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

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

• Private Practice Owners Club Facebook Group
• Private Practice Owners Club
• The Science of Scaling
• Book a call with Nathan