I will say this. It is funny. You said that because you got my brain spinning. I have seen more and more on LinkedIn. They need a better marketing side of it because I have seen committees.

I have seen PPS. We are doing quarterly webinars. I am very up to date with things, but I do not know the reach. I am going to give you an example. I am not going to throw anybody under the bus because I do not remember. Someone from PPS reached out to me to begin the year. "Jerry, we are starting this new program."

We reach out privately, "Would really like you to amplify this, share it wherever you can." I responded, "Sure, just tag me in the post." I am still waiting for a reply. It is like 8, 9, or 10 months ago. By the way, even though I click and as part of my algorithm, they are barely showing up. I am like, "You and I both know send one email and go, nobody is responding.” It is like marketing one time.

I agree with you, Nathan. I am going to say it is there. I am going to say it is poor marketing rather than execution because I see the web. There was a great AI webinar. Someone showed up in my comments from PPS and said, "Jerry, great posts. By the way, we are speaking to this." I was like, "Cool." I am thinking, "Why did I ever see these posts going?"

I have never seen a PPS post. I am admittedly not on a ton of social media.

I am on LinkedIn. 99% of my time is on LinkedIn. If you are going to be anywhere, that should be it.

You should be able to find me easily there.

Drive everybody there.

The other thing I thought as I was walking away, I was like, "Who is going to be the next Rick Gawenda?" Who is going to be that person?

That has got to be a draw, by the way. Rick has got it. Rick's email list is bigger than anybody else's. I know because why? It’s because it is not a conference saying, "Dude, you and I both know you want the monthly updates. You want that. To your point.” Rick has got the biggest email list, the biggest list I know of anywhere.

He should. Hopefully, he does not die. What is going to happen here? There has got to be someone in this world who is committed to reading all that paperwork, going through all the reports, reading all the bills, reading all the proposals, staying on top of all the insurance changes, and actually loves doing that. Who is going to be our next Rick Gawenda? If he were to get hit by a bus, we are in trouble.

He flies a lot. They travel a lot.

There is something there. I like your point about where the connection is. It is funny because right when you said that, I was like, "I can speak to the admin side." It is going to be interesting, but there is just I am going to go out on a limb and say it is a marketing issue, not so much an execution. I see the stuff they are doing with the webinars. They are doing that.

They have the right people on them, as far as I am concerned. It is all about a conversation. They do not have to solve problems every time, but they get it. We have to have the conversations. I always think, and you and I both know, if you do not tell people what you are doing, then we think you are doing nothing. Just give us the updates. We think you are doing nothing. If you do not tell us either.

That was good, by the way. You have got to tell us what is going on because if you do not, that is the thing where I just constantly put out the same thing a hundred times. Someone goes, I get a response on the 101st post with someone going, "I did not know you did that." I just smile. Nod.

Of course, you did not.

That is all me. Not you.

I get it.

I love your takeaways. I jumped on some of that. I have had so many conversations. I am just thinking about all this.

That’s fine.

You are the first one to say that we need a heavier rotation, a more robust rotation of what is going on in the other eleven months.

Admittedly, I am not tagging PPS or APTA in my post and subscribing to their channels. You have got to come find me. You have got to push stuff my way if you want me to see what you are doing.

That is everybody's responsibility.

I am in a large majority there.

You are, too. I agree with you 100%. You have got to push. You and I both thought. I sat back waiting for everybody to show up. Guess how many showed up? Nobody in my business. I was the "You build it, they will come." Fortunately, I had a small space with a small rent.

That is right. Now it is time to go market, I guess.

Looking Ahead To 2026: Policy Changes And The Future Of Physical Therapy

“Wait a minute. This is not going as planned." "Jerry, yes. He planned it poorly is why it is not going." Anything else you want to wrap up with? What about 2026? Nathan?

2026 will be an interesting year. As we speak, the big, beautiful bill is changing our classification from professional. How is that going to impact things? The ACA and the subsidies, how is that going to impact things? Are we going to continue to subsidise the ACA plans? If the government does not subsidise them, how are insurance companies going to react to us requesting more reimbursement? They are like, "Yes, we are not flush with cash anymore. Why would we increase your reimbursement rates?" There are going to be some definite changes. It will be interesting to see what happens. If you want to check out what we are doing, we are at PPOClub.com .

Hold on. PPOClub.com . I just want to make sure we got that.

Thanks for slowing me down. I appreciate it. Under resources, we have events. We are doing an in-person workshop in New Orleans in January to help people strategically plan their 2026, get clear on their priorities, and establish goals, deadlines.

This will probably be out in mid to late December. It will go out before your January event. That will be good.

We will do other events. We have our next conference plan for October 15th through 17th. We will be in San Antonio. People can look out for that. We will have 100, 150, 200 owners in a room, and get a lot of energy from that. I like doing those. Surprisingly love treating patients. I do not know about you, but I enjoy doing the presentations now. Even having the worst.

I live for that, dude.

I never saw myself as being that kind of person. I enjoy it. I really do. I provide some great value. These in-person things are really cool. We always have the podcast going out every week, whether it is or Adam Robin hosting. We have got some pretty cool stuff that we post on the show on a regular basis.

It is all on your website, PPOClub.com .

The podcast library is there with a search bar, which I think is really cool. If you are looking for a particular topic, you can search the bar. It will pull up all the podcasts related to that topic, marketing, recruiting, billing collections, excellent culture, or even particular guests. Whether it is financial stuff, "Should I own my real estate?" All that stuff. You are on there talking about the patient journey from a few years ago, and front desk stuff. It is also on iTunes, Spotify , YouTube , all that stuff. It is all there if people want to find us.

Final Takeaways: People And Process Are More Valuable Than Platform

Great conversation. Sorry, I jumped on some of your stuff. After about now, I am realising this is like the 4th or 5th conversation. Every time it goes a little deeper. I have had more time to reflect on it. That is great because everybody is sharing something with a different perspective. All of these are going to bring great value to anybody listening and making them go, "Yes. This is cool." Again, I like where this started with talking about your talk, because here we are, November of 2025.

We could say, "It was the basics." It is what you need to move forward and grow. It was always there as the foundation for successful businesses, I like to say. Yet, all that stuff is rising to the surface again, as people are expecting tech to take over. Again, it will not. By the way, it will take over, but it may not take over the way you want. You'd better put your process on the tech that you are using to run your business. Under the QA side of it, I am growing my benefit checks and authorisations team.

We have an AI platform. My people are, I am going to say this out loud, more valuable today than they were six months ago. It has been an interesting journey to see where we. I do not believe this is going to be true until the end of time. Again, the people in the process are far more valuable than the platform. The platform is awesome, but without the people in the process, it could not deliver what it delivers.

I could see that.

Finance, billing, documentation. We talked about that documentation. Are you going to sign off on this? You do not even know the rules and the regs? You do not know what the rules the regs are around the codes. You are going to have to know all this. It is time to double down on all that. Thank you, my friend.

Thanks for having me.

PPOClub.com . It will be in the show notes. I will make sure there is a little blurb about January, also.

Thanks, man. I appreciate you having me, Jerry.

Do not hang up.

Nope.

I always saw that on the end because, like once or twice, people hung up. I am like, "Where did they go?" Cheers, my man.

Important Links

About Jerry Durham

Why Is My Business Growing But My Bank Account Isn't? What Adam Learned In 2025

Mon, 08 Dec 2025 19:00:01 GMT

If your clinic looks busy but the bank balance says otherwise, this episode is for you. Nathan Shields and Adam Robin get raw about the slow bleed that almost sunk a practice — and the exact moves they used to stop the leak and re-build profitability. They cover the blind spots owners accept (too much compassion, not enough accountability), the culture cracks that ripple into revenue, and the concrete fixes that actually move margins back into healthy territory.

In this episode you’ll hear:

How a six-month, slow-burn decline (tiny losses here, a few underperformers there) turned into a culture issue — and the moment Adam realized things had to change.
The playbook they used: hit the numbers first, reset breakeven & productivity expectations, co-design the rollout with leadership, and run a company-wide reset.
Why “production is the basis of morale” isn’t just a slogan — it’s how high-performing clinics protect culture and profit.
Real, tactical targets: how to calculate required visits per provider from revenue-per-visit and salary, reasonable ramp plans (4–6 week steps), and what to do if training doesn’t move the needle.
The hard truth: you can be compassionate and still demand profitability — but the owner must lead with clarity and conviction.

What you’ll walk away with:

A checklist to spot the slow bleed (what to watch monthly so the problem never becomes a crisis).
A step-by-step reset playbook you can run with your leadership team (numbers → expectations → rollout → accountability).
Language and scripts for the tough conversations (owner to team, peer-to-peer leadership, and ramp plans).
How to turn underperformers into contributors — or transition them out without wrecking morale.

Quick production note: If margins are slipping, don’t wait 6 months. Start with revenue-per-visit × target visits = required productivity. If numbers don’t line up, recruit and retrain now — don’t romanticize comfort over solvency.

�� Want help running your own strategic planning session? Join Nathan & the team Jan 9–10, 2026 in New Orleans — or book a one-on-one with Nathan: https://calendly.com/ptoclub/discoverycall

�� Learn more & find event details at: https://ptoclub.com

---

Listen to the Podcast here

Why Is My Business Growing But My Bank Account Isn't? What Adam Learned In 2025

Welcome to the show. How are you doing?

Super good. How about you?

I'm doing good. I’ve been traveling a lot.

Me too.

I know. We both presented at the Florida Physical Therapy Association Conference in Orlando. We had our own conference in Destin, which crushed. That was awesome. There were a ton of good owners and a ton of value there. Great feedback. If you're reading this in the future, look for our next conference to be in San Antonio, October 15th through 17th in 2026. Look out for details on that, and make sure you sign up early. I presented at PPS in Orlando, which was very cool. It was fun to see a bunch of other owners. We're both traveling, doing family stuff in between. It's been a whirlwind of six weeks.

We also did our annual strategic planning session.

That's right.

Why Annual Strategic Planning Is A Non-Negotiable For Business Growth

If you're interested in doing annual strategic planning, you need to come to see us in New Orleans. What are the dates? January 9th and 10th?

Yeah. We're going to do a one-and-a-half-day literal workshop. We're going to do some work here, not just listen to us present, but strategize a successful 2026. Go to our Events page. The registration page can be found on our website, PPOClub.com . Under Resources, there is a tab for Events. It's the same place where you'll find the library. Under Events, you can find the registration link. That’s January 9th and 10th in New Orleans, make sure you come with pencil and paper in hand. We're going to talk about what's going to make your 2026 the best, so you can attack it with clarity and excitement.

I want to plug. If you've never done an annual strategic planning session, if you commit to something like this, you'll never not do one again. It will transform your business. It will transform the way that you lead. It'll transform the way that you think about your business. I promise you, you should consider it. You should come here because we're awesome, but even if you don't, you need to commit to an annual strategic planning session.

I do them individually. I'll fly out to your location and do that. If you want to reach out to me, I'll come out to your place and do it individually. Email me at Nathan@PPOClub.com . On that note, especially because we're at the end of 2025 and people are planning for 2026, if you come to our workshop or do it with an individual like me, it takes a whole day, especially if you're going to do it with your team. What was the difference between your year when you didn't have strategic planning and the year that you did have strategic planning, especially when you incorporated your leadership team into that strategic planning session? What was the difference in your organization?

Everyone's a little different. For me, it came down to focus. It’s like when you get married. For those of you who aren't married, you have to go in front of the altar, pledge your vows, and be like, “I do. I have to commit to it.” Then, you're in. You committed to this. It's like that. That's how it felt for me. Whenever I had my team there, and we put it on the board, and we all said, “I'm in. You're going to own this,” and we designed that and put all hands in, it gave us something to be accountable to, specifically for the owner.

The owner usually has nobody to report to, so they do what they want to do. You're the worst employee in the business. You think you're smart, and you're not. When you do that, you give a little bit of authority back to your team, and they have something to hold you accountable to. That was transformative. It brought more balance to the organization and more clarity.

To help them own significant portions of your organization, and their success can be huge in their leadership development. It also makes it clear for everybody, “These are our priorities. We might have XYZ going on, but these are our priorities.” It keeps everyone focused and clear. That’s not our topic for this episode. That is a plug to make sure you're doing that in your own companies. Join us January 9th and 10th, 2026, or reach out to me.

The Slow Bleed: How Tiny Losses Can SINK Your Practice

In this episode, we're going to talk about something that you experienced in your organization. You've also seen it in other organizations, clinics specifically, about what to do when you start losing money or that profit margin starts going down. In these situations, was it this slow, steady burn, or was it like a drop off a cliff?

No. It was slow and steady. You don't even realize it. $1,000 here, a couple of thousand bucks here, then it's $5,000, and then it's 10. They're like, “I have a problem.”

If you were to look back, how many months did you tolerate it?

I’d say probably six months.

It was probably pretty small at the 1st part of those 6 months, right?

Yeah. In January, there's always an excuse. There's always like, “Deductibles are not met. Collections are behind. We hired that therapist.” I got a little lazy with my numbers. After about six months, I was like, “We've got a problem, and it's my fault.” I had to put my big boy pants on and make some shifts.

What do you mean by lazy with your numbers? Was it like you weren't watching them, or were you being reasonable about your numbers?

If anybody reads this long enough, I'm trying to run four companies, so things slip sometimes. I probably backed out of the PT clinic a little bit aggressively in the midst of declining reimbursements, and I underestimated the impact that that might have on the organization. The system being built today doesn't mean it's going to work forever. It's going to always have to be constantly revamped and reorganized as the market shifts.

I know you. You take the blame for it, but it sounds like your leadership team also had some reasonableness. I'm assuming they're looking at the same numbers.

We let some things slide. We had some new grads who joined our team. We had a lot of growth.

You had some underperformers.

We had some underperformers, and we were trying to support them and get them there slowly and steadily. We didn't want to hurt anybody's feelings. That ended up not being a good decision. We decided we were not going to do that anymore.

It ultimately loses you money. That's out of your pocket, right?

It lost us money. It lost our culture. We had some cultural shifts that we weren't expecting. Luckily, we have a pretty awesome company and an awesome team. We were able to withstand things like that. I'm confident that we're going to bounce back and be fine. It was a lesson we had to learn.

Production Is The Basis Of Morale: The Link Between Output And Culture

Do you think that gives more weight to the motto of production as the basis of morale? When you say the culture shifted, I'm assuming some of the productivity also slipped. When that happens, there's room for people to maybe go off on a tangent.

They become self-absorbed. They make it about them. It's like, “What about me?” Sometimes, that's appropriate. It's not like beating your team down until they're smithereens, but you can't make it about you. It's not about you. It's not about me. It's about this company, this team, and this mission, so stop being selfish. It became more of a self-absorbed culture.

We had a couple of people over there talking about things that they wanted to complain about. The OTs were over there complaining about their stuff. The PTs were complaining about the OTs. It all became a selfish-type environment. We have pretty high standards in our culture. We don't tolerate that kind of thing. It was still a good culture, but it was not the one that I left a couple of months ago.

You could see it creeping in.

I could see it creeping in, and it wasn't something that I was comfortable sustaining.

Do you know what's interesting? This is a generalization. It's those people who are the least productive who are having those conversations or making it about themselves. It seems like the ones that are most productive and aligned are not having those conversations. They don't care.

They’re rocking.

They want to rock and roll, and they love being there. They’re like, “We're all a family. Let's work together.” When they aren't as productive, that's when it tends to turn inwards. Frankly, rumors or stories start getting spread, and complaints start creeping up here and there that weren't there before. It’s usually coming from the least productive people. They're the ones who are asking for the raises the most.

It all became a selfish thing. It became a thing where it almost trapped me in. I lost my confidence. I was questioning myself, like, “Maybe I'm asking too much of them.” When you start getting people in the company that are pushing back so much, you start to think, “Maybe I should second-guess this. Maybe I should think about this.”

I don't have time for that. I was like, “You can either do it, or you can leave.” I had to draw that line. I was like, “We want you here and need you here. We want you to be a part of this, but if you need to leave, please, because we're going this way. There's no reality that exists where you're going to get this. You need to get in line, or you need to go somewhere else.”

When did the light bulb go off for you? This is the tipping point. What number did you see? What was said?

You know I'm not a numbers guy. I'm a culture guy. I'm so glad you asked this question. My director of operations typically leads out on the team meeting at the big clinic. There are twenty providers there. It’s a big clinic. She was going on vacation, so she was going to delegate the team meeting to our assistant director, who's a little bit inexperienced.

In the leadership meeting, Joe was there. Joe is our director of marketing. He's a clinic director at a second location. Somebody said, “Joe, Katherine asked. Would you mind sitting in on the big meeting? We don't want it to become a complaining fest for Amber, who's substituting for Katherine.” Katherine wanted Joe to be there because she was concerned that the assistant director wasn't going to be able to handle the heat of the team.

All the complaints.

When I heard that, I was like, “How did we get here?” That's when I was like, “Something's got to shift.” I had to get into the business a little bit, figure out what was going on, and start running some numbers. That was the start of the change.

The Uncomfortable Truth: The Conversation That Forced The Owner To Act

Did the conversation immediately change to that, or how did you hold the next meeting? How did you hold them accountable?

When I heard that in the leadership meeting, I stopped, and I was like, “I'm going to stop and sit with this for a second. Let me be clear. Angel, what did you ask for?” I had to bring it into awareness. I asked it. I was like, “Is this who we are now?” Asking that question inside that meeting brought it into awareness. I was like, “This stops today.”

You know me. I’m a go-straight-at-it kind of guy. When I heard that, I was like, “That's enough. I've had enough. We have to make changes.” I addressed it right there. I let them have their meeting. I didn't want to jump in because Katherine had made plans. I wanted to respect that. As soon as she came back in, it was like, “Email to the leadership team. This is what I noticed. This is what we're going to address.

I'm all about core values. Was there a value that wasn't being lived out at that moment, a particular one?

Yeah, two. One is, go straight at it.

People weren't addressing the red flags as soon as they popped up.

People weren't addressing the red flags. Our second value is high challenge, high support. We were supporting people, but we weren't challenging them. Our commitment is, “We're going to support you more than you've ever been supported. We're also going to challenge you more than you've ever been challenged.” There were some blurred lines with those values, and we paid the price for it.

How did that then bleed out into the rest of the organization? Did you have to reset expectations and talk about the values?

Totally. Productivity was down. What happened was we took a leap, we took a bet, and we overhired. We overhired, and I was like, “Great. We've got the marketing systems in place. Let's roll. We're going to fill these schedules up.” The schedules never quite got there. Productivity was low, cash flow was low, and then we had a couple of resignations. That's when I knew this was the perfect storm brewing.

I went back to the numbers first, and I was like, “We're going to recalculate these numbers. We're going to have a meeting with our billing department and get clear on where our revenue per visit is for the year. We have to re-establish productivity expectations across the board with our current revenue per visit.” We started there, and we made it a barrier.

Did you have to reset breakeven points?

Reset breakeven points, reset expectations.

Weekly visit expectations, skilled units per visit expectations, and all that kind of stuff?

Yeah, all the stuff.

Did you go to the individual clinics and lay that out, or was your team willing to take that on?

The Collective Reset: Implementing Company-Wide Change With Leadership

We co-ruled it out. My leadership team is awesome, especially if they're willing to put up with me. We met and designed this. I brought the data, and they built the plan. I gave them leeway to have some flexibility with the plan. We scheduled a date, like, “At this date, we are going to roll this out. We're moving forward as a collective unit.”

We scheduled a company meeting, and all the clinics came together. One clinic had 40 people in a room. We did a two-hour presentation on where we're at as a company, the trends we're seeing, why change is important, and the changes that we were making. I led parts of that. Katherine led parts of that. Joe led parts of that. Everybody led different parts of it.

That’s so awesome that Katherine and Joe had the opportunity to lead out on that. You and I both know that some kind of peer-led presentation, conversation, or discussion can go a lot further than if it's Adam at the front. They take it differently when they see fellow team members who are speaking to them.

I think so. I usually bring a little bit more heat to the room, which isn't always good. I try not to bring too much, but sometimes, I can be passionate about what I'm talking about. Quite honestly, I'm not going to let the culture slip. It's the only reason why we exist. It's the most important thing to me. That means some people are not going to be happy about the changes, and I was okay. I was willing to live with that.

As we're talking, it's obvious that culture and production are one and the same. It's okay to have a culture of productivity. Usually, the higher-producing companies have the greatest cultures. If you think about some of the great companies that are out there, you can imagine they have a culture of, “We're going to get at it. We're going to crush this.”

How else does Elon Musk get these robots, spaceships, and EVs out on the road? The rate at which he's doing it is so impressive. There's got to be a culture in those organizations that is like, “We see the vision. We're going to do whatever we can to get there.” The culture is demanding, but also fulfilling for those people. Otherwise, they wouldn't be successful. I'm gaining more appreciation for the fact that if you want to have a good culture, part of that is productivity. I don't think you can have a low-producing organization that has a strong culture.

Stop Tolerating Low Productivity: The Unwavering Standard For Solvency

I'm learning a lot about culture, especially as we talk to a lot of powerful leaders. I'm not going to be the first to say that we're perfect because we're definitely not perfect. We're learning every day. I do know that it's the leaders who have this balance between serving others, serving their team, supporting their team, and pouring into them, but also having a standard that they're not going to budge on. It's this balance.

I wish more owners would get a little bit more pissed off about things. It's okay to be pissed off and be like, “Team, this isn't enough. I need you here. I want you here. I don't want you to take this the wrong way, but we've got to get busy, or we're going to go out of business.” I don't know how else to say it. It’s like, “I can't lose sleep at night worried about if I'm going to be able to pay your freaking payroll. We've got to pick it up.” I wish owners would get more pissed off about that.

We've got to stop pretending like one-on-one patient care is the only way to run a business. We have to stop tolerating seeing patients for an hour and only getting three units in. We cannot do that. If your providers are not producing the revenue that is required to support their salary and the overhead, you're going to go out of business, and you're going to be stressed out for the rest of your life.

You have two options. You can either do something about it or not. If you're not going to do anything about it, stop complaining about other things and other variables. You're choosing to tolerate that. We've got to get to this place where it’s like, “I am no longer going to tolerate that. I'm going to be required to ask more from my team.” Whenever you get there, you will build a cultural performance. You're going to lose some people, probably.

I talked to you during this whole situation here and there. You told me the whole story and how you're going to increase expectations for production. You were like, “Some people are going to get pissed off. I'm going to expect a few resignations.” For the good, right?

I wouldn't say good. I'm not happy that they left.

I'm not saying that, but you needed to re-establish the expectations.

We don't make decisions based on your comfort. We make decisions based on what is necessary. You could be like, “We want to support you through the transition. We do the AI scribe. We do the EMR. We do the paid documentation time. We do all the things we do. We do the PTO. We give you all the CEUs that you need. We try every way we can to support you.” Unfortunately, employee and owner, your business doesn't care about your comfort. Your business doesn't care about your feelings. We have to try to find a way to be more objective about those standards.

What I tell my team all the time is, “I'm not saying that it's easy. I'm not saying that it's convenient. I'm not saying that it's fair. I'm saying that it's necessary, and that it's required.” We do what is necessary. We don't care if it's a good day or a bad day. We do it anyway. Maybe that's a little harsh for some people. Maybe I'm going to get canceled for that, but that's it. Stop being so romantic about the business. Be objective. If it takes 60 visits a week, it takes 60 visits a week. If it takes 80 visits a week, it takes 80 visits a week. Whatever it takes, do it. Build the structure and the support you need to be able to build the model. You can make money and build a practice, but it's going to require a different way of doing things.

You know how this usually plays out. You've probably seen this plenty of times as you're coaching. I met an owner that we both know at PPS. She's like, “Profits are down.” I'm like, “What's going on?” I was ready to get into it right there. I'm like, “Have you figured out why?” She's in an outpatient neuro setting, so a lot of one-on-one for an hour. She’s like, “I've got some providers that don't know how to bill. My average skilled unit per visit is 2.8.”

I said, “That's the issue right there. There is no way you can make a profit on 2.8 units per visit in physical therapy.” We're in November 2025. She’s like, “If things haven't changed by March, then we'll have to get serious.” I'm like, like, “Number one, start training them and holding them accountable. Number two, either before or after that training, you get the recruiting engine going now. If this person isn't willing to change, you're going to have to replace them because you're losing money.”

The Low Level Of Concern: Why Compassionate Owners Must Be Objective Leaders

That's what usually happens. We let it happen for 5 or 6 months, as you did. Even then, a lot of owners, unlike you, find out, “We're in a tough situation. We need to train everybody a little bit more.” They soft-hand it or kid glove it. They have a lot of compassion. They’re like, “That's probably on me. We need to do a better job at training.” That's not how business works.

I shared this at the confe ren ce. In Ray Dalio's book, Principles , he spends an entire section on recognizing that the best business owners have a low level of concern. Meaning, their purpose and goals are so high that they don't have time for your comfort and emotions. You either need to get in the game and perform what's expected, or you need to get out of the way. They’re like, “We have to find someone else.” They have a low level of concern. That is our sticking point as an industry because we are such compassionate people. That's what got us into the industry, but it's one of our biggest stumbling blocks when it comes to running our businesses.

It’s weird. I'm almost scared to say that because I don't want to get canceled by the people who tune in. We're probably one of the more business-heavy shows in the PT space there is.

They’re going to say, “You might be swinging the pendulum too far.” I would love to see the pendulum swing a little bit further. Maybe it needs to happen. Maybe we need to be a little less compassionate. Leave the compassion for the therapists. You, as a business owner, step out of it. Get over it. Lead your teams.

Another thing that I'm recognizing is that as I look at all the great business owners out there, they're unapologetic about asking for what they want. Maybe this isn't you, if you're reading, but if your profit margins are under 10%, it is you. Your therapists are seeing 41 visits a week, and you're fully in network. Your revenue per visit is $84 a visit, and you're wondering why you're not making money.

It sounds like you've talked to some of these people every day.

Why don't you try raising it to 50 a week? That means you have to schedule 60 to see 50. They’re like, “What about the documentation here?” Here it comes. It’s like, “I don't care. You have to see 50.”

You have to drop the low-paying insurance.

It could be a combination. It’s like, “Why don't we get to a place where it's 50, and that's it? Whatever you're thinking after that, just do 50.” You want to commit to that transition at a pace that your team can withstand. You don't want to go from 40 one week to 50 the next week. Maybe it's 40 one week, 44 the next week, and 46 the following day. We will ramp it up over 6 weeks, but we're getting to 50.

We're not saying it's easy. We're not saying it's comfortable. We're saying it's required, and that your behavior, and I'm talking to the owner and their team, will need to change in order to generate a business that's sustainable for everyone. Nothing will change until the owner gets to a place where they’re like, “I would rather close the doors than not be profitable. I would rather lose my entire team if I have to before I don't get to that 50 mark.” There's so much conviction in that mission, and you're not afraid to ask for it. That's it. Business doesn't need to be more complicated than that.

You said you dealt with someone where you had to change their business model because of a similar situation. How does that relate? Did they have a similar issue as you did?

Yeah. They were at 7% margins for the year. They're in California. Everything's expensive. If I remember correctly, their average pay for a physical therapist is somewhere around $42 to $45 an hour, which is a little on the heavy side. For a full-time staff therapist with benefits, it's a good chunk. If they're only seeing 40 visits a week on average, and your average reimbursement is $85 a visit, you take 85 times 40, and that's your average weekly revenue per FTE or Full-Time Equivalent.

If you're not generating at least 2 and a half to 3 times that person's salary, then you're going to struggle. All you have to do is calculate what three times their salary is, take your revenue per visit, and divide it by that number. It’s the revenue that you need them to generate divided by revenue per visit. That's how many visits they need to see for the year. Divide that by 48, and that's how many productive weeks per year that they have. That's how many visits per week they need to complete. What we found is that instead of scheduling 10 visits a day, they need to increase it to 14 visits a day.

They’re like, “We have the number. What about my space?” We’re like, “Let's talk about the space.” They’re like, “How do we fix the space? How do we get the schedule in order?” We’re like, “Wait a minute. Let's keep talking.” If you are willing to solve that problem, you can solve that problem. Guess what? They rolled it out. They changed up their model, and now they're running 20% margins because they changed the way that they deliver care. That’s all it is.

It’s like, “What's the next thing you need to do? If that happens, then what? What are you going to do about that, and then what's the next thing? What are the possibilities?” There are going to be issues that come up, but instead of stopping when the first excuse comes up, it’s like, “How do I need to get past that?” That is what led them to open their minds and create a plan. They’re like, “This is how we can do it.”

Stop Being "Too Nice" And Start Demanding Profitability

The biggest constraint for 95% of private practice owners’ businesses is that the owner is being too nice. That's the biggest constraint. You justify low production and elevated expenses because you want to be nice instead of being objective. I don't mean to be weird about it, but stop being so nice. Be objective about it and live in reality. Choose to live in objective reality.

Go to a therapist and work through your limiting beliefs around why you feel like you need to give everybody everything you deserve, and start demanding profitability. If you live in that discomfort for a little bit, you'll start to develop courage and confidence as an owner. You'll start learning how to ask the world for what you need in order to create a business that you need.

What you'll learn on the other side of that is how to be objective, firm, and still have a relationship.

There's the other side of the coin, too. We think that if we do that, we're mean, and people aren't going to like us.

You'll lose the relationship altogether.

People won't want to do that. They’re like, “The only reason they like me is that I'm nice to them.” That's not the truth. You can still have a profitable business that you demand, and you can still have great relationships where you support people and love them. You could have both. It's not either-or.

It just takes some work.

It takes an owner willing to explore that.

Also, develop themselves to be that kind of owner or that kind of leader. People want to be led. They want that leadership. They appreciate it when you hold to expectations and accountability. People want to be held accountable. They want to be given targets to see how they're doing. They want their scoreboard. They want to know how they're doing according to the scoreboard. They want all that. If you’re going to be soft on it, then they start losing respect for you, frankly, and they start questioning the purpose of the organization if that's what we're in this for.

I want to be clear, because I know I can go on a tangent with this stuff. This isn't about trying to build something where you squeeze everything you can get out of people. This isn't like this greedy, weird thing where you’re like, “I'm going to be a slum lord. I'm going to work my team to death.” It's about building solvency. 15% to 20% margins in your private practice are normal.

I didn't say 50% margins. I didn't say 60% margins. It is 15% to 20% margins where you know everybody is getting paid. You've got a little bit to save for retirement. You can give some raises. You can sleep at night knowing, “I'm not worried about how I'm going to pay my rent and my payroll.” You need to have that. You deserve that. That's not too much to ask for.

Not at all.

I wanted to make that clear.

Great stuff. I don't think we need to add more to it. We've said all we need to about it. We recognize in the experience that we've had with so many owners that it’s a commonality that's holding them back and that's holding the industry back, frankly. Hopefully, they start getting addressed before you start seeing the downturn in culture and profits, and that expectations can start being corrected as we go.

It's important to maintain that high level of objective accountability, and in doing so, we can do it in a nice way. We can do it in a proper way. We can uphold our values at the same time. All of those things can happen, but it takes a little bit of effort on the owner's part to become that better leader who holds to objectivity, right?

100%.

Thanks for sharing your experience. I know it was a rough time, but I only know that makes you a better coach because you understand people's situations more emotionally, frankly.

It was a hard thing. It was very hard. It was stressful.

You’re still working your way out of it.

I'm grateful for it. I'm a little bit of a better owner because of it.

That’s right. That’s great. Thanks for sharing again. This is awesome. We'll see everybody on January 9th and 10th, 2026. Put it on your calendars. Put a pin on October 15th through 17th, 2026 for our annual conference. Go to the website and check out what other events we have coming up in the future. In the meantime, good luck planning for 2026. It's almost Thanksgiving. I'm thankful for you. Thank you so much. I’m thankful for everybody out there who's tuning in. Have a great day.

See you, guys.

Important Links

About Adam Robin

Creating A Game-Winning Culture That Attracts And Retains The People You Want With Brian Weidner

Tue, 02 Dec 2025 10:00:06 GMT

If you’ve ever felt like hiring is a shotgun approach and retention is just luck, this session will change how you build teams. In this Total Talent Masterclass, Brian Weidner (Career Tree Network) sits down with Nathan Shields to unpack a strategic, repeatable approach to building a game-winning culture of recognition and retention that actually moves the needle.

Nathan walks through how intentional values, recognition systems, and leadership by metrics turned his clinics into high-performing, sticky organizations — the same factors that helped him build and sell a business at a valuation well above industry averages. Together, they cover how to stop reacting to churn and start engineering a workplace people want to join and never want to leave.

You’ll learn:

· How to hire and fire by values so culture becomes a competitive advantage (and not just a buzzword)

· Practical recognition systems that scale: from peer-to-peer shoutouts to quarterly town halls and value awards

· Why embedding values into every stage of the employee lifecycle (ads → interview → onboarding → reviews → offboarding) prevents culture drift

· Ways to measure recognition success (NPS for employees, retention & productivity KPIs, and qualitative pulse checks)

· How to balance production AND values — and why sacrificing one for the other destroys morale fast

· Leadership playbook: lead like an owner, coach by metrics, and create career conversations that reduce surprise exits

· If you’re a hiring manager, clinic owner, or HR lead who wants predictable staffing, lower turnover, and a culture that amplifies productivity, this masterclass gives you the framework and tactical next steps.

�� Takeaway: Culture isn’t fluff — it’s a scalable business lever. Do the value work, measure it, reward it, and watch retention become a strength instead of a headache.

�� Want to go deeper with Nathan? Book a call with Nathan — https://calendly.com/ptoclub/discoverycall

❤️ Love the session? Subscribe, rate, review, and share! https://ptoclub.com

�� Join the conversation: If you haven’t already, find the Private Practice Owners Club Facebook Group to connect with therapy owners and leaders who are building great teams.

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Listen to the Podcast here

Creating A Game-Winning Culture That Attracts And Retains The People You Want With Brian Weidner

Welcome to the Private Practice Owners Club. I'm your host, Nathan Shields. In this episode, we have another opportunity to share an interview that I did with Brian Weidner of the Career Tree Network and his Total Talent Masterclass webinar. I was a guest on his webinar. We talked about culture, recognition, and appreciation. I was able to share my experience with the culture that we created in our past organization, how it significantly influenced our productivity, retention, attraction, etc., and altogether, the importance of having an outstanding culture in your organization. Hopefully, you take a lot of notes and get a lot of value from it. I'm excited to share this with you.

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We had the bio from Nathan, but I thought I would go out to the podcast on Apple. If you have a chance, the Private Practice Owners Club Podcast is available. It's a great resource on a variety of different topics. That's how you and I first connected back in January of 2019. I found you through your podcast. I had listened to a few of them. I was like, “This is a cool resource.” I had reached out to you from there. Since then, you have had 328 podcast episodes.

It's crazy. I've been doing the podcast since 2018. To do over 300 episodes, I never thought I would get this far. It has been a labor of love because I've enjoyed doing it and always wished that there was a resource like this when I owned my clinics back in the day. I started in 2002. Podcasts weren't a thing. Business coaches, I had never heard of such a thing before. To provide a podcast where I could introduce successful private practice owners to other private practice owners, share successful actions and tips, and talk to industry influencers has been exciting to do. It has been cool. I've gotten some great feedback. That encourages me to keep doing it.

For someone who has never listened to the podcast before, is there one or two episodes that you're most proud of, or you think they should check out, aside from the ones that I was in?

Thanks for putting that caveat on there because those would be the top three. Adam is my partner in this Private Practice Owners Club . You'll hear him be the host many times on these episodes. At the end of 2024, for anyone who is a private practice owner, we did a series. It was an eight or nine-episode series of the Private Practice Manual Series. We broke down the business into nine different parts and talked specifically about those parts of your organization.

I truly believe that if anyone wanted to improve their business, if they were at the beginning stages of their business or honestly at any stage after that, and wanted to improve particular sections of their business, they would get a wealth of knowledge from those particular episodes. If you look back into 2024 towards the end, and it's in the September 2024 range, there were some great episodes there that he and I went back and forth, sharing our experience and successful actions that would help any owner in any situation.

How Brian Sold His PT Practice Above The National Average

Thank you. You built and sold your physical therapy practice for three times the national average. That seems pretty impressive. You're well above average in terms of what you sold it for. I'm curious, thinking back on that, why do you think it sold above average? Were there things especially related to human resources and maybe even our topic? Was there a certain reason or multiple reasons that you think led to your practice being one that was especially valued?

There were definitely a few reasons. The major reason is that we did what's called a roll-up. In the industry, when you do roll-ups, you aggregate many businesses together to be put on the market at the same time. Thus, your valuation does go up. That was one portion of it. The other portion of it is, of those aggregate therapy clinics that came together, we had the most profitable clinics, which definitely added to our value.

We also came with a culture. They knew us as the Risers because we were Rise Rehabilitation Specialists. We brought not only our culture, which was better than anyone else's that was in the group, as well as leadership team members. We had management team members who were key components of the ongoing entity after the sale, which was super valuable. All of these came together to allow us to even get to that multiple that we did.

Building A Culture Of Recognition And Appreciation

We're talking about building a culture of recognition and appreciation. When we first set up this topic, I had given you a few different options. You had selected this one for us to talk about. I'm curious. It's important when you look at staff retention and being able to have people thrive in their roles. Is there something about this topic that you thought was important for us to talk about, or one that you felt like you wanted to talk about versus the other options that we had discussed?

The first thing that comes to mind is that I don't recall what the other options were, so I probably didn't have as much experience in those.

A lot has happened since then.

I mentioned that when we sold, we had an amazing management team and we had an amazing culture. I can speak to that with a little experience as to why. I saw how we intentionally drove that. Intentionally is not from the perspective of, “We want a better culture.” We did it from our intention of wanting to be more productive, work with people that we wanted to work with, become better leaders ourselves, and have a company that we were proud of. We had all these underlying intentions that, if I were to put it together, we wanted a significantly better culture. I felt like I could come from a place of experience to speak about that.

When you think about the culture at your clinics, what are two or three words that come to mind about what that culture was like? Give us a feel. If we walked in and met some of the people on the team, how would we know that they were part of the culture? What characteristics would they all share?

I always wondered if these would carry through, and they did. We had our core professional values. We also had some cultural values. Our core professional values were professionalism, accountability, growth, and empathy. We lived those fairly well, or at least we held each other accountable to those growths. We also had some cultural values that explained the people in the culture a little bit better. That was fun, family, and freedom. We wanted to work with people who we felt like family. We wanted to have a fun time doing it. It was all about freedom to help us be more, do more, influence more, and help each other grow and progress.

Those cultural values that we expressed got lived out. I can see that now, in the fact that we sold back in 2018. The people who bought into our company, I still see pictures of them getting together on Facebook. This is seven years later. They celebrate each other's birthdays. We see each other at the conferences. I saw some of them at the Private Practice Section conference, where you were. Huge hugs, caught up, and never skipped a beat. I know exactly who they are. They know who I am, and it's not uncomfortable. Those truly got lived out.

The Right Approach To Hiring And Firing People

When you think about this topic of recognition and appreciation, would you be able to walk into a clinic where the people are recognized and appreciated? Could you tell that that's happening? What would that look like if you walked into a clinic and you saw that culture in action? Would there be smiles on the faces of the clinicians, motivational quotes on the wall, or stars next to names for recognition programs? What does that look like in a clinic setting?

Let me back it up a little bit before we get into recognition and appreciation. I have a pretty good idea when people are living out the values of their owner when I walk into a clinic that doesn't have a good culture, because I've lived that. That sucks. You've done it, too, or at least I would assume that most people have if you're reading. You walk into it, and it's cold, not temperature-wise. The front desk person hates their job, or at least they don't treat you like they care. They might have systems in place, but people are more robotic. It's not warm. It's not inviting. There aren't many smiles.

That tells me that the owner's values are not being lived out. That's because either he hasn't expressed them or he doesn't care. He or she doesn't express them or care, and doesn't hire and fire according to those values, and hold people accountable to those values. When someone comes in, and there is a great culture, I can tell because it's warm. It's inviting. The people are nice. They're still following systems. They're trying to do as much as possible to make you comfortable and be professional. They make sure things are all going in the right direction.

Typically, if they've been part of that culture for a while, they're trying to do things that are above and beyond what you would expect. They're trying to get that five-star experience and, if possible, a six-star experience on a five-star scale. They're trying to do a little bit more. That's what I see when I go into those places that are truly living out their culture. They are living out the values that have been intentionally pursued and held people accountable to over the course of a long time.

In that situation, to start bringing it back around to recognition and appreciation, I'm not there yet. We would hire and fire according to our values. That was our thing. It meant that our values, professionalism, accountability, growth, and empathy are pretty much laid out in our job classified ads. Back in the day, it was Craigslist. Now, it's Indeed. Maybe Craigslist still happens. It wasn't just like, “We need somebody who can fill this job description. Here's the job description.” It was, “This is who we are. If you're looking for a place that's X, Y, and Z, you agree with these values, professionalism, accountability, growth, and empathy, and some descriptors behind that, and any of that rings true to you, then please reach out because we want to talk to you.”

During the course of our interviews, we would talk about professionalism, accountability, growth, and empathy. How did you show that out? How do you think that is seen in the workplace? On our annual reviews, we would talk about professionalism, accountability, growth, and empathy, and measure you according to those. It is how you can be better, more professional, and more accountable. In our weekly team meetings, we would take five minutes at the very beginning of our meeting and have a little value discussion time where we would pick one of the values.

Usually, one of the team members would lead it up and talk about accountability. “This is what accountability means to me. This is how I've seen it in the workplace. This is why it's important. Does anyone else have any other thoughts?” We would talk about it. We would assess people according to those. When someone has done something that has led us to decide to let them go, I find it helpful to tie that to a value that's not being lived out. “When you're not showing up on time, that lacks professionalism. We've given you plenty of chances to step up. It's still becoming an issue because that impacts everyone else. We need to hold people accountable to the values, or the values don't mean anything, so we're going to let you go.”

We did a lot of that in the background. Coming back around to recognition and appreciation, during some of those team meetings, we encourage the team members to call out other team members who have shown that value to them in the past. Someone mentioned somebody was working with this patient. They were having a rough day. Instead of blowing them off or maybe getting a little bit snide with them, so-and-so lived out our value of empathy, talked nicely to the person, took them to a separate room, and decided to finish up their treatment there and maybe talk it out or maybe allow them to vent a little bit.

They showed empathy during that situation. That's a great example of how we can be more empathetic. That was an opportunity for people to get called out, recognized, and appreciated. On top of that, we would always do end-of-the-year banquets. Inevitably, we would give out prizes for those who lived out those values, such as professionalism, accountability, growth, empathy, family, fun, and freedom. They would get a certificate or a gift card. They would be brought up to the front, handshake, get pictures taken, and that kind of stuff for living out those values. That was a way for us to recognize and appreciate people who not only live those values but were great examples of them, and that other people could look up to for those values.

I love the congruency there between how values come in at all stages of the employment experience, from the job ad, the first impression, to the interview process, all the way through termination. If you look at the full life cycle of employment, it sounds like your values were embedded in each of the stages of that.

How To Know When You Have To Let People Go

When we were letting people go, yes, they could do something wrong, and maybe that loses you money or something. You did something wrong against another employee, or you were late, as I mentioned. Those can all typically be tied back to your core values. You have to say at some point, “That won't work with our team and our values. It could work with someone else. It's nothing against you. There's no shame. It's that it doesn't work here.”

When we started holding those values in place and keeping them sacred, then what happened is we started attracting more people like that. People who were attracted to the ad with those values started applying. They bought in. We're talking about culture. We're not just talking about recognition and appreciation. We're talking about developing a culture. This took 18 to 24 months at least before we saw the fruits of it.

You have to let some people go who aren't part of that, and you have to bring on people who are engaged at that and willing to buy into it. Once we got into doing that, the ball started to get rolling. When you start talking about productivity at that point, we had a culture of production. One of our mottos was, “Production is the basis of morale.” That was one of the first things that we all said together at the beginning of any of our team meetings, like a leadership team meeting and a clinical team meeting.

That was also a cultural piece. We bonused according to their increased production, which is a form of recognition and appreciation. That was a way to build the culture. To tie it back to my initial story, I believe it's those things, getting the right people, team members in place, and showing them how to be productive led us to have greater profit margins than the rest of the people in our group that eventually sold, and developed team leaders that were superstars compared to other management team leader and team members from the other organizations that came on through into the next organization.

I like how your values were not loose and attractive to everyone. When you say empathy, for example, some people are fine and are not that empathetic. They would not be attracted to a value that has empathy as part of it.

If you're not these people, that's fine. We tend to work well with those types of people. You're going to be pretty uncomfortable in our organization, frankly.

It's good that you're setting that up because you want the right type of person on the team. That helps the overall culture to get stronger as you have the right alignment on values and vision.

Benefits Of Holding Quarterly Town Halls

Can I tell you one of the proudest things that came from all of this as we developed this culture, recognizing, appreciating, etc.? We would have what are called quarterly town halls. This was based on some recommendations in the book, Scaling Up by Verne Harnish. We would have these quarterly town halls where we would shut everyone down for an afternoon on a Friday and get together. You would hear it occasionally, but we would hear it. People would say, “I know I can get paid more at other places. That's not where I want to be. This is my family. This is where I want to be.”

Recognizing People Working Beyond Their Job Descriptions

You mentioned your town hall meetings and the trophies that would be given out for identifying with the values. Did you have any other recognition systems, or have you seen any other recognition systems that you think are effective in terms of driving appreciation at a clinic, things like incentive programs, Google reviews, or a celebration that takes place?

A couple of things come to mind as you're talking about that. These weren't like, “This person lived out this value, so they get this.” It was more like giving them opportunities to lead out. It is recognizing that maybe they have more talents than the borders of their job description. I loved it when my business coach would be like, “Do you feel like you have to do that? Don't you think that people on your team could do X, Y, Z?” This was stuff like putting together the birthday recognitions for people's birthdays.

I would ask the team. The team meeting was like, “Guys, I'm not good at getting the card, getting the cake, getting everyone to sign, and maybe getting some balloons or flowers. Does anyone want to take that over?” That's in no one's job description, but the person who loves that stuff shoots their hand up into the sky. He says, “I would love to do that.” That's what comes to mind. That's a way of showing recognition.

You have gifts and skills outside of your job description. Let's use them for the betterment of the organization. One therapist loved CrossFit. She's like, “Do you mind if I take an hour here off of my schedule and go set up a free consult room at my CrossFit box?” I'm like, “Yes, that would be awesome.” Again, let's recognize and appreciate that she has skills and talents outside of physical therapy, but maybe there's a way that the two can meld together.

“What are we going to do for National Physical Therapy Month? Who wants to head the committee for what we're going to do to show appreciation for our patients? What are the decorations that we're going to do? What are the dress-up days going to look like?” Recognize that they want to be a part of something, and it doesn't always have to be related to patient care. They'll love it. They'll do it for free. They'll own it. I don't have to do it, which makes it even better. They'll do it better than I. I appreciate them. “I thank you so much.” They're not doing it for my appreciation and recognition. They're doing it because they love it.

They're able to bring their whole self to work as well and share their passion.

If they love it, they're probably going to do it well. When they do it well, everyone else is going to recognize them. Their peers are going to be like, “That was awesome. Thank you so much.” It goes further than a boss saying that.

We all want to feel valued and appreciated. If we can do things that we're good at and have that be part of our responsibilities, that's an interesting way to accomplish that. Putting someone in charge of something that they would enjoy doing that builds that culture is a great idea.

We would also play games. This all goes back to one of our cultural values of fun. We would have pumpkin carving contests between the clinics. We can have the best pumpkin carving display, not just the pumpkin, but they're at the Halloween display. We would recognize birthdays. If someone was with us for a number of years, they were going to get recognized for their loyalty. Those are some pretty standard things. Recognition and appreciation come along the way.

We're going a few years back, so the memory is a little bit muddy. I can imagine myself having given someone else, like my marketing person, the responsibility of recognizing birthdays, recognizing anniversaries, and giving her a budget for each one of them. “Do whatever you want within this budget. I don't care. Let's show some appreciation.” It was on the calendar. They knew when it was coming up. They prepared all for it. They also weren't afraid to do it after hours. It was fun. It wasn't work. It was fun for them. That benefits all the team members now that they're getting recognized and appreciated.

Advantages Of Doing Daily Vs. Quarterly Appreciation

What are your thoughts on balancing a structured recognition program, like the quarterly example that you gave, as opposed to the everyday appreciation that feels more genuine? Do you look at balancing?

There's room for both. You can recognize and appreciate, and maybe hold people accountable in a timely manner. There's still room for opportunities that need to be taken advantage of, whether that's quarterly assistance or semi-annual or annual assessments. You're looking bigger perspective to say, “This is where I see you in the organization as a whole. This is where I see holes in your performance. This is where I see you can improve in terms of living out the values that we have.” That's also a time to talk about, “Where do you want to go in the future? Are we helping you get there?” It is recognizing that they have dreams beyond us. If you use the word recognition, we can take that in many different ways.

In this way that I'm talking about is recognizing that we've come to a point where we understand that we were typically a stepping stone to something else for most people. They weren't going to die with us. They're usually going to go someplace else for any myriad number of reasons. It is recognizing that they might have goals, dreams, and aspirations. If there's an opportunity for us to provide them a situation where they can live those out, 1) We should know them. 2) Figure out a way, if it's possible, to incorporate that into their employment with us. It is recognizing that they are people outside of the work they're performing.

That's a great point. A lot of our clients hope for that never-ending employment. When we hire someone, we want them to stay for the rest of their life. In reality, you're right. People do have dreams beyond their current role and things that they're working towards, or who knows what life has in store. If you can be a manager or a leader who recognizes that and wants to support the person globally and holistically, you're going to be in a lot better shape, as well as in terms of getting information that might be helpful to you.

If you have an employee who has an aspiration to move to China, that's something that you want to try and stay on top of. You can get a timeline for that versus them keeping it secret and not sharing that with you, and then you're surprised. I had a client who had a person who was supposed to retire in 2027. The person decided to retire in two weeks. They're scrambling to replace that. Every case is different. Certainly, if you can support the dreams of your people beyond what you can offer them currently, you're in a lot better spot.

That's where you take advantage of those quarterly and semi-annual assessments. Yes, you're assessing, but at the same time, “Are we on the same page? What are you looking forward to doing in the next 3 to 6 months that we can help you with?” Sometimes, we would have this conversation even during the interview process. We could open the door to a potential awkward conversation. That conversation went along the lines of, “Down the road, we'll bring you on. You've been working with us for a few years. What does this scenario look like when we're going to break up?” They're going to leave. What would be the potential reasons why? How would you handle that?

You see how we're opening the door to what some of their future dreams and aspirations could be. “I want to live in Alaska sometime.” “I need to know that.” Also, the second half of the question is, “How would you bring that up to me? Are you going to handle this according to our values? Are you going to be professional and accountable about them, but also share your growth aspirations, which is another value?” We would talk about that sometimes and be like, “Are we on the same page?” Start there at the interviews, but then sometimes, that would open up other times. “Are we cool on the same page? What's happening with your life and the family? Are there any issues coming up that you can foresee that we need to address now?” It is that kind of stuff.

Staying True To Your Non-Negotiable Core Values

That's so important, the transparency piece. We think about transparency during the job interview process as being important, but it's also important after they're on your team. It's probably even more important that they were able to share with you what's going on and what's happening in their lives that impacts who they are and how they present in the workplace. We're doing well on time. We're going to have time available for questions. I wanted to switch back to culture building. It's something that I know within the Private Practice Owners Club, you do a lot of work helping practices build their culture. What do you think is most important from a cultural perspective? You've mentioned values before. How would you help a client in terms of setting up their culture and living that out?

I would double down on values. When you reached out about topics to speak on, and culture being one of them, the first thing that came to mind was having values. Those values are understanding that there are non-negotiables when it comes to those things. You hear this from other professionals. Gary Vaynerchuk is one of them. He's a popular small business person on LinkedIn. He's like, “As soon as you sacrifice your values for production, you're going to lose your culture.”

What I mean by that is many times, we will turn a blind eye to someone who is super productive that rubs us the wrong way, or is a pain in the butt, but they can crush it. Their numbers are good. They make me a lot of money. That's a good way to crush culture, because what are the other people thinking? They're like, “You say those values, but you don't care about those values as long as I'm producing a lot.”

That was a hard one to swallow because we did that. We turned a blind eye to an entire clinic that was super productive, but poisonous and misaligned because of one super productive individual. Once he left, that whole clinic was in a tailspin and took us at least a year or two to get profitable. If we had done what we espoused to do and lived our values, we would have held him accountable sooner. We were naive. It wasn't like we were doing something.

This isn't how we ended up working towards the end of our ownership. It was one of the first times we started understanding values, but we were naive. We were willing to sacrifice our values for the production that they created. Not that they did anything unethical. It was one of those situations where I would walk into that clinic. It was my clinic. I'm like, “I'm a co-owner. I don't have a huge ego, but you should at least say hi with a smile when I walk in the door.” I would rarely get some of that presence, walking past us, like we're ghosts.

It is holding firm to them and telling people, “There were values in production. If you can't meet our values, you can't stay here. If you can't meet our values and you can't meet our expectations on production, you cannot stay here.” You've got to balance both. That's why I said production is the basis of morale, and here are our core values. We had highly aligned people who were highly productive. It was amazing. It was cool. Our morale was high, and so were our profit margins. We had a bunch of aligned people who loved each other.

How PT Leaders Should Lead Their Practices

My last question here, and then we'll get to the Q&A. Thinking globally at your work and all the different clinics that you work with, in the next five years, what do you think will differentiate the clinics that thrive from those that struggle?

It has been the same story for a long time. It's still the case, especially now. Reimbursements are getting to a pinch point where it's going to be hard for owners to survive if they don't know their KPIs, key performance indicators, their statistics, and their metrics. They don't know how to get the metrics. They don't know which metrics they need to track. They don't know what to do when those metrics are down. Managing and leading by numbers, your KPIs, and learning how to be a better leader are things that we didn't learn in therapy school. That's why I highly advocate for coaching.

One of the first steps is to know your key performance indicators, the key stats. Track them on a regular basis, daily or monthly. Most of them are weekly. Lead your organization like an owner who happens to have a license, versus a physical therapist who happens to own a business. They need to put on their business ownership hat much more often and think less about business ownership as a side hustle.

Monitoring Your Net Promoter Score

That's a great point. Thank you. That's interesting. Let's jump over to the Q&A here. We had a question around evaluating a recognition effort. How would you go about evaluating whether or not you're doing a decent job in terms of recognizing your people? Would you look at surveying on morale, retention rates, or performance in terms of productivity?

That was one of our KPIs in our annual meetings. We wanted people to love their job. We used NPS, net promoter score. Do you know that?

Yes.

It's simply one question. You can check it out. It's based on a Harvard Business Review study from a long time ago. The one question is, how likely are you to refer Rise Rehabilitation Specialists to family and friends to work there? Not just to become a patient, but to work there. We wanted to have a high NPS score. We would ask our employees that once or twice a year. There would be an email that went out. We would ask them. We would grade ourselves that way to see how well we're doing.

It’s hard to say how we would assess ourselves in terms of recognition and appreciation, other than that we have had a number of them. Could we have done more? Yes, maybe. We gave financial bonuses for production. We gave $20 gas cards for every referral that anyone on our team generated to get a new patient in the door. If they saw someone at the grocery store with their arm in a sling and got them to come to our clinic, or were talking to a mother or a wife whose husband had some back pain and got that referral to come in, they get a $20 gas card. There were these monetary recognitions on top of the value recognitions that we did on a regular basis. We did have a pretty good network of them. I don't know exactly how I would assess those unless I was comparing them to other companies.

Why Peer-To-Peer Recognition And Appreciation Is Worth Your Time

That's fair. Our last question in the Q&A is thinking about peer-to-peer recognition or peer-to-peer appreciation as opposed to leadership and things flowing from the leader down. Do you have any ideas on how you might encourage communication, relationship building, and appreciation among coworkers?

Not that I've thought about it before, but based on that question, we had almost 50 people in the organization. Maybe there would be a way that people could vote on who should get that value recognition at the end of the year. It's a voting process, or on a more regular basis, as I said, we would ask some of our team members to lead that value conversation at the beginning of our team meetings. It would be helpful if you highlighted someone in the organization who showed that value in the recent past that you can exemplify to share as an example. Sharing those stories can be powerful. You're creating some stories in your organization that can flow on and on as examples of our values. That would take a life of its own.

Thanks so much for your time. It’s great to do this. Nice seeing you as well in Florida. Thanks for coming to my session that I did at the PPS conference. I was in the middle of my session. All of a sudden, I looked in the back of the room, and there was Nathan back there. It was great to see a friendly face in there.

I wanted to support you.

I appreciate that.

Important Links

About Brian Weidner

From Rock Bottom To Full Clinic: The Patient-Flow Playbook With Kay Sanders

Mon, 24 Nov 2025 19:00:05 GMT

If you’ve ever felt like your marketing efforts aren’t moving the needle — or worse, that your business might stall before it scales — this episode is a must-listen.

In this episode of the Private Practice Owners Podcast, Adam Robin sits down with Kay Sanders, Strategic Growth Partner for Private Practice Owners and Founder of Elevated Edge Consulting. Kay shares her remarkable journey from hitting rock bottom in 2019 to helping a local PT clinic grow from zero online revenue to half a million dollars — and how that experience shaped her signature Patient Flow Blueprint.

Together, they dive deep into the hidden bottlenecks that keep private practices stuck, and how small shifts in marketing, messaging, and mindset can create massive momentum.

You’ll learn:

● The most common “invisible bottlenecks” that stall private practice growth

● Why tweaking one thing (not changing everything) can reignite results

● How to know when it’s time to invest in paid ads — and when it’s not

● The difference between sales and marketing (and why both matters equally)

● Why belief in your service is the ultimate growth multiplier

If you’ve ever wondered why your marketing “isn’t working,” this conversation will help you identify the real issue — and fix it for good.

�� Learn how to create a steady flow of patients and sustainable success — without the overwhelm.

�� Connect with Kay Sanders and get The Patient Flow Blueprint at ElevatedEdgeConsulting.com

�� Want to talk about how we can help you grow your PT business?

Book a call with Nathan — https://calendly.com/ptoclub/discoverycall

❤️ Love the show? Subscribe, rate, review, and share! https://ptoclub.com

�� Blog Post URL: https://www.ppoclub.com/from-rock-bottom-to-full-clinic-the-patient-flow-playbook-with-kay-sanders

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Listen to the Podcast here

From Rock Bottom To Full Clinic: The Patient-Flow Playbook With Kay Sanders

We have a very special guest, everyone. This is a lady that we met. I believe we met on social media. Got on a call with her. Found out she knows a thing or two about marketing. Her name is Kay Sanders. She is a strategic growth partner for Private Practice Owners. She also owns a consulting company called Elevated Edge Consulting .

I will make sure you guys have a lot of that information before the end of the show. She has a really cool book that she sent me. It is called The Patient Flow Blueprint: The PT Owner's Guide to Steady Patience and Sustainable Success . We will talk a little bit about that. She is the Google Ads Expert and Strategic Partner for Private Practices.

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Kay , welcome to the show. Glad to have you here. How are you?

I am doing great. Thanks so much for having me, Adam.

Exploring Kay’s Personal And Professional Background

Thanks for being here. I am super, I am just thankful that you are here. For people who are curious like me, for those who are tuning in, you are going to notice Kay has a really unique accent. Kay, tell us where you are from.

Yes, I am from Germany. I have been in the States in El Paso, Texas, for going on twenty years now. I came here in 2006. Texas has been my home ever since. I am trying to get rid of the accent, but what it makes me is uniquely me.

I talk to a lot of people. I run my mouth for a living. Before we pressed record, when you came on and you said, “Hello,” I was like, I instantly got in a good mood because it is just this fresh, unique accent. One thing that I do want to make mention of that I just noticed is behind you on the wall, it says, "If you believe in yourself, anything is possible."

I think that is awesome. One of our purposes in our clinics is to help people believe in themselves so that they can see what is possible. I believe that believing that you are worth it and valuable and worthy is a big indicator of how successful you are going to be. I truly resonate with that. Thank you for having that.

Besides the marketing, I also have a personal development business coaching, things like that. Yes, I very much believe in the mindset because mindset is really everything. You can do all the right things, but if the mindset if you are thinking that you cannot do it, you are not good enough, no matter what you do, it is not working.

You cannot policy and procedure your way through that.

No. You cannot push, you cannot grind because it just does not work that way. If you have those beliefs that you cannot do it, that you are not good enough, it does not matter what you do. It is not working. You are just going to work and work and wonder, “Why is it not working?”

People who listen to this show know that we can go down that rabbit hole because that is my favorite stuff to talk about. Before we do that and ruin the whole show, could you just share a little bit about yourself? I want to know who you are, how you got into what you are doing, and what your passions are. Tell us a little bit about you, what you do, and how you help people.

My path is a little unique. I do not just do the marketing. That is actually not what I chose to go into. I started in life coaching, actually, back in 2015. I tried to grow my business, was not really working. This is actually why the whole thing behind us was why. I was doing a lot of the things of inner work and things like that. It had come to a point where, in my business, it was not going anywhere. It was not doing anything.

I did all the right things from the marketing, what I teach now, what I do for my clients, but nothing was working. I had hit rock bottom back in 2019 when I almost lost everything. At that point, I actually got the opportunity to work for a local PT clinic as a marketing consultant or strategic marketing consultant, or something like that. It was more like an assistant. I basically took over his entire marketing department and helped him grow from zero online income to making half a million dollars within three years based on the things that I knew.

The marketing was not something that was like, “I want to be a marketing consultant.” It was actually because, as I was working with him, I loved the strategic part. I am the person who is like, I see a thousand puzzle pieces and I find a connection, even though I hate puzzles because I do not have the patience for that. When it comes to marketing, I can always pinpoint where the bottlenecks are, where the disconnects are, where something is not working.

I find a way how make this work? He gave me the opportunity. I actually met him in BNI years ago when I was trying to grow my coaching business. He allowed working with him. I really helped him. I took over his entire marketing department. I worked with him for about three years. I walked away from that. I helped him grow immensely on YouTube. I helped him make passive income because of online courses.

It was right around the time of COVID. The clinic was not going very well because of the COVID-19 shutdown. I was pushing him, let's do some online courses. Let us do some online stuff. He was like, “No.” Finally, he did. Now he is at a point where he has actually closed down his clinic. He does everything online because of the work that I did with him. At that time, he actually referred people to me who also wanted to grow on YouTube.

I am like, “I could actually do that. I could be a consultant.” That is what led me to start consulting. At first, it was under my coaching business, but I think it was two years ago. That is when I went officially. I actually created my Elevate Edge Consulting Company agency. I specialize in that. Now I still do the spiritual, the life coaching, as well, and the personal development. That is why you see these books behind me, but the marketing was not a path that I chose. That is what I am good at.

I know this is something that I want to continue doing because I love working with my clients, helping them figure out how they can really get that consistent flow of clients. How can they grow? How can they make a bigger impact? I chose to focus just on PTs because I was working with this one PT for three years. I know the language. I know the entire industry and things like that. I really enjoy working with PTs because you guys have so much to offer, to give, but oftentimes, there is something missing. That is where I come in. I like to help them really grow and expand and just make a bigger impact.

Address Invisible Bottlenecks To Improve Conversion Rate

Two things stood out to me when I heard that story. The one thing that I heard first was bottlenecks. That means a lot to me, because whenever you are trying to make progress, whether it is marketing or whether it is your systems or whatever it is, your time management skills, I always think that it is really about being able to define the 1 or 2 things that are slowing you down the most.

If you can remove those things, a lot of times that is the prerequisite to growth. It is removing the things that are slowing you down that lead to success. My question is, in your experience, what are some of the hidden bottlenecks that you see in private practice that prevent owners from being successful in growing or scaling their clinics?

First of all, I want to add on to what you said about removing. It is not always about removing something, but sometimes it takes just a tweak or a shift in that and a pivot to make it flow again. When we are talking about marketing, you can have the best website ever, but if the website, for example, is written in a language that is the PT professional language, but not the language of your ideal clients, you can lose people there.

You can have a ton of traffic coming to your website, but if no one converts, there could be a bottleneck, whether it is the language on the website is not effective. It does not speak directly to the visitor. It is talking to them. When you talk to someone, it goes over their head. They are confused. They are not taking action. If your website copy speaks to them, really resonates with them, like, “I need to reach out.”

That is one part. Another thing is I have seen a lot of websites where they have multiple call to actions, multiple offers like book a discovery visit or request more information, or do this and do that. They are like, “It is too much.” There are too many call to actions. A confused mind will not take action. It is about narrowing it down. What is the one most important call to action that you really want to focus on?

Most people say, “I want people to come in.” Let us focus on the discovery visit or the consultation, or the first visit. Another thing could be the follow-up. If people did not reach out or if they fill out the form, but there is no follow-up, even if the same thing happens if people call, but there is no one to actually answer the phone call, that is also a drop off. As I said, you can have all the traffic to your website, especially if you are using ads and you are paying to get traffic to your website, or even email marketing or social media, anything that you are doing to get people to your website.

If it does not convert, there is that bottleneck, either on the website, on the follow-up, on the call to action, there is somewhere in your entire funnel, there is a hiccup. Even if you have emails that are going out to nurture people, because the thing is, it usually takes anywhere from 7 to 21 touches for someone, a brand new person, to say yes. A touch is that they need to see your offer, your message, your website, and your company multiple times before they say yes.

Unless it is something. Let us say one of my clients works with concussion people. A concussion is something, “I need help right now. I hit my head. I have a problem. I need help right now.” What I have found with, let us say, regular PT, it is like, “Do I need that right now? I am a little in pain, but I do not need that right now.” Let me push that off. Let me wait a little bit. You want to stay on top of mind with people to really keep touching them.

If you do not do that, it could also be a bottleneck. When it comes to marketing, there is always somewhere in your entire ecosystem. I talk ecosystem because it is not just one thing. It is not just the ads. It is not just a website. It is not just social media. It all is. That is the whole ecosystem of your marketing strategy, your marketing approach. If you do not get a full calendar, if you are struggling with clients or getting clients consistently, there is a drop-off somewhere.

It is about figuring out where people fall off. Are they falling off on your website? Are they falling off once they actually land on your website? Are they not clicking? Are they not signing up? Is the follow-up not effective? Even from social media, is your social media good? What if people are not clicking? People are not taking action. Even your ads, maybe your ads are great, but still, they are not clicking. They are not converting.

There is always somewhere where there could be a bottleneck. It is about really looking at everything, not just one thing, but everything to see, “Where is the disconnect?” That is where I come in. That is what I really like to look at. “Where is the disconnect here?” Once we make that shift, now you mentioned take something away. Yes, taking something away could also mean letting go of something that does not really work anymore, and letting us replace it with something else.

Tweak something, upgrade something. When it comes to marketing, it is about optimization. It is never about you. Just create it and poof, it is going to work. No, it is about fine-tuning. It is the same thing within the clinic. When you have your conversation with people. If you are in a cash-based business, you have to basically sell to people. You have the very first conversation.

It is not going to get you every client. It is also about fine-tuning your sales conversation. It is really about optimizing over the long term to get the results. Bottling is basically something that is not working. There is somewhere in your entire ecosystem where things get stuck. That is where we need to really make some shifts to get the flow going again.

I get it. I have learned a lot about marketing as I started some of the online companies. I am not naturally a great marketer. It is not really something I love to do. I am more of a sales guy. I am learning a lot about marketing. I am also learning that it takes a lot of iterations and tweaks to fine-tune. You might have a great landing page.

People are clicking on the landing page, but if they are not opting in, there is some type of disconnect between what your offer is and what the landing page is telling them. How do you get them to click? Now that they are clicking, are they the right type of lead? Are you filtering out the right type of lead?

How To Diagnose And Eliminate Your Hidden Bottlenecks

There is this funnel that is hard to learn. You could do it like me and try to figure a lot of that out on your own, or you could hire a professional who knows how to do that stuff. Next question. I understand that there is a funnel, there is a process, and typically, there is some type of bottleneck that is impacting your leads to take the next step. How do you diagnose that? Is it a lot of data that you are looking at? Is it something else that you are looking at that helps you diagnose where that bottleneck is in the funnel?

I am going to use ads as an example because that is the most clear-cut approach or example to use. For ads, I set up the ads for my clients, driving to the landing page. Of course, first, before I even look at everything, before I set everything up, I look at the landing page to make sure it sounds right. Is it aligned? I had one client before.

Their entire page was all about them using the industry technology terms that sort of say that, but go over most of the normal people's heads. We do not speak that language. We do not resonate with that. That was the first thing. I made some tweaks there. I made adjustments there. We set up the ads. When it comes to ads, I track conversions in different ways. I track conversions of page views.

The first step is the ad drives people to a specific landing page. Here, not a generic homepage, but a specific page. For example, if we are doing an ad around back pain, the page I am driving traffic to needs to be a back pain-related page with keywords and specific language around back pain because it needs to speak to people. There also needs to be a resonance from the ad to the landing page, to the titles, and everything.

Once that is set up, I track how many people get to that page. Most people have a specific landing page or a specific page where people click to book an appointment. I also track that to see how many people actually view that page. Let us say there are 500 clicks to that main landing page. Let us say only twenty people click on the next step to actually book a call. That tells me there is a disconnect there. Out of 500 people, 500 clicks.

I should have a whole lot more people who actually click the book a call page. Here, we make changes to that page to get more people to click to the next page. It could also mean that maybe they are just picking up the phone. I have noticed that a lot in the PT world is that people do not want to fill out a form. They just call. They want to have a calendar where they can actually book, because they want something immediately.

If the ad does not show me that there are a lot of calls coming in, that tells me there is a disconnect here, because also if they are not looking at the page for booking a call. I make tweaks here. Let us say I get a good number of clicks from, and of course, I also look at the click-through rate from the ads and tweak that as well. Let us say there is a good number of people getting to the page and then clicking to the page to book an appointment, but the conversion rate is zero or very low.

That tells me that on that next page, there is a disconnect. We need to upgrade that page. We need to tweak that page to make that one better. It is like testing. It is tweaking. It is also tweaking the ad campaign as well, the ad copy, because that also has a very big impact on the entire conversion journey. This is how I look at the numbers of how many people click, how many people convert, and where they are dropping off.

This is just an example of the ads themselves. Of course, we can go into other things as well, offers and whatnot. That is basically what you want to look at the numbers. You want to look a where people are not converting? Why are they not converting? Making tweaks to that. As you mentioned, the messaging on the landing page could really just be that, or it could be that it is not urgent enough. It is not like I have seen a lot of people driving traffic to just a regular, generic contact us page.

Those pages rarely convert as good as a specific page, book an appointment, or book a consultation. If you have a form there, yes, that is good. If you have an actual appointment calendar where they can actually book literally right there on the page, that converts more than just a regular form. Of course, not every clinic can have that calendar on the page for numerous reasons.

It is really about looking at all these different steps. That is why it is not just about the ad. It is about the entire steps of getting people from the ad to the page and then actually getting people into the clinic. Let us say you get ten leads a week, but you are saying, “I do not have the one on my calendar.”

Let us look at this. Do you actually follow up with people? Do you actually answer the phone when someone calls? I see from my ads that you have gotten twenty calls this week. Did you even answer the calls? It is really looking at the numbers to identify where the drop off is. Of course, this does not happen right within the first week of running ads. This happens over time to see where people are falling off and then tweaking and optimizing along the way.

The way that I have thought about it, and like I said, I am not a marketing expert, is when you are running ads to the same audience or a similar audience for long enough, you start to understand their buying psychology and what they want and the type of language that draws them in and the type of how to position your offer in congruence to that psychology. When you can start to understand that, it takes time to learn.

You probably have a lot of experience with that because you are running marketing campaigns for physical therapy practice owners. If you do not have experience with that, it takes time to learn that. You have to spend money to learn the buying behavior of your target audience. What helps me is starting to track what my cost per click, my cost per lead, and my cost per new client are.

At the end of the day, really, what you are trying to do is get an ROI on your ad spend. If I put $1,000 into the system, I need to get $5,000 out of the system. If those budgets start to exceed my comfort level of my ROI level, I know it is time for me to jump in and look at the funnel. The next thing that I want to get to is, speaking of money, it costs money to market. They got to hire somebody like you.

Why A Good Ad Campaign Should Not Break The Bank

They have to start spending money on an ad campaign or updating their website. There are a lot of different things that you can do organically as a practice owner that can drive patients to your practice. The real question that I want the audience to have answers to is, how do you know as a practice owner, whenever it is time for you to start considering investing in a paid ad strategy versus just doing organic? What is your filter there?

You have to have your foundations down. I would not recommend it to a brand-new clinic that has just opened up. That does not have their procedures down. That does not have all the stuff. The foundation to jump into ads. If you get people to your website, calling, and you do not know how to, and, for example, if it is cash-based, I work a lot with cash-based clinics, you need to know how to sell. You have to sell people on your package.

I am not too familiar with insurance-based clinics. Still, there is a process for getting them to come in and to do the process of getting them to become clients and sticking with clients or keep them coming back because you want them to complete their entire cycle of treatment. If you are not really good at working with patients or things like that, you do not want to get more patients coming in because you need to get your foundation in order first.

Of course, the office stuff. As I said, I am not too sure about what all is required in the clinic, but I do know you have to have your foundation in order. Think of it like that. Once you start turning the ads on, you are turning on the faucet. You are having leads coming. You are having more leads coming in. If you cannot handle them for whatever reason, whether it is the insurance part or the billing part, or just delivering your service, having more people coming in, you are wasting money because you are like, “I cannot do it.”

If you do not have enough PTs or people who can serve the people that are coming in, then you do not want to waste money on ads because then you cannot serve them. You are wasting money like that. You want to be at the point where you know that, “If I get more clients now, more patients, I will be good. This is what I need. I am at the point right now where I can have more patients.” At that point, you can start looking into ads.

Here, I just want to touch on a little myth that a lot of people think, and a lot of agencies say, “You have to spend thousands of dollars on ads.” You do not. Most of my clients are not ready to spend thousands of dollars every month on ads. We start with a small campaign, which is $300, or $600 a month, with one campaign. Starting that out. Yes, it takes a little longer to start really building the momentum, but this is an easy in to start working with ads.

Of course, as the ads start performing, then you can scale because if you say, “My ads are working. I am having clients coming in. I have more money. I have more budget to put behind my ads.” Let us increase the ad campaign. Let us increase the budget or create a separate campaign with a different focus ad campaign. It does not cost thousands of dollars to run ads. You can start with a smaller budget as well.

You need to have your foundation in order first before you can run ads, because you do not want to just waste money. You cannot serve the people who are actually coming in. You do not know how to convert people who are filling out the form or calling in. You have to have that conversation, that sales conversation. If you are in private practice, in a cash-based practice, you want to have all that down or at least good enough where you can say, “Now I am open to having more people come in so I can improve on my skills. I can improve on the foundations that I have already built.” If you are starting out, like, “I opened my clinic and I am ready for ads.” Maybe not. Not yet. Not yet.

Marketing Or Sales: Which Is More Important?

It is the old debate. What is more important, marketing or sales? You say it is like that, and I have an opinion on that. I want to yours first. I do not know if there is a right answer. You need both. What is your opinion on that? What is more important, marketing or sales?

I would say 50/50, actually, because you need the marketing. This is not just about ads, but any marketing, whether it is building awareness. You need that to get people in. You also need to be good at sales. Be comfortable in sales. Be comfortable asking for the money and all that to make your marketing actually work. Perhaps marketing in the beginning is a little bit more important to get the people in.

The sales, you improve that because, as you’ve been talking with people, you’re like, “Maybe that didn’t go so well, so maybe next time I can improve.” Here, I would say maybe the market has a little bit more importance to get people in, and then you improve your sales over time. Sales is not something that you should say, “I do not need sales training. I do not need to do that.” If you are trying to get more patients and especially I have seen it a lot in the cash based clinics where PTs need to sell. They are like, “I am not a salesperson,” but that is where they are really getting stuck.

Good luck with being an entrepreneur if you do not know how to sell.

Honestly, we are selling. I am selling myself right now here on the call for the interview. We are selling ourselves every single day. It is not just about asking for the money, but it is like we are selling our personnel. We are selling who we are, what we do, and just everything. Technically, we are already salespeople.

We just get better every day when we realize, “That did not get me a client. You can look back.” How did that conversation go? What could I have done better? Maybe I did not listen enough. Maybe I talked too fast. That is my problem. I talk very fast. You can look at all these things to see where I can improve.

One of the coaches I had worked with before, one of the mentors, and that was actually for YouTube. They always said, “Try to get one percent better with each video.” Let us apply that to everything else in your marketing. Next time, get one percent better with your social media or asking for the order, or your website. Try to improve by one percent every single time. You will get there. Marketing is important for you to even practice sales, because without marketing, you cannot practice sales.

The sales are really something that you keep improving over time. Keep improving, keep getting better. This also goes back to what is behind the wall, believing in yourself. If you do not believe in your service, if you do not believe that, and going back to cash base, if you do not believe that if you are charging $3,000 or $6,000, if you do not believe that your service is worth that, you are not going to sell that.

You are not going to sell it. This year, I have really understood that more. I always knew that, but there is like level style of entrepreneurship. It is even more true as I continue to grow my companies. If you are not convinced about what you are doing, you are not going to attract people to your offer.

It is like, as soon as I let go of that, as soon as I start to believe it, and I just have a little more conviction, and we got to get to a place of like, “You would be stupid not to want to work with me.” Like, “You are missing out if you do not decide to give me money and work with me.” If we can get to that place as an entrepreneur, where we believe so much in what we do, it is like just doing that, somehow the world just gives you more new patients, more clients.

Here I want to say something else that really helped me before. If you hold back or if you have those doubts, you are actually doing your potential clients a massive disservice because they need you. They need your help. They need your service. If you do not believe in yourself, if you hold back, or if you do not really trust yourself that you can really ask for that money or do the work or whatnot, you are doing those people a massive disservice.

If you do not really put yourself out there, if you do not do your marketing to really get in front of the right people, you are doing them a massive disservice. They might go to a different clinic. I have been to different PT clinics. I was very disappointed. You have those clinics where they are not doing a great job. What if you are doing an absolutely amazing job? What if you could help me get better, get out of pain?

If you did not really believe in yourself, you did not put yourself out there, you did not do all these things to really get me as a patient. I am like, “I will just go somewhere else. I have really bad experience. You did me a massive disservice.” Shifting that mindset around to really think that if I do not put myself out there, if I do not do the things that I need to do, if I do not believe in myself, in my services, then I am doing all these people a massive disservice, of course, myself as well. I chose this industry. I chose this work for a reason. I am doing it.

I believe I say the first person you sell is yourself. Again, I probably am a little biased because I am not a natural marketer. I am more of a salesperson. I feel more comfortable in a sales role. For those reasons, I lean towards sales being more important than marketing. I would not say necessarily more important, but I believe it comes first. I also view any outbound activity, whether it is marketing to physicians or networking, I view that as a sales process.

It is an outbound sales process. I also viewed that telephone call from the front desk. That is a conversion. That is a sales process. If I do not have a process of really doing some outbound sales and converting leads well, I cannot really justify spending money on advertising, like you mentioned, because it is going to fail. I view sales as the foundation.

Once you get to a place where you know how to convert and you know how to get people to listen, then, in my view, the next limiter to your growth as a private practice owner is just people simply do not know you exist. You have to generate awareness around your product. That is where marketing becomes critical.

Google Ads Or Facebook Ads: Where Is The Best Place To Start?

Your messaging, your branding, your email, your conversion rates. That is the way I view it. You asked for my opinion, so that is what it was. It is my right. I also believe that there is more than one way to do things, but it is just the way that I do things. I know we are running a little short on time, but one more question. A lot of marketers that I talk to have varying opinions. You see some people who are like, “Facebook is where we need to be. Facebook is where all the demographics are.

We need to be marketing and advertising on Facebook.” You see some people who are like, “There is no high intention on Facebook.” Google is where you need to be. Google is where people are looking for your services. For you, what do you recommend? Do you recommend people focus on Google first for paid ads, or Facebook, or is it both? What is your opinion on that world?

For every clinic, it is a little different. For every business, it is different. Some people just have a different preference as well. Let us just explain the difference between Google Ads and Facebook Ads. You can form your own opinion of what you think might be best. I will also give you my opinion. Facebook is all about awareness. Facebook, you cannot target. Facebook, over the years, has gotten so horrible at targeting because you have to target a huge audience.

For example, wellness. Health and wellness. Let’s say, if you focus on running, you specialize in helping people, and get better at running. How can you really target just health and wellness? You are targeting everyone in that field, even people who go to a gym and whatnot. Facebook is more in-your-face awareness. “Look at me. I am right in front of your face thing.” It is disruptive. It is like you are scrolling and seeing all these ads.

I have found that on Facebook, yes, since it is disruptive, there is not so much of an intent there like, “I just signed up for that. I can just click here. I will just sign up.” The follow-through is often where things fall off. Yes, you can have maybe a lot of leads coming in from Facebook, but leads do not mean new patients, because what if you have fifteen people that requested or even booked an appointment, but only two of them show up?

If I am hearing you correctly, I want to pause. Maybe what I am interpreting there is that if you are going to choose Facebook as your platform, you've got to be really great at sales. These are going to be people who do not come in with great intentions. Maybe they do. Maybe they just want to click and see what you are willing to give away. You do not really know. You must have really great sales skills and great sales systems in your practice in order to convert at a high level there.

Now Facebook has a place. I will come to that here in a moment as well. Now, let us look at Google. Google, you use keywords. You can target an age group. You can target whether it is male or female. You can target your specific area. Mainly, it is keywords. You can tailor your ad to where there is a lot of content.

There is a lot of real estate whenever someone finds you on Google. Google, the ads tend to perform better over time. Here is about optimizing. Over time, once you dial them in, they are really performing well. Facebook, there is ad fatigue. Facebook is like, if the ads run for let us say a week or two, and there is no conversion, then Facebook is not really showing them. That is the downside of Facebook ads.

Google ads, as I said, perform better over time as you optimize them, as you tweak them, as you really dial them in, and then they start working, where you can get multiple leads, multiple conversions every week. There is a crossover between the two. I like to start with Google because it is laser-focused. You can really narrow it down. You can really target people very effectively.

There is the remarketing. If you remember earlier, I said something about 7 to 21 touches. If people come to your website, as I said, most people do not say yes right away. What are you going to do if they leave? Here then comes remarketing. In the health industry, unfortunately, you cannot use remarketing on Google because it is in the health and personal advertising. You cannot really do remarketing on Google.

Here you can do remarketing on Facebook, and then it is not broad. It is laser-focused. Have you ever gone on a website and looked for something, but you did not buy it, but then you go on Facebook, and you are being bombarded? For example, Go High Level. I looked into that before because of the whole agency stuff or whatnot. I go on Facebook and I am like, “I was bombarded.” I am like, “That is remarketing.”

You are going to do the same. Facebook has a place. I do not think Facebook is a great way to start, but Facebook Ads are a great way to layer your marketing. Start with Google. Drive traffic to your site. I do a lot of Performance Max campaigns because they are the ones that are broad. It is not just search, but it casts a wide net on display, discovery, YouTube search, and maps as well.

Those really cast a wide net. You can get a click for $0.27. If you have a click, the rate of cost per click of $0.27, you have a budget of $10 or $20 a day. You can get a ton of traffic to your website. Those people you track with the Facebook pixel, and then you run the Facebook ads to market only to those. One, your budget, you are not burning through your budget because it is a smaller list. These people have already said yes to you once because they clicked on your ad.

They got to your website. Let us target those people because, as I said, it takes multiple touches for them to say yes. That is how I like to use Facebook, not right out of the gate. This is the only platform. That is the only thing to use, but combining it with Google. Starting with Google and infusing Facebook as a remarketing tool. That is how I work with clients as well. I just saw that this is the best way to go about it, rather than just using Facebook on its own.

It’s so great value. What I heard is, Google is your bait, your hook. You hook them with Google. You can catch them with a net on Facebook. That is my analogy. I love that. That is great.

You do get a lot of conversions through Google, too. Those that do not, you want to stay on top of mind with them. If they do not sign up for free, but if you have them on your website, you do not just want to lose them like, “You made it to my website. I got to do something to hook you in.”

Unpacking Kay’s Patient Growth Acceleration Session

Those who are tuning in, or if you are watching on YouTube, make sure you check out the show notes because we are going to have some information all about Kay if you want to get in touch with Kay. For those who are on YouTube, here is a copy of her book. You can also check out her website. I am going to drop her email as well, a little bit about her LinkedIn. There will also be a link to the Patient Growth Acceleration Session , an opportunity to connect with you and learn a little bit more about maybe how they can help. Do you want to tell me a little bit more about what that session might look like for those who are interested?

I call it the Patient Growth Acceleration Session. We look at where things are falling off. Where are you right now? What are you doing right now for marketing to fill your calendar? My goal would be to get you away from relying on referrals and word of mouth because they are unpredictable. It is also not scalable. We take a bird's-eye view of what you are doing right now in the marketing department to grow your clinic, to get more people through your door.

We look at where things are falling off. We see if we can identify some bottlenecks. Also, make recommendations on what could be your next step. Are you ready for Google Ads already, or maybe should we wait a little bit, because I do not want to sell people on Google Ads if they are not ready? During that session, we look at all that.

I can make recommendations on “What can you do right now to start getting more patients into the door?” I also recommend some non-digital marketing strategies. That is basically what this session is all about. It is to help you get more patients. We can also discuss working together. Is this the next right best step or not?

If not, at least you will walk away with some value of what you can do right away to really move forward. I look at the websites to see if your website is even conversion-ready. A lot of people do not even have conversion tracking installed on a website. I will look at those things too. Make recommendations on what you can do right now to start, at least getting more people through the door. As I said, discuss if it is the right fit for us.

One thing I am going to do is if you have a small team, a marketing team, or if you have somebody in your clinic who likes marketing. If you have that person in your clinic who is really good with marketing and likes to post on social media, I am going to take your book. Let my director of marketing read it and put together some takeaways so we can start implementing some of this stuff.

Episode Wrap-Up And Closing Words

That is how I am going to use it. If that resonates with you guys, maybe an opportunity. Check out the website. You can get a cup. I am assuming they can purchase a book from your website. It is on Amazon. They can learn a little bit more about you. Kay, thank you so much. It is awesome to connect. I am sure we will cross paths again. Next year, we can have you on again. You can tell us what else you are learning about marketing. Does that sound good?

I would love to. Thank you so much.

We will see you next time, Kay.

Important Links

Life After The Sale: Investing Wisely And Living Well - Nathan Shields’ Appearance On The Financial Beast Podcast

Mon, 17 Nov 2025 19:00:02 GMT

Selling your practice is probably the biggest financial decision you’ll ever make — and once the ink is dry, the hard part begins: where do you invest the proceeds so your future actually works for you?

In this episode of The Financial Beast Podcast, host Eric Miller talks with Nathan Shields — ex-practice owner, real-estate investor, and co-founder of the Private Practice Owners Club — about life after a liquidity event. Nathan breaks down what he did well, the mistakes that cost him, and the operational and tax moves every seller should plan before they list.

They dig into:

● Why owning your clinic real estate can change the entire outcome of a sale

● Tax strategies and why you need your CPA and financial advisor in the room early

● Deal terms to avoid (earn-outs, misaligned post-sale roles) and how to sell from a position of power

● Cashflow vs. appreciation — how Nathan structured investments to replace income

● Lessons from private equity, hard-money lending, and 1031 exchanges

● The psychological side: how to plan for purpose and productivity after the sale

If you’re thinking about selling your practice (or want to plan ahead so you don’t get blindsided), this episode is essential listening.

��️ Learn how to convert a one-time payout into lifelong financial freedom.

�� Connect with Nathan: nathan@ppoclub.com

�� Want help planning an exit strategy? Book a call with Nathan — https://calendly.com/ptoclub/discoverycall

�� Like the show? Subscribe, rate, review, and share — https://ptoclub.com/

Private Practice Owners Club helps owners sell from strength (not desperation). If you’re ready to maximize value and protect the life you want after exit, they’re the team to talk to.

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Listen to the Podcast here

Life After The Sale: Investing Wisely And Living Well - Nathan Shields’ Appearance On The Financial Beast Podcast

This episode is a recording of a podcast episode that I did with Eric Miller of Econologics, who hosts the Financial Beast Podcast, and he asked me to come on and share my experience with life and investing after our clinic sale, which happened in 2018. I’ve shared that with you before on the show, and I don't know if I’ve gotten into as much depth as we do here on this episode. I'm taking the time to share with you all about what I’ve learned, what I went through, and what I'm continuing to do now post-sale. Hopefully, from my experience, you guys can learn a little bit of what I’ve done well and what I haven't done well, so that as you're looking for your future sale, you can prepare yourselves well ahead of time. I’ll won’t get into the details and let the podcast speak for self, and I hope you enjoy it.

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Selling Your Practice: The Biggest Financial Question Of Your Life

Selling your practice is likely the largest and most important financial transaction of your life, and you don't get to do it again. Once the deal is done, the big question remains, where do I invest the proceeds? In this episode, I sit down with Nathan Shields, a former physical therapy practice owner. I'm going to talk about his journey after the sale, what he did right, what he'd do differently, and the key dos and don'ts when it comes to investing your practice proceeds. If you are thinking about selling or just planning ahead, you definitely don't want to miss this episode.

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Welcome back to the Financial Beast Podcast. I am your host, Eric Miller, your BFFF, Best Financial Friend Forever. Eric Miller, thank you very much. In case you don't know who we are Econologics Financial Advisors, a registered investment advisor. We help healthcare owners acquire, control and invest their money so that you guys can live life the way that you want to live it and only see patients because you want to, not because you have to.

You can check us out EconologicsFinancialAdvisors.com and of course, please like, share, subscribe, all those things that everybody tells you to do every time that you're on a podcast. I'm excited talking with a good friend of mine. I’ve been on his show many times and I'm reciprocating because he's awesome and you've got a really interesting topic that I think is going to be beneficial for everyone. Of course we have the great Nathan Shields on the show.

Thanks for having me on. I appreciate the golf clap. Thank you so much.

Of course. I also want to thank you for the unbelievable event that you put on. It's probably reverberating in the industry. For those of you that don't know, Nate is one of the Co-owners of the Private Practice Owners Club. They put on an event where they had over 100 physical therapists and it was awesome, him and his partner Adam. It was a great event. Hopefully, you guys got a lot of great feedback from that.

Yeah, thanks for being there. You were a large part of it. You were not only a sponsor, but a featured speaker and so you brought a ton of value yourself. This is our second year doing the conference. Great experience. As you said, over 100 owners and practice administrators were there. Not just physical therapy, but occupational, speech, pediatrics, even some cash pay clinics were there. It was a really cool experience. We want to double what we did. You can always check out the Private Practice Owners Club website, look under Resources or the Events tab and find out when and where we're going to do our next event. 2026 was awesome. 2027, we're hoping to do even better and even double our attendance if we can. Thanks to your support and your promotion of it, it was great.

We just pondered over this topic for hours of what we're going to talk about.

So many late-night discussions.

It took us like about 30 seconds to come up with this.

I think you said, “How about we talk about this?” I was like, “Okay, if you want to.”

I know that you're an investment-minded owner, and it's always beneficial to talk with people, obviously, this being a financial podcast, talk about investing and because it's a favorite topic for a lot of people. You don't always think about it. I do like your viewpoints and your critical eye on how you invest money. Knowing that not every investment works out because it doesn't, and you're never going to shoot 10 out of 10 from the free throw line when it comes to investing. Of course, you've been through a sale of a practice, so you've been through that scenario of having proceeds or a lot of proceeds from a liquidity event and then trying to figure out what to do with that money.

We just want to talk about the good, the bad and the ugly of your investing experience and thought processes and such, because look at some point in time, everyone is going to have a liquidity event. Everyone's going to have to sell their practice at some point in time. You really want to make sure that you have an excellent plan of where you're going to position your money so that it can still provide for you in perpetuity. I think that's the basis of it.

Hopefully, me being on this podcast doesn't demonstrate some level of expertise. It's just simply that I’ve done it. I'm by no means the expert. I like numbers and I like thinking about it and I like talking about money. I appreciate your willingness to have me on, if for nothing else than to be an example of some things that you could and some things that you don't want to do, like learn from some of my mistakes and maybe I have a little bit of wisdom to share.

Let's talk about that. Let's go back to the point where you actually sold because that is when you were now in preparation for, “I'm going to get X amount of dollars.” What were some of the things that you were thinking about in terms of what I want to do with this money and what were like, “I know I'm not going to do this, but here's what I want to do to?” What was your thought process when you were approaching that time?

I wonder if you let me steer it to even further back prior to sale based on what I’ve learned since the sale. Is that cool? Coming into the money is one thing. Setting yourself up for true wealth is something that starts before that actual sale. One thing that stands out was, me and my partner, we’re big proponents and fans of owning the real estate in which we practiced. We were fortunate enough to do that in 2 out of our 4 locations.

The Pre-Sale Asset: How Owning Your Real Estate Creates Wealth

I had full ownership of one of the practices, real estate, and then we co-owned the real estate of another practice. That was semi-intentional. When I had bought it years before, I thought it was a good move, but not how good, I don't know. I just heard it was good a move. I think it's something that I'd learned from The Millionaire Next Door. I don't know if you remember reading that book from years ago, but these guys who owned auto shops found out that their auto shop real estate was worth more than their business 20 or 30 years later.

Taking that understanding, I bought the real estate and then, obviously, rented to myself. I had a separate real estate holding LLC and rented it to myself, and over time, I paid down the balance and it accrued, of course, and appreciation. When we sold, then I was able to still hold the real estate and the company that bought our physical therapy practices. I leased it back to them.

I not only gained in the windfall, but also the ongoing income of them leasing the spaces, which was a huge benefit. We now have this market rate lease agreement for seven years. It's actually worth a lot. I continued on like that. That was something that I was working on in the background. I never really thought about it a whole lot until the event came where we sold and saw the benefit and the asset that I had in the real estate there.

Do you still have that building?

Since then, I have done multiple 1031 exchanges on that. The monthly cash flow is now like doubled or tripled since that event. That's more of the Rich Dad Poor Dad concept, just going bigger and better over the course of time and that takes time. We sold in 2018, and I think I’ve 1031-ed it once or twice in order to do that. It just takes time to be able to do that.

Don't Go It Alone: The Critical Need For A Proactive Financial Advisor

That was a huge benefit for us. That all stemmed from work that I had done prior to the sale. Prior to the sale, yeah, I was doing some investments. I had some cash and made some really bad investments. Frankly, I had some financial advisors that were asleep at the wheel and didn't really help me with my investments. They just said I had a portfolio and I was too busy running my practices.

I highly recommend to all the people that we coach now that they find a financial advisor that is proactively communicating with you. I had financial advisors where I had to instigate the conversation. Once a year, I'd be like, “How's my portfolio doing?” They're like, “You want to learn about that?” “Sure.” We'd go to lunch and they'd say, “What do you want to know?” I'm like, “No, this is your time to report to me. You tell me. What is our plan for the next year?”

They're like, “We just keep doing what we're doing and I think you're doing pretty well.” I was so disappointed in that. If I would look back, those are the two things, getting into some real estate that you can be a part of and invest in, especially if you're the tenant well ahead of time. Secondly, find a financial advisor that actually helps. Their name isn't just on the paperwork, but they actually have a plan for you and teach you how to save on your taxes and also invest your money appropriately and make changes as they see fit. I hadn't experienced that type of financial advisor in the past. Even though I was making good money, I think I’ve lost hundreds of thousands of dollars a year on that.

Part of a financial advisor's job, and I get it, this is how most of them are paid, being one myself. The service model was always really weird to me, which was like we'll just meet once a year, “We'll just take a look at your little pie chart and make sure this is still your little pie chart here,” without really explaining it.

One of the basic principles I try to teach everybody is like, number one, you’ve got to know what you own and you got to know why you own it. I think the job of a financial advisor is to help explain that. “This is why you own this and this is what it is, and these are the characteristics of this investment, and this is what you can expect out of this investment.” No investment's not going to have its ups and downs and such. I think that's definitely part of the process. Unfortunately, too many people just don't do that.

Tax Mitigation Strategy: Why You Must Involve Your CPA Early

The other thing as it pertains to the sale specifically, was I remember talking to my CPA. I really hadn't involved in that much prior to the sale until it was happening. It was in motion where there were some end dates and all that in place, and I should have gotten my CPA involved sooner. I don't know, you tell me if this is a CPA thing or a financial advisor thing, but he told me, “If I had known that you were selling, I would've recommended a different type of sale that would've extended the tax impact over years.” Does that sound familiar? Do you know what I'm talking about? Versus taking it as a one lump sum in one year event.

You could probably try to defer it out somehow where you only get a portion of it. If you want to save on the taxes of the sale of a practice, you can't wait until after the sale is done generally to be able to do that, if you want to set up any structures at all. There are some. There's deferred sales trust and there's different capital gain deferral strategies that are out there that you can do to help mitigate some of that. As I said, certain irrevocable trust that you can set up prior to that. Those all have to be done prior to the sale. Most people are just trying to get through the sale, to be honest with you.

They're looking at it like, “I'm putting it on the market and I’ll tell my CPA about it later on.” If I were to give some advice, just get everyone involved very soon, as soon as you start thinking about it. If you're going to put it on the market, get everyone involved even prior to that. The financial advisor, the CPA,, even find the lawyer who's going to represent you and review the documents well ahead of time so that that you know all your options.

As things come at you have experts behind you to guide and direct and filter and review and all this stuff because you don't have that expertise. You don't want to be the stupidest one at the poker table. You want to have all these people on your side because you got some real smart people trying to buy your practice. Nothing against them. They're going to try to do everything they can to get the best deal out of you that they possibly can, even if it's to your detriment. You want to have these people well lined up. You want that team well lined up ahead of time.

That's excellent advice right there. Definitely have the team prepared prior to when you decide to sell. How nervous were you about the amount of money you were about to get?

I wasn't that nervous about it, frankly. When I got notification of what I was going to be in taxes, that was, that really sucked. I don't know if you would recommend this, but one thing that was recommended to me was to put some money in a Vanguard Charitable Trust to help offset some of the taxes. That has helped. I'm a man of faith, so I use it for tithing, and if my kids go on missions, then I'd pay it out of that charitable trust. That helped deferred some of the taxes. Otherwise, you're pretty exposed. It is what it is. It's 25% capital gains rate, plus the state.

I don't know if this is a donor-advised fund where you just put money in and then got a tax deduction for the money that you put in. That sounds like a donor-advised fund. I think, again, that would be something that a lot of people can do. How those work essentially is you put a big lump sum of money in there and it can stay invested. You don't necessarily have to give it away at that point in time but you do get the tax deduction immediately for whatever amount that you put in.

If you know you're going to be charitable in some regard, even if it's just tithing, it's worth it. All in all, I wasn't all that nervous about it. I probably should have been more nervous or I should have been more careful than I was.

What was the mistake that you felt you made? What were some of the bad investments that you made?

It wasn't necessarily a bad investment, but we were renting at the time and we paid full price for a house. There were reasons. That was one, I didn't really make a ton of huge investments at the time. I could have been better and more prepared as to what was going to go where and how much of it was going to go in the different places. Frankly, I didn't allocate it super well, but I did start putting money in. I'd allocate for my 401(k)s and I'd do some other investments. We found some private equity funds that we were part of. They did all right but I could have definitely been better about that.

Investing in private equity, people know when you have a certain amount of money, you are accredited investor and you get access now to these private deals. Just know the stats on those. There is probably like a 50% success rate on some of these things. For any of them, you just make sure you really trust the operator. You really have to trust the operator because the operator is the person that's running the money in those in those scenarios. We've seen that with some real people did real estate deals in 2023, 2024, and then rates went up. You're going to make some mistakes when it comes to investing money, that's for sure.

Beyond the Money: Planning For Purpose And Productivity After Exiting

We're pretty frugal as well as a household. That didn't really necessarily change how we spent our money. We didn't start blowing stuff on cars and magical trips and stuff like that. We didn't get into that stuff. This is one recommendation I’ll make. If you are going to sell, what do you plan on doing afterwards? I sold when I was mid to late 40s. I still got twenty years of productive life ahead of me. I was not totally clear on what my next thing would be. I frankly did have another. I also do diagnostics. I'm EMG certified and so I had a small EMG practice in Alaska at the time, and that did all right.

It generated some money, but it wasn't like a full-time gig. I’ve been working for the past few years to figure out what's my next thing. I’ve got some productive life ahead of me. What is my next thing? Part of, frankly, being a man is my self-esteem is tied to what I produce. My self-worth is tied to what I produce. That's been a struggle. Psychologically, I found some things. I got into coaching and I can make some extra cash there. It wasn't a full-time thing, so I had downtime. I guess I say all this to help people understand that you do need to consider what your life looks like after a sale.

What are you going to do if you want to produce? What does that production look like? Where are you going to find it? Where are you going to find fulfillment? Where are you going to spend your time? You can only golf or play pickleball for so long for a week before you actually feel like you need to get back to work. Do something productive. That's something that I experienced. As I talk to people who are considering selling, that is one of the first things that I bring up “What are you going to do afterwards? What does that look like?”

Yes, you get this bunch of cash, but if you also don't have some production on the backend, you're just going to whittle it down over so many years and it'll probably go faster than you think. Especially if you make some poor investments, which you probably will, then you need to just consider what that backend looks like.

That's really amazing advice. I think that you've found, especially with what you and Adam are doing right now, something that's really purposeful for you. It appeared that way on stage that you really found a groove here of something that you really enjoy. I think that that's important, that you have to have that because you own a practice, you're going 180 mile an hour, and the day that you sell, all of a sudden, it's like, “I don't have to worry about this anymore.” What's going to replace that activity that allows you to get up and go? I think that's excellent advice right there. Make sure you guys have a purpose.

The Deal Breaker: Prioritizing Deal Terms Over The Dollar Figure (Avoid Earn-Outs!)

Since we're talking about the sale of practices, and I'm sure you guys provide a ton of this advice because you've seen a lot of people exit, it's just the terms of a deal are almost more important than the dollar figure. We had been approached three times to sell with letters of intent to purchase our practice. Three times before we actually sold. We recognized that the terms of those deals just didn't match up. We didn't want to sell and then go and then live as clinic directors. You do like a 70-30 buyout and but then you have to stay on at this salary, at this level of production as a clinic director for the company that you just owned. It's like you're stepping back down into the organizational chart.

We didn't want to do that. There were some earnout options that were presented on in LOIs. From what I'm hearing, and you probably have your own opinion on it, but earnouts are not the best way to sell a company because those numbers can get adjusted, unfortunately, to your detriment. Earnouts are definitely not recommended.

Those are all things that we had seen and said, “No, thank you,” on before we found the right buyer. Frankly, if we agreed before we got the letter of intent, if you meet these terms, or we said to ourselves if that letter of intent meets these terms and this dollar figure, then that's something that we'll consider. That was the only reason why we did sell at the time.

That makes sense. You're right, I think the terms of the deal are of uber importance. You’ve got to remember, if you guys make a decision to sell the practice, it's because, probably, the game is up. Why would you tie your future income for you to have to sit there and work and slave and fret and worry? You can do all that and own the practice. These earn out deals, I just can't stand because it's rarely that I’ve seen them work out.

I’ve had too many friends do something like that where they stay within the organization, and I can understand staying in the organization for a transitionary period of time, for 6, 12 months, something like that, but at the end of those 12 months, we are done. People who have had to stay on for longer periods, not only just to transition, but also to earn the extra, I don't know, 10%, 20%, 30% that was promised to them at the initial sale and meet certain productivity numbers, the value no longer aligned. The processes are completely different and they just end up being miserable. I’ve just witnessed a few too many of those.

They're completely avoidable.

I'm sorry, that's not totally in the investment realm.

Post-Sale Investing: Why Cash Flow Is King For Replacing Income

That's part of the whole exit process. I do want to get back to investments. Right now, when you're investing money, are you more interested in the cashflow that it provides you or the potential appreciation that you're going to get on investment or is it a bit of both?

This is just Nathan. It's not sound financial advice, by any means.

I promise you right now, Nathan, you are not going to get sued. Nathan is not a financial advisor, nor is he providing you any financial advice right now. Purely just my own interest.

I don't have a full-time job, so I am very interested in the cashflow that I'm getting from my investments. Frankly, the stock market has a place in my portfolio, but it's probably small and smaller than my financial advisor would like to see, but not that that's a good thing. Based on what's happened over the past few years, I probably should have been much more in the stock market than I was, seriously.

I’ve done some 1031 exchanges on real estate. I like real estate for some reason. I especially like commercial real estate, not just commercial real estate, but commercial real estate medical offices in particular is where I have unintentionally stumbled into simply because that's what I'm a part of. Most of my commercial investments have some medical component to them, which cannot be outsourced. That's not going to go virtual anytime soon.

People have to be in person for those. That's why I like it. I like the appreciation of it. I like the tax benefits. That's where my focus is, more on cashflow because, like I said, I don't have a job or a salary that's providing for me. Frankly, we can survive on the cashflow for my commercial properties and be just fine. I want to increase those even more as we go down in the future.

If you start looking at medical facilities and things like that, and I don't know if there's corporate leases or who owns the buildings or whatever or who owns the practice inside there. Typically, when you have private equity groups or big corporations that are just leasing the buildings, they're great renters. You're going to get 5-to-10-year leases. They're going to renew every five years.

You’ve got to remember, these people do not ever want to have any blips. They don't want to have, “We defaulted on this,” or anything like that because it looks bad on them, very bad. This is why I really encourage people to try to own their practice real estate if they can. It's not always possible, I get that, but if you guys really can, it really is a pretty wonderful source of income long term for you.

It's worked out well for us, like I said, almost accidentally in that regard, so I'm grateful for that. It's something that I can continue to build off of. I actually was looking at some of my commercial properties, looking at, “When is the lease up for some of the major tenants? When would be a good time to put that on the market again?” Especially if interest rates are going to go down, they might be more attractive and a higher price, and I can then 1031 exchange those into something that cashflows even more.

Investing in the stock market, do you have a basic philosophy of that?

Learned because I didn't do it. Stick to some stock index funds. I look at some of the funds or some individual stocks. I should have in the past put more into just the index funds. Maybe you can decide what percentage to put into individual stocks because those will outperform if you pick the right ones. There were some that I invested in that I pulled out. I look at those now and they're doing very well and I'm like, “I should have just trusted myself on those things.”

I think the basic of that is if you're going to invest in stocks and such, you also have to know that no one else knows what the future prices are going to be of any of these things. There's some predictability there or probabilities, but we don't know. Buying important profitable companies, generally speaking, is going to be a positive outcome for you. It's okay to speculate.

I got a friend of mine that’s like, “I just bought CCP.” I'm like, “Do you even know what that thing does?” “No, but it just went up like 400%.” Of course, it never shows the losses that they have on the portfolio, but there's room to speculate for sure. You should, because it scratches that it's that people have, but compartmentalize your money and I think you've done that.

Not that I would give myself this advice, but there are people who want to play in the stock market. This is what I have done with some of my proceeds. Now I have this cash, I want to look at this investment vehicle. I really tried to get into self-storage at one time. I'm like, “I'm not just going to go out and try to buy a self-storage unit. I'm going to buy a coaching program that can teach me all the ins and outs of buying self-storage and how to put an offer together, how to do due diligence, how to find it. You name it, all the ins and outs of self-storage so that I'm not just going into it blind.

I'm a big proponent of investing in coaching. It has transformed my life. Our purpose with Private Practice Owners Club is to transform the lives of others through coaching. I live that experience myself, and I can't tell you how many hundreds of thousands of dollars I spent on coaching to learn more about these areas in which I'm investing or learning about investing. I even have a business coach right now because I have this new idea I want to put together to benefit practice owners and he's helping me flesh that out.

If you're going to get into investing after a sale, get some coaching. There are programs out there that will teach how to be a day trader or they'll teach you how to invest properly. If that excites you, then invest in the coaching to do it. I frankly get more excited about real estate stuff. I can see my coaching investments have been more related to what would be real estate investing.

Have you ever done any private lending or anything like that?

Yeah, I’ve actually done quite a bit of hard money lending to contractors. That's something that worked out well for me and it wasn't bad. There were some sketchy times. There are ways people who will teach you how to do hard money lending. It's not that all that hard, frankly. You don't need a lot of coaching on that. You want to set it up in such a way that you are lending such that if they defaulted, it actually you get benefit you. If you could set it up such that you would prefer that they default, then that's a great situation. You don't want to get stuck with something that's underwater.

I did that for actually a few years in Alaska. I had some contractor friends that were looking for cash to build their homes. We set up some hard money lending and you can get some good interest return on those, 10% to 12%. These are usually backed by the hard asset of the real estate, which is nice. I did do that for a few years and it worked out.

Anything in like gold, silver, crypto. Have you gotten into any of those?

I think my partner figured out that if we had invested our money in crypto back in Bitcoin in 2018.

You'd be worth probably $100 million.

I wouldn't be talking to you right now, Eric, for sure. I'm just kidding. I'm not above that.

I wouldn't have blamed you.

You might not even recommend this, but what I'm doing right now is I lost on the getting on early on the Bitcoin bus. Even though I got excited about the technology back then, 2019 or whatever, I didn't invest in it, but now, I put like $100 a week into Bitcoin.

Dollar cost average.

I’ve been doing that for maybe a year. $100 a week doesn't mean much. That's all I’ve done with Bitcoin right now.

Wealth Principles: Concentration to Build Wealth, Diversification to Keep It

Here's one thing I will say. The best financial successes come from concentration. What I mean by that is, for most of you guys out there that own your practice or your practice real estate, you are concentrated. Most practice owners that were probably at your event or we talked to, 70% to 80% of their net worth is in their practice and in their real estate. That's where it should be. You guys don't need to get so hung up on diversification or at least some of these terms that you hear from guys like me right away. I really want you to focus on building your practice, building it up, because you're concentrated.

That's how you actually are going to get wealthy. Now, when you actually do have the liquidity event, that's when you start looking at diversification at that point in time because concentration will create a financial success. Diversification will help you keep your wealth over a longer period of time. I guess that was one of my points. Make sure that you don't get too distracted, so to speak, on some of these outside things. Really focus on how to build up that practice, especially right now. Physical therapy is a good business if you know what you're doing.

You want to stay within your scope of expertise and build that up. I’ve found that when I’ve made my mistakes, it's been a couple of things, when I’ve gotten outside of my expertise thinking I knew more than I did and trusted more than I should have, frankly. The other thing was I invested in people that I hadn't gained a relationship with significantly, or they were not in my immediate geography.

When I was doing some of the hard money lending, it was easy because I could drive to each of these properties and view progress on the property at any given time. Where I’ve gotten really stuck is when I invested in something out of state through a mutual friend who's like, “I’ve got this guy who's doing great things in this other state. He's needing some cash.” I did one deal with them and it was going all right, but hadn't fully paid off before they came at me with, “We could use some more money for this other property.” I got stuck on that one, frankly, and I lost some money and I'm still dealing with it two years later.

I could maybe break even two years later, get my money back, but it's been a pain in the butt. I knew better. I trusted sources and it wasn't my immediate geography. I really didn't do my due diligence. I trusted someone else's due diligence on those properties. I got out over my skis. That's something that I’ve seen personally in my own life now, but also in other people that I know who have lost a lot of money either while they were practicing, these were like MDs who had cash or after they had exited.

They just got into like other investments that they didn't know a lot about, and they just thought it would be this cash cow. They didn't know much about the ins and outs and details of that investment. It's one thing to diversify and, but do what you know. If you're going to invest it, it's got to be not only in somebody who has started a private equity fund and has done private equity funds in the past, that's not enough. You’ve got to know what they're investing in, what those returns are and what the industry's like, and what the market's like. In that case, maybe just trust your financial advisor instead of these other people that are coming at you for money.

That's good advice. I think we'll end off right there. All right, I appreciate it. The great Nathan Shields. How do people get ahold of you, Nathan?

You can always email me, Nathan@PPOClub.com. We also have the Facebook group, Private Practice Owners Club. We have the website, PPOClub.com. It's easy to reach out to us and even set up an appointment to talk to us on the website. You can schedule an appointment to talk to us. We're all about helping owners really gain control of their companies so that they're able to experience profit and freedom. If they are going to sell, they're selling from a position of power and not from a position of weakness and like, “Just get me out of here.”

You'd rather be selling from a position of, “This thing is making me a ton of money relatively passively. I could sell, I don't have to sell, but if you're going to buy it, you're going to pay a lot.” Be in that position versus, “Can you just take it off my hands?” Our whole goal is to help owners get to that point.

Beautiful. All right. You guys put on great events and I can't wait to see what you guys do next year. Thanks so much, Nathan.

Important Links

About Eric Miller

Is Your EMR Holding You Back? The Truth About The Next Wave Of Healthcare Tech With Craig Brasington

Mon, 03 Nov 2025 19:00:00 GMT

If you’ve ever felt like your EMR slows you down instead of scaling you up, this episode is for you. In this episode of the Private Practice Owners Podcast, Adam Robin sits down with Craig Brasington , Director of Revenue Operations at Stride EMR , to unpack the evolution of healthcare tech — and what the next generation of EMRs really means for practice owners.

Craig shares his 20+ years of experience in outpatient therapy tech, from his early days as a founding member of Clinicient to his current work with Stride. Together, he and Adam explore how EMR systems have evolved from basic record-keeping tools to intelligent, AI-powered platforms built to streamline every part of your clinic — from scheduling to billing to patient engagement.

They dive into:

The three generations of EMR technology (and why most practices are stuck in Gen 1 or Gen 2)
How AI is transforming not just clinical documentation, but business efficiency
What to consider before switching EMRs — and how to make the transition as seamless as possible
Why “thinking small to grow big” is the mantra behind Stride’s success

If you’ve ever wondered whether your EMR is holding your practice back, this episode breaks down what the next wave of healthcare tech really looks like — and how to make sure your systems are built for the future, not the past.

��️ Learn why the right technology isn’t just about software — it’s about strategy, scalability, and sustainability.

�� Learn more about Stride EMR at www.strideemr.ai

Want to talk about how we can help you with your PT business, or have a question you want to ask?

Book a call with Nathan — https://calendly.com/ptoclub/discoverycall

Love the show? Subscribe, rate, review, and share! https://ptoclub.com/

99.5% of successful owners interviewed on this podcast have leveraged a business coach to grow their business.

Private Practice Owners Club is the coach you need — ppoclub.com

---

Listen to the Podcast here

Is Your EMR Holding You Back? The Truth About The Next Wave Of Healthcare Tech With Craig Brasington

Special guest, new guy, Craig Brasington. He's the Director of Revenue Operations for Stride EMR . If you guys haven't heard of Stride, pretty cool company. I’ve met a few people on the team. Great group. I’ve also had a cool conversation with Craig and started to learn a little bit about the EMR. I was like, “I’ve got to get you guys on the show so we can share the story.” PT, OT, speech primarily is who they work with, specifically in the outpatient therapy space. We're excited to have Craig. Craig, how are you doing?

Doing great. Thanks for having me. Really excited to have an opportunity to chat with you.

Craig’s Career Background And Journey

Whenever we met, I was really just inspired by your story, like your history. You've worked with several different tech companies and it was really evident that you came with a lot of experience and perspective that I didn't fully realize. I thought it'd be really cool to just learn a little bit about you and maybe give you an opportunity to share that story and maybe add some value to the audience. Tell us a little bit about you. Let's start there.

I came into the space when technology was first getting in here. I’ve been in the outpatient technology space for many years, and was one of the original founding members of Clinicient, which was one of the bigger EMRs during the early days of browser-based tools that were out there in the world, WebPT, Raintree, Clinicient. I had the privilege to work with a series of really smart technologists that had stepped into the space, which is what was unique about Clinicient.

Versus it being a therapist owned product, it was a therapist-founded product with a technology group behind it. I got to learn from technologists how they handle and solve problems in a world that is driven by the provider. Jerry Henderson was our founding therapist and he was joined together with my father, actually Herb Brasington, who had built one of the first electronic submission tools for claims back in the ‘90s and early 2000s to create Clinicient.

And during that process, they met me and offered me a job. I came over and started with them. It was an interesting run. I ran pretty much everything in the company, support, implementations, training, onboarding. I worked into the sales end of things. I wrote specifications for the actual product itself and learned more about physical therapy than I thought I might ever know in a very short period of time.

Great origin story, the company took off. We were playing out there in the world with WebPT, who was the dominant player in the space and got to the point where we were a nuisance enough to where they just bought us. Back in 2021, they acquired Clinicient and I rolled over and worked with WebPT for a while and got to see a much larger organization in our space and how they delivered technology and their more therapist focused view of the world, which was also refreshing.

I went out on my own, opened up my own consulting shopper. I worked with a bunch of therapy groups to help them look at technology, what works best for us? What is my environment need? How can I leverage the years of evolution of these technologies to really take a an organization forward? I did that for a while and then I met the guys at Stride who I'd been talking to a few years and they showed me their new product. I was floored that this thing that was at the time about two and a half years old was as evolved as it was. It was a 10-year-old product and a 3-year-old company, hence why I joined the team here.

Why Craig Joined Stride EMR

I'd love to hear more. What was it that you saw in the Stride EMR? Could you explain more about that? What was it that really stood out that really blew you away?

That's what it did. It really blew me away. Taking it back to Clinicient, one of our first visions that we had at Clinicient was to create this single system product. Back in the day, everything was just integrated together using some rudimentary integration capabilities and it tended to fail regularly and/or just not speak well to one another because they weren't written in completely different codes.

What I saw in what we saw then was you needed to build it all in one place. It had to be the hub for all technologies and it had to do 90% of everything that you need to do. In certain instances, you're going to run into technologies that simply make sense to plug in. You can't Frankenstein a product. You need to build it yourself for a number of reasons.

That vision, which we tried to reach at Clinicient a little early in the technology run in our space to actually come to fruition, they had the same vision, had built what I had thought of well before Stride was a thing. The fact that they had seen this the same way and they'd gone about building it themselves and then taking the most modern technologies and using those to build out that product much more quickly, much more cost-effectively, and then deliver a premium product to the market in a short timeframe.

They're very agile, they build things quickly, they deliver on changes that you can't typically do in a large company just because of all the red tape that typically exists in the development process. Just that agile nature and the fact that they had built a thing that was the vision that we had at Clinicient long ago were the main reasons that I fell in love with Stride and came on board.

Where's the company based out of?

We're based out of Brooklyn, New York. The two founders are Ryan Limor, who is out of technology and product in the area, and Dan Blank, who is our CTO. He is out of the finance world. Even more complicated than HIPAA when it comes to building out products. That's where they came out of and they built a team mainly based in Brooklyn. They have a few of us, like myself, who live out in different far-reaching parts of the world, like Portland, Oregon.

What I'd like to get clear on is what does this mean for the practice owner. Okay. Really cool. Technology, we believe you. Sounds good. Sounds cool. What does that mean for the practice owner? Why should they consider Stride versus maybe some other EMR?

There are different use cases for each different practice. As we know, rarely do you run into a practice that's exactly the same as the other and they have their different ways as how they like to do business. This goes back to my consulting days. Picking a technology very much has to do with you mapping your need to the product that's available. You understanding where you sit and the level of reimbursement that you have and what kind of product you can afford.

Things like that are really important to consider before you step even into the realm of looking at products. Once you've determined where you sit and what problems you have and the value you're looking for, then you can start looking at the different products to see how they fit into your world and it needs to fit in your world.

What does that mea,n though? Let's break that down. You said mapping your need to the technology. Can you give an example of what you mean by that? What would be an ideal scenario for an owner?

A good example of mapping a need, I have a very high turnover in my front office. I am constantly bringing people in and training them. I sometimes only have one person working and they're a one-armed paper hanger as it is. I need technology to step in and allow me to offer up times for people to schedule on their own or patients to register and check in and complete their intake without me having to do any of that work.

That's a very common problem you see in clinics and finding a tool that solves that problem. That's your core problem. You need to find a tool that does that. That bleeds into other things when you think about that problem. It's also a data cleanliness problem. Now I need a tool that's going to help me get that correct so that down the line, my therapist has the right information. My biller, most importantly, is getting the right information so that this stuff doesn't have to be worked over and over again. Eating further into that profit.

Typically, a pain or a problem like that is much deeper and more widespread than the problem itself seems to be. Understanding where you sit and then evaluating technologies that look at that and help with those types of areas is really the key in that. When you are in the decision-making process, you take the time you think about what it is.

These folks on the other end of the phone tend to be experts in their area. This is a great opportunity to gather information and learn from them as well. An organization you're looking to partner with should always be that consultant, if you will, back to my old job being more of a consultant than a salesperson. They're not just talking about price or a feature set, they're talking about you and what you need to know, and then what moves you in this process. That will solve the problems you have. As an example, front desk being a limited resource would be a great example of a problem that you might have.

That's really interesting because it's easy to think that all practice owners have the same problems, but they don't. As an owner, sometimes you feel like you're on an island and if you don't understand that every single state and every single part of the country has different markets and different problems, different challenges, then you might feel like you're the only one. Everyone has the exact same type of problem, therefore, any EMR can work for you, but really, it's about finding the right EMR for you and your specific challenges in your area. That's really cool. I’ve never thought about it like that.

It's interesting if you think about the founders of the companies. My PT was a very therapist-based company, so they focused on the therapist workflow, some of the clinical. No desire to go into billing until later in their existence. Their strength still lives in that clinical experience. The technologists that I worked for looked at the overarching problem and built a tool that could touch all of those areas and work into each area to add a wind-down here at my front desk that affected the end of it. If I'm a billing-based product, now I’ve got a tool that thinks about the end of the process very well, very detailed or detail-oriented to solve that problem. Finding out what the best mix is for you is really important to understand solve the problems you're specifically at.

Where does Stride fit on that continuum? What problems do they solve? What are you guys good at?

When I left WebPT, I looked at all of the competitors out in the world and I went through the interview process and I knew most of them already anyway from just years of conferences and other meetings that you sit and run into people. The reason I like Stride is because it took the approach that everything in the organization had equal value to driving a good outcome in the end.

My billers being efficient had to be a thing. My front desk, being able to optimize what they do and be able to handle volume and be able to offload a lot of the work to technology so that they can keep up and decrease air was another huge component because that also fed the billing. Everything has to revolve around the therapist because, of course, that's the time you have to sell, which is where your revenue really lives.

I need to make sure that each one of those groups within the organization can manage their work, do it in a very effective, efficient fashion, and then use the technology to overlay their workflows to offload as much as is possible. This allows me to attack a lot of different areas. All systems will allow you to attack a lot of areas. Some will have more focus than others. I prefer the overarching look of a single system model.

Understanding Generational Changes In Technology

We did talk at one point about this evolution of technology that you've noticed along your journey. I believe you mentioned something around something like Generation 1 technology and then Generation 2 and now it sounds like we're somewhere around Generation 3 and I’ve never heard that before. I thought that was really cool. I'd love if you could share that story again with the audience so that way they can have some context around that.

Understanding where technology is in the moment that you're looking at technology is incredibly important. I don't want to buy a product that is good now, but in two years, it's already gone past its prime. Understanding where the technology sits and how they're using modern technology to benefit not just themselves, but you, the practice owner, the therapist, the biller, the front desk person.

I’ll break it down like we did before, all the different generations themselves. I like to categorize them in the technology change. A generational change in technology is what a hallmark to a Gen 1, a Gen 2, a Gen 3 of anything is. Our Gen 1 technologies were the Clinicients of the world, the WebPTs of the world, the Raintrees even, even earlier on in that process that were represented in the shift from a server-based model to a SaaS based model, software as a service.

That can be delivered via the web and/or the cloud. Cloud hadn't come around yet, but the web, you're able to access your data, it's stored in the cloud or on the web in a secure fashion so that you can offload cost and you can have a much more robust technology that you're running within your clinic and operating in. That's where the Raintrees first came out of and then the Clinicient and WebPT, the more browser-based tools evolved from.

That browser now allowed us to deliver information out to you on these smaller devices at a lower cost point and then allow us to push out updates out to the end users in a very cost-effective, efficient way and for developers to build tools and then roll them out to people in a very effective way. The problem with the technology at the time was not necessarily that the technology couldn't get the job done, but the focus of an EMR at the time was solely to offload the record storing and management of data, so it was a tool of record, if you will.

Those tools came along and they evolved and they started to handle all the things you did in a clinic, but it wasn't in a very effective or efficient way. They couldn't integrate with other partners terribly well because of where they sat. Even though you were on the internet, you still lived in a data center somewhere on the planet. You had to build these interactions across the internet to interact with somebody else. Apis didn't exist at the time. It was not very cost-effective. It was a very cumbersome way of communicating information.

We all lived in that for a long time. We built some pretty decent tools within the technology and then comes a generational shift. That shift was the concept of now having the cloud available for me so I can scale at a significantly higher rate, my capability to manage a level of customer, or I can scale my product. I can spin up new virtual servers to handle different loads automatically through that process so my performance has gotten better, my reliability got better, and then the actual technologies have evolved so I could write more sophisticated and more capable tools for everybody.

You started seeing things like Prompt come out, which was head and shoulders above the existing products. I know that because I was one of the existing products. I got to meet the guys at Prompt very early on. They were very great guys that I met at I believe it was the Orlando State Conference back in maybe 2016, something like that. Really cool. They were taking it from a different angle. There's a group that was looking at it from now we have this thing that we can build quicker, more cost-effectively. We can scale, we can build modern technology with a lot of cool new things in it and focus on one of the big problems that existed in healthcare at the time and still does the day.

However, it was getting the administration, the front desk, some of those folks you get a lot of churn from and providing them tools to help them make their job a lot easier, a lot more accurate so that all the downline effect from that could be felt by your therapist, by your biller, all those different things. They did a phenomenal job doing it. They came in at a very advantageous time. That was a very big shift in technology that had occurred a couple of years just before they launched.

Now that technology has blown up and the Prompt guys have done a great job in evolving that and moving it forward. They're now starting to take some of the hallmarks of a Gen 3 product and apply that to some Gen 2 technology stacks, which is very helpful as well. I’ll explain the difference here in a second.

You have a few new products coming out and you start to see a broader range of more capability in the space. Your Gen 3, the big change here a couple of years ago, and everyone's heard it because we talk about things like this all the time, is of course the advent of AI and machine learning. Now that has changed the landscape of how everything is done. Not just looking at it from a how does it benefit me, the end user. Let’s say I'm a therapist and I want to use ambient listening and all those other things in my documentation. Super helpful, incredibly powerful. How do I build the product itself so that I can bring a product to market that is significantly more cost-effective for me to build and deliver a premium product in a way that's done very differently than before?

Now the AI isn't just something you're bolting on to solve a problem or a couple of problems. You have a an LLM that's built into the system so that you can surface it whenever you need to within the user experience. You can use it as you're developing and decrease the number of developers you need to get a job done. It’s 6 developers developing what 25 could get done. That's a cost savings to the developing companies.

The EMRs are being able to build these things faster at a lower cost point and deliver products to you guys that evolve much more seamlessly over time, have less likelihood of becoming outdated. They can evolve themselves and continue forward. Using the AI in a very thoughtful way is a key thing to that as well. It's not just blanket UI usage, it's augmenting the individual user, the human that's dealing with it.

My developer becomes five times more effective. My front desk staff has a tool that offloads 60%, 70% of their work. That is just the menial task because just me not clicking buttons. The therapist has every way they want to interact with their documentation as well. Whether it be ambient listening or just AI scribing, it has a summarization tool. You're using adaptive AI maybe in your intake forms and it allows them to bubble that up.

Cost effectiveness is really the big key here. It's not just building it cheaper. It's now delivering AI capability cheaper because you own the LLM, you built the AI yourself and you're evolving it as you go along. Now you can bubble that up whenever you want to at just the transactional cost of what AI costs. That is a transactional thing.

Every time I use it, it costs a little bit of money here and here. If you're not buying and bolting on, that means you're not paying the other company's R&D cost. You're not paying the profit margin. You're not paying their markup on everything that occurs or you're buying the company and then you're incurring millions of dollars in costs that I'm now delivering this for.

Similar problem when you're buying or revolving with third-party partners in some of these areas. Gen 3 is the utilization of AI and utilizing it much like you do within the clinic, but even in the development of that product and how you manage everything you do in the day. Basically, living what you preach for the clinics that are utilizing your product. It’s three different generations.

Interesting. The one thing that comes to mind, the question that I have, and I'm thinking about this from a business perspective, what happens whenever you are an EMR that has built their entire company off of a Gen 1 or a Gen 2 type of technology? You explained it a little bit about the Gen 2, you have to bolt the AI on, and maybe it's a little inefficient.

Gen 1 and 2. We did the same thing back in the day when we started running to the end of our technology's capability. That's the answer at the time.

The question is, in your view, obviously there's a price limitation. It's going to be more expensive to build, therefore it's going to be more expensive for the customer. What are some of the other limitations that come with that type of setup? I don't know of a better word. If a company like that wanted to graduate to let's say a Gen 3, what would that even look like? Is that even possible? How does all that work?

That's a fantastic question because in technology, that is always the question. How to stay relevant is you must innovate. Keep innovating within the technology stack I have and/or I now see these guys that have built some newer things on different technology stacks that I can plug in and move the needle within my product, within my user group. That was always the hallmark to it.

Once you get to that point, it's called Frankensteining of a product. Plugging things in different arm, different leg, this kind of stuff. You've seen Frankenstein move. It's a great analogy because, of course, it's not exactly how a human works, but it's close. The interfaces that existed in Gen 1 really limited it because they were two-way integrations, but they were built between Point A and Point B and that is it. It really limited. You built it for every single thing you did.

Gen 2 has the benefit of API, which is allowing you to open up endpoints for credentialed individuals to be able to come back, come in and grab certain pieces of data in a much more cost effective, easier way. That was huge evolution of that, allowing you to now do that. It still has the limitation of I have a code base here that is not the same as here potentially. I have two tools that aren't built the same way talking to one another and you built time together as best you can. AI agents have come in. Now you can use Gen 3 technologies to streamline that a little better too. I can have an agent go through that API and do work within that system.

Now I’ve just tied three different technologies together. That's a costly solution. They can evolve to a degree, but the core of their product is where they need to continuously move forward. That's the tough part because the pieces around it are already more modern. It's the piece in the middle, the hub for everything that is needing to be able to evolve forward. If it's not built in the right way, the architecture isn't done correctly, it makes it very hard to evolve it forward.

Gen 3 technologies, again, are sitting on a different thing and they're using things that can think about how I need to evolve, what else do I need to do? API is just a set, a matter of fact second thought that you have about how you interact in the world. They can, but typically what happens is it's done outside of the product and they build that next version of it with a path of integration coming from the previous.

We did this at Insight back in the day, at Clinicient back in the day when we rolled out our InsightGO product, which was a Gen 2 product. We were a Gen 1 company moving into the Gen 2 world and we built a bi-directional interface with the core product so that you could adopt that new thing in your own time in a way that made sense. That's our theory.

The problem was we now left you in two worlds in that scenario. We didn't force the move, which at one point it is good to push people that direction, but we left it hanging out there. Honestly, I believe Clinicient is still that way now where you can work both ways. Brilliantly done, unfortunately, caused their own problem of not getting people to adopt a new product.

A couple of ways it can be handled, but typically, you're building it outside here and you're building this new amazing tool and then you're going to have a data migration question. How do I take what they have now and get it into the product of tomorrow in a seamless way that doesn't cause a lot of strife and pain for the customer base? Some change is always that way, though, and that's fine. People understand that. You have to do a great job architecting that path. That's where the real hard work comes once you've built that new Gen 3 product or whatever it is.

I'm going to let you guys figure that out. I don't know, it's way above my head.

There's definitely a lot to it for sure. Innovation is key. That's really it. Build it in a different way. The newer products are being built modularly. I can plug and play pieces to the core product as I want to evolve it. Let’s say I have my schedule out there for three years and I want to put in a newer scheduler that has a lot of new capabilities. I can actually build that out here and then just plug it into the core so that now, all of my users, everyone that's on that product don't have to go anywhere. It's just, all of a sudden, a new piece of the product that has more capability and has evolved itself.

Now, if I do that modulate over time, I can continuously innovate in each area that I’ve built. In the old days, you build the scheduler, it was really good. People loved it. It didn't get thought about until someone started hating it because something great came out 3, 4 years later. Now you can look at your product and periodically evolve the product so that you're never making a generational shift. You're making a short-term shift to a slightly different technology. It's just a different approach to development and evolution.

AI Assistant Waitlist And Patient Relationship Management Tool

I know you mentioned AI, but specifically, what are your favorite features or maybe a better question is, what are your current customers favorite features, specific features inside Stride?

AI is used a lot. Automation is another thing. You're building automations within a system to simplify or offload work or get things done. The most popular feature that we have right now would have to be the AI assisted wait list. When you need to find someone to fill a spot when canceled on Tuesday and it's Monday and you need to find someone, the AI sees an opening and it says, “I know the patients that you have listed in your priority, the organization and what other priorities you might want to set for them.” I'm going to send out invites these guys via text, “It looks like a time that you were looking for is open at this time. Go ahead and click.” It gets it as soon as someone grabs it and tells the other folks, “Sorry you missed it this time. Next time, we got you at the top of the list.”

They know they're there, they're moving on. It's keeping that schedule full as things progress or they just see open time that's out on Wednesday. It says, “Maybe no one noticed this. Let me go out and grab some folks and introduce that to them.” It’s one of the newer features that came out here at the beginning of 2025 that people are really liking.

A couple of other things that they love is the online scheduling component to it and marketing pieces so I can brand myself out in the world. My PRM, our patient relationship management, tool allows you to build campaigns and workflows that automate your typical communications. It can send a text to your patient just following up with them at the end of their visit or something like that. “Just checking in, see another visit went.”

It creates that human connection between you and the patient and you don't have to do every step of it. Some automations that are in that workflow that are really popular and then that reaches out into the world of a patient never even knowing who you are. I can get myself out there and put out campaigns and put out things in on the web or have a landing page to an event I'm hosting and then be able to drive them to a patient capture experience.

What I mean by capture is it captures their information and allows them to freely see your availability and then pick a time to come see. Take down the barrier between care and the patient and let them look whenever they want. It's midnight, it's 2:00 in the morning, whatever it happens to be, they can find what they need and not move on to the next guy. Those have been our most popular features that we've rolled out in 2025.

Transitioning To EMR As Cost-Effective As Possible

I’ve got one more question for you. The one issue or caution that I have with practice owners is the transition from EMR to EMR. It's a big one. It's heavy. It doesn't always have to be heavy, but to be fair, I’ve never done it. I'm only speaking from what I'm seeing. How do we get somebody to transition to your EMR from whatever they are, Gen 1, Gen 2, whatever they are, and do it in a way that's like as painless and as cost effective as possible. What's the solution there?

Change management. It is the thing that has been wondered about forever and has never been solved and probably they never will be. You can make it better and better over time. This goes back to some of the earliest things I did at Clinicient actually, which was ushering people from into the product from other places. The limitations of what you could do, it started with a spreadsheet that you can add load data onto. We can pull in some basic patient information, maybe a payer list or something like that.

Our industry specifically has not adopted a true data integration model where it's looking at that database grabbing what it is and pulling it over because it is incredibly cost ineffective. It's fraught with error and there's a lot of things you can't do. What the more modern products are doing is opening up what they can pull in and whether it be from a report that they can be generated right out of that system where you have a list of five reports to generate with everything you need to know about it.

That can be just ingested into the receiving system, or it's a data file that you get from your former EMR, which is a requirement of all EMR to provides you your data. It all has to do with the timing of it to make it better or worse, but they send our file broken down by patient with their numbers and all the other things tied to it, their attachments, things like that. Newer systems have the ability to grab all of that and then bring it into the system.

It's not your AR, it's not things like that because working existing claims makes it very difficult to go in and have to recreate a claim that could be submitted from a different source to a payer and things like that. There typically is a burn-down period of the old AR and the existing until it gets to a patient balance and you just balance forward. Being able to get all as much data as you can over into the system in a meaningful way and then attaching it to it.

When you start in the system, your therapist, for example, can go back and say, “There's that last note exactly as I wrote it. I understand it as I write it, my first note within this system.” There are a number of steps that we do at Stride to make sure that that transition is seamless, but also done in a way that doesn't threaten cash flow. We'll get to that one in a second as well as in adoption. These are the two biggest things that implementations and onboarding typically struggle with if these things aren't done correctly.

First, protect the money. That's the answer. I’ve got to make sure that happens. A good implementation is 6 weeks, maybe 8 weeks for a standardized organization. It'll get more custom with larger, but the first thing they help you focus on, and these guys will help you focus on it, is getting the clearinghouse stuff set up correctly and transitioned into their clearinghouse instance or if they're moving from clearinghouse to clearinghouse, helping with enrollments, helping with setup, making sure everything is done, and then testing of that.

All of this is happening while you're still in the process of learning the new tool and getting set up on that end the end user experience. Simultaneously, you're training and evolving where you are now. That is now set up, we've tested it weeks in advance. Now you're getting to the point where you're training your staff.

Training staff's important and key because you want a high level of adoption. These tools have been built in a certain way because they know what they're doing. Getting the proper training and the time for that to sink in with the providers and the front desk and the biller is incredibly important because you give them the time to do that, they learn it, they understand the methodology behind it.

When they go live that day of go live, which is the big hair on fire day, for most what people think anyway, they get in there and they're worried, they're absolutely nervous, but because of the steps that had been done up to that point, and then the practice period right before, they get in there and they are 80% proficient already. A couple of days later, you're like 90% and by the end of the first week, you're humming at the same pace you were before.

If you introduce it properly and train them correctly, you see a high level of adoption. Typically, providers and administrative staff, billers love this because they're moving from a tool that isn't nearly as capable as the new one. Introducing it to them early and the benefits, not just the features that they're about to use, is a key thing in their transition.

All of that being done and guided by a proper onboarding and implementation team is key. I’ve known many of folks at Clinicient, WebPT, Prompt and other companies that do this as well and there are some fine individuals out there to help clinics get through that very difficult process and as easy a way as possible.

It requires a lot of bandwidth from the owner, at least.

A good bit from the owner, a good bit from the onboarding team for sure, but trying to limit the amount of effort from the end user in the clinics and the practices is key so they can focus on what they need to know and get that down and then we can move them forward.

Thinking Small To Grow Big

Is there anything else that you feel like is in really important for them to know? Did we leave anything else out?

I'd say the thing that I love the most about working at Stride is it reminds me of WebPT when they were first founded. It reminds me of Clinicient when it was first founded. Prompt as well, where there are a bunch of people there that are thinking about and doing things for the right reason. That is why you want to be with an organization. Organizations change over time, all of them do, but you try to fight it.

One of the mantras they had here that I absolutely loved was think small, grow big. They're always thinking about what it was like now. What do they care about now? Even though you may be growing a little bit bigger in a technology company as you do, but always thinking about why do we do this to begin with, who did we focus on, and making sure that group of people are still the focus for everything you do within the organization. I'd never heard it said that way. It really resonated with me during the interview process as I went through it.

Get In Touch With Craig And Stride EMR

I'm sure there's going to be lots of people who are interested in learning a little more about what you guys are doing. For people who reach out to me, what do you want me to send them? How do they get in touch with you or your team? What's the best way to connect?

Probably the easiest way is to send them straight to our website, which is StrideEMR.ai . That way, you can learn a lot about what we do. Click through. We have some ROI calculators to help you understand your scenario in certain areas so you can get in and get a good feel for it before you even have to talk to somebody else. You can go through and go ahead and click and it'll take you in and you'll be able to pick a time that works for you. Someone like myself will be reaching out to usher you through the process and help you figure out what might work best for you.

Are you going to go to PPS?

Yes, we'll be at PPS. Love to see everyone there. We're going to be hosting a big Happy Hour Tin Roof on Thursday night, 6:30. Come by the booth, you register. Amazing band. It's an eight-piece band that's playing all the top hits. Should be a lot of fun.

Craig, thanks so much. I’ll be at PPS so we'll catch up then.

Absolutely. Look forward to seeing you. Thanks.

Important Links

About Craig Brasington

Why Your Business Won’t Love You Until You Learn To Love Yourself With Kelly Higdon

Wed, 29 Oct 2025 10:00:20 GMT

Most practice owners believe burnout is just part of the job — long hours, heavy workloads, and endless demands. But what if burnout isn’t a personal flaw… what if it’s a system problem?

In this episode of the Private Practice Owners Podcast, host Adam Robin sits down with Kelly Higdon , co-founder of zynnyme , therapist, business coach, and author of Therapist Burnout . Kelly has spent the last 15 years helping practice owners rebuild their businesses (and their lives) from the ground up — without losing themselves in the process.

They dive deep into:

Why burnout isn’t about self-care — it’s about broken systems
How personal growth and leadership maturity shape business success
The hidden mental and emotional patterns that block execution
Why alignment, not hustle, creates sustainable progress
The surprising connection between self-compassion and team performance
How to build a practice that serves both your clients and your life

If you’ve ever felt stuck in survival mode — doing “all the things” but never feeling at peace — this episode will help you rethink how you lead, grow, and take care of yourself while running a thriving business.

��️ Learn how to lead from alignment, not exhaustion.

�� Connect with kelly@zynnyme.com

Want to talk about how we can help you with your PT business, or have a question you want to ask? Book a call with Nathan – https://calendly.com/ptoclub/discoverycall

�� Love the show? Subscribe, rate, review, and share! https://ptoclub.com/

99.5% of successful owners interviewed on this podcast have at one time or another leveraged a business coach to improve their business. Private Practice Owners Club is the coach you need – ppoclub.com

---

Listen to the Podcast here

Why Your Business Won’t Love You Until You Learn To Love Yourself With Kelly Higdon

A deep dive into how entrepreneurs and healthcare professionals can overcome burnout, build alignment, and lead with emotional clarity.

Welcome to the Private Practice Owners Club. I’m your host, Adam Robin. We have a special guest, Kelly Higdon. Maybe you heard of her or maybe you haven't. We just met. Kelly is the Cofounder of ZynnyMe and Business Coach for many years. Also, a practice owner for 78 years, eventually sold. We'll get into all that, but the cool thing about Kelly is she is a licensed Married Family therapist in the mental health space. We don't get a lot of guests in the mental health space. I’m super interested. Maybe we're doing this episode a little bit for selfish reasons but I'm just curious to learn about you and what you see in the business world and uncover your story.

The Entrepreneur's Journey: From Burnout To Personal Growth

Thanks for having me. There's a lot of alignment in who you work with and who I work with because there is always a mental health component to the work. Whenever we're working with anything somatic, that's also connected to our hearts and our minds. There's a lot of alignment there. I find a lot of this speech therapist I've worked with does see that mental health component with the work that they're doing. I see a lot of crossover.

That's why I get fired up when we talk about the leadership side of things, the emotional side of things, or the mental health side of entrepreneurship.

I read a book on burnouts. I’m into it.

I know we’re not here to talk about my story, but I want to tell you just quickly why it's important to me. The greatest reward that I experienced during my entrepreneur journey is the personal growth and development that I had along the way. I remember being this business owner that was frankly lost. I could not see two inches in front of my face. I was just completely burned-out, stressed-out working, and barely hanging on mentally and physically.

I hired my coach Nathan, who's now my partner. Literally, he pulled me out of the gutter. I don't have it all figured out, but I feel I’m much more control of my life and I have more control in the direction that I take things. I don't feel like I'm on the emotional roller coaster as often. Learning those skills has helped me impact other people's lives a lot better too.

That's so funny because I was working in a county mental health. I was running one of the largest clinics in the county and I was burnt out. I was looking at going back to school. I was looking at maybe going to medical school or nursing school. I decided my private practice was my last-ditch effort and I hired my coach who is now my business partner. That's how we formed ZynnyMe.

Creating my practice was the healing to my burnout. We've written a book on therapist burnout because it is so common. Burnout is not like, “You don't go for enough walks or take enough bubble baths.” It's a sign of a system that's broken. What I love about having your own practice is while we're in this capitalistic system that is pressing down and asking the clinician to fill in the gaps of the brokenness, we can still create our own little bubble that protects us from burnout.

We create the system. We are the creators who write. I love that sovereignty that owning your own business gives you, and I agree with you. Building a business is your biggest personal development course you will ever take. Some of it just comes with time. Some of it is just like maturity . When I look at my fourteen-year-old, I'm like, “This is normal. You're going to grow into figuring some of these out.” Other times, people need the knowledge and skill development to navigate the whole journey.

The perspective. You're much more of an expert on the mental health side of things. I can always speak from experience. Forgive me if I sound like a toddler as I talked through all these things, but perspective helps me. You don't know what you don't know. You see the world through this lens that is built around the experiences that you've had and the upbringing that you've had. The product of that sometimes causes you to feel like you have no options because you can't see them. In order to see new things, you must hang out with people who've been there. That's what I've got from a lot of that and what I got from coaching. Nathan was like, “Have you ever considered this other thing?”

You just don't know what you don’t know.

“You can't even see that's right next to you? You just got to turn your head to the right and see it.” That creates this euphoric feeling of like, “I have options now. I can have a vision and I can create.”

It's like a family. When you're racing your family, you think this is how family is. This is what relationships look like. When you go to create your own family or your own business, which is you creating your own system. We replicate those patterns because that's what we know and that's what's comfortable. Our whole nervous system is like, “I create familiarity.” If you come from chaos, I bet you do business like chaos. If you come from slow processing, your business will be slow processing. Those kinds of things. we’re mirroring. When we have community and we bring in other voices. It helps us shift faster and heal some of those things that don't work for us anymore.

The Entrepreneur's Limiter: Overcoming Self-Imposed Blocks

I hear what you're saying and I understand it. I just haven't heard it communicated so cleanly, but it's so true. That's why you always hear the entrepreneurs say, “It's a game. It's you versus you.” You're always the limiter. You're always the bottleneck. You're always trying to figure out what silly habit or belief that you are holding onto that you need to let go of that. You are not quite aware of it yet. Sometimes that's where a great business coach or a mastermind or just a good accountability friend can just call you out. They will be like, “Kelly, you look like an idiot now. You need to stop that.”

All of our coaches are trained in brain spotting. I don't know if you've ever heard of it, but it is a cool tool for any of your PTs and OTs as well. It can help with the integration of what you are teaching your clients. It came from EMDR, which is using eye movement to help the brain rewire. Instead of brain spotting, it uses gay spots but it can help you rewire your brain and expand into creativity. Sometimes, there's this block and you're like, “I don't know why I don't want to raise my fee. I feel gross about it. I keep fighting around it.”

The brain spotting can help you take that feeling, hold it somatically and then your brain starts to process where this comes from and then you can expand into what you want to create. You start to notice behavioral changes, even at a PT level. I've seen people do this for performance enhancement and all sorts of cool stuff. It can help people if they are struggling with implementing or integrating the treatment that they are being given. BrainSpan can help with that.

We’ve seen that with CEOs, entrepreneurs, and leaders. They've got the knowledge but there's these blocks to implementation. There's these blocks to follow through. Some of that brain spotting can help extract some of those blocks and help you understand where they're coming from and how they've been there to protect you. Maybe you don't need that protection anymore.

This is super helpful because we have our annual conferences and I'm supposed to get out there and talk about execution. I have my way of getting things done and I would love to hear yours.

How do I execute?

We don't have to diagnose it all but you had mentioned that there's these blocks to implementation, is what you called it. To me, that means execution because you're exactly right. When you think about creating anything meaningful, it doesn't come down to your ideas or what you talked about. It comes down to what you get done. Usually, we know what we need to do but for whatever reason, we don't execute on it or we have a hard time creating alignment with our team around it. What do you feel are some of the keys that you help entrepreneurs with around that?

Who I was many years ago and how I executed it is so different than how I execute now. I used to work from a five-year plan and reverse engineer. I don't do that anymore. I'm much more likeable within a year because things change pretty rapidly now for me. I used to project out five years and have this whole vision. I had a whole course on it like how to calendar it out and reverse engineer. I always prioritize my life first and then I see where my business can fit into it.

That, hands down, has never changed. I go through the year and I plan out all my time off. I look at the things and the events I want to do. I make sure there's lots of room for my life and then I fit the business into it. I look at it like, what is it that I want to achieve? I got back to what's important week to week. I use Asana and all of that. What I noticed is that if something is staying on my Asana board and I'm not getting it done. It is not about pushing. That is something that's very cultural to the American mindset of like hustle, push, and do it anyway.

Grind, which you're leaning on me. I do that.

It's so disembodied. What happens is, why you aren't getting by in your team is that you aren't an embodied leader. You’re not convincing me because you're speaking but the energetics are not aligned. That doesn't draw me in. In fact, that makes me feel more suspicious and less like I want to follow that. A true visionary is inspiring and aligned. If you're not in your alignment, your team is not going to follow very well.

They may for a while until they figure it out and then it's going to fall apart. That's where I do more of that somatic work of like, “Where is the conflict within myself? What is going on? Why is this continuing to be on my list of things and me not touching it? Getting more curious about that because if I can start to understand that pattern and unleash that and heal that or figure it out, then I'm not going to have this ongoing struggle. Some of the brain spotting does help me with that. If I get stuck, I just notice where resistance is. I lean in and get curious about it, instead of pushing through it.

I don't know if there's a right answer to it, but I just heard the word alignment and that resonates with me because I was raised by a father who was blue-collar like, “Shut up and work,” kind of a dude. I find myself pushing into things that I probably shouldn't.

I pushed myself into an ER visit one time and I can't do that again.

Business In Service Of Life: Prioritizing Self-Love For Success

I literally said this out loud. I said, “Your business won't love you until you learn to love yourself.” It’s like you mentioned. First, you identify what's important to you and your life and you serve that as a priority.

My business is in service to my life.

Correct. Many times, we as CEOs, especially me. We treat ourselves like crap. We’ve worked too hard. We tell ourselves to shut up and we don't matter. We just push through things that don't serve us. I can tell for myself when I look back at all the times whenever my business was doing the best and whenever I was happiest. It's always when I prioritize myself. I'm pouring myself into it. I'm eating well, sleeping well, and doing things that fill me up well.

What are we here for? As I said, I have had those moments and, for me, it's very ego-driven. My identity was wrapped up in my business. Some of the work I do with people in their practices is I have them talk to their business like its own person. If you're in an intimate relationship with a person, you don't just constantly demand something from that partner. You have to nurture that relationship and it's the same for the business. We're just like, “I do all this for you and you do nothing for me.”

There's just this demand. There's not a loving relationship with the business. The business is like, “How am I going to give you clients if you're not showing up for me in the right ways? If you don't like taking time.” You think you know everything. Instead of looking at the data and taking time to understand and getting the support you need. I will have them speak as the business and then they'll speak as the owner back and forth and realize like, “I've wanted this business to be successful, but I'm focused on the wrong things. I'm not nurturing it.”

At the end of the day, they're still things on the Asana board that have to get done. How do you get them done?

I make time. I batch my time.

What if you don’t want to do them? What's the next step?

That's where I get curious about the somatic aspect of it. I will sit and feel the resistance in my body, then I will close my eyes. I will talk to that resistance and get very curious about, what are you wanting from me? What would you rather be doing? What is coming up for you? Nine times out of ten that resistance has a purpose. If we push through and bulldoze over that, we are missing the point. We are missing the lesson.

If you want resistance to go away, you have to give resistance to the microphone. I have a project now. Part of it, I feel incapable and that's partly why I've just been avoiding it. If I sit with the resistance and then I can have a conversation with it and realize, “I'm needing more support.” I asked for that to get it done. It's having a relationship, getting curious and talking to those parts of yourself that are like, “I don't want to do this.” Instead of being like, “You're going to do it anyway.”

I used to tell clients this. If you had a kid and you took them to the park. At the top of the slide, you're like, “Slide down. It will be fun.” They're like, “I don't want to.” You don't scream at them and be like, “Get down the slide." You're like, “What are you nervous about? What's going? Do you want me hold your hand?” The same thing but we're not doing it with ourselves. We are not treating ourselves with the kindness and compassion we need.

There are days like I have certain days where I batch certain things. I don't have meetings typically on certain days. That's my neurotype, too. That's another thing you need to think about. It's not just the emotional makeup of a person. It's the way our brains work. If someone has ADD or any neurodivergence, you want to accommodate your task list to how you do things. Some people need consistency, the same routine every day. Other people batch in months, quarters or weeks. We're all different.

There are people in this world who don't want to go there with you like it feels woo-woo. It feels like, “Give me the step. Give me the freaking blueprint.” Is there a space for people like that in your world? How do you help them? How do you navigate that type of client? How do you navigate that type of leader on your team?

To be honest, when I started my entrepreneurial journey, I was very much like I would talk to Miranda and I'd be like, “Tell me the steps.” I would do the steps and I was very successful but then there came a point where the success capped out. That's where cookie cutters can only go so far before you need to tailor something creatively to you, your team and your vision.

I do love giving plans and there are some facts out there. There are some definite strategic things that you must do. There's a lot of creative capacity. At some point, you will hit a limit and you can keep doing like formulas, but it will only get you so far. It doesn't have to be woo. We're talking about just simple like understanding yourself and your makeup.

Building Systems For Success: Clinical Outcomes & Client Journey

Let's transition over real quick to what we talked about before the call. You were talking a little bit about what you do with owners. What I remember hearing is, you work on trying to build systems that improve outcomes inside the business. Can you talk around that? How do you help owners think about solving those types of problems?

When you are creating a practice, you have to understand who you are serving and understand their psyche, as well as the pain points so that you can meet them where they're at. When people are like, “Is my marketing successful? My phone's ringing off the hook. I'm booking. I'm full.” That's not success to me. Success to me is a successful completion of treatment. You could have your phone ringing but people only make it to the third session and then drop out. Is your marketing really working? It's not.

What is it we need to change into the marketing so that we get people that want to stay for the duration of treatment? What is it that we can do in our initial consultation that can get the buy-in for the treatment? What can we do along the course of treatment to keep them engaged to the end of treatment? Whatever service you provide or what that looks like. There are processes. If I think about it, how do people book with me? If I create a lot of barriers, I'm going to have a lot fewer clients come to me, but there are some things that I might want to create barriers for so I get the ideal people that are going to stick.

If I'm a cash paid practice, I need to be clear up front. I want them to check a box. I have reviewed the fees. I understand this does not cause me financial hardship. We already know before we hop on the phone with them that they have awareness and that they're more committed. All of these little steps from our marketing message to how we do the client journey. How can we improve the chances that they're going to complete treatment successively and have a good clinical outcome? That is very important to me. You can have great marketing, but if you don't have the service to back it up that's not great. I believe in profitability and sustainability for the owner but also great clinical outcomes because you create a feedback loop.

Those are the same.

If your clients are terminating well, they are more likely referred to you. Their doctors are seeing the transformation. They're going to refer to you. You're creating more ease for yourself. You're going to feel a heck of a lot better about the work you do as well.

When you put that type of energy into your product, you become a real believer of your product. You get excited about your product and you can sell it. You get your team around it. There's a lot of good things that happen whenever you put a lot of energy into your product.

Also, when you have a team. A lot of times, we come out of school or our training and we're like, “Am I enough?” All of our training tells us we're not. You have to put in the hours and work for nothing. You go through all these processes. It's just like, “I'm just never going to arrive.” We aren't taught what good clinical care looks like, what great clinical outcomes look like, how what you're doing is good and that it's making an impact. We need to teach our team that. We need to build their confidence to look for that and to care about that. If they're not feeling good about the work that they're going to do, you're going to lose them as staff. You're going to have retention issues. It also helps your team stay more cohesive for sure.

Managing Expectations: Proactive Communication For Better Outcomes

I wrote down managing expectations, which is the way I define this idea of getting out ahead of the objection with or from your patients. Whether it's money or scheduling or whatever it is. One thing that we do is we help owners with recruiting. Now, it's hard to hire clinicians. It's very tough.

It is wild out there.

We're on this call and this is a tip for anybody reading who's having a hard time recruiting. We're out there pushing our job out on Indeed and we're getting a lot of people that are saying. “Denied. I don't want to work there because of the location.” This was a practice owner in Alaska. I said, “I got an idea. How about in the second line you overcome that objection? You just say, ‘Are you a clinician who wants to be autonomous? Before you have questions about Alaska, I want to let you know that we're giving you a big sign on bonus to consider moving here. Also, here's the other perks of moving to Alaska. Let me tell you a little bit about our company.’”

The next week, two people applied. It comes back to like addressing the fear or addressing the discomfort. If you can understand why your patients are dropping off or why your customers aren't getting what they need from you. You could be more curious around that and be willing to confront that earlier in the process. You're more likely to have a better outcome, whether that's recruiting or marketing or whatever it is.

I had a client. She provided a service that was normally 8 to 10 sessions. She worked with couples and right after the third session, they dropped out. She was like, “It's almost consistently, like 70% of the people would drop out at the third session.” I was like, “When you do your intake call, you're going to say by the third session, you're going to want to quit. I can’t do this process.’ On the third session, you'll be like, ‘After this, you're going to want to go home and quit but remember what we talked about, if I can get you to that eighth session, you're going to get what you want, so please stick with me.’” She went from like 30% completion rate to like 90% completion rate. Knowing the patterns or talking about the elephant in the room and just being honest about it is so important.

That's a good topic that we probably don't talk about enough. I had a good friend of mine. His name is Will Humphreys. I'm going to be a little bit extreme on the words but part of the onboarding process for his clinicians used to be something like, “Welcome to your first day. Let's talk about what it looks like when you quit. When you quit, you're going to put in a 30-day notice.” I used to think that was so weird. I didn't understand the genius behind it until later, but it's just the same thing.

My partner Nathan always recommends when you're running a business, when you're trying to balance that clinical care with profitability. There needs to be some type of productivity expectations based on your reimbursement levels and that thing. Depending on where you're at in the country, not every clinician's comfortable with seeing that many patients a week. Whether sometimes it's 30 or 50. If you're in New York, they're seeing like 90 a week.

That's why you have those conversations in the interview. It's like, “By the way, here in this practice, this is our expectations. We don't want to force you to do this. We want to give you an opportunity to accept this. Do you feel comfortable with that type of case load?” Getting out in front of those issues early.

That's why I think when a lot of people move into a group practice like that, they figure it out with their first hire instead of like looking at, this is where you need to look ahead. What is your pay scale? What is the productivity scale? How does it all scale up? I, as an employee, I'm going to want to come in and know what the potential is. You got to paint a picture for that potential for them and of reason to stay.

If they're like, “I know I made this and this is how many people have to see.” That's all they know. Don't you feel lost? Can you imagine just sitting there like, “This is what it is.” If you hold a bigger vision and you show them their path as well. You're creating pathways. You create the client journey and a journey for your employees as well and give them that vision so that they know. It's very clear from the get-go.

Healthcare is tough. Reimbursements are declining, costs are going up. All the things.

We have AI replacing us, so it’s very fun.

We have a lot of clinicians, specifically younger clinicians who are coming in and wanting higher salaries. They want to earn money. They want the money now. What I have found is that sometimes, there's no way to solve that problem. One of the ways that I have found to solve that problem is to help them understand what it's going to take to get to where they want to go. Especially the younger clinicians. They're not so tied up on exactly what they get paid, but they just want to know that there's an opportunity to earn more in the future.

If you could support them with mentorship or other things, flexibility on the schedule or whatever that is. They are much more likely to choose a place that can help them have a vision for themselves. I don't know but what I have heard about the mental health space is that there's a solo practice owner and then there's the group practice owner. How do you guys build that out? Also, you guys use 1099.

No. I am pro W-2. It's very hard to do mental healthcare as a 1099. You will see that. I feel like a lot of these companies that are doing 1099 are having labor disputes.

I'm totally with you. I just want to hear your perspective there. I haven't seen very many successful group practices.

The only time I've seen it work is where you do a co-op model. You're providing like, “Rent my office space. I have a website. I do marketing. I provide these kinds of services, but I don't control your practice.” That can be like a 1099. Look at the federal guidelines. It's pretty hard to do our work and not be a W-2.

The Phoenix Principle: Recreating Your Practice For Well-being

Last question. What's the message that you want to give to the healthcare entrepreneur, the practice owner? What's the important thing that you want them to know?

I feel like if you are feeling burnt out, it's not bubble baths that are going to help you. It's going back to the basics of the system that's surrounding you. Sometimes, you got to tear it down and be like a phoenix in the ashes like recreate. We built based on what we know and what's familiar. As you have more time with it, you might discover it burns you out and it's okay to pivot. It's not like there's something wrong with you. It's first looking at what needs to shift within what you've created to support you better, your staff better, and your clients better.

The one thing that I've realized more is, I used to think whenever things clear up my calendar, I'll be able to feel good or be happy. It’s like, once I feel good, I'll do the thing. Now I'm realizing that it's what I choose to do that helps me feel good. I totally line with that. If anybody wants to learn more about you, your team, your services, and your methodologies. How do they get in touch with you?

You can go to ZynnyMe.com . We have over fifteen hours of free training. You can download our book for free on Therapist Burnout . It applies to OTs and PTs. The concepts in there are still the same, because we're service professionals in the healthcare industry trying to help people heal physically, emotionally, and all these different ways.

Thank you for being here.

Thanks for having me. It's nice to chat.

Important Links

The Tough Conversations That Make Or Break Your Private Practice With Dan Neissany

Sun, 12 Oct 2025 19:00:04 GMT

Most practice owners think profitability and patient care are at odds—you either make money or you do right by your patients. The truth? You can (and must) do both.

In this episode of the Private Practice Owners Podcast, Adam Robin sits down with Dan Neissany—physical therapist turned entrepreneur, healthcare consultant, podcast host, and co-founder of Best Practice Strategies. Dan’s mission is simple: help practices grow without burning out.

They dig into:

● Why money isn’t evil—and how profitability actually fuels better patient care

● The tough conversations practice owners avoid (and why avoidance kills progress)

● How data-driven decisions reveal hidden profit leaks and growth opportunities

● The mindset difference between thriving owners and struggling ones

● Why systems, accountability, and leadership—not just hard work—are the real drivers of success

If you’ve ever felt torn between helping patients and making a profit, this episode will reframe what it means to run a business that serves everyone—patients, employees, and you.

��️ Learn how to balance care and cash flow without compromise.

�� Connect with Dan at tbpstrategies.com or find him on social media @DanNeissany. Links in the show notes.

---

Listen to the Podcast here

The Tough Conversations That Make Or Break Your Private Practice With Dan Neissany

Entrepreneurial Roots: How Dan Learned Business In Healthcare

We have a new guest, a first-timer. We have Daniel Neissany. Daniel. It’s my first time meeting this guy. I can already tell he is a sharp cat. A little bit about him is that he is a physical therapist turned entrepreneur. He is a healthcare consultant, podcast host, and the Cofounder of Best Practice Strategies. I’m going to use my words, but they help practices grow their business without the burnout. Does that sound right?

Yeah.

It’s great to have you.

I appreciate you having me on.

I would love it if you could maybe do the introduction. Tell us about yourself. Tell us about who you are and what you do.

I graduated in 2007. I practiced for, give or take, about fourteen years. I started like everybody else, entry-level. I was treating patients and was loving it. I grew into a director role and started understanding the business at a high level, and more so about how to collaborate business between good patient care. One of the misconceptions I find in healthcare, in general, is that you either can make money, but you treat patients like crap, or you treat patients amazingly, and then you make no money out of it. Seeing that we can blend them both was insightful for me. We grew and developed.

In about 2001, I started hitting a major plateau with where I was at. I loved the company, but I advanced as far as I could go. If I left there and stayed in New Jersey, it didn’t feel right. My wife and I also got a little bit plateaued with being in New Jersey, which is where we’re originally from, so we ended up moving out to Las Vegas in 2002.

I took a little bit of time to figure out what the heck I wanted to do. I was at the point where I wanted to take what I did with that company in New Jersey, which we can touch on, and bring that to other healthcare practices. I saw what works. It’s a great model that’s not utilized too much. I started a podcast back in November 2024. I focused on a lot of great high-level business concepts that we teach. I’ve done some business investments. It’s been quite a great last few years.

That’s cool. You were an intrapreneur with your involvement in the private practice. During that time, how did you learn so much about business? Was there some structured mentorship that you got in that company, or is that something that you took on on your own? How did you develop your passion and knowledge around business?

At the end of the day, I feel that it takes two things. Number one, you have to want to learn the knowledge. You need to be curious enough to seek it out. Unfortunately, in healthcare, there are a lot of owners who want to hide information because they’re almost afraid. You see this in business, in general. They’re like, “If I teach you everything, then what’s to stop you from opening your own clinic and using my secrets to do your own thing?” It’s so silly.

Fortunately, the CEO of the company I worked for was an open book. He specifically said to me, “Whatever you want to know about the business and the company, you ask and I’ll tell.” I was very fortunate. What I got as a strong benefit from him is that his background was not in healthcare. His background was in finance. He worked on Wall Street, so he saw things a little bit differently.

I know somebody might read that and say that he was all about the numbers. He understood the numbers a little bit better than a lot of us in healthcare tend to see them. He was able to see patterns and understand the importance of data. That’s what helped me out. As I got better, he kept supplementing me with some knowledge. Like anybody who wants to grow and develop, you do stuff on your own, and you have to actively learn. Being able to read books outside of healthcare and content related to finances, economics, and stuff like that made a huge difference in combining the medical background with the financial background.

I love that. That’s cool. One of the biggest challenges, and I would assume in most industries, but maybe more specifically healthcare, is that we have a tendency to do a few things. Number one, we look at the numbers side of things and label that as evil. If you’re interested in anything besides giving all of your energy, time, and care to your patient, then you’re labeled as an evil person or a bad person.

It’s like, “You’re making money? How dare you?”

The Balance Act: Profitability And Patient Care In Practice

I’ve worked with a lot of practice owners, and I’ve never seen any practice owner be successful with that frame. I don’t know about you, but I’ve never seen that. I’ve always seen that the practice owners who do well are able to have that balance between, “We’re still going to serve our patients better than anybody else, but we’re also going to get paid more than anybody else, too.” They’re both equally important. Understanding the numbers and the metrics and demanding profitability inside the business is as important as providing that world-class experience as well.

If you think about it, a lot of the good people in medicine tend to be very altruistic, which makes you want to almost give stuff away. Maybe giving that stuff away is your time, your energy, or whatever it may be. There’s that aspect, to your point, where it’s like, "You're doing something financially well. Does that mean you’re doing something unscrupulous? Are you doing unethical work? Are you billing fraudulently?”

It’s hard for a lot of people to wrap their heads around being able to provide great customer service while understanding what makes a business run. That’s one of the things that I find in not just PT, but chiro and healthcare across the board. Healthcare is still a business. If you don’t make positive revenue, A) How are you staying open? B) How are you giving raises and bonuses to employees and re-investing into the practice to maybe buy new equipment? If you’re growing, fortunately, and you want to maybe open up a new facility, it’s hard to do that if you’re not making any money.

Overall, that goes into this mindset that we have in the US, where a lot of people have grown up thinking money is evil because they don’t have those conversations when they’re younger. You see stuff all over social media that if you’re wealthy, you’re probably doing some crappy stuff. The people who know how to run a reputable business also understand that part of that is developing a great brand, and developing that great brand means treating people well. That means externally, which are the patients, and then internally, which are your employees.

Creating that great customer experience also includes creating an even exchange with your customers. It’s give and take. It’s layering in that accountability with your patients and saying, “You’re going to have to have some skin in the game. You’re going to have to pay your bills. You’re going to have to show up to appointments on time. You’re going to have to be accountable to your plan of care.”

The layering, accountability, and challenge are part of providing, because at the end of the day, what we’re trying to do is we’re trying to empower our patients to be independent around their health. If we play the savior and do it all for them, then we never even accomplish that. We put ourselves as the solution instead of empowering our patients to be the solution.

I’ve talked a lot about patient retention. Some people push back and say, “Don’t you want them to get better?” I’m like, “You’re not understanding what I’m saying here.” Patient retention doesn’t mean just coming into the office. It’s like you said. It also means that they’re doing the necessary things globally that are going to help them get better. If they’re not even willing to commit to whatever recommendation you made for their frequency or what have you, then they’re not doing what they need to do at home. It’s plain and simple.

I’m very interested in the stats that help us understand those kinds of concepts. When we’re research-oriented, a lot of us know, or at least we should know, that the number of patients who don’t do anything at home, don’t do their home exercise program, or how many exercises they will do and for how long, the psychology of people is that they will get complacent. To your point, how do we get them to take care of themselves and understand that you get better, but the name of the game is how you stay well?

It’s no different than running a business. You start something and it’s like, “How do I continue this long-term? I’m not looking for a stopgap solution.” It’s creating accountability. Even that goes into being able to have conversations with patients that sometimes a lot of providers find a little difficult or challenging. If you care about people, there are a lot of difficult conversational avoidance, in general, with people. It’s like, “I don’t want to hurt their feelings.”

In reality, the people who care the most are the ones who have the conversations that tend to be avoided. It’s talking to that patient who has knee pain when they’re 350 pounds and they’re 5’4” to understand what the real culprit is and not be afraid of, “What if they don’t like me?” That’s what it comes down to. It’s also understanding how we need to even set our employees up to have those kinds of conversations as opposed to assuming that they all will.

The Gift Of Truth: Why Difficult Conversations Drive Patient Outcomes

What a great gift for you to be in a position where you can learn from a guy with that mentality and that mindset. I never had that. I had to pay for that.

That’s the thing. At the end of the day, a lot of us, in general, always say that we care about people the most, or, “I want to bring a lot of value.” I don’t think we fully understand what that means. When we look at bringing value or being the provider who is committed to an outcome, are you going to talk to a patient about what needs to be said in order to get them the outcome?

It’s easy to do stuff when it’s low back pain. I’m 5’4” and 110 pounds, so you’re not having a conversation centered around weight. It’s probably your body posture stinks or body mechanics. Those are easy conversations to have. Are we willing to have the conversations that are necessary? The ones that are easy, anybody can do that, but what about the ones that are hard? What about the ones that maybe the patient says, “Screw you. I’m not going to come back in because you made me feel like crap.”

There is a way to deliver feedback in a good way versus a bad way. If you do these things with kindness and are coming from a place where you’re focused on, “What do I need to do to get you the outcome?” You’ll have the conversation. For me, I didn’t have to pay, but it’s not even a matter of getting coaching and whatnot. It’s understanding the mindset of what it means to care as much as I say I do.

I was almost thinking about moving on to a different topic, but you fired me up when you said that. That’s such a good point. We’re talking about patients, or the tough decision to demand that they pay their copay. Whatever that hard friction is in the business, when you avoid that, you’re doing it for yourself. We call it care, but in reality, we’re avoiding the uncomfortable emotion that we have to experience. If you truly care, you’re willing to absorb that inconvenience and be the leader in this situation. That was a good point that you made.

It is true. Ultimately, in those scenarios, if you don’t tell the patient the truth, what ends up happening is the same outcome all the time, which is they don’t get better. If you’re going to be focused on growing and improving yourself as a professional, then you have to say, “What do I need to do to do that?” Even to your point about something like copays, I’ve seen that a ton.

Maybe the patient has a $20 copay and is like, “I don’t want to pay.” Whoever is in charge is desperate, or desperate-sounding at least, to get the person in and is like, “I’ll waive it.” You don’t understand psychologically what you’ve said to the patient. You’re telling them that you’re desperate. It’s not a matter of power, but you have to have some authority.

It’s not a matter of that doctor who says, “You got to do this,” but you have to at least demonstrate, “I know what I’m talking about. I’m a professional here.” When you transfer that power over to a patient, they right away know, “I can pretty much do whatever I want. You’re not going to say anything. If you tell me to maybe come in twice, I’ll come in once. I know you won’t say a thing.”

You’re not being the leader in that situation. You’re being led. The way I’ve heard it said is, “If it’s not important to you, it won’t be important to them.” I did a live training. One of the first things is that if you want to generate referrals or if you want to generate a culture of performance, you and your team must be seen as the authority. They must be perceived as the authority. They have to. You have to.

People don’t want to be your buddy. The reason they’re there is that they’ve lost control of that domain of their life. They’re seeking out an expert to lead them and guide them through the challenges because they don’t know what to do. If they knew what to do, they wouldn’t be there. They need you. You’re super smart and talented, so be a doctor.

Mastering Your Finances: Unlocking Profitability In Private Practice

Let’s move on. That’s a great topic, but there are other things that we want to talk about. I want to talk about finance, since that’s your background. Talk to me about finance. Profitability is tough in private practices. Some of the things that I see from my perspective around profitability are not having strong systems around the financial touchpoints in the practice, like over-the-counter collections, billing, denial rates, and inefficient coding. I also see a lot of limitations with health insurance, such as low reimbursement rates. Also, the Medicare rule impacts your ability where you can’t see two patients at one time and all that stuff. In general, how can we help practices get more profitable?

One of the biggest aspects of business is understanding trends or patterns. If we look at something like insurance reimbursements, by all means, if there’s somebody out there who says, “Where I live, they go up every year,” please tell me. I might move there and open a clinic. We know that year after year, the reimbursements go down. Year after year, the amount of denials goes up. Costs are going up. These are things that we know, but it’s either information that some of us ignore, or we’re not paying attention to it. You mentioned some good data there.

At the end of the day, you could be like, “I don’t know how to create KPIs.” Understand you’re spending more and making less. That’s the major trend. To your point, it’s like, “What do I do?” Most people are going to say, “The only thing that I know to do is treat patients, so let me get more of them.” Do we have the bandwidth to treat them? Half of my staff is already telling me they’re exhausted. Maybe 20% of them are feeling burned out. What happens if I add more patients to their plate? Do I lose them? It’s a cycle.

At the end of the day, to your point, you have to understand the data. There's so much stuff you can do. It doesn’t mean you sit behind a desk, figuring out the day, scrutinizing spreadsheets while your team’s out there struggling to treat patients. It is understanding, to your point, “Are we getting paid? What are we getting paid? Who’s paying us? Is my team collecting copays at the front? What does our billing look like? Are we getting all the necessary information at the front?”

I’m a big believer that we tend to want to focus on all the stuff that is not in our control. It’s very easy for me to complain about insurance, like UnitedHealthcare. They’re not changing. Insurance is the second biggest lobby in the United States. Nine figures. Pharmaceuticals are number three. The deck is stacked against us, but that’s what we want to focus on. It’s easy to complain. A lot of us don’t focus on, “What are the components in my business that I have full control over that I can improve?”

You mentioned leadership. There are systems. How long does it take to get a patient on the phone? How long do I make them wait? What’s all that stuff? In our culture, how long do employees stay? What’s their work level? Are they motivated? Do I have a plan to grow? I remember there was a practice owner. I asked him that question. I was like, “What do you want to do for growth?” He was like, “If we keep doing what we’re doing, I’m good.”

I’ve probably said this 100 times. If you’re not making at least what inflation is, you’re losing money. If inflation, under normal circumstances, is 3% or 2.9%, that means if you want to make money, you have to increase your revenue by over 3%. It’s simple stuff like that that a lot of people don’t comprehend. Even if they do, they don’t understand. They’re like, “How do I do that when I’m in a field, unfortunately, where the reimbursements are going down and denial is going up?” That’s where it’s being able to look at, “I know the easy answer. I can just get more patients,” but it’s really looking at, “What services can I possibly add?”

In the PT world, a lot of people open their own clinic and stick to PT. It’s hard to do that, for sure. You can make improvements and get better, but at some point, you’re going to be looking at, “Do I add something to the mix? Is it a new provider?” Maybe it’s a new discipline, like OT or something along those lines, that can help treat the patients. You’re still providing good support, but it’s helping you get revenue. It can create some good relationships with doctors. It’s like, “Is there some DDME that maybe would help my patient base that’s within reason to prescribe to them?” That’s how I would look at it.

Ultimately, nobody is coming to help you out. I know there is a saying that nobody is coming to save you. You've got to take control. Even if you do not own your own practice and you start out like me, where you’re a practice manager or a director, and your goal is to still help run a business, there is this aspect that you’re affecting other people’s livelihoods, not just the employees. You’re affecting their family, too. If you’re not growing and figuring out, “How do I sustain this over the next two years?” or, “What’s my plan for the next five years? Do I want to sell it or get bought out?” These questions have to be asked. A lot of times, we end up being very reactive instead of being proactive.

A few things that I took away from that are, number one, it starts with data. I had a new client who said, “I'm a little fuzzy around profitability. I’m struggling this month. I’m not sure what’s going on. Can we jump on a call? Can you help me?” I said, “Sure. Is your dashboard up to date?” He says, “No.” I was like, “Call me when your dashboard is up to date.”

I said, “I can’t help you until your numbers are ready.” I’m not a magician. I’m not a wizard. I must have data. It’s like if I went up to you and I was like, ‘Here’s a blindfold. I want you to get me to Disney World.’ It’s impossible. I can’t help you.” All of your profitability, in my opinion, is in your data. Your profitability will change when you stop trying to tell the story, let the data tell the story, and start making data-driven decisions around how you should deliver care in a financially profitable way.

Some people would view that as sounding very business-like and not maybe as focused on the patients, but it could even be simple stuff. If you’re spending $4,000 a month on marketing, are you paying attention to how many patients you’re getting in as a result of that? You’re like, “I’m not doing any of that.” It’s even normal stuff that is important. If you’re wasting it, that’s less that you can reinvest into your employees in the company.

I always love it when you ask business owners, “How many of you love numbers?” and half of them have their heads down. It’s like, “Your business is all about knowing numbers, and you’re saying you hate them and you don’t keep track of them.” It's very difficult and nearly impossible to run a great business without understanding data. It doesn’t have to be reams of Excel spreadsheets, but it’s at least some understanding of what’s coming in versus what’s going out.

When you’re looking at the data, it’s important to know that it’s not all about pushing numbers. It’s about understanding what your options are. You can’t make a decision if you don’t know what your options are. Sometimes, it might be about increasing productivity. I’m not saying that’s never the case, but sometimes, it might be about dropping a low-paying insurance or going out of network with somebody.

That’s what I was thinking. It’s like, “This insurance is now paying us $20 a visit.”

We don’t know that unless we have the data.

I’m like, “When did that happen?” They’re like, “Four months ago, but we found out now.” I’m like, “How much now did we end up maybe giving away by not understanding what’s coming in?”

It might be that your denial rate is at 10%. You have a billing issue, so we have to fix the billing. It might be that you’re not collecting over the counter. It might be that the new grad you hired doesn’t know how to bill it. There are so many things that it could be, but I’m not going to sit around and try to guess. I need to know what the data says.

The data will tell you, “There’s the issue. Here are the options.” It takes the emotion out of it. Here’s the cool thing. There’s usually always a solution. When you do see the options, it’s about like, “Which one of these options aligns with the values and the culture that we want to have?” That’s a much more productive conversation than, “I don’t have any money to pay my payroll. What do I do?” You’re being more proactive about it.

It’s like, “Could we have maybe worked on this a few months ago instead of where we’re at now?” That goes back to my point about being proactive. You don’t pay attention to these things until you start noticing, “We’re barely skimming by.” It’s like anything else. You don’t start a business to struggle. You’re going to struggle at the beginning. It’s not that you open the doors, and then you’re flooded.

When you ask every business owner, “Why did you start this?” They are going to give you a lot of the same thing. They’ll say, “I thought I could treat patients better. I wanted a little bit of freedom and some flexibility.” It turns around, and they’re saying, “I’m barely getting by. I’m more stressed now than I was when I was a W-2 employee.”

The Entrepreneurial Mindset: Navigating The Highs And Lows

It’s also important to recognize that entrepreneurship isn’t easy. It’s a pretty rough lifestyle. Not everyone should be an entrepreneur. Not everyone should be a business owner. It’s going to come with some sacrifices. There are going to be some ups, and there are going to be some downs. I don’t think it’s about eliminating those. It’s mostly about developing systems and structure in your life so that you can handle them effectively without crippling yourself, like having the team in place, having the systems in place, and using the data to help you drive decisions. If you build an organization that is equipped to solve hard problems, then it won’t land on you all the time, which goes back to building that organizational structure .

Even before that, though, there is a definitive mindset that you need to have to step into the world of being an entrepreneur or being an owner. You get to the point where you say, “I’m going to build out a team and build out systems.” As Mike Tyson always said, “Everybody’s got a plan until they get punched in the face.” Are you going to be able to encounter those setbacks and those little failures and not let them crush you? At the end of the day, entrepreneurs have some of the highest alcoholism and depression rates. Sleep issues are horrible. Their relationships tend to be crap.

When we’re talking about building a business, you’re also probably doing it for family, too. You’re not looking to say, “I ruined my relationship with my wife, and I have a crappy relationship with my kids.” It is, “I hope I have more time to spend with them.” These individuals who don’t understand that and then combine it with not having any systems in place, then how do they deal with the stress?

They didn’t develop the mental fortitude to prepare themselves. They’re like, “I've got to deal with it by either pouring in more hours.” A lot of us tend to think harder and longer that work gives us a better outcome. They’re like, “How do I deal with it? I have to resort to drugs or alcohol.” Unfortunately, for some people, it is suicide. It’s stuff that we don’t typically talk about. To your point, you go on social media, and everybody is saying, “Be your own boss.” Please don’t do that before you understand the challenges that go with that.

Traits Of Top Performers: What Makes Entrepreneurs Truly Successful?

Let’s stay here for a second. When you’re working with entrepreneurs, you’re getting on these phone calls with them. You’re meeting with them. What are the characteristics that you see in those who are way more successful versus those who struggle? Are there certain characteristics?

Yeah. Not the most successful, but a lot of entrepreneurs have a big drive in them. You have to have a little craziness in you. It’s way easier to be an employee. You don’t care what anybody says. Even back in the day, when my family would be like, “Why don’t you open your own clinic?” I’d be like, “Why would I do that? It’s much harder.” Also, I wasn’t there.

At the end of the day, a lot of those individuals who do well are high drivers. They’re the ones who are like, “I take action. I’ll figure it out as I go along.” A lot of other people who don’t become entrepreneurs are the ones who overthink or over-deliberate, which is an issue in medicine. Typically, a lot of us are very analytical. The individuals who are like, “I’m going to forge ahead. I’ll make the mistakes and learn along the way,” typically, at some point, need to be complemented with somebody who does some analyzing.

The best entrepreneurs fill themselves with people who fill in the gaps. The people who tend to do the worst, but they won’t get to the point where they open a lot of their businesses, are the ones who want to overanalyze. Maybe it’s all about building social connections, but then they struggle because they have a lack of systems.

That’s where it’s at. Everybody has some real strengths to help them out, but the best ones are the ones that take a lot of action. Those guys and ladies are also some of the most challenging to work with because they’re very headstrong. It’s being able to not make them feel stupid or that they’re doing anything wrong. It’s to show them, like, “Here’s how we can complement what you’re already doing, which is great. You've got to this point where you’ve been successful.”

We end up leaning on that success and think in our heads that that’s going to create a feature success. We think, “My way has worked, so why change it?” Going back to the numbers, what are the numbers showing? How are you growing year after year? Those individuals are awesome to work with because they tend to be very action-oriented. It’s a little challenging dealing with the ego, but we all have it. It’s giving them some grace and helping them see how you’re there to make their business that much better.

I love how you recognize that. I see this in employees and team members that I bring on when I interview clinicians. I’m always looking for that high-drive individual to bring onto my team. They’re somebody who wants to be an entrepreneur, but doesn’t necessarily want to take the financial risk. They want to have a safety net.

The two things that I look at are, number one, do they have a vision? Do they have a big, scary thing in their head that they want at least a little bit? Have they figured out what they wanted? Are they brave enough to say it out loud? Do they have the courage to say it out loud?” A little bit of ego is good where it’s like, “I want to open five clinics.” I want to hear that versus, “I want to figure out how to hire an employee.” It’s fine, but the ones that have that big drive and the ones that have that big vision, even if they don’t land at 5 clients, they might stay at 1. They’ve got the drive that drives them day over day.

That’s a great point. The biggest thing with that is also understanding why that is their motivating factor. When somebody says to you, “I want to scale up to $10 million a year,” it’s like, “What’s going on in your head to give you that?” Is it all about feeling significant, like, “I’m doing this to make myself feel big,” versus, “I want to make this much or open this many clinics because I want to be able to serve 2,000 or 5,000 patients a year.” That makes sense.

It’s like, “I want to be able to make $10 million so I can donate a crap load of it.” That’s good because then, you’re going to have the right mindset where you’re more focused on the actual business, including the employees, versus that person who says, “I want to grow 5 clinics so I can say I grew 5 clinics.” They’re going to be all about themselves.

Connecting With Dan: Resources For Aspiring Practice Owners

I appreciate the conversation. I’m pretty confident that at least one person is going to get some value. If people want to reach out to you, connect with you, and learn about you and your world, how do they find you?

My website is TBPStrategies.com . In every social media platform, it’s my name, Dan Neissany, not my full name. It is Dan Neisanny on my social platforms. That’s where we’re at. Honestly, we have good content on the website. We’re putting out some courses specific to healthcare, hiring, onboarding, and patient retention. We’ve got some good stuff coming out as well that, hopefully, can serve some people quite well.

I appreciate it.

Likewise. This is awesome.

Important Links

About Daniel Neissany

The Unfair Advantage: How VAs And AI Give You A Competitive Edge With Adam Robin

Mon, 06 Oct 2025 19:00:00 GMT

Are you still doing it all in your private practice? The administrative tasks, the scheduling, the follow-ups – it's a one-way ticket to burnout. In this episode, Adam Robin of Inbox Zero , a company that specializes in connecting healthcare practices with top-tier VAs, talks with Nathan Shields about these two modern yet under-utilized resources. We dive into how leveraging virtual assistants and cutting-edge AI isn't just a luxury but an essential strategy for modern practice owners.

Adam and I reveal the two-pronged approach that can completely transform your workflow: delegating routine tasks to a VA and using AI to automate the rest. We break down exactly how this powerful combination frees up your time, slashes overhead, and allows you to focus on what matters most: your patients and the growth of your business. If you're ready to move from working in your practice to working on it, this episode is your roadmap.

For more info on how Nathan and Adam can transform your business, go to www.ppoclub.com and book a call with us.

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Listen to the Podcast here

The Unfair Advantage: How VAs And AI Give You A Competitive Edge With Adam Robin

Welcome to the Private Practice Owners club. I'm Nathan Shields. I got my partner, Adam Robin, with me. How are you doing, man?

Locked in, ready to roll. I'm good. How are you doing?

I'm doing good. We are two months away from the conference. A little anxious, still nervous, and excited. Mix of emotions.

Two months?

Did I say two months? Two weeks?

Two weeks. I was like, “Wait a minute.”

In two weeks, we've got to be ready to go, but I'm excited about it. It's going to be significantly better than last year, and we've some amazing speakers and amazing content, and it's going to be fun.

I did some role playing through some of the things I'm going to be talking about, just to talk through my lines, my talking points. It was really cool to feel how I got so energized, as I was doing it. It felt like I was getting pumped up about it. It's really fun. Just getting excited about the whole thing.

I need to do some of that because right now I'm stuck in editing my PowerPoint so they look just right, and hit the key points, and that stuff. The editing and whatnot are draining. I’m just staring at the computer for hours.

Which brings me to a point. You should have a virtual assistant doing that for you. Whenever I say I'm role-playing, what I mean is I press record and I talk about the things that I believe in, and then I send her the video and she makes the whole PowerPoint. She does it all.

What?

I just talk about what I already know.

That’s cool.

Come on, man. You've got to get on the deal.

AI Tools Nathan And Adam Are Using

I do need to get on board. I know you do that a lot with your AI. Are you using ChatGPT right now? What are you using?

I use ChatGPT. I figured out how to build out some custom GPTs. It's not hard to do. It's pretty simple, but I use that, and also, I leverage Loom to transcribe my voice, and then I train the GPTs on my transcriptions, and it starts to sound like me, write like me. Through using it, you start getting the outputs that you're looking for.

I've been doing a lot of Gemini simply because it's tied to my Google stuff, and it's on my home screen on my phone. I can use Gemini a lot. I like Gemini a lot. I use Gemini, ChatGPT, and Claude because I'm writing a book. Claude is good for more of that content, per se. It's got a better voice when it comes to writing out that stuff.

If I'm doing something for a social media post, if I'm making checklists, I spoke into Gemini, and I said, “Here are all these findings that I'm doing as I'm auditing this clinic. I don't want to write my notes. Here are my notes for what I'm seeing amongst this information. Give me your version of the audit to see if it would be any different than what I was coming up with in my audit,” which is cool.

That was really cool because it gave me all the PowerPoints. It gave me a structure. Now I can save that digitally instead of having this handwritten piece of paper with all the notes on it, scratches and scribbles, and trying to decipher. You're taking it to another level than I am, and it sounds like you're even having conversations with it, going back and forth?

With AI?

Yeah. My wife and I started doing that a little bit with ChatGPT, which was interesting, but I find that their responses are a little bit verbose. It gets really wordy, and I have to, like, cut them off and say, “No.” Do you have conversations with it?

I do. For me, it’s usually if I'm seeking out information, if I'm trying to get clear on something, then I use it to get clear. I can say something like, “GPT, I'm thinking about this idea. This is the thing I'm worried about. This is what I want it to look like. Spit me out what you got.” A lot of times, it can be like, boom, it can break it down. Basically, it's like, “This is what I'm hearing you say. A little coach, like a little mentor.” Through that, I've been able to find a lot of clarity, like,” That makes sense. I can move forward with whatever it is I'm looking for.”

I'll usually have a conversation with it if I'm trying to find clarity. Now, if I'm trying to rewrite something, I cannot stand sitting down and typing emails. I got to write this email and put a lot of thought into it. I would rather just look at the email, hit record, and just talk out my response on the email, and then just throw that right in the ChatGPT, press enter, and copy and paste. Boom. There's my email. Just productivity hacks like that have helped me move things forward. Just that more capacity. It doesn't require so much energy for me to move things forward.

I noticed that in your emails, they are well structured and clear in your thoughts. Are you using the built-in Gemini app for your email responses?

No, I just pull up ChatGPT and hit the record button, and I'll read the email, and then I'll just talk through it. If I'm responding to it, then I'll say, “Nathan, that's a good thing. This is the way I see it. The main things that come to mind are 1, 2, 3. Let me know what you think about that.” Boom. I'll just prompt it to make me an email.

Saves so much time.

Yeah, it does. It saves so much time.

Using AI To Send Out Email Referrals

What else are you doing with AI? Maybe it's something that other owners aren't doing, could do, or aren't thinking about.

Writing policy and procedure is really big. It's allowed me to delegate very quickly. Scary quickly.

Give me an example.

I have a full-time executive assistant, a virtual assistant. She is unbelievable. I mean like, “Good God, how did I do this without her?” One of the things that comes to mind is “How do I send a referral?” Some people always come to me and say, “Adam, I'm looking for a biller.” “Adam, I'm looking for a good accountant.” I have a list of people that I refer to. These are people that I trust and I know. I just built a list of like, “Here's their name, here's their phone number. Here's what they do. Here's their website. Here's their email.”

Once I felt like, “I cannot refer 50 people a week.” That's not practical. What I cannot do is I can press record on Loom and say, “Angela, we're going to go through what I call the referral process. This is how we send referrals. Step one, you're going to get a note for me, and I'm going to pull up this list. Here's our referral list. This is now your list.”

Anybody that I tell you to add to the list, this is the list that you add to. “Moving forward, if I want to send somebody to Will Humphries, here's his name, here's his phone number, here's his email, this is what he does. Here's the template that we use to send referrals. See you next time.” Click on the video. I just take that transcription, plug it into my custom GPT that builds SOPs for me.

You've got an SOP template already laid out in GPT, which I'm going to do.

I just throw it in there, and it will spit out an SOP with a title and a video training. I'll just link that Loom link right there. A purpose, a product, and a process. I give that to Angela, and I'm like, “Add this to your executive assistant playbook. It's yours to do now.” Literally, I just have to do it one time and it's already, right?

Yeah.

That's so very massively helpful.

Just the time that it takes to put all that thought on paper, spell it right, and structure it right with indents and tabs and the video and writing out the step-by-step instructions, dude saves an hour right there easily.

It saves more than an hour. It saves an hour of doing it, an hour of thinking about doing it, an hour of going back and double-checking if you've got it right. It's a lot of time

Brain energy.

Your policies are more captured. They're like, you just do it, and ChatGPT handles all the rest, or your virtual assistant handles all the rest.

Combining Video And Text Content For Better Clarity

The beauty of it is, and going back to a book that I feel like I've been referring to a lot was one I read a few years ago called Clockwork by Mike Michalowicz. He also wrote Profit First and The Pumpkin Plan . He's got a number of business books. In that, he talks a lot about not just having written policy and procedure, but also video policy and procedure with screen capture and all that stuff.

Thinking Twice About Hiring A Virtual Assistant

Tell me about your story a little bit because your executive assistant is a relatively recent hire, within the last month. If you're willing to be a little bit vulnerable, talk us through what you were thinking that kept you from bringing on that executive assistant initially? I don't think your story is unique. Everyone is feeling the same things that you were worried about. You brought on a personal. When we're talking about executives, this is someone who works with you solely, and you can tell us all the things they're doing for you.

How much it's freed you up, but you had a little bit of resistance to bring you one on initially. Share with me if you're willing a little bit about that. Just to add a little bit more context to it, I think there are a lot of people out there. They're like, “I'm hearing a lot about virtual assistants. It sounds like a cool idea. It sounds like a lot of people are getting a lot of help from them. Should I do it? What's the benefit? I don't get it.”

I wouldn’t know what to give. I wouldn't know how to use them. That's the biggest thing.

That’s the thing. “How do I train them? Bringing on another person sounds like more training and more headaches for me. How do I get past that?

I don't know if you do. There's a learning curve. Just like riding a bike, you're going to fall down a couple of times. I'll try to be brief, but I'll start at the beginning. In the beginning, I didn't have any virtual assistants on my team, but I just knew I was completely overwhelmed and busy because I was like, we all know what stress feels like, chronic stress. That's where I was at. I got to the place where I was like, “I'm just going to hire this person.”

My first hire was, “I'm going to hire somebody good with automation and good with operations. I'm going to figure it out. I'm going to give it like a month and figure it out.” I'm going to meet with you every day, and we're going to figure out how you're going to be useful for me. That was the first one I hired.

The good thing about most entrepreneurs is that we're good at figuring out how to move things forward as long as we sit with it for a little bit, if we just give ourselves the time to sit with it. That person ended up building out my org board and building out my job descriptions, and they started building out policy and procedure, and my client life cycle, and they became very useful. Working with the assistant helped me realize what was truly possible.

I was like, “Great, you're going to work with that person now, and you're the operations person, cool? I'm going to go hire another one and call them my marketing assistant, because now I have to figure out marketing.” I started to work with a marketing person, and now I know how to delegate. I started building out that role, building out this is how we social media posts. This is the graphic design. I hired a marketing director, and I was like, “Byron, you're going to work with Joe now. Go over there, work with Joe.”

They were both virtual assistants.

It was like I was training these people throughout the whole organization. I started hiring one for recruiting. I built a recruiting person. It was like, “You're going to learn how to recruit.” We're going to build out authorizations and billing. We built out these roles throughout the organization. That was the journey, just like you would build out any role, but then it got to a place where I opened up a couple more companies, and Adam Robin was its own business.

I had a bunch of companies, I had executives, and I have partners now. I got so many emails coming in and out. My office was chaotic, but I had never hired somebody to just be like, “I'm going to work for Adam and whatever Adam needs.” That means things like managing my emails. They have access to my emails. They have conversations with really important people for me on my behalf. That was scary. Building out my calendar, managing my calendar, calling people at my house, sending referrals, receiving referrals.

I didn't really know how that would work. Part of the reason why I think that I was hesitant was just more of what you just said. I didn't really fully understand how I was going to get that person productive quickly because I didn't really know how that worked and what it looked like. You were the person who basically was like, “Dude, just shut up and do it. You idiot. What are you doing?”

You've done this 7 or 8 other times in other areas of your business. Why not this one?

“Why don't you do you stupid idiot?” I was like, “I don't like that. I don't like being called a stupid idiot.” I did it.

I didn’t say that.

No, but I did it, and man, it was great. It was a gamble on myself to figure it out. I figured it out within a couple of days. Most things, it's like, it's not nearly as hard as we think it is.

The Right Way To Train Your VAs

I think I got this from you or Will, but just having the VA with you, even if you weren't talking, they're just watching you click on screens and you're pushing record, or maybe you're talking to them through what you're doing with your emails and how you respond to people and hear some of the things. Eighty percent of the stuff they might not have anything to do with, but they're just watching you on screen. Will, after a few days of that, even a week, would be transformatively different because they get an understanding of how you work, what you're doing, what you're looking at, what's important to you, that stuff. Did you find yourself doing some of that as well?

Yes. I like to follow the 10/80/10 rule by Dan Martell. The 10/80/10 rule says, “You work on the first 10%, you delegate the middle 80% and then you clean up the back 10%.” You manage the ends, you don't manage the middle. I'm going to give you an example of something I delegated to Angela. I met with a really popular company, maybe not quite as popular, but you guys will hear about them coming up, an AI company. There were three things that we needed to happen. Number one, I needed to get them connected with my clinics, because we're going to do a free trial with them.

I had to connect them with my director of admin. I had to figure out the paperwork. All that stuff. I had to get them added to our affiliate program so that we could start referring clients back and forth. That was number two. The third thing was that I needed to send them information about the conference because I wanted them to come to the conference. Three things, three different email threads, three different projects with follow-up, and get that signed and all up. Does that make sense?

Yes.

Instead of doing it, I just made a quick two-minute Loom video. I said, “Angela, here's the name of the person. Here are the three things that we need to do. This is what the definition of done looks like for all three. As soon as you get to this point, I want you to ping me and let me know where we're at.” Done. Does that make sense?

You didn't have to start the threads. You didn't have to start the communication. She starts them on your behalf.

Introduce that person to Angel, get Angel to get the pump, all of it. Now I get to grow my company instead of getting bogged down with all the loose ends. It's not so much. It's your ability to bump multiple things forward all the time and not have to hold on, and like push it forward all the time. Does that make sense?

I love that analogy. Bumping them forward and knowing that they're going to continue to move forward without you.

They're going to continue to move forward, and you can bump. Now I can have a hundred projects go in. I'm not going to delegate the big things, but like creating PowerPoint slides. I don't need to be creating PowerPoint slides. I can create one video and say, “Here's what I want it to look like. It's an hour-long presentation.” If you get stuck on the graphic design, send it over to the side. He's going to take care of it. I'm done. I need it done in a week so I can practice on the plane.

Yeah, exactly. Right.

We are preparing for the conference, which would have been like this big, tedious thing that would occupy an entire month. I can get my PowerPoint slides done, and I can still meet with vendors, and I can still grow my company, hire people, and do the things that actually move things forward.

How Inbox Zero Can Help Hire The Right VA

You started Inbox Zero of a company to help the private practice clinics do these exact same things that we've been talking about, right?

Totally.

I assume a lot of owners who are coming to you are saying a lot of the same things we were talking about. I don't know if it's a fit for me, but it feels like I need to try it. I don't know how to train a VA. How do you walk them through that process, and how soon thereafter, after bringing on the VA, do you find that they're pretty comfortable in noticing significant changes?

Regarding walking them through the process, we have a training built out. The things that I'm talking about aren't complicated. They're not very complicated. A few tools, a little bit of communication.

Let me guess. You've got a few Loom videos, and you've got some written policies on what to do next. “Just watch these videos, read these policies, click these buttons,” and there you go.

It's not complicated. I don’t know. I'm thinking about a canoe. Like, “How do you get a canoe to move forward? You get the paddle and you start paddling.” You've got to get in the videos and start using them and orienting yourself with them and actually put them into practice. You get better at it with practice. A VA is not going to come in, nothing is going to come in and solve the problems for you. You've got to get better at it. The only way you're going to do that is by jumping in and figuring it out. We do have some training in place, and we have some training for the virtual assistants, so that there's some alignment when they get placed.

That's good to hear. You're not just bringing this person who's wet behind the ears and just throwing them into a clinic owner. There is some training that you're doing on the other side with that VA, so they can know what to expect. What is expected out of that? Maybe you're doing a little bit of training on, “This is what we expect you to do with the owner.” When you get in touch with them, “This is how you move this forward.”

A 100%.

Totally coming from the owner. It's also the VA saying, “This is what I need you to tell me.”

A 100%. Our whole mission, and then we train our virtual assistants, is for their job to be more of a consultant in the first 30 days. “This is how I feel like I can be useful for you. Let me show you what's possible. Let me show you a better way of doing this.”

It’s off your hands.

Just through that, a little bit of conversation, you're going to be like, “There's another level to this. I didn't realize I didn't have to be doing all that stuff.” If you get on a call with a VA and they're not doing that for you, then you got the wrong VA. You need to get somebody else on your team.

You need to have someone willing to show you the ropes. Like, “You haven't used the VA. I am a VA. This is what I need from you.”

Three Primary Catego ries Of Inbox Zero Clients

“I've been doing this for ten years. I know how this works. I've got a ton of experience doing.” What we found is that there are three primary categories of people we've been working with. These aren't in order of magnitude or anything, they're just the order that comes to my mind. Number one is the small solo practice owner who needs a VA to do everything. You might be by yourself, or it might be you with just a few part-time clinicians, and you need somebody who can help you with billing, help you with answering the phone, help you with a little bit of credentialing, and help you with a little bit of authorization and verification.

Do some scheduling. Do some social media stuff. All the things that are drowning you on the weekends, that's your VA job description. For those people, our whole goal is to get that stuff off the owner's plate so that they can grow their company, so that they can hire more providers, increase the production in their clinic, and have some capacity to get things moved forward. It's like your general admin person.

For sure.

The second person is going to be somebody who's a little bit more established, and they probably have a front desk person already, and maybe like 3 or 4 providers, but they're in that bridge between where it's like, “I need a second front desk person, but I don't quite need a front desk person.” Like, “I'm trying to expand my operations.”

They're probably about a hundred visits a week, 125, 100.

Maybe you just open a second location, and you're getting stressed at the first. That kind of phase.

I see it.

Usually, what we do is we bring in a front desk support. Anything that is occupying your front desk person's ability to fill the schedule and collect every dollar over the counter. That's what we're going to do. It's usually insurance authorization, insurance verification, running reports, and managing incoming faxes. Things like that to free up your front desk. Big ROI there. Huge ROI there.

I think I'm focused on filling up the schedule and collecting everything without being distracted by all that other stuff, that'd be huge.

All you have to do is get like a 5% or 10% bump in visits per week, and it's like a 20X ROI. It's like such a good ROI. If you have your team only focused on that, they're going to crush it. Assuming you have a decent team. The third group of people is going to be people who need help with recruiting. Recruiting is probably our third biggest ask.

We do have a pretty in-depth recruiting training. It's the same training that I've used inside my practice, where I meet with them every single month. We train them on all of our systems, and my VA teams are there. Our whole mission is to help you build that internal recruiting process inside your clinic to help you be consistently out in front of the providers that you can bring into your company.

It’s because we're always hiring, right?

We're always hiring. It's so cool, especially on the recruiting side, because there's such a really intimate connection with the CEO on the recruiting side. That recruiter becomes like your sidekick. It's like, “We're going to find us a PT.” It's really fun.

Unlocking More Bandwidth By Hiring VAs

That's cool. I'm assuming people, what are owners blown away by? What is the big a-ha for them after they bring in a VA and they’re working for them?

I'd say the biggest thing is just going to be the time. It's the bandwidth.

I just have more time or bandwidth.

“I have more bandwidth.” The problem is, we're going to talk a lot about this at the conference, and we're all guilty of this, including me, we underestimate how much time and energy and attention things need in order to move them forward, to be good at them. Our idea of running a clinic sometimes is “We'll do it when we have time,” or “We're going to get to that recruiting thing. I'm going to write that indeed ad over the weekend.” It's not even close to enough energy. You've got to have 100 X the amount of energy that you need to actually hire a PT these days. We underestimate how much holding onto those things has on the negative growth of our company. Does that make sense?

Yes, I totally understand that.

Whenever you get a body that you can delegate to effectively. You get that little bit of brain space and time on your calendar, actually, like put some creative energy behind something, that's whenever you start to realize like, “I should have been doing this a long time ago.” Your front desk team will say the same thing. They're going to be blown away whenever they actually have time to help you grow the company.

It's one of those things where you have those instances in your life where you're like, “Why didn't I do this sooner?”

Totally, man. Listen, it's just like anything. It's not going to happen overnight. It's going to be a little bit of a learning curve, and it might take 30 to 60 days. It might even take 90 days, but I have never put a really good, talented person on my team who gave me some time back and deployed that time into a more important part of the company. I've never seen that not work out ever in the history of business. It's a good deal. I would say that whether it's VAs or automation or whatever that is. Having time on your calendar is the prerequisite to growth. Therefore, it's incumbent upon you, as the owner, to find the most affordable, cost-efficient ways to get your time back. That is the thing that will allow you to grow. Nothing else. There are no other tricks.

It's all about valuing your time over money.

It's all about it. There's no better way to leverage that VA AI mix. There's so much capacity in that.

If the VAs are working appropriately nowadays, they are personally leveraging AI to get 100% right. I see that with my VA, Kevin, under the director of operations, he's just popping out stuff left and right by leveraging AI. It's a huge difference. They're leveraging those tools to get everything done just like we are, and you should expect them to.

For sure. It's here.

Get In Touch With Adam And Inbox Zero

If people wanted to find out about Inbox Zero and the VA that you set up for people, where do they find that out?

Check out the website InboxZeroVA.com . All the information's there. If you're in the Facebook group, you'll probably see a few posts about it and listen. There's no weird pressure or anything. I've done this for a long time. I know when it's a good time to hire. I know when it's not. I'll give you the best piece of advice I can. If it makes sense, we can show you what it's like to work with a good VA. If it doesn't, then that's fine too. Whenever the time is right, we'll circle back.

Cool, man. I’m excited to see you at the conference.

I'll see you there.

Important Links

From An 8x8 Room To A Thriving Clinic: How Jeffrey Smith Built A Multi-PT Practice In Under 2 Years

Mon, 06 Oct 2025 07:00:07 GMT

Most practice owners dream about freedom, growth, and leading a thriving team—but few are willing to suffer through the grind it takes to get there. Jeffrey Smith is one of those rare owners who bet big on himself… and won.

In this episode of the Private Practice Owners Podcast, Adam Robin sits down with Jeff Smith, owner and CEO of Alpenglow Physical Therapy in Billings, Montana. Jeff launched his practice in June 2023, joined PPO Club Coaching just a few months later, and in less than two years has scaled from an 8x8 room in the back of a gym to a 3,200 sq. ft. clinic with five PTs.

They dig into:

Why Jeff knew—even in PT school—that he was destined to be a practice owner
The sacrifices and sleepless nights it took to go from solo hustler to CEO
The hard decisions (and risks) that became breakthroughs
How to lead employees without micromanaging or being “the answer guy”
Why betting on yourself is always the safest bet

If you’ve ever wondered whether you have what it takes to step out, take the leap, and build something bigger than yourself—Jeff’s story is proof that you can.

��️ Learn how one owner turned vision into reality, and why the best investment you’ll ever make is in yourself.

�� Connect with Jeff at jeffrey@alpenglowpt.com and check the show notes for links and resources.

---

Listen to the Podcast here

From An 8x8 Room To A Thriving Clinic: How Jeffrey Smith Built A Multi-PT Practice In Under 2 Years

Welcome to the Private Practice Owners Club. I'm your host, Adam Robin. I got a good friend, good buddy, and coaching client, Jeff Smith, the owner and CEO of Alpenglow Physical Therapy in Billings, Montana. Jeff started his company in June 2023 and started coaching in the PPO club coaching program in October 2023. That's when I went full-time business owner. I'm not going to bring clients on here who aren't doing good.

Jeff's one of the guys. He's doing really good. He's one of the top ten percent in the program. He's made transformative progress in his business. He's a hard worker. He's like a really great business owner. I wanted to bring him on, introduce him to the audience, and learn a little bit about his story and glean some of the lessons that he's learned along the way.

---

What's up, Jeff ?

Good to see you. Thanks for having me on. I'm excited to be here and just talk about my journey a little bit, and the journey has been. A long journey in just two years.

As I'm thinking back, like when we first started this journey together, you were like renting a space, I believe.

Yeah, I was in the back of the gym and had an 8-foot by 8-foot space to myself.

I remember that you got on a couple of calls with me, and you were in your house, like upstairs in an extra room or something, and you looked physically exhausted, because you were working full-time and trying to get your practice off the ground, and you were trying to figure it out. I remember like you were hustling big time. Man, I'd love it if you could just like introduce yourself to the people, to the audience. Tell them a little bit about you, a little bit about your backstory. Why'd you get into practice? How did you find physical therapy? Just take it away. Tell us about yourself.

The Entrepreneurial Spark: Towards Physical Therapy & Business Ownership

I'm originally from Vermont. I'm an East Coaster transferred to Montana. A lot of us East Coasters make it out here. I got on the path of physical therapy as an undergraduate. I like spending time with people. I like anatomy. I was like, “This seems like a pretty good gig.” I just pushed through and got my PT degree. Even in undergrad, I knew I wanted to be a practice owner.

I've always had that entrepreneurial spirit, even in high school, which was always like coming up with businesses and schemes to create a business. It's always been like a passion of mine, even in PT school, I was like, “I'm opening a clinic.” When I got into PT school, I started working for a couple of private practices around, really got a good feel of what the atmosphere looked like, what was lacking. I remember I started listening to the podcast right when I got out of school. I found it. I was listening to Nathan, and I was like, “This is amazing.”

This guy is smart.

I know. The keynote is everything. He's saying in my businesses that I'm working in, and I would talk about it, and I was like, “This guy seems like he's got it figured out. We need to be doing what he's doing.” I jumped around a little bit, and just with where COVID brought things like finances, everything was just tough, being a PT with student loans and everything. It's like, “I think now's the best time to just start my own business.”

Actually, after listening to the podcast a bunch, I actually called Nathan, emailed him, got hold of him, and talked to him for a little bit in January of 2023. He's going to give me the rundown like, “Here's what you got to do.” He's like, “Check back with me in June.” I went all in, opened the clinic in my little 8 by 8 room. It was pretty tiny. I had to collapse my little massage table every time somebody came, and then put it back up, and we had to shuffle around it. I got the clinic and I called Nathan and I started working like a dog right away.

The Visionary Mindset: Cultivating A "Scary" Vision And Saying It Out Loud

I was like, “I'm treating two hours before my job. I’m going to my other job. I'm leaving at lunch to treat a patient, and then I'm going back, and then I'm going back in the evening to my clinic to treat patients again.” I was like, “This is tough.” He's like, “I got somebody they should reach out to.” It took us a little while for me to get in touch with you. Come October, I was like, “I think I'm ready to jump into this coaching because I'm overwhelmed.”

Number one, you said, “I'm opening a clinic.” You were telling yourself that the NPT school. Where did that come from? Who planted that seed inside of you?

I don't know where it came from. As I said, since high school, I've always just been like being a business owner. I think it's in my blood. It was things that are part of me, and I just love the idea of building a business. I was like, “PT seems like a good gig.” I was like, “A PT clinic seems pretty darn cool. Put two and two together. Here we go.” It's just something in me. I don’t know exactly, but I just love it.

It gives me chills to hear you say that. From my perspective, I've been able to talk to so many entrepreneurs and just ambitious people. What I love about it is just learning the way that they think and how they view the world. After you talk to a ton of them, a ton of you crazy entrepreneurs, you could start to pick out some of the common characteristics that separate the ones that are going to be great and the ones that aren't.

Two things really stand out when I get on calls with people. Number one is that they have a vision for themselves that's scary. If you're in PT school, you're a little whippersnapper in PT school. You're walking around telling all your buddies in PT school, “I'm going to open up my own clinic.” What were they telling? They were probably like, “Come on, just pass the anatomy test.”

I remember you specifically telling me, I remember this all the time, it’s like, “That’s too much work.”

You have this big, stupid, crazy vision. That vision continues to grow. The second thing is you're willing to say it out loud. You're willing to say it out loud and know that people around you might not even believe, like they might like to shoot you down. When people do that, I notice that those are the people who always make it.

They always perform, and they're willing to, which goes into my second point, work like a dog. You said, “I was working like a dog” because you were called. You were called to do this. You were willing to sacrifice and hustle and do whatever because you were called, and you had already said it out loud to so many people. It's like you had to do it now. That gives me chills, man.

Scaling Up: From An 8x8 Room To A Thriving Multi-PT Practice

I tell people all the time, for those who are tuning in, if you sound anything like that, that is why I know you're going to be great. That's why, whether you work with us, whether you work with any other coach or whatever, you're going to be great because you're bitten by that thing. That's why you're on this podcast. I'm proud of you, man. That's awesome. Let's fast forward to today because it just started in the 8 by 8 room. Where are you at now?

Now we have a 3,200 square foot space. I have four PTs working for me right now, five, including me, but now I'm stepping back in treatment, working more on the business side of things, focusing on growth and building leaders. That's the big thing that I'm really focusing on right now, and helping people take control of their own things. It's cool. It's a big change up. When we first talked, I remember you telling me, “We'll get you far.” I was like, “If I have 1 or 2 PTs working for me in two years, I'll be psyched. That'll be cool.” Now I'm double where I could have expected I was going to be at that time.

It's awesome, man.

It's honestly an incredible change.

It wasn't easy, was it?

No, it was hard, and different things are hard each time. The beginning was just man-hours of hard work and not much sleep, but now, like we've been talking about, it's mentally hard now that we're figuring things out that aren't so intuitive. In the beginning, it's like, “I need even more patience.” That was hard. I didn’t know what to do, but now I'm building a business and building leaders. It's not just like getting more people in the door. It's figuring out and learning people and really dialing that in.

I love to hear, maybe this is a big question, but I asked you to do some thinking about this, so maybe you'll be prepared to answer it. I'd love to hear as you reflect on your journey, because you've had tremendous growth, and I'd love to hear what you think about. What were some of the hardest challenges that you faced along the way? What do you feel like were some of the big breakthroughs for you along your journey? Can you answer that?

Leaning Into Discomfort: Overcoming Challenges And Pivotal Breakthroughs

Yeah. The hardest challenges were always taking risks and stepping out of my comfort zone, because when I was in that 8 by 8 room, it was comfortable. It was cheap rent. I was working hard, but it was just flowing and happening. To get to the next step, I knew I needed a space, and I remember I was looking at a 1200 square foot space or a 3200 square foot space. The price difference was a lot, and I was kind of like, “I don't know if I can swing the 3200 square foot space.”

It was my own doing. I would have gotten the 1200 square foot space because it was safe. I was like, “I can make that rent payment easy.” I talked to you about it, and you helped me understand, like, “You're going to help grow that 1200 square foot space faster than you think.” I would have thought it was fast. I had to push into that discomfort, and you helped guide me through that, which was a huge breakthrough.

Preaching out, I remember my second PT, that one was an uncomfortable hire because it was just very stressful bringing another person on board, especially one that I had to work a lot harder to get. I had to dig a little bit deeper, find some new tactics to show her why Alpenglow was such a great place to be. That was a lot of discomfort because there were conversations I wasn't used to having. Those were two really pivotal ones. It kept getting easier and easier to have those conversations after you helped me push leaning into that discomfort, and it helped a lot having you just talk through me.

Ground me a little bit and show me that, like, “These are doable things. Trust yourself.” That's a big thing too. You always help motivate me by being like, “You're a good worker, a strong worker. You've got these dreams and you've got these goals.” You help me take the right steps. That support is huge because my spouse is amazing. She supports me, but when it comes to like the business side, it's harder for her to see that, where you can really see it from that business perspective and be like, “I can see the road you're going on, and let's keep driving it.”

Those who are tuning in, Jeff is the perfect client to work with. He's one who's like, we don't have to motivate you. It was just like getting you out of the way, which is so fun because it's like all you got to do is stop trying to do it all yourself, get out of the way, and lean into a little discomfort, and like you always figure it out. That's the fun part. We give you a few tools and a little bit of clarity, and that makes our job super easy. It’s really cool, man. I'm wondering if the next question is a step like leaning into some of the discomfort. How do you do that? What do you feel that motivates you to do hard things? Why are you so motivated to suffer?

I know. That's a lot of suffering. I think two big things. I really want it badly. I know what I want, and I want it bad. I'm willing to sacrifice a lot of stuff to get there. Actually, a big change for me now is that I think I'm so motivated because once I started getting employees that I really like and care about, I also wanted to give them an opportunity. It's more than just motivating for me, wanting it, but I want what they want. That's a huge drive for me now, not being able to create a future for everyone involved because a lot of people took a big risk joining me early on. It's scary. We're the first or second PT higher to this.

The answer is no.

It's like they took a big risk on me. I want to lean into that discomfort, do uncomfortable things so that they can grow and have opportunities to do uncomfortable things themselves too, and grow as well with the business. That's a huge motivator for me now.

I can see that. It goes back to that thing. Sometimes you need reminding that it's not all about you. There are people who are counting on you to be uncomfortable and to do the hard thing. When you do the hard thing, you do the hard thing, you learn the skill, whatever it is, bet on yourself, you elevate yourself. That's the thing that gives everyone the room to follow you. If you stay small, they stay small.

Learning From Setbacks : Navigating Mistakes In Hiring And Leadership

You don't grow. You don't give them an opportunity to grow. That's awesome. Tell me about the mistakes you've made. What are some of the biggest mistakes? Failures are always our biggest teachers. When you look back and you're like, “I really screwed that up,” or “Maybe I didn't do that as well as I could have.” When you think back, where do you feel like some of those mistakes are?

There are so many, from small to big. The small ones are small business mistakes, such as not filing my unemployment insurance soon enough. That's small, but those are bound to happen when it's your first time in business. Bigger mistakes, luckily, I haven't lost any employees yet, but I've lost opportunities with employees because I wasn't confident enough in myself and what I was offering to instill confidence in them for what they could have here.

Those are some of my bigger mistakes I've made. It's all a learning period. I've had interviews where I haven't really nailed it, and they can sense that I get really nervous in the interview process. It's stressful for me. I was interviewing that one individual, and I kept calling you because I was like, “I think I'm losing it.” We pull it in, but I just got myself in too deep in the beginning, on just the wrong path, where it just wasn't recoverable, which is unfortunate because I think they would have been an excellent fit.

That's how it goes. I learned from it. Now I feel much more confident in my interviews. My last hire was smooth. I definitely showed her how great it is here. I learned a ton from that. As well as I've made mistakes with interactions with my employees, just not being the answer guy is one of my big mistakes too, which we talk about a lot. I think that I have to be the answer guy all the time. That's created difficulty with personal growth for my employees, as well as understanding the clarity of where they're going.

If I'm answering all the questions and they're not having that self-realization, then it's hard for them to understand for themself where they fit. That's one of my big mistakes as well, which I'm learning from. I've learned a lot from you, and we've actually been working on that. I think it's getting better. As well as micromanaging. That's another mistake I made for a long time, and it really deterred people. Luckily, with you guys and having problems, like something really blows up in my face, where you're able to objectively look at it, be like, “Why don't we try approaching it in a different light, a different manner, and we can reorient the course?”

Mastering The Interview: Building Trust And Finding The Right Team

For those who are tuning in, we're talking about the enrollment interview process. I think I shared with you a script for the enrollment interview. For those that are tuning in, tell me what the enrollment interview process looks like? When you're conducting interviews now with candidates, what does that look like for you? What's that process like for you?

Now I've pretty refined it down for physical therapists specifically, the first interview is really just getting to understand the individual that I'm talking to. Genuinely being interested in what they have to say and learning in depth about them, who they are, what their goals are, which is crucial because then it gives me the basis where I can rule out either for them or however our goals and their goals align. Once we get that, we set a second interview. In that interview, they are told to come to the meeting with the team and spend an hour with the clinical director.

They spend about two hours shadowing, and we have lunch somewhere during that time. They spend an hour with me where we really dive a little bit deeper into the details, where we talk a little bit more in depth about their professional goals, where they can fit into it, and where they can grow within the business. That's really helped just by gaining that genuine interest right off the bat in them. That's really, I think, the biggest change that came for me.

I love how the first step of the interview is not to ask questions. It's not to talk, it's to listen. When candidates come to you or when they're having a conversation, people build trust through their story, not through your story. When people get to tell their story, they naturally grow fonder of you. They grow more comfortable with you because they're actually open and vulnerable with you.

A lot of times, and I've made the mistake of missing that, of treating my interviews like an interrogation and being like, “Tell me about this. Talk to me about this. What's the first time you did this?” It's rigid and structured, and you don't really build trust, especially in today's profession, where a lot of therapists are burned out and overwhelmed, and they do feel frustrated in the industry. Just being really intentional and showing up and allowing people to, like, give them that space to tell their story is like such a powerful way to start the interview off.

It's incredible how powerful it really is.

There's a new practice owner starting a practice, and they're thinking about it, but they're not really sure. What is some of the advice that you'd give them?

You just got to do it. You've got to trust yourself and bet on yourself. There's no better guarantee than yourself. You're the best guarantee out there. Invest everything in yourself and go for it because when you get to be the deciding factor, you're not going to let it not happen if you get to make the decision of it happening. It's worth it. In every way, working for yourself is unbeatable. I'm a million times happier than I ever was in my profession at any other point.

That's awesome. What's next for you? What's the future look like?

The Future Is Bright: Expanding Alpenglow And Empowering The Team

We're still trying to grow. We've got something amazing going. We're really focused on growth right now. We're talking about clinic number two. Hopefully, we're looking for a couple more staff members to help get the clinic along, move along. We're not sure where clinic number two is going to go. Is it going to be a pelvic clinic?

Is it just going to be another outpatient clinic, or are we getting dialed in on this clinic right now so that the second clinic can be happening hopefully early next year, is the goal on that. Get that rock and rolling, building our leaders so they can take over, and I can just focus on building the business. We're super excited about that. I know everyone's excited, too, about continuing to get opportunities.

I think that builds a lot of excitement for people as well. We talked about this, where it builds that excitement for people to be a part of that growth. A lot of businesses don't see themselves in the future where they're like, “We're thinking of opening another clinic. Maybe I'll be able to manage that one. Maybe I'll be able to go over here and have a clinic owner go back to my hometown and open a clinic there.”

I really want to support people to take those leaps, too, and be there for them, so that's something they aspire to do. They can open it. Once we get clinic number two going, hopefully, we'll see if it just keeps flourishing and keep changing the way PT is in the area, and just really offer high-quality services that are trying to shine. I think we do a job.

I love how your vision expands. It's like as your vision expands, once your vision grows, now you're talking about opening up another clinic or expanding, now it gives people underneath your room to have their own vision within yours. That's super cool. That gives you something to be excited about.

A ton of excitement. We've worked really hard in our meetings. Alignment is a really big thing we work on. We do a lot of stuff to show people that work is work, but work's also fun. I think that really helps with our growth and getting people involved to do quarterly outings, where we'll take a half day once a quarter, and we go out and have a good time and hang out as a team. That's a ton of fun, but they say, I think it's like, “Spend 75% of your thirties with your coworkers.”

I'm like, might as well have a good time with them, too. Trying to build more fun with everything, too. That's a big thing that we're really focused on, and keeping it fun because I love work. I'm maybe a little different where I really do like work, but a lot of people would probably rather be out in the woods doing something fun, but I like to make work as good a place to be as any. That's a big goal for us.

There are probably 1 or 2 people who would benefit from reaching out to you and just getting some advice. If somebody wanted to reach out to you, how would they get in touch with you?

They can email me. My email is Jeffrey@Alpenglow-PT.com .

Awesome, man. I'm going to send them your way. If people reach out to me, I'll send them your way. Jeff, man, I really appreciate your time.

Thank you.

Important Links

About Jeffrey Smith

The Financial Plan Of Care With John Askin

Mon, 29 Sep 2025 19:00:00 GMT

Most practice owners work 60+ hours a week trying to grow their business – yet when it comes to their personal and business finances, most are flying blind. What if you had a simple “financial plan of care” that gave you clarity, confidence, and a roadmap for building real wealth?

In this episode of the Private Practice Owners Podcast, Adam Robin sits down with John Askin , a financial planner who specializes in helping clinicians and practice owners take control of their money. John shares his journey from Division I soccer player to financial coach for practice owners, and explains why most clinicians never learned how to extract wealth from their business.

They dig into:

· Why cash flow is the number one metric owners must know cold

· How to separate business and personal finances so both thrive

· Why your business is not your retirement plan and how to fix that

· The “financial plan of care” framework that mirrors how PTs guide patients through rehab

· Why paying yourself first isn’t selfish – it’s essential

If you’ve ever felt like your practice is growing but your personal wealth isn’t keeping up, this episode will challenge your perspective and give you a path forward.

��️ Learn how to build financial health in your business and at home without the overwhelm.

�� Connect with John on LinkedIn, check out his YouTube channel, and find resources linked in the show notes.

---

Listen to the Podcast here

The Financial Plan Of Care With John Askin

Welcome to the Private Practice Owners Podcast. I'm your host, Adam Robbin. I've got a special guest, a young hustler, financial planner John Askin , and he specializes in working with practice owners, helping them set out financial plans in their practice. He's all over LinkedIn. If you guys haven't seen him, check him out. He's going to tell us a little bit about how to put together a financial plan and make some money. How about that?

Sounds good to me.

Financial Planner And Money Therapist John Askin

Introduce yourselves. Tell us all about you, man.

Where to start? In the beginning. You're absolutely right. I've been working in this space. I'm a financial planner. I work here in New Jersey, based out of the Jersey Shore. I got into this space right out of college. I was studying finance in college, and I didn't really know originally what I wanted to do. I interned in this career and really fell in love with it. I really liked working with people, having a direct impact on their lives, and being client-facing.

I didn't really want to sit behind a desk and work for a corporate company in New York City like a lot of people do in the metropolitan area around me. I was always an athlete my whole life. It always was something where I thought a lot of athletes gravitate towards this career. There is a sales component to it. There's a hustle. You've got to build up your own practice basically from scratch. I saw it as almost like a challenge, and it definitely was. When I first started, it was just to be everything to everyone. I didn't really have a niche.

You cannot really niche down too soon. We'll get to how I got there. I started to find that there was a gap, and I enjoyed working with a lot of practice owners. I had some connections, thankfully in the space specifically in physical therapy, that I had known and just naturally reached out and said, “Listen, this is what I'm doing, I'd love to tell you about it if there's any way to help, absolutely. If not, just want to get my name out there.”

They actually started to say yes, like, “Yeah. I had a question about this.” I put two and two together, and I came to the conclusion that there's a lot of really intelligent business owners out there when it comes to being a therapist and/or a physician or a doctor, and they're doing that and then starting the business. When it comes to the planning aspect and extracting wealth from the business, all that stuff, there's no real education on that.

It's pretty much either that, maybe they had a mentor who probably didn't have any education in that, and schooling, you go through all these years of schooling, and it's not really talked about. I thought naively, it was like, I thought they knew everything. I'm like, “They're a doctor. I think they know all this. They should.” I go and talk with them, I'm like, “They don't.”

They probably should because they're so successful in terms of everyone looks at doctors, PTs who have higher education than most, but the financial aspect of things was never really talked about. I carved out my niche in that space and have been doing that for about three and a half years now. I'm working primarily with individual healthcare clinicians, PTs, OTs, physicians, surgeons, and also the Private Practice Owners, helping them create what I call their financial plans of care. It's been really fun.

I enjoy working with these people. I think it's also due to my experience as a patient myself. I think that's also maybe a good segue here. I was a Division one athlete, played soccer my whole life, played at Monmouth University here in New Jersey, and never so much as had a minor growth plate injury in my elbow when I was eleven. That was like my only injury, and I ended up tearing my ACL. Pretty major injury in sports, extensive recovery, did the whole rehab process.

It was really just trying to get back to playing at that point. I didn't really care. I was a sophomore in college. It's like, “I just want to play soccer, man. I'm not worried about where I'm going to be in my career five years from now.” It comes full circle. I can speak from experience about that process and have essentially formed my entire financial planning process around it, similarly to a patient's rehab process.

I found that the simpler I can make things for clinicians and owners, the better and the more they actually implement. Money's tough, number one taboo concept. There are a lot of moving parts as a practice owner. That oftentimes is one of those things that, “I'll get to it when I get to it,” or “My business is my retirement plan.” A lot of those things come out, and I've been a sounding board for those people and found that they're willing to listen and also work with someone like myself because they don't know what they don't know a lot of times.

As I said, full circle started out in this career. I didn't really know the path I was going to take. Maybe by chance, I fell into this. I wasn't really planning on going this route. Part of me was like, “I'm going to work with professional athletes,” or something like that, because that's what my experience was. I just carved out this niche, and here we are talking on this show, man.

Keeping Your Finances As Simple As Possible

I love the hustle, man. I love how you mentioned just be everything to everyone. Through those repetitions, you found your niche. You found the gap that you're talking about with practice owners. I also love the idea of the financial plans of care. I want to get into that in a little bit. First question that I have is, you mentioned simpler is better, or maybe you didn't say that, but that's what I think. Let's keep things really simple, right?

Yeah.

If you had to bullet point like 1, or 1 to 3, these are the three things you have to get right. Do you know what I mean? With financial planning, whatever that means in your world. It could even just be the one thing. What are those 1 to 3 maybe items that you really feel could make a big impact for practice owners?

I want to preface this with, and this can sometimes get misunderstood, maybe when I say this, simple is very different than easy. It's simple, it's not necessarily easy. There's a big distinction there. I'll see where I'm getting to there.

The answer is always easy, but it's always challenging to execute. It's the execution that's the hard part.

It's a simple concept. Like, “I can do that.” It's just when life gets lifey, I always make a joke of you got to stay disciplined.

It's always easy. You want to get in shape, so start working out.

Start working out and eat a little less junk.

You want to have a business, so start asking people for money. It's always easy, but it's hard to execute.

Yeah. The number one thing for practice owners is what I see 9 out of 10 times. There's very rarely that I come across an owner who has this down to a tee, and it's just business in general. They're not these massive conglomerates like Amazon and Google that got a CFO and ten people working under them, and they know their numbers and they got public reporting, all that stuff, but the cashflow.

Not necessarily just the business's cashflow, but also their personal cashflow. I have to sit down, and that's like, it could be two bullet points, but I put that under the one most important thing, you have to know your numbers. I'm talking from someone who's probably a little more established. When you're first starting out, maybe it's just you, or maybe you and one clinician. The most important thing is just getting more patients in the door.

You've got to grow first before you have to give a crap about what your profit margins look like. You've got to actually have a business running and a well-tuned machine. When you're at that point, it's really important to understand your cash flow because most business owners are making a lot of money. They just don't feel like it because they're spending on a whim.

I get that.

They don't know when the right time is to hire a person. They're waiting until it feels right, like “We had a great month. Now I can hire,” instead of like, you probably had three months of that, but you just weren't looking at your numbers enough, or you didn't know them down. I make a point of saying to clients, “Listen, I should be able to wake you up in the middle of the night, and you should be able to recite to me roughly what your revenue is at year to date.”

What's your EBITDA? What's your cash flow look like? Are you operating in a deficit this month? Not to the dollar, but you should know the answers to that as the owner. A lot of times, the response is, “My bookkeeper has that,” or “My accountant has that.” It's like, “Great. You need to know that, though, because your bookkeeper doesn't give a crap as long as you pay them monthly for their services.”

Their job is not to tell you, “You have a thriving business or not.” Your accountant's job is also not to tell you that either. They're there to tell you, “Here's how much you owe, here's a couple of things we can do,” or “Here's how much you're getting back. Here's your monthly, your quarterly estimates that you need to be making.” Other than that, it's on you. If you don't know your numbers, you're lost. It's like navigating, you're just like, “I'm driving down this road and I'm heading west. Eventually, I'll get to California, I guess.”

What if you keep driving and you just go right to the ocean? Knowing that is really important because once your numbers are from a financial planning and like a business planning, because I always differentiate the two, especially for owners, and this will be great for anyone who's tuning in, there needs to be almost two plans. Every owner I work with has two plans. There's the business plan from a financial standpoint, and there's a personal plan. I'll pick on you, Adam. Adam's personal plan of what he wants for his family, his legacy, his kids.

What he wants personally out of life, but also the business side of things. What is the business doing to grow? How much are you investing in marketing? How much are you investing in your building and the products that you buy or sell, or anything like that? They're two very different things, and a lot of times this starts to happen. It's co-mingled. It's like, “I'll buy the house or the vacation home when this happens in the business, or I'll just take a big lump sum and I'll make it back in the business.”

Oftentimes, they're co-mingled, and there's no real strategy or vision around, like, how are you going to take what the business is creating to build your own life personally, but then also not rob from the business's profitability and where you see the business in twenty years. That's a really tough thing to do because it takes a lot of work, I won't lie. I'll give an example of a practice owner I'm working with now.

We onboarded them at the beginning of June. We've had about twelve meetings since then. They went from only making like $300,000 to now doing about 2 million a year. They've grown very quickly. With that comes a lot of things that you now have to implement. Hiring and taxes are a big thing now. You don't realize how much you owe and all that stuff. It's been a lot of work. I'm not saying that to scare you. It's just that they're going to be in such a great spot in ten years because they started it now, rather than if they started ten years from now and then they were like having that, crap moment of, maybe now I should probably start figuring this out.

All that opportunity cost they lost along the way. Again, not to get too detailed on it, but I really think the cashflow is so important when it comes to, especially to business owners, because there's so much nuance. If you're a W-2 person and you're in a single-income household, you have your monthly bills, your mortgage, there's nothing wrong with that, but it's a lot simpler to track everything.

When you're taking income or salary as a business owner, and how you structure that, and how you pay your employees and benefits, and all that stuff, you need to know what your cash flow looks like. That's why I say if there was one thing that they need to know, it's that. That's what a lot of times we have to go down, and the answer is “No. It's my job, and they hire me to do so that they can say in three months. Yes, I know it in the middle of the night. I know my numbers.”

I love that. That lands because that's where we start in our program as well. We always start with the data. You cannot really make decisions until you understand how those decisions affect your business. The language of your business is data, metrics, and numbers. You have to learn how to speak that language. We start with data, and we cannot really even implement systems until we understand our data. We have to have data.

Why Financial Planning Should Be Personalized

I got a question, though. What I generally recommend, and I might change my recommendation based on what you'd say. I'm sure you've heard of the 50/30/20 personal plan, where it's like 50% of your income is spent on needs. Was it 30% on wants? 20% is savings or whatever. That's what we do in our home.

A lot of, for me, I felt a lot of freedom when I defined that first. Whenever I was like, “This is what my home needs to operate.” From a bare bones perspective, like I got two kids, I got a mortgage, I got a house, like I have to have X amount of dollars coming into my home every month in order to live and to function. I would basically demand that from my business. The question became, how do I create that inside my business?

I want to create that as an expense line. Adam's home, whatever that is, through salary and distribution. I find a lot of comfort whenever I define what I need in my personal life and demand it from the business. Not the other way around, where I define what I want in my business and demand it from my personal life, because then that's when you start to get that, “I'll just work later. I'll just borrow money from the business,” or “I just won't take a salary this week.” All those things. How do you recommend starting? Where do you usually start?

I mean the 50/30/20, if it works, think that's great. Everyone's different. There's 50/30/20. Sometimes people are like, 30/30/30, or 30/40. Everyone has a different number for their lifestyle. It's very different, like if you have a wife and two kids or if you're single. You don't have a mortgage. There are very different things. Number one, financial planning is personal. There is generic advice out there. It's generic for a reason.

That's definitely generic. I got it from the internet.

It is, but you've personalized it to you, though. Because if it didn't work for you, you probably have something different. You said, “No, I'm going to have 50% because that's what I think makes the most sense for my family. If we ran the numbers, it'd probably be a little bit, maybe it's totally, I've heard. It's probably going to be skewed a little bit. You stuck to it, and it works, and that's the best thing. For someone else, it might not. What I do a lot of times, and it does vary because I don't think there's a one-size-fits-all approach. We implemented something called a reverse budget for owners. It's basically the same type of concept. I almost explained it differently. You're paying yourself first.

Love it.

Meaning a business owner. I'm to use the business owner that we're working with right now because it's top of mind for me. They're saving for a house that they're looking to buy in the next year. That's automated. We're saving $25,000 a month towards that out of the business. We're automating their 401(k) contributions as well as profit-sharing component. That's a non-negotiable for them because if they want to get where they want to be in retirement, we have to do that. They understand that.

Again, this is someone who's humming in business, so we can tap right down to maybe a little bit smaller scale, but I'll start there. It's okay. How much do they need to save for taxes? A lot of business owners don't realize, at least when they're first starting out and they're starting to make money, it's like, you've got to make quarterly payments out of your business, safe harbor, what are those? We automate that.

We have them basically automating that to a separate bank account for taxes only, so that they don't even have a chance to spend that in the business. I've seen multiple times where business owners are like, “Get money, receive it, and then it's like, “Crap, by $300,000 in the bank account isn't really $300,000 because I know X amount to Uncle Sam.” We've automated all that. Done. Whatever that is for you, you have to define it. It might not be to the extent that my client is, but maybe it's you're doing a thousand bucks a month into your 401(k), or even you don't have that.

It's what I am reinvesting into the business until I get to that point. Once you've done that, “It's okay. I've taken care of it. I paid myself first.” After that, I take care of exactly what you did. What do I need to live off of? What are my fixed expenses? You have to be really strict and understand this because sometimes people can get lenient with what is actually fixed. Food, shelter, water.

Totally. Thank you for saying that.

That is your fixed expenses. I also need to have hard conversations with people.

You cannot donate to the charity every month.

That's another thing. You've got to put your oxygen mask on before helping up.

I have these conversations with practice owners. They're like, “I'm barely making money.” We look at their books, and they're like, “I'm donating a dollar a month to charity, and the business is paying for my mortgage.” You've got to pay, like that's not the way this works. You're saying not 47 visits a week, like you got to hustle.

If you have kids, it's like “How do you put food on the table? How do you keep your utilities bill, your utilities bills,” all that stuff. After that, you're going to probably need a car to drive, but if you're a practice owner, listen to this, don't go out and just buy the nicest car because you can, and there's the whole section 179 write-off in it. This isn't tax advice or anything like that, but I know a lot of business owners can get a little bit lenient with that.

Remember, if it's a write-off, it doesn't mean it's free money. It's a savings, you actually spent, you're in the 30% tax bracket. You spent 70% on that. You didn't save 30%. Don't get that confused. Identify what you need to actually function, what your family needs, in the same way you did. Everything else, you don't really have a problem if you like to spend a little bit more that month, or you reinvest a little bit, or you splurged and went on the vacation because that extra money was discretionary.

Meaning you already took care of your future self, you took care of your current self. The rest of the money is there to enjoy the fruits of your labor. What do most people do? They enjoy the fruits of their labor, they barely scrape by with their mortgage and their fixed expenses, and then they save what's left over, and it's usually not a heck of a lot.

When that happens, the longer you do it, like any habit, the worse it gets because it's a hell of a lot harder. They always say, “I'm going to do it when I make a million,” or “If I make a million and a half, my business is making $3 million.” Guess what? When your business is making $3 million, you're going to somehow figure out a way to spend $2.9 million.

You are not lying. That's so true. I've had to learn that the hard way. I used to think just like, it's the whole problem with thinking that top-line revenue is what matters.

Go make more money.

It doesn't matter.

“Next month, I'll treat five more patients, and I can pay for the vacation.”

Two things that land for me. Number one, your business is starving, and it has an appetite that never ends. Any money that comes in, there's going to be so many things trying to grab that money and gobble it up. It's going to be people trying to sell you a coaching program. It's going to be a new EMR. It's going to be Amazon.com , whatever. It's going to be people stealing from you.

The BioDex machine's got to come in.

Your Business Is Not Your Retirement Plan

It's all the little things. If you're not disciplined with them and you're not funneling that money down to the bottom line with intensity and some type of demand, it's not going to make it there. Your business is starving. It'll never get full. It's going to eat everything that you allow it to eat. I'm stealing this from my friend, Greg Todd.

He said, basically, like you said, “In the beginning, we make the mistake in thinking that we're just going to work our ass off and then whatever's leftover at the end of the month, we're going to battle for ours. If there's anything left.” When you operate that way, you're essentially telling yourself in the world that the only thing that you're worth is the leftovers. I like the leftovers. Nobody likes leftovers, man. Let's be real.

They're not as good.

You want the hot and ready, man. You're that first bite. Pay yourself first. You're valuable. You're worthy. You, as a CEO and the owner, and your household and your kids, like don't be greedy, but also recognize that there is a need and a necessity that you have to have. If you're not taking care of yourself, you're not going to be able to take care of everyone else. Pay yourself first.

I have a big saying or philosophy on this, especially with practice owners, that there's a big misconception. This is for most, not all, but most. Most private practices in this country, whether you're a doctor, a PT, or an OT, are not the conglomerates like we're seeing across the country. They have 3,000 clinics, the ATIs of the world. That's not you.

You may have maybe 3 or 4, and it's you and maybe 30 to 40 employees. Some or most of them are even smaller, actually, from what I see, the ones I work with. Your business is not your retirement plan. The quicker you realize that, the better. I'm not saying it cannot be, but a lot of times people have this mindset because they see the Jeff Bezos's and the Elon Musk's, the world that builds all this wealth, and then they could retire and obviously whatever the hell they wanted to, they don't have to work.

Even on a smaller scale, someone builds up $100 million construction business. If they sell the business, there's probably another construction business that's willing to buy it. It can run seamlessly without the CEO being there. This ties into your coaching that we talked about on my podcast, but a lot of times, they're their own worst enemy and bottleneck in the business because if they go to sell and they don't want to stay on, their business is not worth what it's worth, what they think it is.

You could be doing $2 million a year, but if you're the main person running the show, or if you and maybe your wife or someone isn't going to be around for the company that's going to come by you, or the new PT that you've mentored that's going to buy you, the business is not worth it. If that's your only retirement plan and you're banking on that, you're setting yourself up for failure. I'm not saying that it cannot be there because you're probably going to be able to sell it for something. It's still a business.

Here's the risk. I know this because I've got a good friend who's in the mergers and acquisitions space. Ninety plus percent of the practice owners that he works with are people who have held onto their business for too long. They got older, they got tired. Their skill sets, and I don't mean like treating patients skill set, but I mean like business, like keeping up with technology, innovation. It takes some energy to be on the cutting edge, and if you get behind, people start leaving. You lose some key leaders, and the next thing they're there by themselves with a front with an aid, and their business isn't worth anything. You've seen the old boxers that they want to go in one more round, one more fight. They end up getting knocked out.

They get killed.

That's the same thing with business owners. We don't usually go out with a bang because usually we don't have a real plan of exiting until it's too late. Start early, have that plan now, and also definitely don't bank on that being the home run, because it might not be.

I always talk about extracting wealth from your business. Not in a greedy way. It's not that you're going to extract all the wealth from your business because then you're basically funneling the blood out of the body. How much can we take from the business and build in Adam's personal accounts or investments so that he can one day say, “Even if this business sells for pennies on the dollar, I've built up my net worth over here and I use this business as a tool.

Maybe I was able to pass it on to the guy I mentored, and I wasn't worried about the top purchase price for him because I remember my shoes back in the day, and I would have wanted that opportunity for myself. Because I put my own oxygen mask on financially, I could then go and help others. The more likely scenario if you're going to sell to a private equity or maybe another bigger business that you're going to merge into, well, guess what?

They're going to look at every single thing and dissect it and analyze, and they're not going to sell for what you think it's worth. The whole “I sell for three times revenue,” whatever that came from. That's probably not going to happen because then they ask you the question of, like, let's say you're 65 years old and you're like thinking, “I'm going to get this $5 million payout and then I'm going to ride off into the sunset, retire and live in Florida every day of the year.”

They say, “By the way, you've got to stay out with us for ten years.” You're like, “That's a lot different than what I planned for.” They're like, “No, you can do that, but just letting that $5 million now it's $400,000.” You're like, “I put all my money back into the business, into my people. I thought I was doing the right thing and then I'm left here like I either got to stay and work as an employee now to a bigger company,” or “I got to sell for something that's not able to sustain what I thought I would.’”

Meanwhile, if you have the whole time, you have leverage and you're like, “I got $3 million out here and I've used that and built up my bank, role on my personal side. I've got the leverage now. I don't need you. I can go on to this thing, and they can go to zero, and I don't care.” You have a little bit more leverage. At the end of the day, everyone ends up winning because of that, because if you have employees, you're not just letting go of the business for the top purchase price.

It might not be the best fit for what you built up, and you're just selling to the person who gave you the most money. You made friends who were employees who worked with you for ten years, miserable in the process, and so you just wrote them off. There's an aspect of being a little bit selfish when it comes to that, for like the 30 years of building the business. Instead of trying to be like, ‘I'm going to put everything in the business, I'm going to sell it.”

When that time comes, you're shocked. I've seen that. That's a lot of times what we talk about is, like you said, paying yourself first and having a strategy. You really need to come up with an exit strategy. Personally, I think at least five years before you're even ready to sell. You've got to make sure your books are in order. You've got to make sure your numbers are the most important thing because they're going to ask for it day one. You think I'm asking for it, wait until you go to sell and this. Let's see the books. “Bookkeeper, can you get the QuickBooks?”

“I haven't talked to my accountant in a year.”

Like, “I got to get my bookkeeper. Can you update QuickBooks for the last seven years?” Maybe I should have updated those quicker. I'm really a big advocate of that, like that's all where those two different plans come in of having a plan for Adam personally and having a plan for the business, and how do those work? It's all one big plant at the end of the day, but there are two aspects to it. That's a lot of times what I sit down and work with.

That's the hardest part because we're answering some questions that probably haven't been talked about before. It's always been about how much bigger can I make the business? How can I grow? How can I get more people? All of a sudden, you wake up and you're like, “Maybe I didn't think about myself as much.” It's no fault of your own because you do have to a certain point really only care about the business, or else there's no business to even extract wealth from.

It's the leftovers, man. You get the leftovers.

I think this is a good segue into that financial plan of care that I've come up with. Number one, I think it resonates with clinicians because you guys are implementing plans of care all day long. That's the business model. How many completed plans of care? How can we make sure that we're having them completed from start to finish? I try to make, like I said, speaking the language and making it similar to that process.

I think a lot of times it can be scary talking to someone in my industry. There's unfortunately a stigma around it that it can be sleazy and salesy, and you're going to be pushed into something you might not need, which, unfortunately, there are always bad actors, but I think I lead with the plan and let everything else follow with the practice owners and the collections I work with.

The same way someone would tear their ACL, and you're not like rushing to sell them the newest knee brace, you're like, “Let's take it one step at a time. We're going to have the pre-hab, then we're going to have the surgery, then you're going to come in, and then we're going to start out. We're going to start small.” Eventually, you might need a knee brace when you go back to certain activities, but we're not just shoving that down the throat like day one. It's like, when I implement, because I remember for me, like I refused the knee brace.

I was like, “I'm playing soccer. I literally trap a ball on my thigh. I'm not wearing this massive brace. I'll figure out how to do it without it.” I talked to my PT, and he was like, “That's okay. We'll just make sure that you're a little bit stronger before we give you the okay to go back to playing.” Again, it's very personalized, but back to the plan and care thing. I say, “You guys are really good with muscles. I'm good with money.” It's the same thing, just a different M. We're still going to take the same approach. It's an acronym.

The C is the clarifying of the goals because I think everything needs to start with what your goal is. You can save $1,000 in an investment account, but for what? If you're someone who's like, “I don't really want to retire, like I might want to work until I'm 70.” Very different than the person who says they want to retire at 55. Different needs. We have to clarify those goals. What do you want? Someone in your position who has a wife and kids is very different than the person who's single.

It doesn't have a lot of expenses or a mortgage, and they're just running the business because that's what they want. You've got to clarify those goals. You really got us, the A is the assessing of the finances. This is the knowing your numbers. Actually, the first part is me getting clear on, like, what is your goal? What the heck do you want to accomplish? I can help you get there, but if we don't have a vision, like we're just wandering on a path.

We don't need to, we're going. If you don't have vision and clarity, you're never going to get there because the days get hard. You're like, “I don't really know what I'm doing this for. If I slack off, it doesn't really matter.” If you're like, “No, I've got to get my kids to college. I got to pay for that myself. I don't want them to ever go into debt and be able to retire and be with my wife at 55.”

You're setting budgets and restrictions around your life. It's going to be tough. You've got to want it. You've got to know where you're going with it. Make sacrifices, right?

Yeah. That's like anything, like I know you train for races and things, and I do the same thing. If I say, “I'm going to run the Philly half-marathon, “I'm just going to show up and run,” but like, “I'm probably not going to do as well as if I implement a plan.” I actually have a plaque here. I ran 42 hours in New York, so my goal is 30 for this one. It's a very different training plan than someone who's trying to break just two hours.

Different regimen, and there's nothing wrong with either, but if you have that clarity and that goal, you have something to work towards so that those harder days, they become just that much easier, like, “If I want to get there, I've got to just do it.” There are going to be days that suck in training. I don't care if you're an athlete or a business owner or anything, there are going to be those crappy days. It's human. It's what happens.

I do financial planning, and there are some days when I probably spend a little more on this. I come back, what do I actually want to achieve? What are my goals? I'm like, “Let's do the 24-hour cooling off here to see if I actually need to be there.” Anyway, that's assessing the finances after we get clear on our goals, because then once we have the goals and the finances figured out, then we really have the recipe for success of what we have to work with and what we are working towards.

How can we allocate that capital to accelerate how quickly we can get to those goals or keep us on track so that we can accomplish them in the timeframe that we need to? It's different for everyone, but that's where I come in, and I make sure that I'm asking the questions that they probably may not have thought about before, the hard questions. Sometimes the layups are like, “When do you want to retire? What do you want to do with your business?’ It's like prying and prying and really getting down to the root of it so that they're buying into the process.

Same as a patient. If you got someone that comes in and you're like, “We're just going to get you back and you'd be able to walk a mile,” versus the grandparent that might come in and be like, “If I'm not able to play with my grandkids, like I have no purpose in life.” If they have that reason to show up to PT every time, and you like almost drive that knife into them like, “Listen, this is why we're doing this. I know it sucks, but if you want this outcome, I bet you they're going to show up more than just to need my knee to get better.”

Your Business Is Not Your Retirement Plan

You're like a coach, too. A hundred percent like coaching people to maintain accountability around their plan.

I call myself a money therapist.

You're like a PT. PT is the same way.

That's why I love working with people in your position and owners, because they understand what a plan is. Number one, because they've been taught how to set a goal. You go to school to learn how to implement plans of care for patients, except that the roles are reversed. “I'm now your PT. You're the patient. We're just talking about money.” Once you've coached and been a player, you can get both sides. It's very easy.

I found that practice owners and clinicians get it, and they actually implement it more than most. I have other clients that are not clinicians, just for my career, referrals, and things like that. They're a little bit tougher to work with, depending on their career and what they've done in life. I've found that that's also why I really love working with them, because once we get the buy-in, it's like, “Take action,” because business owners, the best ones, they don't second-guess things.

They take action, look at the results, and fix. How can I complete and just take action, learn from it, and get better? The R is the recommending of strategies. It's like, “Here's your goals. Here's what I'm recommending.’ It's not that it's the law, and that's my advice, is the end-all be-all. They're paying for the advice, but it's more of, “Here's what I'm recommending. I think I can get there.”

We almost have another brainstorming to make sure that it makes sense. Maybe we're adjusting some things. Maybe I said to save X, and it just wasn't as achievable. “Let's dial it back a little bit, but we still made progress. That's the E part, which is the most important in my opinion. It's the evaluating of progress. It's the same thing in treating a patient.

I show up, I'm going to use myself because I can speak on that the best. I tore my ACL, and I showed up to PT after getting surgery, and my knee is looking like a bowling ball, bruised and in pain. If my PT just handed me a piece of paper that laid out the plan of care for the next 12 months, for 10 months, he said, “Here you go, bud. Put this together. Good luck.”

“You got it, kid. Open the leg.”

I would not be on that soccer field. I didn't have ChatGPT to tell me how to do it. It would not have been as successful if I weren't showing up every week and committed to getting better. I was the one who had to actually do the work, but I had the sounding board and the coaching aspect to like, “Do this,” or “Tweak this, or “We're going to ramp this up,” versus like, “I need to do ten squats and knee extensions.” That was easy, but whatever, I did it.

It's your coach, man. You're a financial expert. I can totally understand, especially with practice owners, business owners, like we're busy. We don't think about money. We worry about money more than we think about money. I love how you are able to look at the financial health of their business without emotion and play offense. How do we play offense? A lot of times, with business, especially with private practices, it's hard to win in private practice.

They're good at defense.

You’d be like the leftovers, and there's a lot of fear and insecurity around our money. It's just think about it. Here's this person in the corner working 80 hours a week, fearful, insecure, and you're just tired and burned out. You're probably not going to have good financial health in about 5 or 10 years. What do I mean?

Yeah. It's going to bleed into that.

I could definitely see how working with somebody like you would be super transformative, man.

Evaluating and looking at progress, it's almost the accountability aspect that's more important. It's like, “You told me this is what you want to achieve.” Six months later, your motivation is fleeting. You're probably not. I'm going to be here saying you told me this, “Let's have a meeting. We're talking about this now, forcing you to do this.”

Also, maybe the business grows and then you have to pivot the plan and make new goals, or it shrinks. Maybe you sell something. I totally get it.

It's always changing.

Get In Touch With John

How do people get in touch with you? Where do they find you? I'm sure somebody could use your help.

The best way is that I'm really active on LinkedIn. That's the best way to reach out to me. Shoot me a DM there. My contact info is in there. If you click the button, you can probably send me an email and stuff, but shoot me a DM on LinkedIn. Give me a follow. Connect with me. If you want to have a conversation, I always lead with like an intro call to see if it's even a good fit.

Some people are a great fit. Some people are not, I'll be completely transparent. I've got a ton of resources. If you're looking for things and you're like, “I got a question about this.” Don't feel ashamed to ask, and I've got a bunch of PDF guides that I give out, and then I've put together over my experience working with people in this position. I might have a free resource if you're not ready. I don't expect everyone to be ready day one.

You can enter my world that way. I've got a YouTube channel where I have interviews. I've interviewed private practice coaches like yourself. I've interviewed people who have even made transitions out of private practice and sold. There are resources there, but the best two places would be LinkedIn. You can find everything else that I have from there.

For those who are tuning in, if you check out the show notes, I'll have links to the YouTube channel . Your LinkedIn profile, and then I'll also have a link to your email.

That works.

Man, I appreciate the time. Let’s definitely circle back later in the year.

Absolutely. Thanks for having me.

Later, brother.

Important Links

About John Askin

Injury To Income: How PTs Can Help Clients And Fuel Growth With Ron Cappello, Tanny Crawford, MPT, And Greg Perry, MPT

Mon, 22 Sep 2025 19:00:00 GMT

Most private practice owners want to diversify revenue—but the thought of managing inventory, upfront costs, and admin headaches kills the idea before it starts. What if there was a way to add meaningful value for your patients and create a new stream of income, without adding work to your plate?

In this episode of the Private Practice Owners Podcast, Adam Robin sits down with the founders of LASO Wellness — Ron Cappello (CEO), Tanny Crawford (Senior Advisor), and Greg Perry (Strategy)—to unpack a new model for bringing supplements and wellness products into private practices the right way.

They dive into:

● The “three no’s” that make this model a no-brainer: no capital, no admin burden, no inventory

● Why supplements are more about solving, not selling

● How recovery, sleep, gut health, and joint health products can accelerate patient outcomes

● Why nutritional guidance builds trust, compliance, and profitability

● How LASO’s done-for-you systems and field support make integration seamless

If you’ve ever wanted to boost revenue and patient results without piling more on your plate, this conversation will open your eyes to what’s possible.

��️ Learn how to add value, elevate patient care, and unlock new profits with zero risk.

�� Explore more at lasowellness.com and check the show notes for resources and links.

---

Listen to the Podcast here

Injury To Income: How PTs Can Help Clients And Fuel Growth With Ron Cappello, Tanny Crawford, MPT, And Greg Perry, MPT

We’ve got 3 knuckleheads on the show, 1 of them you know, and 2 of them you don’t know. These guys approached me with a pretty cool concept, a new startup called LASO Wellness , where they’re providing unique value adds inside private practices. We will be talking about things that would be interesting for you guys, things that are going to help your patients, help improve the autonomy of your clinical team, and then also help you make some more money. I have Ron Cappello, CEO of LASO Wellness. What’s up, Ron? How are you?

It’s good to see you. How are you doing?

I’m doing fantastic. We also have the one and only Tanny Crawford, the Senior Advisor at LASO. What’s up?

It’s nice to be here.

We have Greg Perry. I believe you’re a physical therapist. Is that right?

I am.

Greg is going to be the strategy guy for LASO. It’s great to have you guys here.

Thanks for having us.

We’re glad to be here.

Where do you guys want to start?

The Genesis Of LASO W ellness: Solving PT Pain Points

I’ll kick it off and let everybody else fill it in. The idea behind LASO was born because I messed up my shoulder several years ago. I got to know my physical therapist well, and we became friends. I then had a client in the nutrition space. I put the two together. When I talked to Greg and Tanny about it, they said, “You’ve got a good idea, but you’ve got to make it as simple and painless as possible, or it’s not going to get any traction with PTs.”

I said, “How about this? How about three noes to get to a yes? The first no is no capital invested. The second no is no administrative burden. The third is no inventory.” Lo and behold, as we’ve talked to practitioners, they like that idea a lot. What we want to do is provide high-quality natural supplements manufactured by a very reputable firm in Long Island, a 52-year-old family-owned business that’s been a leader in the space.

In addition to that, each practice is provided with a QR code. The patient can order their supplements, and they’re delivered right to their door. That’s one half of the equation. The other half of the equation is being able to call upon a lot of experts, like the three of you, and provide additional value to a practice. Meaning, marketing expertise, business expertise, and ideas.

One of them is the eBook that you guys created with eight chapters. We designed it for you, but you guys wrote it from the perspective of a PT. You think about a two-sided coin. On the one side is product, easy to make a recommendation, and help the patient in their recovery process and beyond. The other side or the second side of the coin is a lot of value information, resources, etc. Those all lead to a better patient experience and a better bottom line. I’ll turn it over to Tanny and Greg, who are a lot smarter than I am about the topic. That’s the genesis of what we did.

Ron, you said no capital, no admin burden, which is a big one, and then no inventory. Tanny, how do you see it?

Diversifying Revenue Streams For Private Practices

Being part of the Private Practice Owners Club for the last couple of years, the mission that you guys started was to protect the independence of the practitioner, not pile on anything more, train delegation, empowerment, and profitability. LASO aligns with all those boxes to check because it diversifies revenue. Especially the cash-based practices throughout the US that I’ve talked to a lot are looking for another way. There are some that are selling branded apparel for yoga or Pilates. They’re selling branded TheraBand. They’re selling laser packages and dry needling packages. Why not nutrition?

You’re doing 100 visits a week, and you think, “There’s nothing else I need to add to my plate.” That’s true. There needs to be a couple of words delivered to the patient for nutrition. I’ve used this analogy. Greg and I were talking about this not too long ago. If you have a couple of guys at a job site, wanting to construct a house, and the lumber doesn’t show up, they can’t build and can’t frame that house. As PTs, we’re trying to repair rotator cuff tissue, muscles, tendons, and joints. If the material is not there, it’s not going to happen.

It’s almost like we haven’t paid a whole lot of attention to the nutritional side of physical therapy. We do the stretches. We do the strengthening. All you guys lift weights and work out. If you go and you work triceps one day, and then you don’t take in any extra amino acids or you take in 30 grams of protein a day, why do we think they’re going to repair and get stronger? I figured this does bridge that gap.

I started training for triathlons. I got into triathlon training. I did my first sprint triathlon, and it was terrible. It was brutal. I was like, “I want to get serious about this,” and started training like an athlete. It’s amazing how much more important recovery after the actual exercise is compared to doing the actual exercise. You can train and recover. You can do the mobility work and the strengthening, but at the end of the day, you’re providing a traumatic stimulus to the area, whether that’s neurologically-based or it could also be tissue breakdown.

The improvements don’t typically come during the activity. It comes when you recover from the activity. You've got to recover like a champion if you want to be a champion. If you want to be a great athlete, you have to recover like an athlete, too. I take my creatine. I take my fish oil. I supplement with my protein. I can tell you that I feel tremendously better. I tolerate exercise intensity a lot better when I manage my recovery well. Everybody understands that. If you’re a physical therapist, you know that that’s true, but we don’t do it for our patients for whatever reason. Greg, what do you think?

Why Physical Therapist s Should Embrace Nutritional Supplementation

A couple of things. One hit when you said supplements. That’s what these are designed to do. We as practitioners, at the beginning of our specialty of physical therapy, have always recommended to patients to eat right. We were like, “Eat your protein. Eat your vegetables. Eat your fruits,” but we’ve never talked about supplementing that food intake, which is needed even more during recovery phases. I’m not as young as I once was. To your point, you’re doing training. We need supplements to help our bodies recover if we want to perform at an optimal level. We, as therapists, have lacked that, not because we don’t have the knowledge, but because we weren’t trained as much on that.

It’s 97110.

To hit on a couple of other things, I’m going to start at the beginning with something Ron said on the three noes. I won’t repeat them and bore anybody, but that was so key to this. In today’s world of physical therapy, it’s not like it was when I got out of school, when Tammy got out of school, or when Adam got out of school, and reimbursement was better. You didn’t have to work as hard. It is what it is. You can have a good practice. As busy as we are trying to run efficient practices, so many therapists go, “I don’t have time for anything else. I can’t spend more time on something.”

Or the money.

Or spend the money. The brainchild of it was genius, and I commend Ron on that. As we all sat down and started discussing the strategy, we were like, “We got a North Star. We got an avatar. What’s the strategy to get there?” Tanny may have been the first one to bring it up. He was like, “Therapists don’t like selling. They don’t want to sell things to their patients.”

This is not a sell. We don’t want this to be a sell. We don’t want to come to you and go, “Go sell these supplements to your patients.” It’s about solving an issue they have. It is solving versus selling. We say that all the time. We recommend to patients all the time how to sit, how to stand, how to pick up things, and what they should be eating. We’re like, “You smoke. You should stop smoking. You’re a tobacco user or dip user. You need to stop doing that.” It’s the same thing.

If it’s going to help that patient, then we, as practitioners, should advise them on that. It doesn’t mean everybody, but for the vast majority, this is going to help in their recovery. We should have that fiduciary responsibility to those patients to recommend it. That’s all you have to do, and Ron’s concept is we take care of the rest.

The Gold Sta ndard: Ensuring Quality And Ease With LASO Wellness

To that point, the advisory group that informed the manufacturing of this product included 3 PTs, 1 orthopedic surgeon, 1 ER doctor, 1 very renowned chiropractor, and 1 general physician. To your point, the first phase of the products that we’re delivering is as follows. Joint health, energy and circulation, sleep and recovery, to your earlier point, and gut health, which is a huge topic, particularly. The fifth category is general wellness. These are people who want a multi-type vitamin to supplement what they have.

This company is vertically integrated. They got into the business many years ago, sourcing the best natural ingredients from all over the world. They do everything at their plant. In addition to the supplements business that they have, they provide foodstuffs for hospitals for tube feeding for people who need that. They have a facility that has all kinds of certification qualifications.

In addition to the FDA, they have to meet all of the standards for hospitals and the foodstuffs that they create. Two times a year, the FDA is in there unannounced, doing inspections and stuff like that. One of the questions that PTs have asked us is, “Is this quality? How do I know that there’s no junk in this stuff?” We will guarantee the quality and the integrity of the product.

The one main thing that I think about is that most practice owners, every year, are trying to think about, “How can I squeeze out a little more revenue in the practice? How can I increase revenue by 5% this year?” 5% makes a big difference. I know that’s a topic that I’m always circling back to as a practice owner. One of those ways is to sell products. You could sell TheraBands, foam rollers, swag, and supplements.

I’ve looked at doing that, but honestly, I’ve never done that at a high level in my business. The main reason is that I don’t want to go and drop $5,000 on a product line of stuff that I don’t even know if I can sell. Who knows if I can get my money back from it? That’s one. I don’t want to store it. I don’t have any room, trying to squeeze out every square foot of my facility that I have.

For me, as an owner, from an owner perspective, not having to put up any money, store it, or manage it is a huge, “What’s the downside?” If that were the only thing that mattered, it would be a no-brainer. The only other thing that matters is the quality of the product and whether it helps the patient. If we can get those two things clear for the audience, I feel like it is a no-brainer.

The other thing I’ll tell you is that the ordering system, the backend for the eCommerce, is Shopify, which is probably the best-known backend. It provides all of the reports and all of the accounting. It provides, at the end of the month, a report to each practitioner, saying, “Here’s what’s happened. Here are the products. Here’s your check.” It provides for automatic deposits into an account. Everything is accretive. We’re providing not only the marketing material, the educational resources, videos, and the like as to how to do this work, but for the products, you can use your FSA or HSA money to buy them if the patient is so inclined.

We want to make it as easy as possible. For the practitioner, when they’re doing their initial assessment, we’re providing not a script pad, but a recommendation pad that you’ll have the different things. You, Adam, or Tanny can say, “You’re concerned about recovery. Let’s do this. You have a little bit of a gut issue. Let’s do that,” or, “We’re going to rehab your knee, so I want you to have this joint supplement to help in that process.”

The thing that’s important for your readers to understand is that the involvement with LASO doesn’t stop when you stop seeing the patient. We hope they’ll continue to take the supplements, and the participation on the revenue side continues going forward. It’s a cumulative effect. As you get more patients and more subscribers, the more money the practice is going to make.

That’s a great point, Ron. Adam, to your point about practices wanting to do TheraBand, foam rollers, swag, or whatever, there’s nothing wrong with any of that, but that’s a one-time sale. When you have a new patient, during their course of treatment, they buy whatever they buy, and that’s it. As Ron explained, this is more of an evergreen. It continues as long as the patient continues to see value and order their products.

The other thing that we’re doing to support particularly older patients, let’s call it 65 and older, is that there are wireless pill boxes or automated pill boxes where you can load up the supplements for a week. Each day, you take it. If you skip, it reports back to the practitioner, and the practitioner can say, “Mrs. Jones, I see you haven’t taken your supplements for a couple of days. It’s important that you do that.

Tell me what’s going on. Were you out dancing late last night, and you forgot to pick up this morning? What is it?” The whole remote treatment management is becoming seamless, wireless, easy, convenient, and not intrusive. That’s what we want. We want it to be almost a feeling of this service being ambient within the atmosphere of the practice and within the atmosphere of the home.

Unlocking Patient Compliance And Elevating Trust

I love it. Tanny, do you have anything to add there?

Dovetailing on that, as PTs, we’re in the evaluation. We talk to the patient about biomechanics, nerve roots, vertebrae, where the muscle inserts, and what a labral tear is. Why not give them nutritional guidance as well? We’re experts on how the body moves. It’s not about selling supplements. It’s a value add to them and explaining to them why minerals, nutrients, and protein are important.

Those are the basic building blocks to repair what we’re doing, so it makes it easy. It’s not upselling or selling. That’s the first thing. I keep bringing that up because with everybody that we talked to, their first subconscious thought is selling, but it’s not. It’s a recommendation. It’s like, “We need to get a Strassburg sock because you’ve got plantar fasciitis.” It’s the same thing.

There was a quote, in fact, on Instagram from a nurse at Vanderbilt. It said, “Every time you eat or drink, you’re either feeding disease or fighting it.” It’s inflammation, lack of sleep, lack of protein, and lack of whatever. If we can combat those things, which we can, it works through giving them guidance, not selling.

Unfortunately, I hate to admit this, but I’m older than the three of you. I’ve had a 30-year career in branding, marketing, and messaging with a lot of great clients. The one thing that I’ve learned is this. At the end of the day, word of mouth is still the most powerful way to market something, sell something, and make a recommendation. That’s one.

The second thing is that credibility matters. When you are a healthcare professional and you have such an intimate relationship with someone where you’re helping them recover, helping them get back on their feet, or helping them get mobility, you have a high level of credibility. That matters. Don’t sell anything. Use your education and experience and say to the patient, “You don’t have to do this. It’s additive. What we’re talking about isn’t a lot of money, so it’s not like I’m asking you to take on something expensive.”

The other thing is, for many people, when they’re doing physical therapy, and this was particularly true for me, the physical therapist was meeting me at a moment when I needed that help. It’s an a-ha moment where you go, “Maybe it’s time for me to look at my overall condition and how I can, when I’m done visiting with this PT, carry that forward.”

What I took from that was that most people aren’t sitting around thinking about the next supplement they can take. Tanny, you’re going to say this. You have 1,000 problems until you lose your health, and then you only have 1. It’s one of those situations. When they come to the PT, they’re interested in their health at that point. They’re like, “Tell me what I can do.” A large majority of those people would be willing to take supplements that we all know are useful if they were recommended by the doctor of physical therapy that they trust.

That’s right.

It makes you a trusted person. It elevates your trust. I can see how recommending taking a daily supplement is a great way to drive compliance because it’s an elevated commitment by the patient as well. They’re investing in their health outside of treatment by taking that supplement. There are a lot of great reasons to take that, in my opinion.

It’s a physical reminder. There’s a wonderful book called Nudge . It talks about how to change behavior. If you hit somebody over the head, trying to get them to change their behavior, it’s not going to work. If you do a lot of subtle, small things, and that one little reminder on a daily basis of, “I was at the physical therapist. Now, I need to take that moment in the morning or the evening,” whenever you want to take these, that’s that elevated commitment to me. There’s this whole new area that’s growing called self-optimization. You guys have heard about that. Dr. Attia and Huberman, a PhD from Stanford, talk about this. People are beginning to say, “I have to be more responsible for myself.”

Be the CEO of your own health, right?

That’s right.

They’re saying, “It is so I can be a better mom, a better dad, a better husband,” or whatever you name it.”

Did you have something else?

No. I was in total agreement. Ron and the rest of our team are on to something here that is not just a great business and value add to the clinic. I know Tanny said this a while ago. This is a value add to the patients. Why would we not? I had a mentor say this to me a long time ago when I was early in my physical therapy career.

He said, “If your grandmother came in for treatment and she had a total knee replacement, would you do everything in your power and at your disposal to get her better?” We would all say, “Yeah, we would.” That’s how you need to treat everybody who walks in the door. If you would recommend supplements, protein, or a multivitamin to your grandmother or mother, then we should do that for all of our patients.

TB12's Playbook: Integrating Supplements For Optimal Recovery

Greg, I don’t think I’m speaking out of school here, but your experience in your career includes a stint working with Tom Brady and TB12. Can you expand a little bit about how TB12 addressed supplements and nutritional matters?

Probably everyone reading this knows who Tom Brady is. The vast majority probably know about his health journey, how seriously he takes his health, and how seriously he takes his recovery. He spends millions of dollars a year on his body. He can afford to, and I know everybody can’t. He was a huge proponent of supplements. He was a huge proponent of adding to where his diet can’t fulfill all the needs, especially during the season and during training when he is getting beat up.

For the people who don’t know what TB12 did, it was physical therapy with a little bit of a performance and training twist to it. We were like, “Why are we not taking what Tom does to the fullest?” We brought in a supplement line and would recommend it. It wasn’t every person that walked through the door, but it’s a huge percentage that could benefit.

What’s a little different there, and this is why I love this a little better, is that we had huge inventories. We had so much inventory because it was all ours. We didn’t have a company like LASO to go through. We had to make sure we had enough of every single item we sold on the shelf. When the patient finished, the therapist recommended that they need protein or whatever.

They write on a little script pad, like Ron talked about, or a recommendation pad, hand it to the patient, and the patient hands it up front. They buy it and walk out the door. It was taking that concept, which was wildly successful. Patients would come back after they were finished and buy more. They were walking in and buying more. We did start shipping, but those costs and that administrative burden were huge. That’s why how Ron has set this up is going to be so much more user-friendly for locations than we had at TB12.

Bridging The Gap: Nutritional Needs Across All Ages

Can you guys address the issue of the stage of life? A lot more young people are coming in, trying to throw a baseball as hard as they can from the time they’re 8 to 18. There’s the weekend warrior who’s trying to recover his youth at age 60 and doing something like that. As I’ve understood from all the experts, while they vary, regardless of the age or the condition, there’s usually some positive effect from supplementing, to your earlier point, a diet or a recovery discipline. Adam, I agree with you. I don’t think people pay enough attention to that rest and recovery period to not just heal, but to better themselves. That’s an open question to any one of you as practitioners.

Forgive me. I haven’t treated patients in a while, but the thing about these patients is that most of them are in some type of acute or chronic inflammatory state. Not all of them, but most of them would need support more than somebody who’s generally healthy or who’s training for a triathlon. Their body is craving some type of resources to heal. For those reasons, it seems like they would be uniquely positioned to benefit from some type of advanced nutrition or supplementation. Forgive me. I’m not a scientist, and I don’t have a bunch of literature behind that, but that’s the way that I’m thinking about this. Greg, did you have more to add there?

Yeah. I agree. The only thing I would add is even your general athlete that’s in good shape, if you will, or condition, think post-surgically. Almost anybody who has gone through surgery is going to be craving the same thing. That’s one thing to add.

People are like, “I’m sold.” Practice owners are sold. Now what? How do they get started? What would you advise them to do from this point?

Let me jump in on that. When Ron started telling me about this, one of the biggest things besides nutrition, patients, and revenue is that LASO does the heavy lifting for the PTs. It’s not like, “Here’s your QR code. Order the nutrition and go,” and that’s it. LASO has built-in nutrition scripts and plug-and-play resources. There’s ongoing support. PTs don’t have to reinvent anything. QR code displays are set up. There are sample conversation starters, email templates, and even ideas on how to integrate nutrition into your eval talk. It’s not like they’re handing you a supplement and saying, “Go.” It’s a value-add system. It’s almost like PPOC’s vault.

That’s huge. I could see that being a big value add for owners. Especially if you have a team of five, six, ten, or twelve, there’s a burden of, “How am I going to get this rolled out?” It’s helpful to have that.

We will have, in each market, a field force of people to go set up some display-like things, some materials, and the recommendation pads. That field force will visit once a month to make sure everything is in order, answer any questions, and all of that.

We want to be a new line of business support system. To your earlier question, they can go to LASOWellness.com and see the first version of our website. We have a new version of our website, but the first version is enough for them to go sign up for some things and begin to see the resources that we’re starting to provide. We’ve got an eBook. We’ve got a PDF of eight briefings around the products themselves.

We are developing a strategy for recommending, “What’s the issue? Here’s the product. Here are the ingredients of the product,” and answering that question, “Why are you recommending this?” We’re like, “We are recommending this because it helps to be an anti-inflammatory. We are recommending this because it helps with gut health. We are recommending this because here are the ingredients in these particular supplements that are going to help you with sleep and recovery.”

I hate using this word because everybody’s bastardizing it, but we want to be both transparent and fully engaged behind the scenes and not interrupting anybody’s business life or their interaction with the patient. It’s that idea of ambient assistance. We’re so excited because we’ve got the right group, the right manufacturer, the right backend with Shopify, and the right pick, pack, and ship folks. The marvel of the digital age is that you can tell people it will be seamless, and it will be seamless. Amazon has set that expectation.

They set the bar.

They set the bar as to what you’re going to get and how quickly you’re going to get it. You can track it and know it’s on a truck to your house.

I know we talked about an eBook and a website. Any information that we have, we’ll make sure that people have access to all of that so they can go and check it out. When does this roll out? What should the readers expect?

What they should expect is this. We are signing up practices. The reason why we’re not introducing the product is that we are continuing to get feedback from those who are signing up, as well as advice and counsel as to what they need and what they want. With that said, by the end of October 2025, we will have the product in the practices and be available. We’re purposefully going slowly and deliberately because it’s not what I want. You get it.

I understand.

What do the practitioners want? What is the daily routine of that practice? How can I, on the one hand, make it easy, and on the other hand, make an exceptional experience for them and the patient? That’s our role. We support and educate. It’s that simple. I’m a simple person, so I want to try to keep it nice and easy.

Tanny, any last words?

I want to thank you very much for having us on. It’s been wonderful. We’ll also catch up with a follow-up as well.

We’ll catch up whenever you guys are ready. It’s interesting to hear what you guys are doing. There are not a lot of people in this space doing anything like this, so it’s going to be transformative. Greg, you got anything?

To echo Tanny, I appreciate the time. I always love getting together with some fairly like-minded folks. I do think this is pretty cool, so it’s fun to talk about.

The Future Of LASO Wellness: What To Expect Next

I will drop all the information if any of you guys want to reach out through the emails, ask questions, get on board with this, and get the information that you need to make a decision on whether this is going to be right for you whenever you’re ready to move forward. Thank you.

Important Links

About Greg Perry

About Tanny Crawford

About Ron Cappello

Scaling Your Practice Like A Pro — Insights From Investor & Strata PT CEO, Paul Singh

Mon, 15 Sep 2025 19:00:06 GMT

In this powerhouse episode, Dr. Adam Robin sits down with entrepreneur, investor, and unapologetic capitalist Paul Singh , CEO of Strata PT , for an unfiltered conversation on building successful businesses—inside and outside of healthcare.

Paul has invested in over 3,200 companies across multiple industries, giving him a rare, big-picture perspective on what really drives growth. He shares why the core challenges in healthcare mirror those in other industries, and how private practice owners can leverage proven business principles to scale smarter.

They dive into:

● The surprising similarities between healthcare and other industries

● Key business lessons from investing in 3,200 companies

● How Strata PT is helping PT, OT, SLP, and ABA clinics run stronger

● The mindset shifts every owner needs to compete and win

● Why focusing on fundamentals will always beat chasing trends

If you’re ready to think bigger about your private practice and borrow success strategies from the best in business, this is a must-listen episode.

��️ Get ready to take notes, take action, and take control of your growth.

And don’t miss the upcoming Private Practice Owners Club Conference where conversations like this go even deeper. Register now at ppoclubevents.com/homepage

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Listen to the Podcast here

Scaling Your Practice Like A Pro — Insights From Investor & Strata PT CEO, Paul Singh

Welcome to the Private Practice Owners Podcast. We've got an entrepreneur, crazy capitalist. I think he said he called himself before we started recording, Paul Singh with StrataPT. The CEO of StrataPT . You guys might've heard of him. They've been around since March 2010, and they do a lot of cool things to support private practice owners, PTOT speech, ABA clinics, and more. I'm going to lead out by saying that Paul said something super cool before we started recording. He said that Paul has invested in 3,200 different companies.

This guy knows a lot about business, and he said something that was really interesting. He said that, from his experience that healthcare is very similar. When you're comparing different industries, healthcare has a lot of the same challenges that other industries have. We're going to pick Paul's brain. Learn about what he knows about being successful as a business owner, and then talk a little bit about Strata.

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What's up, Paul ? How are you?

I'm living the dream. I got four great kids, and my wife's cool. I'm having a good time. I cannot complain.

Where are you located? Where do you live these days?

Home base for me is Northern Virginia, just right outside of DC. If you've ever flown into Washington, Dallas airport, or whatever, we're like twenty minutes from there. I could get to downtown DC in like 35 minutes from here. Fun little place to be. I grew up around here. My extended family, everybody's all around here. It's great. I got access to a great airport, so I can get anywhere else I need to be really quickly.

The Entrepreneurial Journey: Paul's Background And Business Philosophy

Listen, you've got tons of experience. At least a little bit about being successful as a business owner. I'd love to hear more about you. Just like who you are. What is your background? I'd love to hear your take on business. We can start talking about like some of, maybe some of the interesting things that you're seeing in the business world these days.

I’m happy to talk about whatever you like. I grew up in this area. I'll give you, like, maybe the one-minute condensed version. Grew up in this area, went to high school here, and went to George Mason University here. I will tell you that by the time I was coming of age, eighteen years old in the mid to late ‘90s, I thought that the way you made money was you traded time for money or a thing for money. The concept of the internet and technology was foreign. Back then, half the people thought the internet was a fad.

I got an internship at this place called AOL, America Online. I think at the time, they probably had fewer than 300 people. That one summer internship changed everything for me because there were two lessons I learned there. Number one, technology is fascinating because you can build anything for anybody from anywhere. That was lesson number one. Lesson number two was one of the things that they talked about a lot that summer at AOL was this idea that nobody at that company at that time was smarter than anybody else on the planet.

The only reason companies like AOL succeeded more than other competitors at the time is that they were willing to try more stuff in a given time period. Operationally, they looked at a 52-week calendar in the year as 52 things they could try, which sounds so basic, but I would argue. It shaped the rest of my professional career because now it wasn't about being right or wrong or spending six months thinking about an idea. I was like, “What's the fastest way I can test out this thing I want to try out? Whether it was me trying to start a business, or maybe I wanted to go invest in something.

Let's try it out. Let's just control the risk. What's the risk? Let's go.” Anyway, I grew up here, got an internship there. That very thinking got me to accidentally start my first business, which ultimately turned into a bunch of data centers. There was web hosting and stuff like that in the late ‘90s. By 2004, I had built six million square feet of data centers here in Virginia. We still operate those. Lots of traffic, lots of customers, that keeps going. Same mindset. I just then did that. I built the business up, got a great team running it.

We don't have any outside capital, just all bootstrapped. Second business was I started investing in a bunch of startups. I was hanging around websites like Hacker News. It's like a website for nerds to talk to other nerds. I met this guy on there. I want to say it was like 2008, maybe, maybe it was 2009, something like that. Anyway, I met this guy, and he was like this broker guy at Blackstone or something fancy bank or whatever. He was on this message board like, “I'm building this thing.” I cold emailed the guy, and I was like, “I think that's pretty cool. Here's a check for $50,000, but you can only cash it if you quit your job.”

I didn't know what I was doing. I was like, “Whatever. Let's try it.” He did it. I'd started making little investments like that. My buddies started wanting to get into it. I'm like, “I don't know how to manage other people's money, and I don't want to make like happy hours weird. Why don't you just invest in the same things?” Long story short, that turned into a venture capital firm. We had to formalize that. That was my second, we grew that up, and that's still running. I got a great team there. The third business was an e-commerce company for moms.

My wife and I have four kids. I was like, “How come I cannot go to CVS and buy like a pregnancy-safe deodorant or whatever?” Things like that. We started building that. As that grew fast, I'm like, “Who are these people sending free breast pumps and stuff to my wife? How does that work?” I learned all the acronyms of this industry. It was like, “RCM, DME. What is all this?” That led me to Strata . Now, the last thing I'll say before I stop talking about myself is that it's easy for me to tell you that story because it talks about the wins.

What you don't hear, because nobody ever wants to hear it, is that there were a million little experiments along the way of, “What if I tried that?” For me, I will come up with an idea and kill it within a week. The way that people who know me, the way that they'll experience this is if somebody ever says like, “I've been thinking about this thing for like three months now.” I'm like, “No. I'm going to stop you right there. That's dumb. I don't want to hear it anymore.”

I don't mean to be cruel, but my life lesson here, really on this topic, is literally this. It's like, “If I asked you for $20,” chances are, if we weren't strangers or whatever, you'd be like, “Paul, here you go,” or “I'm sorry,” chances are, you'd be like, “No, even if I knew you, no. I don't know if I might ever get it back.” If I said to you, “How about you get a cup of coffee?” Chances are, you say yes to that. I argue it should be the opposite. I think you should be loose with the money. You can always make it back on time. That you cannot get back. It's like, stay no to the coffee.

Let the guy borrow the $20. That's so opposite to what most people would do. Most people would hem and haw over the money and be like, “Listen, I don't have any with me.” They make all these excuses and bend over backwards. If I said, “Let's go get coffee,” like, “Yeah, let's go.” That twenty-minute coffee is going to cost them an hour commute round-trip. It's going to cost lost opportunities, things that they can never get back. Anyway, that's the background. I just tripped and stumbled my way forward. The only reason I'm successful is that I'm probably more, I'm not afraid to look like an idiot.

Time Vs. Money: The Ultimate Business Equation

Dude, you're dropping so many things. I'm taking notes. I had a call. We have a virtual assistant staffing agency. We help place Filipino workers inside practices to help them scale out their operations effectively. The guy's like, “Should I hire a front office person or a back office person?” I'm like, “What do you think your business needs?” He said, “If I had the money, I would probably do both. I think they need both.” I was like, “There's your answer.” It's so refreshing to hear you say that, because, like somebody like you, you have so much.

You have a lot more experience than I have, and what you've done is like super cool. I preach this to my clients all the time. It's like, “You have to value your time more than you value your money.” It's like, let go of the money, and the money will come back. If you occupy your time with low-leverage tasks continuously, you're just always going to be bootstrapped. I think James Wedmore is a guy that I quote all the time. He says, “Value your money more than your time, you'll have neither. If you value your time, then your money will have an abundance of both.” It's really cool to hear you say that.

Your experience is correct. Most people will be that way, and it's natural. We don't teach this in school. We probably should. Here's the thing. Business itself, like all the stories of business are like total clickbait. You look at it like Shark Tank, and you look at all these popular shows, and they make it sound like risk. Like, “This guy, this gal, she like risked everything to start this business.” You're like, “God, that makes for great clicks.” Lots of clicks on that.

That's probably not exactly what happened. Often, what happened is they were running a side job to power the business while they were getting the business off the ground. It's not some rich uncle somewhere. There's always such a story. The way I think about it is that business itself really is just a math problem. Not even like the heart. It's not like a hard, like calculus three math problem. It's literally like, “If I know that like two plus two equals four, but that first two that I'm adding in, if I could have somebody else do that, and then I could like make the second two a four myself. Now I got a six over here.”

The fancy term for this, and I would argue the most important business concept that is not taught in any university anywhere in the United States and probably not even taught in any university anywhere else on the planet, is the concept of capital allocation. Capital in the sense of time, effort, money, all of the above, people. I think if you were to go back and look at the most successful business owners, business people, it doesn't matter if they're the CEO or like a general manager of a department, it doesn't matter.

If you look at the most successful business people of the last 50 years, they all have different methods of getting to where they want, but the one common trait they all have is this incredible ability to deploy capital well and deploy that where they will get the most benefit for it. Everybody would agree with me. If there was a way that I could put a dollar into something and get ten out, of course, we would pile drive into it. Coming back to your point, that's how people should be thinking about it. I'm just pretending to be that guy.

When I was talking to that same person you were driving to, it's like, look, we both agree that if you had unlimited money, you'd just staff up everywhere. We all agree with that. Now the question becomes if I put a constraint on you and said, “You can only pick one. Which one gets you more measurable output?” Whatever's important could be measurable revenue. It could be faster phone pickup times.

Whatever you think you need as a CEO of that business. Anyway, I think here's the harsh truth on this topic. Money is rarely the actual gating item to starting or growing a business. Yet it is the number one reason everybody will tell you they cannot do something well. Listen, “I cannot afford four.” You're like, “That's not the question. The question is, I never want you to have the four if you cannot afford them. Where should I place one person to get you the money back or the one X back?” I think a lot of people just don't.

Unpacking Practice Owner Challenges: Beyond The Money Myth

The question is, what do you think if it's not money, what do you really feel like is the most common restraint for small businesses? Maybe if you can be specific to practice owners, that'd be incredible.

I think most practice owners that I meet, and I'm going to say this is true of any entrepreneur I meet, but let's just use practice owners, and to be clear, they're all the same anyway. They're all entrepreneurs. Most practice owners are romantic about their business. They're just overly romantic about their business. It comes from a good place. They probably went to school to help people. That's a good thing. I like that. That's great, but they almost don't realize that you have to have two hats. I'm just a visual guy. I'm always drawing on the whiteboard and stuff.

The way I have to think about it is when you're the clinician, you have to put your clinical hat on. “Let's do this. Let's get that outcome.” Whatever, right? Once we start talking about business, you've got to take that hat off and put your business hat on because there are two different ways of thinking. I think most practice owners don't do that. What they do is they're trying to load up their patients, their calendar, because that's how they're going to make their money. They'll get the bill, get the payments.

They don't realize that in those, they got to do this fast context switch between the clinical version of themselves and the business owner themselves, because like some of the things they end up doing because they don't do that are the things that would totally get them fired if they were employed by somebody else that was like that. They're overly romantic about it, and they end up falling into the spiral. It spirals fast, and it leads eventually to burnout. Along the way, they hit frustration. “Why am I so busy?” I guess here's the bottom line.

Most practice owners will fail. Most businesses fail. The ones that succeed end up creating a job for themselves and never actually get out of it. The very few that make it out, like they were, in hindsight, good capital allocators. It's funny. I go see a PT. I do a lot of try and run a marathon every quarter. I go see a local PT, but I don't tell them what I do for work. He has no idea. He doesn't use our product yet or anything like that, but I don't tell them what I do. It's so fascinating watching him because I've been going to him for a while.

He opened up a shop near my kid's school. I'm like, “I'll go over there.” It's fascinating to me. He's a great PT. His clinic's always busy, but like I asked him, “You got excited about summer? What's up? Any fun vacations?” Like, “No, man, I cannot take time off. I don't make any money.” I thought to myself, “That is insane.” The guy who sold me my house five years ago, I haven't talked to the guy in five years.

That guy markets to me once a quarter, sends me a magnet on the fridge, with the local high school football calendar. He's targeting me on Facebook. I bought one thing through that guy five years ago, and the guy markets to me more than my PT. The guy doesn't send me text reminders saying, “I'm looking for you. Your plan of care was six visits. I know you were busy last week.” He doesn't do any of stuff but he doesn't do it because it's not that he's not smart. He falls into this spiral. He's occupied. I think practice owners need to make a decision. The minute your calendar is about two-thirds full, I would argue you need to make a decision.

I don't care how you staff it, but you need to make a decision on what the next hire is going to be. Is it going to be that the next one third of the patients are going to have like some, I'm making this up, some PRN, some like part-time clinician that you're going to like load up their schedule so that your third stays empty or is the next hire going to be front desk admin, something like that, so that you can jam up the net, that full calendar. They're worried about, like, “Let's make sure we send text reminders. Let's call. Let's do this. Let's do that.” They don't do that. They just get hung up.

I can tell you why I think that happens just from somebody who talks to a lot of practice. I think they don't know what to do. They don't have the confidence. They step out of treatment, and they don't. They have to be the person to make this thing move forward. They have to go up there, grab the hammer, start hammering the nails in a different type of nail, like not treating the patients, but like building a marketing plan, whatever that is.

Breaking The Mold: The Power Of Exposure And Peer Influence

They don't have those skillsets. They don't know how to deploy their energy and effort, their capital, to the next thing. They stall. Part of the reason why they have a hard time letting go of the thing that they're comfortable with is that they don't know what it looks like to step into the new thing. Can you speak around that a little bit? What are your thoughts on that?

I think it's absolutely right. Think about it this way. It's like, I do a lot of running. My analogy is always going to be running. It's like, if you're just like putzing around your neighborhood, and you're running with like the local guys in the neighborhood, they are the only people you know that are running. Now, like your sample set is that. If you run a little faster than them, you're the fastest guy in the world. You run a little slower than they do.

You're a man, you suck. When you sign up for the Marine Corps marathon and you're like, “There's a division of people that will finish in 2 hours and 15 minutes. Is that possible?” The analogy I would use here is like, let's just let's continue running for just a moment. For like 2000 years of recorded history, we thought that if a human ran faster than like five minutes a mile, they would surely die. It was like in the 1950s or something, somebody broke the record. Here's the interesting part. That record then got broken after thousands of years.

It got broken like almost every year over year. Now all of a sudden we're talking about high schoolers doing like, 3-minute 45-second miles now. What has changed over the last 50 years? Certainly, evolution and even nutrition couldn't do that alone. I would argue that it was the rise of the media. If you think about it 1950s or so, somebody breaks a world record. Telegrams start going out. Those telegrams then result in newspaper articles about, “Today in the Bobway or tomorrow, like yesterday in India.” Information starts flowing.

Some runner in Boston is like, “If that guy could do it, I wonder if I could do it.” Where are we today? I can scroll Reddit, and I can see a live video of some crazy thing happening around the world five minutes ago, like TikTok, too, right? I think really it's just showing people it's possible, and so back to practice owners, think like you probably shouldn't.

I'm not saying you shouldn't have friends, like be nice to your friends, all that stuff. I don't think you should take advice from people who aren't like maybe three rungs ahead of you. To say it in a different way, let's just use my investor mindset for a moment. If I knew who the next LinkedIn was going to be, I wouldn't need to invest in like 37, I would just pick the next LinkedIn and chill. In a world where I don't know who that's going to be, all I really can do is try to make fewer bad mistakes.

How do I make sure I don't invest in the majority of those 37 that are clearly doing the wrong thing and only invest in maybe the three that have the chance of being the best one? It's similar here. It's like when you're running a practice, you don't know what's going to work for you. What you can do, though, is try to reduce the number of bad decisions you make. I would argue the best way to do that is to try to forge personal relationships with other practice owners who are just figuratively a little ahead of you.

They're doing the thing already. That's right. What I heard there is, it just comes back to like, “Show me your friends or show your future.” You also mentioned there's a sense of competition, like if you're not a little bit competitive, maybe you shouldn't be a business owner. Maybe you should.

Here's the thing. The default state of your business is failure. I say this to everybody in every industry. I'm like, “Listen, the default state of your company's failure. The only person that's going to change it around or turn around or has a chance of turning around is you. You have to be optimistic. You have to be competitive. You have to have some grit.” The reason this topic comes up, by the way, is that I will probably just like you. I will almost always get hit up by somebody every week. Like, “I got this idea. You think I should do it?” I'm like, “No, I don't think you should.” They're like, “That was harsh.” I'm like, “Look, I don't know the answer, but I do know one thing. If you're talking to a stranger for a little pump you up to do it, probably a bad idea.”

I just got into the triathlon world. I did my first sprint triathlon a couple of weeks ago.

I’m trying to say, at what point does a try guy actually get the tattoo?

I’m not there yet, but I only trained like 4 or 5 weeks. I was in decent shape, but I had to do what not. My friend that I did it with, he's been training for six months, and he beat me, and man, my competitive juices flowed. I was like, “There's a way I'm letting that guy beat me on the next one.” Do you know, I mean? I’m like a Garmin watch. I'm excited about it again. I think you have to tap into that competitive nature. It goes back. It's like, when you see other people doing things that are beyond what you thought was possible, it challenges your perspective and it helps you believe that it's possible, and therefore, if you believe that it's possible, you're more likely to like demand it or ask the world for it if you're intrinsically motivated.

Hard Work Isn't Enough: The Capital Allocation Advantage

Think about it. Here's a harsh truth. I probably hopefully, I don't get canceled by somebody listening to this. It's like, look, if you and I were just sitting at a coffee shop looking out the window, and let's just say hypothetically. Before anybody cancels me, just hear me out for a second.

I'll block this part out if it's too bad.

Here's the thing. If we're like standing out there, you and I are just sitting there having a cup of coffee, and let's just say we see somebody roll up in a Toyota Corolla and somebody roll up in a Lambo. Let's just say we pulled both of them out, and we built a little rapport, and we asked them individually, “Do you think, do you work hard?” They would both say yes. The reason I bring this up is that hard work is not the differentiator. If the topic we're discussing here is entrepreneurship, especially in the context of private practices.

Hard work is not the differentiator between a practice owner that crushes it, opens up 30 clinics, and has a hundred clinicians versus the one that is owner-operated. Both of those people worked hard. They both believe they worked hard. They both got the same finite 24 hours in a day, the same finite 10-hour workday. The difference is that one of them was a better capital allocator. Whether or not they knew it, one of them was clearly better at saying, “There's somebody better at that task that I was doing to start this practice.” I'm going to go find that person, hire that person, put them in there. You repeat that cycle over and over and over.

You call it a capital allocator, and I've been calling it skills. Maybe there's a blend of the two, but like I've been screaming that for two years. Hard work is the thing that gives you the at-bat. That qualifies you to be on the, like, at the plate. That doesn't mean you're going to hit the ball. You have to have the skills, have the technique, have the coach. If hard work alone mattered, I would probably be a billionaire by now.

Whenever I promote anybody in any of my companies from an individual contributor role to their first managerial role. This is true across all my companies. If you are moving from a, if it's your first move from an individual contributor role to any management role. You could be a supervisor of three clinicians now, as opposed to just being the clinician. I have a fifteen-minute conversation with them, and I have the same topic, the same discussion with all of them. It is this, say, “Congratulations on the new job. I think whoever promoted you, I think it's a great idea, by the way.

I want to give you one piece of advice, I hope you will take with you through your journey.” I say, “The amount of hard work you put in, as an individual contributor, is what got you noticed. It got you the attention and showed that you're ready for the next stage. I want to warn you now, in your first managerial job, that no amount of hard work is going to help you succeed in this job.

The outcome, the determination of whether or not you will be good in your first management role, is the quality of the decisions you make. If you come back to me, if I find out in a year from now that you failed for any reason, I can almost guarantee you that if you were to say to me, “Paul, I put in 80-hour weeks and you I still didn't get to keep it down.” That was never the goal. The goal was not to make you work more as a supervisor or whatever.

The goal was to put you in a position where you have to make decisions that will affect how these three people, or whoever reports to you, use their time. If you make a bad decision, three people will have wasted their time. Now scale that up. Imagine you're managing 80, 90, 1000 people, and this is what you were talking about. This idea of it's the hard work is that's like the table stakes. That's not what we should be debating.

I'm writing that down. I'm calling my director of operations and telling her that.

That's right. That's so great.

The One-Week Test: Rapid Prototyping And Constraint-Driven Innovation

I've got two questions, and then I want to get to Strata. One is that you talked about you'll start an idea and killing it within a week. What are some of the things, like, what are the one or two things that you recognize in a bad idea? How do you know it's a bad idea? What stands out and you like, what makes you feel like, “We got to kill that.”

If it doesn't work. Let me give you an example. Let me give you a concrete example. There was one small process in our business that was slow, paper-based, it required me to have ten full-time people printing pieces of paper out and sorting them. I turn around, I go to one of my product guys, I'm like, “Listen, I understand why we did this. We did it to prove that this process was necessary. This particular process is necessary.

Otherwise, I wouldn't employ ten people to do this.” We figured out, the good news is we know this is important and it's working. The bad news is that life sucks for those ten people, and I hate it. “You get one week. I want you to ship a version one prototype of how that entire paper-based product process goes away.” He says to me, “Paul, but one week, I cannot possibly do anything in one week.”

I'm like, “No, you cannot do a perfect anything in one week. I didn't ask you for that anyway. I asked you for the smallest version 0.1 ghetto prototype that proves that we can incrementally make this better.” I swear to you, I'm not making this up. This is a real thing that happened about ten days ago. We talked on Monday. He built something really quick, really ugly for him. He was embarrassed by it. He was afraid to even show anybody it.

He rolls it out on a Thursday. By the following Monday, tens of thousands of pieces of paper stopped getting printed. Ten people can now work remotely. The quality of their lives changed. The business is better for it. My point is that the reason I use a week as an example is that it forces you to have a constraint. The reason why most projects fail, and I'm not just talking about my business or yours, it's just in life. The reason why most things fail is that the scope expands.

Too much time.

Yeah. One more feature, one more feature. “I'll do it later.” It's like, “No constraint is good.”

It always comes down to budgets, doesn't it? This is a weird analogy, but I always use the cheese grater analogy. It's like, “If you want shredded cheese, you've got to push the cheese through the grater.” It's like, with management in general, there's this theory of constraint. It's like, you have to demand the thing to happen.

I was talking to one of our practice owners, and just out of the blue, I was just like, “What are you doing with your? I see your patient responsibility balances are going up?” He's like, “It’s because we do the insurance side of it.” Anyway, so I was like, “What are you going to do with that? It's like $200,000 or whatever of money, just in $20 and $30 co-pays that are owed to you. What's up with that?”

He's like, “It's just hard. The patient comes in and doesn't want to pay. If I say no, I don't want to lose him to the patient or whatever.” I'm like, “Are you good with just people owing you that much money?” He's like, “No, of course I'm not good at it. I get with it.” I was like, “What are you going to do about it?” He's like, “What can I do, man?” I thought it was a joke. I was like, “Is that a real question?”

He's like, “What can I do?” I was like, “You pick up the phone and you make 200 calls a day and you get your money.” I was like, “Listen, man, you and I don't know each other. I don't care whether you get this money or not, but I don't care what drives you. Figure it out. If it's your kids, put a picture of your kids right by that phone as you dial.

Every time somebody is not paying their portion of that, that's money that you could have used to take your kids to Chuck E. Cheese or buy another dinner.” Just whatever it is that drives you, but drives the action. We can fix this problem. Now we may not be able to fix the full $200,000 in a week. I don't know how long it'll take, but I'm sure as hell that if you don't pick up the phone now and start having that conversation, like I know it's not going to work.

I know for sure where you're going to be in another six weeks.

Speed is ultimately the superpower.

I want more speed. That's what I wrote down.

That's it. Honestly, I don't live in Silicon Valley. I have one foot in Silicon Valley, just with some of the other work that I do. What I've learned about Silicon Valley is that what makes it special, those people are not from there. Silicon Valley is a really tiny little place. It's a little peninsula. It's like five miles wide. It's not that big. They're not any smarter than us. If you went to a coffee shop in Palo Alto right now and you were like, “Where's everybody from?” I bet you like 10% of the people in there would be like, “I grew up here.”

The 90% are like, “Nebraska, Wisconsin, Massachusetts.” The thing about Silicon Valley that makes it truly special, in my opinion, is that it has its incredible sense of urgency. As a culture, they'll just try it out. They don't say like, “What do you think?” Like, “I built this thing last night. What do you think it is?” Even their sales teams are so good. They're not like, the market research says, “Listen, I called 100 of these potential customers. Here's the number one objection. You know what it was? It wasn't the price. It was this. It was that.” It's just so fast, and that increases their probability of finding the solution.

Strata PT: Revolutionizing Healthcare Reimbursement With Tech

I love that. Thank you for sharing that, man. Let's get the Strata. I want to hear about it. What is Strata, and what does the world need to know about it? How does it work? How do you help practice owners?

We are essentially an EMR and RCM combined to guarantee 99.9% reimbursement rates. We'll capture every dollar for you. We've been around for a while. Long story short, there, for the first 10 or 12 years of our business, fully service-based, old school. Just had to cut our teeth as an RCM service, learn how it works. I'm not from health care, you can figure out quickly, I'm not from health care.

Over a decade, just trying to understand, how do you process claims like everybody else does? We didn't advertise the business. Less than 1% of our dollars are spent on any marketing. It's just, “You got a couple of clients, let's just learn this and run it.” By 2022, is like, “I think we're ready to step on the gas. What would be crazy?” All the people who gave me advice were like, “What you should do is partner with the EMRs.” “That seemed logical, but if that was true, how come they're not doing it right? Why is everybody complaining about the existing EMRs in the current RCM?”

Like, “I don't want to jump. That's not working for them. I'm not smarter than them. I don't want to play that game. I'm going to go the other way.” We're not going to integrate with anybody. We're going to just build our own EMR. Of course, everybody came out of the woodwork. Let me pause for a second. Quick life lesson here. The world wants you to be vanilla. The moment you agree, they ignore you. Let me give you an example. If you go out there and you tell your family, “I want to do this. I want to be the biggest one in the world. I want to be the president or whatever?”

They're going to like cheer you on, but 9 times out of 10, they're like, “Listen, man, I don't want to see you fail. Come on, let's be realistic, Adam.” They're doing it out of love. They don't want you to fail, but the minute you agree, because all the pressure is like, “It'd be easier if I just agree with them. They're smart.” The minute you agree, they ignore you. They move on to the next thing. Now let's come back to this. Everybody's like, “This is crazy. You shouldn't do this. This is dumb.” They're so quick to tell us that, like, “I shouldn't do this.”

Here's the thing. We went in the opposite direction. We're like, “Look, I don't want to be blamed when the front desk does something wrong.” I don't want to do that. Let's just control the entire software stack. Version one of the EMR that we built was ugly as sin. Back to my mantra. Once a week. The bad joke in our company is making it worse every week. Make it less worse every week. We started doing that heavily in 2022 and effectively like 3 to 5X the business every year since then. It's not because we're smarter than anybody else.

It's just that like we're just really aggressive about it. This leads to maybe a lesson for practice owners here as well. That is what was alluded to earlier. Don't be romantic about making your money. We don't worry about being featured. We don't need it. If people looked feature for feature us against everybody else, we have every feature, but we don't talk about it because what we talk about is this fact that, like you ought to get paid. Your practice owners ought to get paid for the work they did and the way to get paid, as long as we focus on what resonates.

It's an emotional thing. Nobody wakes up and says, “I cannot wait to change my RCM. I cannot wait to get a new EMR.” Literally nobody on the planet ever woke up thinking that, but they all wake up thinking like, “Man, I wrote off this much money, or my biller adjusted this much. They have these fans.” They don't even say write off anymore. They say, “We adjusted it.”

It sounds like it's still coming to you.

I'm going to just roll over to Starbucks, take the coffee, and then adjust the register and see if I don't get put in cuffs. Anyway, Strata is built around this whole idea of just how do you make sure that we capture every dollar owed to these clinicians? How do we do that with a tech-enabled focus? That's the way I just think about everything.

Every industry that has been disrupted by technology, it's always technology that comes in and disrupts the middle. In this case, the billers are in the middle. I know I lose some friends here on that, but it's like, because the payers make it so hard, it's the smallest practice owners that are hurt the most. It's because, like the interface between them is these billers and these billers aren't inept. They're not bad, but they're human. The payers are changing the rules. Anyway, so summary and Strata are essentially free.

It's a free set of practice management tools that we build, operate, and give away for free. The catch is that the RCM has to go through us. That's how it works. We've grown pretty rapidly. We won the best in class award. We beat out Rain Tree and WebPT and all these other guys that had held the award for ten years. Tiny little team of 80 or so people, and we collect hundreds of millions of dollars each month for our customers. I'd like to think we're the funnest little company that nobody knows about.

Just based on the talk that we had, it just feels like you guys have a really strong culture. As you mentioned, like you said, “If you're not focused on being the smartest. You're not focused on being the shiniest, but you're focused on being the most disciplined, the most risk. You're focusing on speed. You're focusing on who you're being on the pro along the way.” It's like, if I can be disciplined and take risks and allocate my capital appropriately and get less worse. How'd you say it? One percent less day. That we can win. We can beat a few people. You know what I mean? I love it.

Here's the way to think about it. I think that it takes the same level of effort to build a million dollar business as it does to take a billion to build a billion-dollar business. It takes the same effort, in my opinion. The subtle difference is that to get to the billion-dollar business, you have to have a level of clarity, essentially the ability to have so much clarity that you have the ability to say no to a lot of things.

That allows you to like then be ruthless about just running right down the middle while everybody else wants to go wide. Let me say that now, let's bring it to practice owners. I think private PTOT practices are incredibly profitable by default on day one. What happens is they don't have, like, there's not one big leak in the bucket. It's not like they bought one crazy table and all of a sudden that killed their business. It's a thousand little slashes.

It's like, “Yeah, don't worry about that co-pay. Don't worry, Steve. I'll get it next week.” Look, that claim just got rejected. All the patients are “Sure, I'll deal with that in a minute,” but then they never really deal with it. By the way, when I say this, a lot of practice owners roll their eyes like they're probably trying to stop tuning in. Here's what I would say.

I would say, “If it was wrong, if it was true that private practice ownership was not a good idea, then explain to me why private equity continues to buy it up. If it truly was the case that running and owning a physical therapy practice was unprofitable or had a small margin on it, nobody would buy it. That's not true. We know that private equity is coming in. Every month, you read up about such and such firm buying up five practices in this area or ten practices in that area.

They're buying them. The common denominator is the practice owner. It comes down to the practice owner being unromantic about their money and being serious about what they want to build. I really do think business is a skill that can be learned. It really can be. It comes back to what you said earlier. It's like, “Show me who you hang out with. Show me who you're getting advice from.” I'll tell you exactly what your outcome is going to be.

That's incredible, man. That's so cool. I feel like you've been watching my content, and you came prepared to just talk about all this stuff.

The 10x Challenge: Unlocking Your Practice's True Potential

No, I have been watching your content, but I think we largely see the world the same way. My whole thing is like I told you in the pre-show, I don't care if anybody talks about Strata or not. I care about practices making all the money they deserve. I know this is going to sound like a cliche, but it's insane to me that if somebody went to Starbucks, bought ten cups of coffee, and only paid for six, that wouldn't last very long at all. A lot of bad things would happen there, real quick, to make sure that that didn't happen.

It's insane to me that, like that's okay in healthcare, that I can have ten patients come in and that the payer is only going to like maybe pay for 60% of this or 70% of that. It's not that they don't pay, by the way, it's a little obscure reason why they reject this or reject that or whatever. The next thing you know, you forget the timely filing and all these things. The words of healthcare are so fascinating. Timely filing, that's a, “You messed up.” Like, “No.” Anyway, I could ramble about this for hours, man. I really think that, like for practice owners tuning in, I think if I could give you one piece of homework, and I'm speaking to the practice owners tuning in to this.

If you're not completely turned off by the way I talk or whatever it is, I hope you'll run one exercise in the back of your mind. You don't have to tell anybody about it. Just run this one exercise in your mind. If I asked you what you needed to do to 10x your business in the next 12 months, what would it be? What would you have to do to 10X it? Don't answer it out loud.

Don't tell me, don't tell Adam, whatever. I would argue that you already know the answer, and it's probably not to do 30 things. It's probably that you already know right away. If I had to 10X it, it's probably this and that. Whatever this and that is, you either need to commit to doing that to yourself or tell yourself, stop lying to yourself, and just admit that you're not going to do it anyway. Let's just stop being unhappy that we're not getting where we want to be, because you know what you have to do.

Overcoming Hopelessness: Mindset, Simplification, And Action

I just asked myself that question, and it came to me. I could feel it. Man, I've got one more question, and a lot of practice owners are struggling, and maybe you could have just answered it. I get on the phone with these practice owners who do feel they're in a bind. You know what I mean? They're struggling. They feel hopeless. I'm sure you've been in positions where you felt like you were going to lose it all. Do you have any tips on getting through those times? What's your recipe for getting out of the hole when you feel like you're at the bottom?

I'll admit. I'll just tell you a little personal story here. Anytime I feel like that, which by the way is not foreign. It's probably 2 or 3 times a month. I'm probably in that headspace. My wife will tell you, it's almost always when I've skipped like 2 or 3 days of running. I would just say like, “Look, I think you're good.” First of all, you have to understand that this is natural, by the way, like any entrepreneurship is not what the magazines and the TV shows show you. I'm a math nerd. The way I think about it is entrepreneurship is like you have like five days of glory, 360 days of grind.

They are unevenly distributed. You have no idea. All you can do is make sure you get your head in the right space, and you've got to do what's good for you. For me, I'm up and running every morning. Other people I know like to play golf. Some people like to meditate. Other people read. Other people hang out with their kids. Whatever it is. Just accept that it's going to happen. It's never going to stop. Anybody who tells you that it stops eventually is lying to you. Number two, once you've accepted it, it's never going to stop.

Number two, figure out how you're going to cope with it. Running for me, you pick your poison. Number three, I like to recognize that most of these decisions we have to make. When you're feeling hopeless, it's not because of one thing. It's probably something complex. What you've got to do is I think, is teach yourself that it's okay to oversimplify. I'll give you an example. I had a manager in one of my companies the other day. I had talked to him once a month for like six months. Every time I noticed he always talked about this one employee on his team, he always talked about.

Finally, we're recording this at the end of July. Anyway, two days ago, I just had a little check-in with him. “How's it going, man? How's the business going? How are you doing?” Of course, he brought that name up. I said, “Listen, I've heard you bring that name up for a while now. I think you know what you need to do. I don't understand why you and I keep talking about this particular employee this many times.” He's like, “Yeah, but the guy's a nice guy.”

Like, “No, I didn't. I'm not debating whether he's a nice guy. I'm just saying, I want to call you out. You keep bringing him up. Are you just afraid to make a decision? It sounds to me like you need to get rid of him.” He's like, “I know.” I was like, “Listen, man, you know it's possible to be kind on the person and hard on the problem.” The problem right now is that every piece of mental bandwidth you use on this is bandwidth you cannot give to your kids. It's bandwidth you cannot give to the business. It's the thing. I oversimplified it.

I was like, “Listen, I'm going to make this easy for you. I will not take any more calls with you unless you tell me in writing what you intend to do in 24 hours.” “Is it that it seems fast?” I was like, “Yeah, but you had six months, and I'm not telling you which way to go. Make a decision and tell me because I don't want to hear his name again. I want to focus on helping your business grow.” He responded 24 hours later. He wrote me, “We are going to go ahead and terminate them this week, but I do want to be kind to them. We're going to give them three months of severance.”

I was like, “That's pretty generous. Cool. Great. I look forward to never hearing about them again.” I know that sounds cruel, but I'm talking about him and his mind space. I just tend to oversimplify decisions like that. I know that sounds cool, but I would argue that for somebody in the example you just gave me, somebody is sitting there, they're hopeless, they're thinking about payroll, they're thinking about all these things. Accept that these problems will never go away. Get your head in the right spot.

Over simplify. Even though the ultimate answer may not be simple, you just have to find some place to start getting your head to start thinking about the decision. Worst case, what do I do? Best case, what can I do? We zero in from there, and you put a constraint on it. The only decisions that you can make that are irreversible are legal and financial. You signed the wrong contract. That's hard to undo. You run out of money. That's hard to undo. Everything else is reversible.

I like to say the fear and discomfort you're experiencing is usually tied up in the decision that you're avoiding. Every time I find clarity around the thing that I'm fearing, and I just act and like pursue it and make the decision like I open myself up to clarity, and I move forward.

Simplifying Decisions For Business Growth

Somebody once said to me that I don't know if it's true or not, but the phrase has always stuck with me. Somebody once said to me that “Your probability of business success is directly correlated to the number of hard discussions you're willing to have.” I never really understood that for years until, like, all of a sudden, it clicked. Like, “I'm probably avoiding the thing that I need to do.”

I know we have to end, but I would just say one thing. I want to be clear, by the way. I don't know anything that you don't know. I'm not smarter than anybody tuning in, but I do know this. I am willing to try more things in a given timeframe than anybody else. That's the only thing that has worked for me. If you want to get into investing, it's not about doing one deal. If you seriously want to get into investing, look at a hundred deals.

You want to buy an apartment complex? Don't look at one apartment complex. Go walk through a hundred and figure out what it looks like to own one. Same thing here with practice ownership or whatever. It's like, 80% of every business is the same. You've got to acquire the customer, retain the customer, or whatever. It's 80% of every business that is the same. I don't care what industry you're in. Let's get back to basics.

If people want to get in with you, how do they connect with your team? What's your website? They want to learn about your EMR and your RCM.

If you guys want to talk to me about business or anything like that, even if it's not about Strata, you can just buy me a LinkedIn Paul Singh, or you can email me at Paul@StrataPT.com . You can check out the website too, if you want. I'm always around. I'm happy to help, LinkedIn DMs, email, whatever. I'm pretty active on all the social media. Usually, I try to run around the conference circuit. I don't hang out in the events themselves. I'll usually like be cranking on my laptop and hanging with folks in the hallway.

If you're at any events, come say hi. Happy to help. I want to see more people make a ton of money. I don't care if they use us or not. I don't know. It's like this whole healthcare industry is crazy to me. It's like, there's so much money flowing through this industry. Yet we have practice owners who are like, “I cannot make payroll.” It's like, “That's not right.” That means that the problem is the practice owner, and this is fixable. We can fix this. Anyway, happy to help anyone, and hopefully, there's at least one nugget somewhere in here that made your audience think a little bit.

I look at this as a coaching call. I was very inspired. I enjoyed it. I love your insights. Paul Singh on StrataPT. You guys check them out. Paul, let's do it again soon.

Thanks, man.

Physical Therapy Owners Club

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