Industry Expert Roundtable, April 18 Webinar Hosted By Nathan Shields, Feat. Adam Robin, Sharif Zeid, Will Humphreys, And David Straight

Industry Expert Roundtable, April 18 Webinar Hosted By Nathan Shields, Feat. Adam Robin, Sharif Zeid, Will Humphreys, And David Straight

Private Practice Owners Club Expert Roundtable

Welcome to the first expert roundtable. First of many, hopefully. We're excited to have the experts that we have. We've got Sharif Zeid of Empower EMR, Will Humphreys of many companies, but In the Black Financial Services, Virtual Rockstar, Rockstar Recruiter, and more to come, I’m sure. David Straight of E-rehab is joining us. Thanks, David. Adam Robin, my partner in the Private Practice Owners Club, is joining us on the expert roundtable.

I'll be leading out and moderating our discussion. We're scheduled to do this for about 90 minutes. Hopefully, there will be time there when we can take the Q&A. Don’t be afraid to raise your hand or put something down in the chat if you have questions as we’re doing this roundtable. The experts do have some things that they are prepared to speak about, but I'm sure they're very open to discussion and taking your questions as well. We'll lead forward in that regard.

I did do a little bit of intro, but let's go one by one. Do some introductions of yourselves so you can speak a little bit about where you're coming from. Also, after that, I'll do a couple of announcements particular to the Private Practice Owners Club. After that, we'll get into our discussions. Sharif, why don't you start us off? Give us a one-minute intro about you and where you're from.

I appreciate being here. I appreciate the invite, Nathan. Thanks for having me. I am with Empower EMR. We've been around for quite some time, serving rehab practices all across the country. My personal background a little bit is that I'm a finance person by education. That's what I went to school for, but I've been in the tech space for twenty years. I have been working with PT practices for probably nineteen years and 364 days.

I have been around for quite some time. I have lived through the EMR revolution, if you will, when everybody adopted EMR for the first time. I am living in the modern age of AI, portals, and all that good stuff. In my day-to-day and week-to-week, I'm fortunate in that I get to interact with so many practices of all sorts of different sizes in all sorts of different places in their journey from early on to late-stage, looking to sell, etc. I get a cool perspective on that. I'm hoping to offer you all some value and be able to offer you my perspective from what I see out there.

Sharif has been in this for a couple of decades. He's worked with a ton of different owners, so he’s got a lot of perspective as to the challenges that ownership faces, in general. He is a great value source for us. Will, why don't you share a little bit about yourself? I know you like to talk, so keep it a little bit brief.

I'm a passionate physical therapist from Texas originally. I started being a PT in 2002. I became a PT owner in 2007 and 2008. I was a partner with Nathan, growing five locations in Arizona, including a diagnostic company in Alaska. We sold in 2018. Like Nathan, I'm so passionate about this industry. I want to double down in helping you guys in so many ways, but the big thing I'm focused on is to free you up. That's what I care about.

People know me more as a recruiting expert. I'm all about recruiting. My main company is Virtual Rockstar, where we hire virtual assistants for over 100 physical therapy practices across the country to help free you up. It's been an amazing journey. Thank you, Nathan, for being so kind to invite me here. It's such an honor.

David, tell us a little bit about you and E-rehab.

I am also a physical therapist. I have been in the physical therapy space since 1988. I started as an aide in 1988 and then went to PT school and treated patients for 12 years. We lost 47% of our business to pops clinics. We had to get good at sales and marketing, and we did. We lost that business. We didn't have to let go of any PTs because we got good at sales. I have been exploring digital marketing since 1996. I built my first website.

I started E-rehab in 2003. We've helped over 2,000 private practices. Unlike some of the other gentlemen on the panel, we only work with tiny practices. That is my perspective. Our goal is to do the $10 an hour job so you can do the $100 an hour job. It's to take digital marketing off your plate. We implement the fundamentals for our clients and do that work for them. Like everybody here, I love what we do. I love the profession. I love the value we bring. I love to support private practice, too.

Thanks for joining us, David.

Thank you. I appreciate the opportunity.

Adam, tell us a little bit about yourself.

I am partners with Nathan Shields. I'm blessed to be here. David does our website and a lot of our digital marketing support. Sharif, I use Empower EMR for my practice. I was also blessed to be mentored closely by Will in his company, In the Black. Will and I chatted for over a year. Was that in 2020?

In that range.

I started my practice in 2019 with a lot of hustle and hard work. A couple of years later, I met Nathan. Nathan coached me and taught me a thing or two about business. I’ve since opened up two more clinics. A few years ago, we started the Private Practice Owners Club, where we support the heck out of practice owners. The thing that I love about my journey is that it has been such a personal journey.

As Will and Nathan have poured into me, I've felt myself become more empowered and more confident as a leader and an owner. That's what I am passionate about. It is helping owners believe in themselves so that they can realize how powerful they can be for their teams and for the organizations. Thanks for allowing me to be here.

I hope you guys recognize between the 5 of us, there are over 120 years of therapy experience that we're bringing to the table. There's a lot that we can add to any discussion. I know each of you is taking particular topics that you're going to discuss, if I recall correctly. Will and Adam are going to talk to us a little bit about recruiting and retention of providers.

Sharif is going to talk to us a little bit about organizational development and structure in your organization, leading to leadership development. David is going to talk to us about how to stand out from other practices and not be the commodity that physical therapy can be at times. Before I get into those topics, these are the issues that they believe a lot of the industry is facing. This came from their perspectives and their 100 years of therapy experience that they're bringing to the table.

Before I get into that stuff, in the Private Practice Owners Club, there are a few cool things that we are doing that I want to highlight. On our website, PPOClub.com, we have an Events tab. We are coming to Nashville, Tennessee, on June 7th, 2025, to do a workshop all about scaling, how to make your clinic more profitable, and the growth KPIs that you need to know in order to grow. Also, Adam's going to focus a little bit on recruiting, retention, and getting providers to be productive.

That's June 7th, 2025, in Nashville, Tennessee. That is on our Events tab. That's also in the Facebook group. If you go to our Facebook group, Private Practice Owners Club, where there are over 1,700 members at this point, under the Events tab, you can register and find the details about that workshop in Nashville, Tennessee. That is on Saturday, June 7th, 2025.

I, at the request of many people, have submitted and been approved for CEUs. Some CEUs that Saturday morning of June 7th in Nashville. Further down the road, October 2 through 4, 2025, is our second annual Private Practice Owners Club Conference. All these people here were in attendance at our last one. David wasn't there personally, but E-rehab was there. It was great. It was our kickoff conference in Clearwater.

This 2025, it is going to be in Destin, Florida, at the request of so many people that we have it at the beach. Namely, Maggie and Mike. They were like, “We don't care where you go. Be by the beach again, please.” We're going to be in Destin, Florida, where there are beautiful beaches. Look forward to that. That is also on the website page. There are also details of that on the Facebook group Events tab. Look for that. Registration is going to start on or about May 1st, 2025. Look for that here in the near future. That is on the table. Am I missing anything else, Adam?

No.

Addressing Reimbursement Challenges In The Physical Therapy Industry

I don't think so. Look forward to us doing more of these expert round tables. This was the brainchild of Sharif. Thank you, Sharif, for igniting this and getting us started on this. We think it's a great idea to bring experts to the table and talk about some of the issues facing the physical therapy industry or the therapy industry, in general, whether you're OT, speech, or physical therapy. Let's get started. I'm going to moderate the discussion a little bit.

Bear with me if I cut you off here or there and I want to ask questions. If I see something in the chat that pops up that might be pertinent, I'm going to get into that. Before we get into the topics, though, I want to ask a question. I'm going to be on a little bit of a tangent. Hopefully, it doesn't take too much away from the discussions or presentations that you guys have.

The experts were faced with the question of what some of the issues facing the industry are. The one thing that you didn't talk about or bring up that I want to make sure we address, at least in part, because it could be the 500-pound gorilla in the corner of the room, is that you didn't mention anything about reimbursement.

If we were to pull many owners across the country about the issues facing physical therapy, reimbursement might be number one. If it's not number 1, it's number 2. I thought I'd start off with a little bit of a curveball and say, what are your thoughts about that? Am I off base, or do you guys feel like what you're presenting is a way to address it? Who wants to start on that one? Sharif wants to start. Let's go.

I'll take the first shot at it. In an ironic sense, I'll probably Dr. Jekyll and Mr. Hyde myself here by giving you two thoughts. The first one is that reimbursements are a challenge. It's fair to acknowledge that we've all been in this space for a while. We would all agree that that's a perennial issue. It doesn't go away. You don't have to replant the seeds of reimbursement issues every spring. It's always there. It's ever-present.

In working with and speaking with so many clinics, there are clearly a lot of practices that are having a tremendous amount of success out there despite reimbursement challenges. My attitude or thought on this is that it’s not something that should be fully ignored. There needs to be continued efforts through lobbying, legislative actions, APTA, some of the organizations, and then on an individual level where practices are trying their best to negotiate with insurance companies and trying their best to demonstrate their capabilities, their success, and all the things that go into that, measured in numerous ways. That may be through outcomes or speed of cost to rehabilitate all the metrics that you can start to pull, but with the recognition that those are long-range actions to try and solve a long-range problem.

The real key is finding a way to thrive in the environment rather than constantly lamenting that the reimbursements are not working. In the last few years, there's been a significant ignition in conversation around things that were previously thought of as being unheard of, like leaving and not accepting a specific insurance company anymore. If it's out of bounds and so cheap that you're losing money on every visit you do, there's no amount of gasoline you can throw on that fire to make it better. All you're doing is making the problem worse.

That's my thought. We want to address it. We don't want to ignore it. It's an 800-pound gorilla in the room. We also need to be cognizant that in the life cycle of the ownership of your practice, maybe this is more of a generational problem than something that's going to be addressed in 3 weeks, 1 month, or even in the next Medicare cycle when they release another 10,000 million page final rule for 2025. Everybody is trying to read it to see if we're getting anything or even not being hurt. Oftentimes, it's more of minimizing damage than it is.

I'll close with this because I'm sure others have thoughts, too. There are a lot of businesses out there, not just PT, that are dealing with the same concept. It is the Walmart or Amazon problem. They're trying to sell low-margin products. How do you make money if you're selling something that doesn't quite have the margin you want?

A lot of it comes down to efficiency and some of the other themes you've already heard about, protecting time, getting the time in the right place, and so forth. I don't want to say you can't cry in your soup, but you have to work with what the market is and find a way to be successful with it. There are absolutely practices that are doing that. The common thread between them is often operational excellence and efficiency. That's why that's my topic. I'll stop there and see if anybody wants to maybe argue with me or maybe agree.

Recruiting Talent: The Ultimate Solution For Practice Growth 

You're on the right page. The way you wrapped it up is that the clinics that we see thriving are the ones that have optimized their internal systems, the financial systems, like over-the-counter collections, the billing collections management, and the provider billing optimization. They're aware of their financial KPIs, so they know the health of their company. They're tracking what's going on, so they know. Whereas most business owners or most therapy owners don't have the knowledge base to track all that very well, if they haven't had some kind of training or coaching. Will, you're nodding your head. What are you thinking?

In my mind, all of you at home at work who are fitting in food in between your crazy day-to-day wants to acknowledge it. I’ll get right to the point. I don't think there's any problem that learning how to recruit doesn't fix. I believe what Nathan's saying is dead right. The reimbursement thing is a hot issue, because if we got reimbursed more, for sure, we would do better. The biggest thing that moves the needle is knowing how to recruit and retain talent. In my professional opinion, if you can master that, you don't have to know anything else, which is a bold statement.

What if you can't pay for them?

If you have good people, you'll never worry about money again. I love that you challenge that. Here's my thought. Go get a loan, go get an A player, and go see how money falls into place. Let me answer that question like this. If I had a button that I could give you, and you push that button, and your favorite provider could be duplicated and wanted to work with you over and over again, would that solve all of your problems? Yeah.

If you know how to recruit talent, you could even hire someone to run your company for you. If you know how to recruit, you can go find someone to fight your insurance. There's no problem that recruiting doesn't fix. It is the quintessential expression of leadership. When you're doing that, you're fulfilling your purpose as a leader, which is to build more leaders. This is a fact in my world. If you build that dream team, you're profitable, and you have time and money to fight insurance and move the needle for the industry at large. You've got so many spinning plates. Which one should you focus on the most? I'm going to tell you it's learning how to hire people.

Can I bring a 1B to that?

Please.

When you said it's all about recruiting, I'm like, “Yes, but.”

Challenge it because I want to show that I'm right.

The follow-up is that if you have those A players, you still need to learn how to manage them. I'll add this back to your point. When you have A players, they are much easier to manage. I want to say this from personal experience because you and I have experienced this personally. We had a bunch of crappy billing options that we went through over the years at our clinics back in the day. When we found the right billers, they were the ones who taught us how to hold them accountable, how they needed to be trained, and what resources they needed from us.

Will and I didn't know the first thing about holding billing collections teams accountable until we had the right biller. Now that we've been through that experience and we know what holding a biller accountable looks like, we can tell other people what that looks like because we've been through it. It started with what you said about that A player.

I was going to disagree with you a little bit for a second, and then I changed my mind. My first point was that you don't have to know how to manage if you know how to recruit, because you can hire people to run your people for you. I do think there's truth in that. Here's the other truth that you started speaking about that became real for me. In order to attract the right people, I have to become the kind of leader that they would want to follow. It's a little chicken and egg.

With my medical billing company, I don't even promote. We don't even take people. If you're interested, don't call me. We don't have any room for people. I spend 30 minutes a week on that business because I want to. Katie runs that business. She's crushing it. We've hit our max capacity. I love it. It's like a mail check. It's not even about the money for me. It's about the impact. There's some income. Where there's profitability, there's possibility.

You have to learn to become that kind of leader and be in that space.

We would've lost Katie, you and I, if we weren't working on ourselves through coaching, which is the throughline of everything we ever talk about. You have to have a great coach.

What do you want to say, David?

You can't deny the fact that all of the things that you mentioned are intertwined, though. You have to know your finances. You need to be a leader.

I don't think you need to know your finances. You can hire out for that.

You can't be blind to your cashflow.

You can know the 20% to get you 80% of the way there. I have five companies. Not to toot my own horn, but I don't run around with spreadsheets. I look at my bank account every day. I have someone who reports the 20% that I need to know.

I don't think it's the linchpin, though. Finance matters. You need to know how to lead. You need to be taught these things. This is why the Private Practice Owners Club is critical. This is why I refer people all the time. You need to understand leverage. Those are all part of a business education. In my market in San Diego where you're working on 3% or 4% margins, it's hard to hire the top talent and pay them $120,000 or $150,000, get the patients in the door, and then also manage your billing. It's difficult.

David, I have to disagree with that. When you say it's hard to recruit, I have to stop there because that's the problem with why people aren't recruiting. They think it's hard. It's easy.

I don't think he's saying it's hard to recruit. It's hard to justify paying the top people six figures.

Why? If you have the top people who make it rain, go get a loan. I am going to fight on this issue to the end.

You said make it rain. You're assuming that there were all these patients in the market that we had when there's a private practice on every single corner, too. All of that, some of them have a different skillset. I don't disagree with you, but it's much more nuanced than that. What Sharif and Nathan said are also important components to it.

Understanding how to run a business, understanding how to be a leader, and then having the capabilities to do what you say, which is to recruit, all of those things are super important in a group of people until they get to the larger level in which they move out of the job of being a day-to-day clinician and move into the job of being a business owner. I come from the frame of reference of the 1 to 3 practice owners.

I see what you're saying. I agree with that because we don't want to invalidate all their efforts.

That's a whole different dimension, and they figured it out. They’ve learned from you guys. They use you guys. They figured those things out. I'm saying the three of them are intertwined. If you say, “If you recruit, that's great,” they don't even know what their cost of visiting is.

We're talking about the same thing from different angles. When I say recruit, you're hearing higher people. I'm saying if you know how to recruit, you know how to find good coaches who teach you the 20% you need to know.

Thank you for sharing that.

My underlying thing is that our main skill that we need to learn is this one lesson. My four boys came to me and asked what the number one lesson is that I could emphasize as the most important thing to teach anyone if I had to pick one thing. It was this. Your network is your net worth. I am a product. I am not naturally good at business. Adam is. It’s one of those things I love and get jealous about with him because he was born with so much born leadership. That was never me. I was the guy who was like, “I'm going to leave my business.” I told my wife, “I'm leaving this stupid practice. Only idiots would run this hard.” She was like, “Maybe get a coach.”

What I'm passionate about is knowing that taking time like you guys to be in this call is the thing that moves the needle. It is part of this thing about building your network. When I say the word recruit, I'm talking about it from a space of learning how to align yourself with great people that look like recruiting and hiring employees, but it’s the right coach, the right service, the right E-rehab, and the right EMR.

I don't lightly promote services and products because we're on a call. In case you haven't noticed, I'll speak my opinion no matter what. I love you guys. I don't openly talk about companies I'm not a fan of because I like their owners, but I don't like their products as much. When it comes down to it, learning how to recruit the right people around us solves all problems, including finance and reimbursements. Nathan's got a solution that he's sitting on for reimbursement solutions. I'm like, “Recruit him and that course.”

This is the big lesson for me, and then I'm going to shut up. In all cases, that means you've got to spend money. You've got to buy your freedom. I hired my most expensive coach for $130,000. It's going to pay off in multiples because I have learned that I trust the system and that I've got to invest time and money with the right people. When you find someone you trust, like this whole wonderful club that you're in, you have to go down that road. Once you're down and feel confident in hiring and recruiting the right coaches, you're unstoppable. If I can do it, anyone can.

Your definition of recruiting helps a lot. We would all agree that leveraging the resources that are available to you can make all the difference. The only thing that most of the therapy owners on the call have leveraged is their therapy education that they got and their hustle. They've got some innate will and capabilities. No one ever taught us, most of us that are on the call, how to lead a team, hold one-on-one trainings, onboard anyone on our team, and how to fire somebody. “What are my financial metrics?” They don't know how to read a profit and loss statement or a balance sheet. There are all these things.

What you're saying is to recruit the experts around you to let them be the experts. Some of those are business coaches. Some of those are website creators and designers. Some of those are high-leverage or highly capable EMRs like we have on the call, coaches, and whatnot. When you're saying recruiting, get a cohort of experts around you to build you up and show you the way.

The overwhelm for me is that I suck at a lot of things. I don't want to get in the habit of thinking, “I've got to figure that out next.” I've already got a lot of crap to figure out. My whole thing is learning how to do that solves all problems. Sometimes, you've got to lean on others, but recruiting is the word I use for that.

Reimbursement Clarity Vs. Other Industry Challenges 

Adam, what do you want to share in regards to reimbursements and whatnot before we move into our other topics?

I'm not so sure that the reimbursement is the real issue. It's the lack of clarity around the reimbursement that's the real issue.

I like that.

We're all talking about insurance reimbursement declining, but nobody on this call accepts insurance and their business. We're all doing fine financially. I tell owners all the time, “It's your lack of knowingness that's the real problem. The real skill that you have to learn is the capacity to learn new skills. What that means is you're going to have to learn to let go of the old way of doing things and carve out some space so that you can step into something new.” We have to learn the skill of financial management. We have to learn the skill of measuring metrics, designing a model that is profitable, and operationalizing that. More importantly, if we're going to decide to increase reimbursement, we have to learn some marketing and sales skills.

What Will would say is hire the people to teach you those things, or do them for you.

I understand where you're going with that, Will. I do agree with some of that. I've never found success throwing money at my problems, like, “There's a person who knows more than me. Here's my money. Figure it out. Let me run away.” It only worked when I decided that I was going to own that problem, become the student of the problem, learn the skills, and elevate myself, and then the business moved. That's the real skill. The real hero is the owner. Your lack of skills and understanding of how to move the needle forward is the real problem. That's the main thing.

I like your point about the lack of clarity. Most owners, the depth to which they know about their reimbursements, is limited to their average reimbursement rate and that crappy United Healthcare flat rate payer.

Nathan, I'll push back on that. They think they know their average reimbursement rate because they checked it last quarter, last year, or some random month, but they're not measuring it. If I were to pitch you guys a coaching program, 90% of you might say, “I can't afford that.” We would go into the numbers, and I would show you why you can afford it. I do it all the time. It’s a lack of clarity.

I know exactly where you're at.

It's like, “We do pretty good at collecting over the counter.” Do you? How often are you measuring that metric? They’ll say, “We measured it last year.” Did you measure it yesterday, though? To build off of Sharif's point, it's that operational excellence and that lack of skill. We need to fill that gap so that owners can become the leaders that they need to be to move the business forward.

I agree. Adam, knowing what I know about you, you are one of the most highly skilled, capable people I know. It makes sense to me that you're able to take that on and move forward, but that wasn't my experience. I'll agree with you on this main point here that clarity matters more than anything. Mindset is the foundational piece before anything else happens.

You could do anything in a company well. I'm not that guy. When it comes down to it, clarity and skill only work to a point. I'm not debating that we shouldn't have a baseline skillset. At the end of the day, I love that we're on the same page. We have to get to the point where we start investing in other people, assets, and team members that are going to move that needle because it's honestly too heavy to do it alone.

Standing Out: Strategies For Private Practices In A Competitive Market 

Thanks for the discussion, guys. We'll move on to the other topics. For those who are reading, make sure you utilize the chat. No one's mentioned anything in the chat yet. It's there. You guys can ask questions, share your comments, talk to each other, or whatnot. Feel free to do so. I’m going to go randomly. I haven't decided which order we'll go in. I'm going to start with David. The topic that you brought up was how to stand out from the crowd. I might not have even worded it properly. I'll let you take it from there and present on the topic that you think is a big issue facing the industry.

I am bringing my experience from the practices that I work in and with. Most of them are small practices. The challenge that I hear constantly is that the playing field is overcrowded. There's a PT practice on every corner. I spoke with Larry Benz. If you guys know Larry, he’s like, “Things have become commoditized.”

I work with the people who are trying to figure out how to stay afloat. You guys have already alluded to these things. Wanting to learn the proper mindset and then recruiting the right teams and people around you are all critical. You have to be a continuous learner. What's working for a lot of my clients is that they're making an active decision to differentiate themselves to stand out in the crowd.

If you're an ortho clinic and you're still doing ultrasound, then you're probably not different than anything else. For us, we started off as one clinic in 850 square feet. My business partner at the time, his passion was cardiac rehab. We took cardiac rehab to the point where we're the premier cardiac rehab facility in San Diego County. He's the only guy who's CCS certified. He teaches at USC. The doctors call him the Heart and Lung Transplant Center at UCSD. Call him. Why are your patients doing so much better? Do you know why? It's because he's passionate about always learning and being the best, but he's also gone off into the blue ocean, if you will. There isn't much competition there.

I've seen a number of people differentiate on providing services that are unique to the community, even something like aquatic rehab and lymphedema. Pelvic floor is becoming much more popular. The people who are reading know these kinds of things. Even for the private practice that's passionate about orthopedics, are there a certain particular type of patients? You have to ask yourself, “Are there enough in those communities to support that?”

In most cases, if you're in a smaller community, you can't do total joints. That's the idea. At the end of the day, private practice, in my opinion, good clinical care is table stakes and up for a ton of debate. You can be Maitland. You can be McKenzie. You can be exercise-only functional. At the end of the day, and somebody mentioned it, maybe Will or Sharif, customer service is what differentiates small practices from the big boys on the block. You have to do what Nathan, Adam, and I'm sure all of you teach. You've got to understand operationally what good customer service looks like. From the very 1st impression all the way through 2 years later, what does great customer service look like? Own that.

I'm tactical at what I do. I can talk strategy all day because over the years of constant learning, I've learned strategy. I can tell you that one of the simplest ways to differentiate, and Adam is going to nod his head as soon as he hears this, is Google reviews. Own Google reviews. It blows me away in so many markets. There are markets where people have owned this, but if you looked at mid-sized to small-sized markets across the United States, you couldn't find a practice that even cared to differentiate online that is providing this, dare I say, commoditized orthopedic service.

Turn to Canada, where I've got tons of clients, especially in the greater Toronto area. For some reason, they get it. You'll see they have three hundred, four hundred, five hundred, or six hundred Google reviews, and they're not stopping. It is a unique opportunity that is still available in many markets. I like to learn from you guys about strategy, business, and those kinds of things, but at the end of the day, people pay me to leverage my time and my service. I'm the $10 an hour guy. I say, “What can we do for $10 an hour that you can do that can set yourself apart?”

For me, it's Google reviews. I give that to the group. If you want to take something away that you can do tomorrow, that's something you can do. It's a great marketing multiplier because A) Anybody that sees you, if you look at your Google business profile, you will see that you get thousands of impressions per year of your Google business listing. How do you set yourself apart from everybody else's business listing? Google reviews. It also helps with search rankings in the local listings. What about any other advertising you do?

Ultimately, there's this messy middle that Google has defined in the last couple of years in their research, where they know you, but how they find out about liking and trusting you is all over the place. It's not this linear path, if you will. If they search for you, which so many do, and your listing shows up, how are you different? Google reviews. It's a great opportunity. All of you consume reviews and read responses, but at the end of the day, you don't implement.

What Adam said about how you got to do something different, my idea is that we all live in a box. We are comfortable in there. You've got to get outside the box. You've all heard it. Plenty of these experts here have shared their knowledge, and you all know it, but real success happens when you start doing something new and something different. You need to take a risk.

For me, being tactical and working with the tiny practices, I have to find efficiencies for them. They don't come to me and say, “I can spend $5,000 on my marketing strategy.” I would quickly pick that apart and say, “Here's why you don't even need to spend $5,000.” What Adam and I talked about. At the end of the day, try to differentiate, try to open a different service, something you're passionate about, because that'll help you through the rough waters, the obstacles as you're developing that service.

If your true passion is orthopedics, then A) Differentiate yourself on customer service, B) Get the message out there to your community online through Google, and C) Get outside of the practice. Be your own local hero. I don't have too much to offer at the big strategic level like you guys have, but I’m a boots-on-the-ground, the brigadier general kind of guy.

Don't discount it there, David.

I'm not.

Building Culture & Marketing Differently In Physical Therapy Practices 

I don't want you to discount yourself because you bring a ton of knowledge that a lot of business owners need to hear. Sharif, you raised your hand. What would you want to say?

David's being overly modest, too. That's tremendously valuable. What I would offer to complement what he said, working with lots of different practices across the country, I can't emphasize how important market research is before you decide what you want to specialize in.

You have to have a market big enough to address that if you go into that specialty, you're not choking yourself by having an insufficient number of patients in the area. What I've seen that's pretty successful is you often need to have that base orthopedics practice to always make sure, because that exists everywhere you go.

I have worked with a number of practices in Florida where they're seasonal and the patients are older, so the issues are tracking with the age of the patient. I've worked with practices in New York City where performance PT is sustainable in a way that you would never be able to do in rural Arkansas or wherever you are. Give some thought to making sure that you have the addressable market and that you have a path to get that pipeline, which Dave was getting at with the Google reviews. Not only do they have to exist, but you have to be able to reach them so that they can get to you. That can be generic across any sort of marketing effort.

You need to then reach specific people with a specific issue if that's what your jam is, and you want to sustain something on it. It's good to have some core stuff that you know you can have a steady business on. I wouldn't say be safe with it because you're never safe with anything, but to know that it exists. You can have some portions of the business that are a specialty. You can hire a specialty PT if you want, which often comes with a cost that you have to be able to consider. That is my addition to that because it's fantastic. We all work with practices across the country, but the differences in local markets are substantial, in my experience.

You mentioned the idea about a cardiac specialty that got carved out. If you go to Adam's small town in Mississippi, that might not work out well in his market. Who knows how many cardiac patients there are in the rural area?

That's what I mentioned at the beginning. You need to have a big enough market to support it. I echo everything Sharif has said. I will comment on the ratings and reviews through text message. You'll get about 1 in 7 people who respond to a text message review. If you're starting and you're like, “I need to maximize my dollar as far as return goes,” then ask your patients for ratings and reviews. It's one of the most valuable things you can possibly do.

The tiny practice that wants to work with you guys and get to be the bigger practice has to get there efficiently. They don't have the expendable cash. The good thing about Google ads is that you can understand your customer acquisition costs very transparently, and we do that extremely well. You need to know what your numbers are. The CAC doesn't matter at all. I don't want to be too tactical about things.

Adam, I'm going to come right to you because you are the one person on the expert roundtable who owns physical therapy practices. I want to know how you guys stand out. Our experience when Will and I ran our companies was, and we learned this from our mentors, was those discharged patients that love you, you're handing them t-shirts, mugs, and stuff like that, they always bring cookies on their last visit, and they talk about how much they love you, we got to the point where we were like, “You like us so much. Do something for us. Leave us a review. Give us a referral or something to generate more business down the road, and hopefully, do something to invest in our future business.

That's a good time for those discharge conversations to highlight the request for Google reviews when they're happy, when they love you, or when they want to show appreciation. I remember interviewing someone years ago on the show. He didn't have a website. He built his business on handing over business cards with a QR code for Google reviews. He's the small practice in San Antonio that came up first on the Google search. He built it off of Google reviews and had a lot of success with it. That is a possibility. Adam, how are you standing out?

I like to keep things simple. David and I are going to agree here, but a lot of people in the industry who want to sell you marketing stuff are going to make you think that it needs to be this complex algorithmic beast that's complicated, and you've got to spend $5,000. I don't believe that. I believe consistency is key. The one thing that's going to help you stand out better than anything is developing your culture. That's the key to marketing.

Your marketing message should be less about what you do and should be more about who you are, what you stand for, and what you believe in. There's only one of you. Nobody in the world can be as good as you are being you. You instantly put yourself at number one in the category. Building a strong culture and building a language that describes the culture, what are your beliefs? What are your core values? What's your purpose? What's your vision? That's key. Aside from that, building operational excellence inside the practice that drives profitability and world-class experience for your customers. Intentionally and strategically capturing testimonials and internal referrals is key.

That's like part of the system.

If you're not doing that at a world-class level, and I say world-class intentionally, average is not good enough. I wouldn't spend any money on marketing. We've got to get that right first. If you do decide to venture out and start spending more dollars on marketing, communicating with physicians, or spending money on ads, in my opinion, the most important parameter is consistency. Consistency is key. Develop the discipline of consistency. How many times have you guys ever started something and you’re like, “We're going to start this marketing program.” You do it for three days, and then it goes over the ship.

Google reviews.

You're not disciplined enough yet. You have to develop consistency for a long time to prove to yourself that you're able, and you're going to prioritize it. Once you establish consistency, then you can turn up the volume. Instead of 1 outreach a day, let's do 50 outreaches a day. Once you establish consistency, you push quantity. Through the repetition of quantity, you start becoming a decent marketer. You start learning how to be a good marketer.

You can attract leads, people who understand you, and people who identify with your culture, to your practice and insert them into an amazing culture with world-class experience. We're going to capture that testimonial, that review, and that internal referral. That's how you build a practice, in my opinion, or any business.

Will, your two cents, and then I'm going to come back to you, David, to wrap this up.

Adam hit it square on the head when we talked about consistency. We're going to talk about recruiting at some point. Marketing and sales are called business development. That's biz dev. It's all the recruiting, the new patient gathering, and all that stuff. That's the hardest part of any business. That's the most challenging part. This is where we live and die by.

I was very big earlier about, like, “You've got to hire people.” There are a lot of people out there taking advantage, too. Two things can be true at the same time. Marketing is one of those areas that you have to be leery of a lot of companies that are out there. That's one of those areas I found experience-wise has that issue.

I want to reiterate that. I won't go longer. Consistency is the most important piece, whatever we do in that. Whether that is us or somebody else, you can hire for that. It's a trickier piece, whether it's an outsourced company or an internal person, but you have to have at least 20% of that knowledge to be able to manage that person.

To tie into what Adam was talking about, sales isn't hard if you've got a great product. What Adam was talking about is the product that you provide to the patients is their experience, the culture that they experience.

Culture and operational experience.

If they're like, “That was an amazing experience at the front desk compared to what I saw last week at the doctor,” you're going to stand out. That's going to be a better product. Maybe they’re like, “Paying my copay was easy that time. I'm glad I didn't have to cut a check. They sent me a QR code with my balance so I could pay it by phone, all the things that are available to make it a world-class experience.” It's easy to sell at that point. It's easy to get referrals and stand out. David?

What's very important for me, and that's why I had an emotional reaction to Will's statements, is clear communication. We've intermingled sales and marketing. Those things needed to be defined. Sales is face-to-face, belly-to-belly, Zoom-to-Zoom, phone-to-phone. Marketing is, more or less, when you're pushing a message out, getting people to know, like, and trust you. Ultimately, they come in, try, buy, repeat, refer.

It's important to distinguish the differences between those because both of them are critical. You all are exceptional at what you do because you offer an exceptional product. If you offer a mediocre product, then you're going to offer a mediocre product at your PT practice. If you don't know how to a) Treat well, so you don't have confidence, B) You don't understand how to do business, and C) You don't know how to sell. For me, sales is far more important than marketing.

I agree.

Agreed.

If you can sell, Will, then marketing is about turning up the volume and scaling the message out to people. We don't teach what, respectfully, Nathan said, to maybe ask if they had a good time at the end. Ours is very systematic about getting reviews. Adam knows this because this is my thing. It's all about systems. How do you get a review? A) On day one, set the expectation that you're going to ask.

Use psychology to get a commitment from your patient. Simply ask, “If you're happy with our care, would you mind leaving us a review?” When they say, “Thank you,” and it's not always a discharge, then you make them good on their commitment. Say, “Would you mind doing me a small favor and leaving that quick review, please?”

Make it fast, easy, and friction-free by using technology. If you don't have the system of communication in place and you don't set up the expectation, A) Your staff aren't going to support you. We all know that it's better to have 10 people on the bus than 1 person on the bus, especially when it comes to doing anything as far as sales or asking for reviews, in this particular instance, goes.

Your staff doesn't ask for reviews for one reason. They're embarrassed. They don't think they've earned it. They think that it's arrogant, greedy, or whatever. If you set expectations and then the patient said thank you, and you understand the context in which they're saying thank you, whether they thank you for helping them out of the pain or thank you for helping them walk again, you say, “Can you do me a small favor that you already agreed to do?”

Is there anybody who's not going to do it? Yeah. Do you know who's not going to do it? The person who has no idea what a review is, which is next to no one. 98% of people are willing to leave you a review. It's all about the systems. This is a practical example of what you are all talking about. Implement systems into your practice.

Have a great company, culture, and product. Know your business.

I'd like to bring it back to clear communication. I can talk a lot about in marketing vernacular and make people think I'm smart, even though I've done it forever. I've transitioned back to explaining things simply. Understand things clearly, implement those systems, and then work outside of the box and do something new. There's plenty of room. There are plenty of practices doing well. Thank you for letting me wrap that up.

That's great. We need to remember one of the topics that you brought up and that Adam and Will vocally agreed to. We need to understand the importance of sales in our therapy world. Maybe you guys would agree with this, but I think therapists, in general, are poor salesmen.

Some of the worst.

We don't want to look salesy.

We don't want to have to make people make a decision.

How many times have you heard, “I don't want to sell. I don't want to market. I want my good work to do the sales for me.”

“My manual therapy skills should speak for themselves.”

It's not going to magically happen anymore when there are people on every other corner that are like, “I need to know how to sell. I need to know how to market.”

It shows up in our industry as a whole. We bow down to the AMA.

We lose focus as an association. I would argue that if we got paid for what you do, we could then recruit and do exactly everything that Will talked about. If you're getting paid below your cost to do a visit, which, with good knowledge and good training, those things can be adapted to as well.

They can be rectified.

Creativity can help us with any challenge that we have. If there's an obstacle, we can creatively think through this, for sure.

A topic that we should consider for future roundtables is how to be better salespeople.

That's a brilliant idea. The biggest problem in the industry is how we relate to money. There's not enough educational support. When I have an opinion, I have a strong one. This idea of PT sitting there, going, “Mrs. Smith, if you'd like to come 2 to 3 times a week for maybe 3 to 4 weeks, we'll see how you feel at that point. Maybe we'll continue, but maybe not,” is the whole reason our reimbursement suck and we're drowning.

I want PTs’ owners to stand in front of their team and go, “I want us to make as much money as ethically possible.” What if we had that mindset? It’s like, “I want all of us to make as much money as ethically possible, and here's why. We're not doing physical therapy to make money. We're going to make lots of money to do better, more physical therapy.” It’s that mindset shift right there.

It then goes to the sales of the PT standing there and thinking, “This person won't hold their grandkid again unless I convince them that I'm the doctor and I'm the expert, not something that gets referred out to. Mrs. Smith, I can get you better. You'll hold your grandchild again, but you've got to commit 3 times a week for 6 weeks.”

I love it so much because people need to look back historically at what a professional is. Look up on ChatGPT what a professional is. We don't act like professionals. We don't act like doctors. We have fallen into the trap of what ancillary providers mean. If you look up the history of ancillary, it means a woman slave. No disrespect to women or females at all. We haven't broken out of that at all. We still act like physical pharmacists in so many ways.

Four times a month, I write on clinical research to support physical therapy. You know where my bias is. To save a trauma, a cognitive fracture, something that no PT is going to help, there isn't a diagnosis in the orthopedic world that physical therapy can't help. In most cases, it is as good or better than aggressive care. If we adopt that mindset, own it, behave like professionals, learn how to sell, and then we're willing to say, “I'm not going to give you that $5 piece of therapy that's my profit’s margin on this visit away,” we have no problem with that whatsoever because we're confident. We can do so much better, but we have to learn those skills that you guys talked about.

We’ve got to move on. At the rate it's going, this is an awesome conversation. I'm not doing the best as a moderator because we only have half an hour left to talk about two other major topics. I apologize ahead of time. If it's okay with you guys, we might go past the 30-minute mark, but if you have to battle out early, I understand. I want to get to a very important topic that is top of mind for many owners. We're going to talk to Will and Adam about recruiting and retention of highly scaled, capable, and aligned providers. I don't know if you guys have talked a little bit about this beforehand, but who wants to get us kick-started?

Unlocking Recruiting & Retention Secrets For Top Talent 

I can jump in because that was the initial thought, right, Adam?

Sure. I'm cool with it. I'm going to go fast. I want to give you guys maximum value in the least amount of time possible. When I was recruiting for 26 locations at that time after Nathan and I merged and sold our companies, and I stayed on as VP of recruiting, through all my coaching, I'd learned how to build out this system to where I never had a hard time hiring positions. It was me and one person who was an assistant to me filling out 26 locations.

Here are the two key things I want you to know, and then Adam's going to bring tons of value. I mean this very humbly. I don't know anyone else in the industry who knows how to recruit as well as Adam and I. Adam is the only person I've met who's at this level, and it took him not all the coaching that it took me. Let's say that.

The idea is that we have to change two things. Number one, this is going to sound very ethereal, but you need to pay attention. If you're struggling in recruiting, pay attention. Your mindset has to shift from scarcity to abundance. I get it. Here's how you know if you have a scarcity mindset. You're saying, “It's hard to recruit.’ That's why I jumped all over David a minute ago.

When you use that language, you're creating it. You're done. You'll never recruit, I promise you. It's hard to recruit. You'll get an occasional random thing. It's a mindset thing. It's an excuse. It's okay. It’s challenging. It's okay for it to be challenging, but for it to be hard means I'm throwing in the towel. “Recruiting is a challenge that I currently struggle with, “is a completely different mindset, because in that mindset, I have hope. I'm serious. Change your language. Correct each other. Stop people from saying that.

Secondly, I want you to start recognizing that you're not recruiting. You're coaching. All of you are amazing salesmen and women. I promise you are. If you have patients who bring you cookies, you can recruit like a boss. If you have patients that you have a hard time getting off your list to give to an employee, you can recruit like a boss.

The best news of all is that 99.9% of the people out there recruiting are doing exactly what you're doing and getting your exact same results. They're putting out an ad, talking to a few people, wishing it wasn't a problem, and burning out. You have an opportunity to think differently, which means you can be in that blue ocean strategy and be in a completely different space by thinking differently.

Here's what I mean by coaching. What would it look like if someone came to an interview, sat down in front of you, and you said, “Before we get started, I want you to know my purpose is to help you find your best fit, whether it's with me or somebody else. My goal here isn't to hire you. It's to help you. My goal here today is to help you find the home you were born to be. Here's the thing. If it's me, you're going to hear about it. If it's not me, you're going to hear about it.”

Scale that back because all of you don't have a recruiting problem. “What do I do?” No, you don't. You have a lead generation problem. You don't have enough people who know that you exist to show up at your door to sit down for an interview. That's your problem. If you solve that problem, you're automatically better at sales organically than you realize. I want to highlight David and Adam’s wonderful point about sales.

When it comes down to that, what would it look like when you show up at universities as not trying to recruit but trying to serve? It opens up a whole new possibility. This is where that mindset shift is going to start getting you leads, so pay close attention. I've helped over 100 companies through my program, Rockstar Recruiter, which I no longer sell. I'm not promoting it. It was a coaching program. We took 100 companies through that. Adam was one of my star students.

When you guys are going through this mindset shift and show up at a university from a place of service, which you're so good at because all of you are healers, and you're there to heal the next generation of physical therapists, you're going to get energy. You're not going to walk in there and go, “What PTs do I need to talk about? Who do I need to talk to to hire someone who is going to leave me a year later and break my heart again?”

That's why it's been so challenging. You've been rejected, all of you. No one gets rejected more than owners. We are the ones who get our hearts broken more than anyone else. What I want you to start doing is doing the most obvious stuff that no one else is doing. Here's an example. Go to the university in person. No one's doing this. Go there in person, walk in, and say, “I'm Will from Will Physical Therapy. I am so passionate about this industry. I'm a private practice owner. I wanted to know how I could help your university. Do you guys need sponsors?”

Money is always the easiest thing. You could say, “Do you guys need sponsors for any student events? Do you guys have any charity things I can help with? Do you guys need some educational support for your students in the classrooms? What do you need?” I know it's like, “How am I going to have time for that?” You need to realize that it is your main job. The number one job of your life as an owner, whether you knew it or not when you signed the lease on your building and the debt that you took on, was to build more leaders. That's why you exist.

That was me. I wanted to treat all day. I was like, “Those annoying employees are the worst. I wish they would go away.” That used to be me, but here's a preview of when I sold with Nathan. I was in this room with this dream team that took me a decade and a half to build with lots of help. They were the best part of the journey at the end of the day. They're the legacy. It's not your care. It's your team. It's the team you build that's the legacy.

If you start realizing that mindset-wise, all of a sudden, it's not going to be hard because you're the only one showing up giving. You're out there like, “Let me support you.” When you're talking to students at events, you're out there going, “What is your purpose? What do you want to be? You want to be an inpatient therapist. Let me see how I can help you with that. That has nothing to do with me, but let me keep talking to you in that regard.”

You can learn some techniques from Alex Hormozi, who is a big marketing guy. Adam, I would love it if you would chime in here in a little bit. This is maybe a good handoff to you. It comes about the consistency and the effort in keeping that connection. You have to shift your mindset around recruiting and look for these little things that no one else is doing, that if you do it, you'll dominate. What's crazy is it will start to get its own momentum, and you'll start to not just fill your roles.

You'll build a bench of people waiting to join your practice because they've heard you, they know you, they trust you, and they are hearing it from other people. That is your job. Your job isn't to treat. It's to go find these wonderful human beings that you're going to build and invest in, and then the business skyrockets. That journey requires coaching.

I do work on myself as much as I hire experts to take things over from me because I want to be the leader that attracts the best human beings on the planet, which means I've got to work on myself. Circling back in my last comment, as it all starts with getting a coach, I have never ever not had a coach. I've had over 30 coaches over the years. I've never regretted a single coaching investment ever. That's it.

I'll go back to saying the mindset shift made all the difference. When we started seeing people coming into our clinic, and we built that bench, it started with the mindset shift. I had this experience. He was a tech for me back in the day. Now, he owns his own clinic here in town. I went to lunch with him. He said, “There's not a lot of talent in this town to pull from to fill the spots that we need.” I'm like, “If you believe that, then that's the case.”

You're exactly right.

It’s like, “What kind of effort are you going to put out after having that kind of mindset?” They say, “We steal from the other local PT clinics in town.” You could, but I can tell you that his marketing efforts consist of putting an ad on Indeed. He stopped focusing on the U local universities he could draw from. Now, he's blaming it all on the fact that his ad isn't working on Indeed. You're not doing anything, and you have the wrong mindset about it to begin with. What if you changed your mindset and said, “There are great people out there. I have to find them. Once I find them, turn on the spigot. Let's go.”

More than that, not even great people. People who need you, not anyone else in this call. I swear to you this is what's happening. I'm a big believer in God and how these things all connect. There is purpose in everything. You have something special that no one else can bring to the table. It starts with service. Service is the ultimate expression of leadership.

When you're out there and you're serving the industry, it will be fun. Recruiting is the most fun thing we do in a business. There are some technical things that you have to learn how, and that's okay. It's not even a tool in your tool belt as a leader. It's a different belt. You can learn how to do it with the right coaching support.

As you're going through this journey, it is opening that possibility for hope for you guys, like, “What if I had an hour a week where all I did was every day, reach out to people on LinkedIn or text, or I went down to a university?” Have an hour a week. What if that hour turned into a half day, and that was your deal, and you started moving things forward? You would find that many of your problems would disappear. You'd have more freedom, time, and passion.

Keep that in mind as you're staying in this place, as many of you might be. It took me ten years. I told my wife I was walking away from my business. Here's the most amazing thing. Back in those days, I had team meetings that would turn into staff meetings. Do you know why we call them staff meetings? It is because staph is an infection. They'd go talk trash about me after the meeting.

Fast forward years later, I'm still the same guy. I'm a better leader. I'm still relatively Will, and people think so much more of me than I deserve, but I don't even care. That's what I've learned. What they think about me has so much more to do with them than me. My job is to go find those people. Believe that there are people who are looking for you, and believe that you can serve them. You'll have all sorts of ideas with these techniques that Adam is going to serve as well.

He teed it up for you, Adam. Let's go.

Prospecting, Outreach, And The Power Of Volume In Recruiting 

I agree with everything he said, especially the good stuff you said about me, too. That was the best one. Honestly, everything you said landed for me. I love how I can uncover the principles as you talk through that, Will. The language that I used to describe those things is a little different, but we're still doing the same thing. It’s maybe a personality difference or whatever it is.

My coaching. I'm working with recruiting experts. That's the language I learned.

Maybe that's what it is. Mindset is key. I’m going to start there like Will did. More important than a mindset is a decision. You have to make a decision that you are going to prioritize recruiting over patient care or over anything else. You can talk yourself up in the mirror all day long, but nothing is going to move the needle until you start taking action. Even if you don't fully believe in what you're doing, by taking action, you will develop the belief as you start to prove to yourself that you can win. Does that make sense?

The first step is to do it scared. We had two coaching clients join our program. They were like, “Teach me how to recruit.” I said, “Here are all the techniques. Do it even if you don't believe it.” Two weeks later, they're hiring therapists, PTs, OTs, and speech therapists. We get in our own way. The first thing is to decide. The second thing is to take action. You've got to start prospecting for your business. You have to start promoting your business to everyone, all the time, everywhere. Universities, LinkedIn, Facebook, and emails. You have to start leveraging as many platforms as you possibly can, and then you will start developing the mindset.

Regarding the sales piece, I love the language that Will used, which is, “I'm not here to hire you. I'm here to help you find your dream job.” The way that I describe that is that we want to show up detached from the idea of hiring them. We want to show up with an intention to serve, like, “I'm interested in uncovering some of the problems you're having with your career, only so that I can serve the heck out of you and I can help you solve those problems.” When you can uncover that approach, you might be able to find some inspiration and the language that you can use during some of these enrollment conversations you're having with candidates.

I do want to touch on lead gen. Will dropped Alex Hormozi. I'm an Alex Hormozi fan. Write this down. One of my favorite things that he says is, “Volume negates luck.” The reason why I hired eighteen therapists in 2024 is that I sent 20,000 text messages, and you sent 0. That's it. The people who get what they want are the people who ask the most. I'm more interested in putting in the volume that I need to do because I'm searching for my people.

I'm not there to serve everyone. I might have to get 100 noes, but when I find those 1 or 2 yeses, those are my rock stars. Those became my leaders. Those are the people who help build the marketing program, change the operational capacity, and improve the financial health of the practice. We opened more clinics together, all because I was willing to put in the work and the volume that it took to find them.

My best advice for lead generation is to become violently obsessed with outreach. How many DMs did you get from me to get on this call? We had 100 people sign up for this. You guys got text messages, emails, and DMs from me. I was blowing your phone up. Look at you. I got you here because I was radically obsessed with getting you here. I was willing to push away the people who might not have aligned with me so that I could attract great people. How do we get violently obsessed with outreach? We can then start learning what we can do to automate so that way, it doesn't take as much time. If you do that, you'll never have a problem recruiting.

Was that it?

That was it.

That was a great place to stop. I was feeling excited inside. I'm like, “Tell them. Preach.”

As you can tell, I get super passionate about recruiting. I'm starting to like prop Will up on the pedestal. Maybe I do believe that recruiting is the most important thing. You, as the owner, have so much to offer. You pour into your patients. You're changing people's lives, and you're changing their families' lives.

All recruiting is, is learning how to believe in yourself so that you can serve at a greater capacity. You have clinicians in your network who could benefit from a little bit of you because you have so much to offer them. When you tap into that and become a little obsessed with that, you change the world. Your practice will transform.

Great stuff. 

That's going to be the mic drop.

Thank you. Sharif, we're turning to you. Sorry, we don't have a ton of time.

It's okay. It's all right.

If you need to jump off, even the experts here, if you need to jump off on time, it's understood, but we'd love to make sure we get enough value and answer questions as they come on. Go ahead, Sharif.

Organizational Structure & Streamlined Systems For Practice Success 

I'll start my stopwatch here, and I'm going to try for five minutes. You guys can hold me to that. I think it's fitting to go last because I feel like I'm battling cleanup. I get an opportunity to incorporate all these different things. Imagine there are some people here who are into Shark Tank. I don't know if you watch the show, but the number one thing you hear over and over again from them is, “I want to use my money as gasoline. I want to take something that's already working, even if it's not working perfectly, and ignite it.” I hear that often on that show. If you enjoy it, you probably know what I'm talking about.

What they mean is if you have something that's operationally doing pretty well, even if it's not perfect, then money can help take that and scale it. What they're saying is the product is good, and the way you're selling it makes sense. You've found a market that wants to buy it, and they're buying it. You see the threads here of David's comments that you've got a team that's making it work. You see the threads of Will and Adam. That's my big pitch to you all.

The question was, what do you think is super important for practices? What I see is that a lot of practices are doing a lot of things very ad hoc. There is no actual system. It's whatever the patterns are. I'm from Boston. Most of the streets in Boston are cow paths. They evolved because that's how people used to walk. Unlike other major cities like New York or Chicago, which burned to the ground, and then they built a grid system of streets, if you come to visit Boston, you'll immediately be like, “Why are the streets so messed up?” You can't get there from here. Everything is one way.

I see that parallel in practice. Many things are ad hoc. They're cow paths. People got used to walking that way, so we always walk that way. I'm preaching this idea that if you can be a little bit more thoughtful about your process, about your systems, and about how you deploy your various human resources, all of these pieces will come together. You will be the one who is ready for gasoline. Will said, “Go get a loan.” If you get a loan, then that can be your own gasoline. Maybe you're bootstrapping, or however you want to do it, wherever you are in the phase of your practice.

To stay true to my 2 minutes, there are 2 things I would talk about that I would urge you to think about. Number one is organizational structure. If you go to business school, this is one of the classes you'll take. It seems dumb. You have an owner, and then you have PTs. Is it that simple? It depends on the size of your practice. It depends on how many people you have.

Do you have somebody whose sole or primary focus is to manage the front desk? Who is that? Do they know that they're the person who's managing the front desk, or did they become the person who's managing the front desk? Do you have a billing team? Is there more nuance to your billing team besides, “This is my billing team.” Is there an authorized person? Is there this person? To David's point, is there somebody in your practice who has any responsibility directly for marketing? Do they know that they have that responsibility?

If you can take a few minutes and draw a picture of your organizational structure, you might quickly find that the page is blank because it's undefined or unknown. That could be a tremendous opportunity. The second one is focusing on your systems. I am a big fan of workflow, where you draw out a process on a piece of paper and say, “When the patient calls in and we say, 'Hello. Thank you for calling Will Physical Therapy,’ what happens next?”

Does the same thing happen every time, or is it being very ad hoc, where sometimes, it's this, and sometimes, it’s that? It depends on whether David answers the phone or Adam answers the phone. Adam does it this way, and David does it that way, so it is super inconsistent. This is also where you're losing money in the whole. You're losing time and therefore, you're losing money. Consistency matters.

What I find is that this seems very unapproachable to people because it's so big, the organizational structure and systems. If you break it down into pieces and say, “This quarter, I'm going to get the team to focus on our intake process only. That's going to be what we're going to do for this quarter,” and you align everybody against that goal and make sure that you have all the right people at all the right places and they all understand what the process is supposed to be, you clean that up. You don't have to make it perfect. You need to make it better.

You need to be very respectful of yourself and be kind to yourself, frankly, in terms of what your capacity is. You will not be Amazon, where you can get an order at 4:00 PM and have it at the person's doorstep at 4:00 AM the next day. If you are Amazon and it's taking you 3 weeks to deliver an order, can you make it 1 week? That's a big win by itself.

If you follow the story of Amazon, that's their story. They started with, “We'll get you an order in two weeks,” which at the time was revolutionary. They've gotten it to where you're in an urban area, and you can get your order in four hours. Be Amazon. Take your time and improve your process incrementally. It has been 5 minutes and 1 second. I'll stop there.

Nice job.

Operational efficiency. This guy is on point. Let's go.

The stuff you shared was amazing. That's true. We don't go into it, understanding that there is an organizational structure. Most of us assume that there is, but it's not written down, and it's not trained into our teams. Even if there are two, three, or four of us, you still have an organizational structure. It could be what you have. It could be what you expect to have in the future. You're filling all the names because you're holding all the responsibilities in that tree.

Unfortunately, if people go into it and think, “We sit here at the top, and then everyone else is underneath us,” maybe 18 different roles underneath 1 box, that's not organizational structure. That's not what it is. I would recommend that people, if they're not quite sure what that organizational structure looks like, read Traction by Gino Wickman.

Somewhere around page 100 of Traction, he breaks it down easily for you. There are a few departments, and you put everyone in their proper place. There are even examples of different organizational structures. It helps with not only the structure but also the workflow. Communication flow goes through that structure.

Run your systems. Adam has not just been violently passionate about recruiting. He's violently passionate about creating systems and then handing them off to his VAs. He does well at it. Will knows what I'm talking about. You've set up a VA on a system, and it's almost unstoppable. Good stuff. Did you want to add anything more to that, Sharif?

Final Thoughts: Building Stronger Practices Through Leadership & Systems 

The only other thing I'll add is that do not think that these are only concepts for large practices. What's resonant in my head from David at the beginning was the 1 to 3, the 3 to 5. For you, the organizational structure is more about the differentiation of tasks and roles. There was a question here in the chat about, “How am I going to do all this stuff? You guys are telling me what to do, but how or when am I supposed to do it?”

The first thing is to define what resources you have at your disposal. You need to know. It’s like how much gas you have in the tank. That's going to define how far you can drive. Maybe that tells you you need more gas or you need more people. Maybe it tells you you're not distributing your load well, and some people are overworking or underworking.

Also, people like having ownership of things. If you go to a staff PT, and I know Will hates the word staff, but a team member PT and say, “I want you to spearhead some marketing for us. You're going to be the text guy who's going to sit and text people for reviews,” people love to own things. It gives them a sense of, “Their performance of this thing is my thing. It's my name.” If they don't know they own it, they can't possibly do it.

Organizational structure is not meant to be that you have a Fortune 500 company with 10,000 people. It can't just be you, and then it's one manager and all soldiers. You've got to have some things. You may be thinking very black and white that the next step is to hire the next person, but maybe it's a small incremental thing for taking on additional responsibility and having them own it. Your money will go far if you know what you're trying to do with it.

I read the book The ONE Thing a long time ago to help you prioritize what to do next. You don't have to read the book. Answer this one question as you go into every administrative session or any few hours that you have to work on the business, and that is, “What can I do that by doing it, everything else becomes easier or unnecessary? What's the one thing I can do right now that, by doing that one thing, everything else becomes easier or unnecessary?”

Sometimes, that's delegation. Sometimes, that's writing a new system and passing it off to somebody. Sometimes, it's sending an email to someone. Maybe it's committing to doing 50 DMs on LinkedIn for that next provider. What's one thing that you can do? Go off of that on a regular basis. Sharif, you did an amazing job there.

Thank you.

That's my fault. I'm sorry I didn't give you a lot of time to moderate appropriately. That's why you are an expert. You know how to work efficiently.

My pleasure.

This is cool. We've got a couple of minutes to wrap up. Let's do this. Each expert, what is your one big takeaway, or what's the one big thing you want to stress to the people who are reading to end this session? Let's start with Will.

Never give up. It’s ethereal, but I don't want you guys to ever stop it. You guys are here for a reason. You are attracted to this for a reason. You're the best of the best of us. No one says thank you, so thank you for all that you do. We appreciate it, not because we have businesses that serve you, but we know what it's like to be you. It makes a bigger impact than you think. I promise you it's going to be worth it. Keep pushing forward. You got this.

David, what do you have to say?

The one thing I want to say is that a lot of this stuff has already been said, and it's restated in another way by some excellent experts. Take action. Do one thing. I dropped this in the chat for you guys. There's my lead conversion phone training. Is it perfect? No, but we have a saying around here. Done is better than perfect.

If you're striving for perfection, you often never get there, and you never do anything. You keep sitting on the sidelines. People prefer the certainty of misery instead of the misery of uncertainty. Get out of the box. Take some action. What we teach, our lead conversion phone training, is a start. Is it better than anything? No, but implement something. Anything that you learned here, implement it. That's what I have to say.

We did use the done is better than perfect phrase to anger Michelle Bambenek, who is on this. Sorry, Michelle, but we did follow that.

I love it.

Go, Michelle. Sharif, one more thing you want to add?

I'll ask. Does anybody watch the show Alone, where they dump people out in the middle of the woods, and they have to survive?

Yes.

The one quote I love from that, and I don't even remember when it was, was, “I don't have to accept failure in the same way I have to accept loss.” That stuck with me. If there's something you're not happy about with your practice, and the other guys have said it, do a little better every day.

That's what you can do. You wake up and make it a little better every day. That's something I try to do myself. Thank you. Thanks, Nathan, for putting this together. Thank you to everybody for taking time out of their busy days and weeks to attend live. It's meaningful. I know how hard the time is to come by, so I'm grateful. Thank you.

Adam, wrap us up.

Invest in yourself. You are the hero of this story. You've already proven that you're willing to do the work. You have already proven that you've got what it takes. You're busy. It's time to go to a new level, and that's going to require you to delegate. Invest some time in yourself. Maybe invest some money in yourself. Invest in learning some new skills. I've never gotten a positive ROI when I dedicated myself to improving myself as a leader and as an owner, and elevating my skills.

I do want to pitch a very quick offer to everybody on the call. As you may or may not know, we have a coaching program where we support the heck out of practice owners. We're not right for everyone. I talk to practice owners all the time who come to us, who aren't ready for a coach. Maybe they need a little marketing support, or maybe they need a new EMR. Maybe they need to get with Will and hire some VAs to support them administratively.

If you want to talk about what it's like to get some support in your practice, I'm going to reach out to you guys either via email or text. I'm going to give you an opportunity to jump on a call with me. What we can do is we can do a practice assessment. We can run through your numbers. We can identify your top three priorities in your business. I can point you in the right direction. I'm going to give you an opportunity to jump on a call. All in all, the main takeaway that I want to give you is to be willing to invest in yourself. You can do it.

Experts, thank you so much for joining us. It was awesome that you shared your expertise. One hundred and twenty years' worth of coaching experience in the room right here. Thank you to all the attendees. You guys are awesome. It was great to see everyone join us, ask your questions, and share your comments.

Look for more stuff on our website, PPOClub.com, under the Events section. These webinars will also be posted there. Follow the Private Practice Owners Club Facebook group. Make sure that you follow that. In the Events section, look for our workshop in Nashville on June 7th, 2025. Look for our conference on October 2 through 4, 2025. You guys were awesome. It was great to see you. Thank you, everyone.

Thanks. Bye.

 

Important Links

• Empower EMR
• Virtual Rockstar
• E-rehab
• Private Practice Owners Club on Facebook
• Traction
• The ONE Thing