Transcript
Adam: You ready to rock Mike?
Mike: Let's do it. So first off, thank you everyone for joining us. We know you all have busy lives but from this research we've done, this is clearly a pressing topic for everyone. so as you may know, we ran a survey asking therapists leaving care, why are they leaving care? And far and away, the number one answer was 85% are leaving care because of lack of growth opportunities and the practices they currently work at.
And at Prompt, we are really passionate about solving that. It affects everyone, including us. And we wanted to put together a round table of leaders that have great cultures we've gotten to know over the years. So for some quick introductions Nick Weber is the CEO of Team Rehab. They're in about a hundred clinics, over a hundred clinics across five states, primarily in the Midwest.
Josh Funk is the CEO of Rehab to perform who? Josh, I think yesterday was clinic 11. 11 clinics in the DC area. And last but not least, Michelle Colley, who is the CEO of High Bar Physical Therapy, and they have about 20 plus clinics in Rhode Island. We're also joined by Emma Brady and Emily Kelly, who founded the Clinical Transition Group, where we pulled this report from.
And they also happened to both work at Prompt. for this conversation, we want it to be conversational, informative. As we go, if there's any questions you want to ask, please hit the q and a button in the bottom of the screen and we will do our absolute best to answer them. So to kick off the conversation, Michelle, I'm gonna pick on you, how do you approach keeping your therapist motivated and excited at High Bar?
Michelle: Thanks for the opportunity, Mike, and also thanks to the team at Prompt. I think analyzing and asking the right questions and gathering data so we can support the future of our industry is essential. 'cause it really is easy to get stuck in the weeds and the challenges that we all face in practices, especially with the challenges and payment.
And so understanding why so many folks are leaving and an element underlying, there are some financial components, but really what it comes down to is the opportunities for growth and development. I think you need to stand back and have a really holistic, A strategic approach to that, understanding what your culture is.
So for us, I believe it very much is about having that team approach, listening to your people to understand what are the kinds of opportunities people are looking for. Then you have the ability to create professional development pathways, leadership opportunities, learning opportunities, community involvement, DEI initiatives, whatever it is to actually ensure that your physical therapists or your assistants are more than just a PT.
They can be a PT and a mentor, a PT and a faculty member, a PT and an advocate. So again, to create those opportunities for ongoing growth and development, but really that team approach. Listening, a variety of options, giving people choices. And then finally celebrating people, making sure you create joy and actually rewarding and celebrating, and it doesn't just need to be financial, but really highlighting the good work that people are doing.
'cause PTs, by nature, want to do good work. They're good people and they wanna receive credit for the good work that they're doing. So as leaders, it's important to develop cultures that revolve around that.
Mike: Michelle, do you give everyone the choices upfront? When they start? Or are those people that you identify as people that are well suited for a growth opportunity?
Or is that given to everyone?
Michelle: It's given to everyone and I think that's what we've tried to evolve with. And if I go way, way back in time when our practice started, we were one clinic. And even the founding sort of principles of growth were like, how do we create opportunities for folks so they don't need to leave this practice?
And so it's very early on getting to know that individual. Do they wanna be a clinic director? Then create the opportunities for that. Do they wanna be a specialist in pediatrics and have a side hustle? Then it's our then develop that. Because to me, failure was always when a clinician left because there was an opportunity somewhere else that I actually could have created for them.
So I think it's very individual, making sure you really listen to every clinician that begins with you.
Adam: Great. Nick, same question.
Nick: Yeah, I think everything Michelle said resonates quite well and it, and I think the way we look at it is, we wanna hire the absolute best people. We've worked hard to build a culture and side a clinic and in each clinic is a little bit different, so we want to hire the absolute best people who, are motivated by the things are important to us, which is taking great care of people, both taking great care of our staff as a teammate and a good worker, but also, and most importantly, like being empathetic towards the patients that we see. We all got into this to help people and my role as a therapist to a clinic owner or an executive has always been the same.
Just take care of people. I'm just doing so on a larger scale, and that has to be reflected from the top of the organization all the way through and upon entry into the organization. It's gotta be stressed that we're here for people and we wanna make sure that's our primary focus as far as motivating the individual therapist and growth opportunities.
It's gotta be a personal conversation and each person. May or may not know what they wanna do, and both are okay answers. What our job is as employers and certainly as mentors to these employees, is to make sure we get to the bottom of what they wanna do, whatever that is. And if they don't know, let's give them some structure and some options and allow them the course to pivot.
So what the team did is made sure that as we listened to these conversations and we got our requests and built our data pool of what people wanted, we either created or hosted. Advancement opportunities and educational opportunities for advancement for these people to make sure that they're feeling, that they're being pushed, that they're not just being pushed, but they're going towards their goals.
All the while, if you're, like Michelle said, your culture's good and you're all working towards the same thing, 'cause you're high performers. It's important to make sure that people feel that sense of belonging and that sense of ownership. Whether it's literal ownership in the clinic, or ownership of some part of the day, creating schedules, choosing the next social outing, being the one to write the nice NPS, feedback on the whiteboard. give some of that ownership to people so they really feel like they belong. And then you have to recognize the good work that they do when it's done and celebrate those things. The big ones and the small ones.
Mike: Nick, you mentioned compensation there. Ownership in the actual clinic, do you mean by that?
Nick: Yeah. At Team R model is it's a partnered model. clinic directors own a third of their clinic. buy-in can happen, for a tenured employees as a reward of saying, Hey, we value you as an employee. We want you to stay. Your hard work is, directly responsible for, the success of this clinic. and then we have the ability for therapists and other key performers in the clinic, like a front office person that we call a pack to buy in one, buy in 1% and then they can own part of the clinic they work in and they truly can belong at that point. There's other incentives too, monetary or otherwise.
We want people to be rewarded for what they do, whether it's. Sharing in monthly profits or, staying a little bit later to see a patient or two, a productivity bump or bonus. And then the collective bonus where we have all the aspects of the clinic working together towards a common goal. And if they hit the targets, everybody in the clinic gets rewarded with the bonus. Sometimes that clinic isn't profitable yet, but they're working on the right things that teach the skills to, to be successful. So we wanna teach that teamwork and share in that reward, all the way throughout the clinic.
Mike: That's great. Josh, do you mind taking the same question?
Josh: Yeah, I think I'm left wondering a little bit more about Nick's structure. Obviously he's further along than we are as it relates to partner and LLC and operating agreements and some of the paperwork. But for us, we have profit sharing for leadership at offices.
I'm not sure if that is specifically what he's communicating, but for individuals who want to help us open a clinic, they have to be good at three things. They've gotta build, themselves build the service that we have. They have to be able to lead themselves, lead others, and then sell themselves and sell the company.
So we are always talking about building, leading, and selling. If you have people that are those triple threats, usually they get identified early on and they're communicating to us that they would like to open an office if they don't quite have those skills. And regardless of whether or not they do or not, we now have in addition to internal soft and hard skill training, from a clinical side, we have an internal leadership program.
And then we're working on building out more of our internal sales structure for those individuals to obviously put them in a position to be successful. But, what we're finding more and more is individuals are strapped with debt. There's no secret that the costs around them are going up more and more, and trying to find ways to pair them.
With the community of which they grew up in. When we open up locations, a lot of times it's, opening up in areas where people have some kind of history. The latest office that we're opening, we have an individual that grew up 15 minutes down the road that knows that community very well.
She wants to go back to that area, call it home. And another individual of which they're gonna be doing a co-leadership role, that lives just south of it. We're trying to make things easy for people. We're trying to decrease friction as it relates to work life decisions. Knowing that it's also easier for them to probably operate and open a clinic that they're not having to drive 30, 45, 60 minutes to, knowing that this generation is talking about work life all the time.
But, it is something that we're still more in our infancy with. but out outside of opening a clinic, we do have, individuals who have intrapreneurial roles, potentially surrounding a program or a service of which almost becomes a side hustle for them, where they're overseeing a department.
Let's call it pregnancy or postpartum care, concussion rehab. We've got a force deck program coming out, running analysis, things that they take ownership over as an entrepreneur, but underneath, obviously our entrepreneurial umbrella, they use our ecosystem. They use the resources of the company to pour into a passion project and ideally increase their earning potential.
Mike: You mentioned, I think, earlier that they're coming to you with that, one of the things that affects everyone is silent quitting and then someone going out on their own and doing their own thing. How did you structure it where people are coming to you and saying, Hey, I wanna spearhead my concussion program here.
Is that just from culture day one of when the therapist is onboarded or the employee is onboarded?
Josh: Not only with the therapist is onboarded, but we also have this communicated in our DPT student. Onboarding, materials, the opportunities that are present here. So we're trying to create these conversations earlier and earlier where we have people who start day one and they already know that this is an option for them and they're trying to fast track their career.
They know the value that they're gonna bring to the company. They want to know exactly what the company's gonna provide for them. and they're doing a really good job of shopping around and making sure that certain things, are working out in their favor. With regards to the short-term crew, we have an individual that helped us open our ninth office. That was not even two years out, but he came in, crushed it. We have a Culture Champion Award called our Green Team Award. He did great from a clinical standpoint. He is doing great from a leadership standpoint where his peers recognized him. and he was somebody that was regularly out, doing a good job of, on, on the sales side.
So it made it easy for him to come in as he did, and make the impact that he had opening up an office where, some people might come in, not have an idea of what exactly they're looking for outta their career, not have an idea of what the company's exactly gonna provide for them meander through a 90 day onboarding year, first year with the company. And it may take them a much greater amount of time to actually get connected to something that appeals to their long-term goals. I think the earlier and earlier we're having those conversations. It's better for us from an attraction standpoint where you're building out your pipeline to your team but it's also better for the individuals. There's less uncertainty, there's less, there's more awareness. They get to move forward with a lot of clarity in the decision making. Hey, I'm moving here. I'm open to a clinic here. I'm buying a house here. and they're able to probably put themselves in a position where other individuals in their life, potentially a spouse or kids, are a lot more settled.
Mike: Michelle, you had your hand up prior, before you got kicked off.
Michelle: I know. I don't know what happened there. Some it glitch. I actually heard you ask the question twice, Mike, like, how do you identify these folks? And Josh I think did a really great way of bringing up a point that someone told me once as show don't tell.
So when you have a culture where you're actually. Telling the stories and showing whether it's students or new employees this is how this clinic got to this position, this is their pathway. If you really show it in the behaviors rather than just telling people we have all these opportunities, I think it is a good message.
'cause you so often hear people saying, we do this, we promise this, we do that. But I think people are getting much more aware of what they can actually see and experience. So if you wanna motivate it and get your therapists and your staff excited, don't tell 'em about all your offerings. Show them, Hey, I've got this clinic director, Rob Gru, he was a student with us.
He wanted to become a champion at Dry Needling. Now he hosts our two day courses, level one and level two. He's also the clinic director. Tell the story, show the story. So that. Your clinicians can be motivated and excited by what they see around them.
Mike: And Josh, you're shouting that out publicly, right? You mentioned an award of some type
Josh: Yes. So, we have a green team award. We paired up with a company called Lead 'em Up, and they do quarterly touchpoints with our team, virtually, semi-annually in person. And then we actually have an asynchronous leadership module, which ideally helps build them to be leaders.
In the company. So that is something we are communicating to people they have to earn into that. If they don't do a good job on the clinical side, they don't get to earn their way into the leadership side. If they do a good job of service and leadership, they do a good job, then they have the potential to help us open up a clinic if they want to.
But it's that build, lead, sell, trying to put them in a position where, let's be honest, if they do this for the company, this is a benefit to the company as well. So this is all about us making sure that we're transparent about what, this mutual relationship could look like moving forward and ideally communicating to them in a way that's appealing to them, how much we are going to support them through that process.
Mike: And throughout that process, for you guys to in general, gauge success, are there objective data points you look at, but there also has to be soft skills that you're monitoring as well for that. I guess KPIs are easier to go around, but are there soft skills that you guys look at to identify these folks? question to the group.
Josh: This is something, I guess I'll just chime in real quick, but we have a, a quarterly survey goes out and they nominate. These individuals. So it allows me to not have much trouble going through direct feedback from site directors. When one person pops up at an office, they're brand new to that office and every single person for that office is nominating this person for our Green Team Award.
We also have, for anybody that uses Slack out there, we have High five Friday. So High five Friday is our MO micro dose dosing, our culture champions or our best teammate award. So when I see individuals regularly popping up that another individual has noticed them, standing above or standing out with regards to something that they did throughout the course of the week, those are also some things that become a lot more apparent in those instances.
Nothing. KPI oriented, it's entirely looking at an individual. The traits that we decided that we value as a company, it could be something that aligns with core values. It could be something that they did that was discretionary, that was outside of what is considered typical and standard. and that gives us a better idea of an individual who might be standing at, standing apart as a leader at that particular office. especially in a situation where you keep getting bigger and, it's harder and harder to get those touch points directly myself.
Nick: I think that Josh's points are super valid in that goes back to, you have to recognize not just a clinical outcome or a KPI, but these little things that feed into the culture and support and prop up the values and the high five Friday's a great idea. champion stuff, it's all really good.
And one of the ways we embrace that a team is, we have a team MVP where somebody can nominate someone within their department, within their clinic for doing everything from, walking a patient out to the car with an umbrella to, turning a donation box into the clinic 'cause they heard about a tragedy from one of their patients or just made somebody's day. It's all those little wins that go a long way. And I think it's twofold. One, Josh mentioned, recognizing it in bigger or smaller doses, which is phenomenal, but also the people who take the time to recognize that, that is really important because it's so easy for us in leadership to hear only the bad noise.
And we wanna hear. So much more of the good things that go on 'cause it completely dominates our day. There's so much good going on in and around us and it's important to make sure you pause and focus on that and really try to put that other spin in a, in, into a different conversation when it's important.
Mike: Sorry Emily, I missed your hand was uo.
Emily: It's okay. It's okay. I just wanted to call out a trend that I'm noticing with what Nick is saying and what Josh is saying and what Michelle is saying just from the very beginning. And that is that you all created a culture and a psychological safety to have these discussions with people.
And so there's a lot of owners out there that might not have all these programs built out yet, but for a clinician they might be very nervous to come up to their owner and say, Hey, I wanna do something else that's gonna have a big and broad impact on the clinic that could help everybody. So just, you might lay out that conversation for your team first to give that, like that permission giving so you can catch those people who might be itching to try, something hybrid or something a little bit different from the traditional patient care approach.
Michelle: Yeah, I can add to that, Emily. I think you make a great point. And I do believe too, the underlying culture is about your expectations for how people are behaving. And I think for all of our organizations, we've got organizations where we wanna listen and we wanna ask the right questions, and we want people to be the best versions of themselves.
And I'm sure it's very challenging if you're a clinician who's in an organization that might want to have that culture. They just haven't figured out how to create it, because there's still a lot of strategy and processes and structure that needs to go into figuring out, especially as you grow. How do you ensure that you take that culture that you have in a single clinic, but how do you ensure that it stays?
As your company grows, how do you make sure that the clinic leaders understand the value of feedback and those one-on-ones? And I think to bounce off Mike's points when he brought up KPIs. It is important to look at the data because it gives credibility ultimately and how having one-on-ones and how getting feedback and how engagement and engagement isn't just about saying, Woohoo, I love working here.
It's actually just participating in a survey as well. How all of those measures actually have an ultimate impact on not just the financial success of it. Practice, but also the kind of care that's given and its opportunity to grow. So I think that's where this blend of looking at the right measures, the right strategy and the right behaviors, that they actually are all related.
But you do need to pause, as Nick mentioned, to stand back and think, what are the right processes? I hear Josh I love your Fridays and in your organization. That works great. And for us, we've done other things. We have awards, annually and for all these different awards and we do it virtually.
We used to do it in person. We have other, employee of the month. But as your organization evolves and not just based on size, but I think based on the evolving generations and what they expect, you'll have to change how you provide feedback or how you recognize or how that is. It's, I'm old, I'm 52. And how we celebrated and how we worked and what motivated myself when I was 27 is very different to the current generation, which is great. And so again, every few years continually listening to that next generation and evolving the way that you're giving feedback and rewarding and recognizing people, this isn't just to set it and forget it, it takes ongoing work and looking at the actual impact of the initiatives and the behaviors that you have in place.
Mike: I guess I'm a millennial. Michelle, what do you notice?
Michelle: I love millennials. I actually think it's great. I actually think it's one of the most enjoyable and fascinating things about my job, is actually getting the chance to listen to people and each of different generations. so I actually think it's really fun and fascinating and, and it helps us evolve our organization because again, I'm not here to create an organization that attracts and retains 52-year-old physical therapists.
That is not a good business model. I'm here to make sure we've got an evolving practice that supports the next generation of clinicians who can practice at the top of our license and take our profession to the next level. So I gotta listen to people like you and the, and everyone else.
Mike: What are you noticing of what people used to care about versus now? If you were name one or two things you're seeing in the new generation of people coming up?
Michelle: Obviously the work life balance, and that's really important. I think that what I'm seeing in the next generation is people are very aware of, with them as a state is a word, what's in it for me?
Which they should be like very aware of how do I be the best version of myself? That means I can't work to eight o'clock on a Friday night. I do need to go and spend time with family or go to the beach or do whatever. significant increase awareness of that because in my day, yeah, you just worked your ass off and that's just what you did.
And everyone did and it was great. So there's that, but yet people still wanna actually have an underlying sense of purpose and be part of something bigger. So I'm seeing this kind of mix, yeah, they, purpose is really important, but at the same time, being super careful about my own journey and that I can, evolve and grow in the best version of myself.
I didn't feel a sense of purpose when I was in my twenties. I was like, the higher you work, the luckier you get, study, go on courses on the weekends, like work. And I loved it. So it was, I didn't have that, there wasn't the purpose there that I believe is there now.
Adam: I think everyone's brought up some great points on it starting with creating a culture of positive feedback.
Like when we look at the NPS state of therapists, like it's mostly plus 80, plus 90. So the overwhelming majority of the feedback is positive. But like Nick you said, I think people tend to skew on the negative side. And we actually, we did a leadership training at Prompt where this company told us that people.
Need to hear five times as much positive feedback as negative feedback to think that they're getting, overall positive feedback. So it's, I think that's a great, one easy takeaway is create a culture where whether it's a Friday, every Friday people give positive feedback or it's, whatever cadence works.
But creating a culture that encourages each team member to give that feedback about others is a simple, easy way to start pivoting the mindset of the practice to be skewing more positive. 'cause it really is I go to PT all the time and my wife does, and Mike's a chronic PT patient.
The experience is overall positive, but it's so easy to skew on the negative.
Josh: Adam. I think piggybacking on that, I always think of the word ecosystem. You have an, you have to have an ecosystem based approach. To patient care. You have to have an ecosystem based approach to caring for your team. and I think, you should be asking yourself on a regular basis for your team, if you're creating micro wins, macro wins. We're talking about weekly, monthly, quarterly touch points. Michelle pointed out, we have a big annual award show. It takes the ESPYs for anybody who's familiar with ESPN and we have the R two Ps every year we make it a big deal.
Last year's theme was, the eighties. and granted, 80% of our team, or sorry, 80 members of our team, are 38 or younger. And maybe that works a little bit well for the millennial and Gen Z side of things. But regardless, you're trying to come up with the best ecosystem for the individuals that are with you and that you're trying to attract.
I also think it's very important, and we talk a lot about NPS. For team and improv. It's for patient care and your facility. But are you asking NPS of your team? Are you asking your team how likely they are? To refer a family or friend member to work for you. So that's something that we do on a quarterly interval.
And then once a year, we're asking about workplace happiness and work life balance as a part of our 360 survey. I'm not big on performance surveys personally, just because I think they're largely one way conversations. I'm a big believer in a 360 survey. It's tremendous. They rate themselves, they rate the company and they rate their peers.
But that's a great opportunity where you're getting more and more information about their subjective experience, and the experience that they have around their leaders. Because in that survey we ask them to rate the leadership at their location or their direct report. Hopefully that's something that's beneficial, thinking about the ecosystem approach, but also measuring some of these things that we're talking about and actually putting a data point to some of these buzzwords that do seem more subjective in nature.
Adam: That's awesome. Super helpful. We have a couple questions from the audience, so I'm gonna drive 'em and then we'll see where we'll go from there. But one of the questions was from an actual out, a current orthopedic PT who's working as a staff therapist and is seeking opportunities to grow earnings potential, and asked, what are some ways that you can increase, as a therapist, the knowledge base on the sales side, both from convincing patients to buy into their plan of care and also the business development, standpoint, and how can a therapist that's looking to grow their sales skills. Emma, maybe you could actually start on taking that question since you've done that quite a bit.
I don't have your audio, Emma. You're just on mute.
Emma: Yeah, this is definitely a passion of mine that I'm, I don't wanna take up the whole webinar about. But yeah, there's lots of resources. If you go to my LinkedIn, I have an article on my favorite salespeople and how to apply that to the therapy world.
It’s the number one indicator of patient satisfaction is the medical staff's attitude. So we've already said how great therapists are. So as long as you're having a great attitude, you're already a great salesperson.
Nick: I think that the a, a quote that I got early on from a course was nobody cares how much you know until they know how much you care.
And caring is the easiest thing you can do as a therapist, and it is the most essential thing that you have to have as a leader as well. As a therapist, and I hate to say it, a young therapist in your career. Being a great therapist, certainly by listening and caring, that is what's gonna get your name recognized.
That's what's gonna start filling your schedule. It's gonna go from, no return patients to all of a sudden half the patients on your schedule are either return patients or word of mouth or whatever. The only way you get there is by demonstrating that you care. And then that what that then leads into, and this is where you have to have your radar open a little bit, and you need a mentor, like a Michelle or a Josh to clue you into this is now a physician might keep popping up on your radar and you need to have an opportunity to have a conversation with them about it.
Preferably not the oops conversation. Preferably Hey, Mrs. Smith said I should reach out. But if that's not your bag. You've got the caring and the listening down and you really wanna focus on your clinical excellence, your schedule will fill up through your excellence as well.
So you've gotta bifurcate, at least a bifurcated path to learning how to sell. And it can be in your face, cell, or direct relationship building, which is at the key of any cell, or just based on your excellence is what's gonna help you sell. But you gotta find what works for you and you need a mentor to give you some outside feedback on how to do that.
For sure.
Mike: Before going Michelle, I read a book by Dale Carnegie, like, how to Win Friends and Influence People. I really recommend reading that it's people remember how you make them feel, not necessarily what you say or do. It's the main takeaway of the book. Sorry, Michelle.
Michelle: No. I love that and it's a great book and it is how you make people feel. I also like to remind therapists, 'cause therapists usually, the generalization here, but I still believe it to be true that we don't like selling and I am so grateful. Casey, I think it's Casey that you brought up the word selling because we need to get more comfortable with it 'cause we're not selling cigarettes.
What we're doing is helping people feel better, and we need to be comfortable talking about the value that we provide. So whether you're talking, working with a patient who has an ailment or enjoys a sport and you wanna see more of those people, let them know, Hey, how can I help more people like you?
I'm happy to have a conversation offer, be there and show that you wanna help and don't be fearful of that. So whether it's communicating with a referral source or with a patient, or word of mouth, realize that you need to get comfortable and authentic because what you're doing is really good work and people will trust you, but you do need to feel comfortable talking about it. Find a mentor. Set key objectives and goals, what do you wanna accomplish that'll help you feel accountable so you can actually reach the goals that you want to do, rather than just thinking, I wanna do this. And, and you'll go really good places. Excited for your question, Casey.
Thank you.
Adam: And then we'll go to Josh, and then I've got a couple more questions as well.
Josh: Casey, if you can think of sales as not a four letter word, that's five letters. But sales is storytelling. And then if you pair that with marketing is market relationships. So if you have storytelling done within relationships that you have in the market that you're looking to serve, you are gonna be in a situation where you are able to make your stories known to a lot of people who are potentially patients of yours.
If you've never thought about your ideal client, otherwise known as your avatar, that's a good place for you to have a little bit more of that entrepreneurial mindset where you break out. These are the types of diagnosis that I like to see. These are the patient populations that I like to see and value out.
Get outside of the clinic, go do workshops, involve yourself at events, authentically, engage with individuals in that area, and you'll start to attract. Individuals that then are looking out for your services when they're actually paying customers. But you have to value out without expectation first.
In my opinion, that's gonna allow you to have net new, and then what I want you to think of next is I want you to think of the word retention. You can do all you want to get net new and individuals who are your ideal patients, but if they get on your schedule and you have them churn out and you lead to a higher churn rate at your clinic, you're not gonna be very busy.
So it's gonna be tough for people to see that you have the potential to carry a busier caseload. Then ideally, you're taking care of the individuals that are coming to you to seek you out for services. And then at the end, you're gonna do what's called an ask. You're gonna ask for an introduction to somebody in their network.
You're gonna ideally put yourself in that community, in that patient population that you're looking to serve more. And this is where you're going to directly ask for word of mouth instead of a situation where a lot of people are waiting for passive word of mouth. But if you took care of all three of those, I guarantee that you would have a busier caseload in the clinic that you're at, and you'd ideally set yourself up to be viewed as somebody who could potentially help open a new clinic or step into a new role.
But if you have net new and if you have a certain amount of retention and not high churn, and you have the ability to ask to continue to generate business for yourself at that clinic, it's gonna be hard for somebody not to put you in the driver's seat for the kind of opportunity you're looking for.
Adam: Awesome. Thanks Josh. I think another question, shifting gears a little bit, once someone's made it to a clinic director role, how do each of you think about trying to help them prioritize their time between, developing the talent on their team, treating patients and, all the other biz dev and other things that go into, being a clinic director?
Michelle: It's a really hard question because I think how you set your structure up of your organization and what does success look like and what are the roles and responsibilities for that clinic director, because it is about figuring out how to prioritize the best use of your time. And for us at High Bar Physical Therapy, our clinic director's primary job is to support the success of all the folks within that clinic.
And that can change week to week. If you've got a brand new clinic and that person needs to do more business development, that's what they need to be able to do. But if there are times they've got two new clinicians in there who need some mentoring, yeah, you need to be nimble and adjust. But I do think having a mentor or an experienced person who's been in that role before or understands how to support that, the best use of your time is a question that every one of our clinic directors continuously brings up, but really clear measures of what success is and of roles and responsibilities.
What does your site coordinator or your practice coordinator or your other PTs do? Get very clear on who's responsible for what aspects, but it comes back to the clinic director's accountability got off track here a little bit. There's a way you can think called a RACI and if anyone's ever looked up RACI or knows what that means, it helps to understand a team.
And I think it's really helpful in organizations to understand you have a team, but yet someone's truly accountable for what happens. Yet. Other folks may be responsible for all different elements. Other people might be consulted and other people give input. So it helps to give clearly defined roles and responsibilities when you're coming together as a team, rather than just saying, Hey, I gotta manage everything.
Nick: And I think to, within those structured roles and goals of a clinic director, whatever they may be, there's a little bit of. An ebb and flow. if EBB is, we've got a high volume or we've got, we're down a person or you really need to hire, you might have to shift some of those hours towards patient care.
'cause that's what supports the team. That shows that you're leading from the front versus we've got somebody new and onboarding. I gotta spend some extra time with them to make sure that they're off to a really comfortable start. Or it might be, we've got this new person, I gotta go out, I've got this long list of contacts I haven't touched base with, I wanna introduce the new therapist and a flow.
So it's a bit of an ebb and a flow. You never wanna be completely ebbing, you never wanna be completely flowing. As long as you know what your role is and goals are. You just have to make sure you understand that you can't just constantly ignore one part of it just because that's what's right in front of you.
You have to be able to pick your head up and look around to see ahead, not just in the day that you're in right now.
Adam: That's great. And I think we started to pivot into another topic or talking point, that I think will be insightful is, obviously all three of your companies have gone far along this journey of building out this, upward mobility and growth paths.
But if you can think back to like, when you started building these out, what were some of the things you tried early on maybe that worked or didn't work well, or how did you even think about okay, we want to grow our business and create growth opportunities. Here's some of the things we're going to try and some of the strategies that, helped you get to where you are today.
Nick: I think, at team what was nice is, each little clinic was our own little company. And, what we learned is by, we had a clinical mentor, somebody who's a few steps ahead of the road on you to help you out and be that, outside voice to help. But what was nice is you wanted to bring in the best people who were motivated to take care of people, and then you wanted to make sure that you celebrated all of those little things and that, there's trial and error.
Whether some clinics like to do, a weekly get together and talk about things in a huddle or a monthly extended meeting where they're together or even set a target and have it be their outing or event for the year. The trial and error has gotta be about constant conversations with your staff about what they want.
And some people might not value time outside of the clinic together. they wanna balance what's going on, elsewhere and have work. So then you need to shift your priorities and do those events during the day. And take a little break. 'cause any time out of the clinic that you miss, like that is gonna be rewarded to you 10 times if that's what's most valuable to your staff.
So as long as you're listening to your staff or your state or your company and acknowledging the feedback that they give you're gonna have your best chance for success. Whether that's a third party, anonymous, once a year, top workplace survey, like team rehab believes in, or the yearly feedback that each employee in the clinic, like Josh said, gives their clinic director and their leadership team, we have to recognize that feedback and build from it from there.
We trip up, but if the feedback tells us we did, we own it and just have to move on, you have to listen to that feedback constantly. So you're keeping up with the culture and the people in your clinic.
Michelle: I'll jump in here too and say that I think it's really important, especially if you're a leader or a business owner here, is remember, you're, you are running a business and again, lots of PTs are like, I'm a clinician as well.
We wanna, we're really good at being clinicians, but we don't tend to be very good at business. However, it's really important that if you do have specific objectives or goals, you do need to treat it like a business. And if you don't have business training, like use one of the resources out there. one of my favorites is traction.
That's what lots of folks use where you could use the leader. I'm looking at all my leadership books. I think I've read every one. Or your leadership, operating system. And from that, make sure you've got clarity. What is your purpose? What is your mission? Your purpose will drive the right behaviors, get really clear about what success looks like. What are your strategies? for us, one of the things that's super important. Is igniting people's potential. That's something we've always been about. And so what are the things we're putting in place to ensure that we are igniting people's potential, which drives many of the things Nick mentioned and how are we measuring that we're being successful in that?
And yes, your best places to work and your surveys and your retention are all great ways to actually hold yourself as a business leader accountable in your responsibility to actually have a business where you're employing people and you wanna make sure that they've got a good, secure and safe place to work.
So I do think it's important to stand back and don't just think, oh, let's throw spaghetti against a wall and put all these courses together. You do need to listen, but you need to stand back and really create a strategic plan again, if you don't know how to, there's great books out there that really simplify it so that you will continue to move forward and you won't look back and have regrets like, oh, why did we invest all this money and do this?
It doesn't even really align with who we are. So get clear on those things, and that will help to drive your culture and drive the kind of people that are attracted to your organization.
Josh: I think just piggybacking on what Michelle was mentioning there, it makes me think of ways that we had misfires early on where we were operating under more of this belief that more was more, and that by doing more, we were going to end up with more and not being as, lasered in on ROI when you have a young person, they're in your organization, they're having certain things that they're doing that are discretionary in nature.
They want to make sure or sorry, we want to make sure that we are. Allowing them to have some wiggle room to figure things out on their own. But there's nothing worse than having a well-intentioned young professional get in your organization and you're like, sure, go. And you let them go.
And they are high effort with very minimal return. So I think to a certain extent, we are using, the historical information that we have. Providing adequate structure, providing guardrails, so to speak, and really leveraging the experience of individuals within the company so that we make sure that whatever more they're putting into is as efficient and as effective as possible. You don't want to contribute to greater burnout or greater belief that work is not gonna lead to things that are coming in out of intangible results for that individual. More is good, but we're really trying to come up with that Goldilocks effect. We want to find the purge that's just right.
We wanna find the work that's just right. Obviously there's certain feedback loops that have to come in, play with that, but one of the benefits of a bigger organization should be that track record that allows that individual to come in, say, Hey, I want to do X and Y. What can the company do for me?
And then you're figuring out where that shortage is.
Mike: Nick, you mentioned earlier the Mentor relationship. A lot of people, at least coming into our company that are younger, are looking for that. Do you put structure around that relationship?
Nick: Yeah, we want an, in speaking, strictly clinical mentoring, in the clinic. All of our therapists, whether they're new or tenured, have monthly one-on-ones with, either the one of the leaders in the clinic, whether that's the clinic director or the two ic, somebody who's really interested in professional development.
Whoever suits that role and wants that role and qualifies for that role in the clinic, it's there every month. As far as new clinician type mentoring, we have external mentors as well who are therapists at other clinics who just have a passion for teaching and we provide that external support.
Let's say, you're a new clinic director and you're just slammed and you don't have time. We have a way to make sure that mentoring takes place. As far as a clinic director, each clinic director has a mentor, somebody who represents the partnership with team rehab, but is really a fellow clinic director and colleague who's been there and done that and has excelled at the KPIs both, measurable and unmeasurable that make them a great clinic director.
And that what relationship is, based mainly around what works for the clinic director. Is it a quick huddle every week for a few minutes and then a quarterly meeting? Is it a one month sit down, in person and go over whatever that clinic director wants to go? And the key for all of these mentor relationships is.
This is that mentee's time, that's their time and we are there to support them and give them the conversation structured around anything they want to. Now, if they don't come with anything that's pressing, we can help find them. That we will help make sure that the metrics of making their day goes smoothly or going well, whether it's documentation time or PredictionHealth scores or NPS or MIP scores, whatever they wanna focus on that helps them deliver the great care.
We will do it, but it's, the key is it's their time and we're there for them, and we wanna make sure that's a regular and important touch point.
Adam: I think Nick, you mentioned like a second in charge, and Josh you mentioned co-leads and we actually got a question about that. So figure, dive down that, but how do you create, let's say there is no new clinic opening next month or next quarter. How do you create those other leadership opportunities or development opportunities for PTs who want to develop?
And it sounds like both of you have a strategy and I'm sure Michelle, you do as well. So it'd be great to hear some on the co-lead the second IC and some of those strategies.
Nick: Yeah, the two IC is our term and I basically we have a room for people who either wanna use, being a great therapist as a stepping stone to continue to be a in work in clinical excellence, whether it's run a niche program, like Josh said, or continue to grow down a business path where they'd like to own something. and being a two IC gives you a little bit more structured responsibility with a little bit more reward. We'll double up your monthly bonus. It definitely can buy in at an extra share at the clinic, but you have some duties, whether it's scheduling support, staff handling a little bit of marketing, doing all the communication with workers' comp or mentoring all the staff, whatever that clinic director needs, whether the clinic I ran, I was blessed with great help.
The gentleman who took over had 1.2 ics who loved to market. So he did all the staff development. And then when they moved on to clinic director roles or other positions, his new two ics wanted nothing to do with the market, but I wanted everything to do with staff development and day to day, he gave them that and then went back out on the road and market.
Having that conversation with your leaders in your clinic helps you as a clinic director dictate the workflow and the workflow. So that's where our two IC comes in for that. But as far as the clinic director pathway, that's something that's open to great clinicians who score well on metrics and do well.
We'd have formal training for that and we have them meet with their mentor or their state vp, the business development, VP A as well, so they can know exactly what path they need to go. And then as opportunities come up, we share them with the company so that they can understand them.
Josh: I'll chip in real quick. Just on the coast site director roles, that has been something that is newer for us. We are allowing individuals to go into new clinics together, so we're actually increasing the profit sharing pot for those individuals under the belief that we're gonna get to profitability quicker.
Overall, having two individuals incentivized in that clinic is better than one. That'll be something that we want to do more and more moving forward. 'cause it also allows more people in the company to potentially have opportunities. In situations where individuals are preparing to be a site director.
They would be at a mature office, they would be working with that site director and they would have their allocated time blocks. Their roles and responsibilities in more of a job sharing type of role. So their cadence, weekly, monthly, the type of reports or conversations that they're in, are gonna be just like that site director.
And we usually do that in less than a six month or less window in preparation for them to eventually open up a new location.
Adam: Awesome. Thanks Josh. Emma, I see your hands up.
Emma: I was just gonna say something I've noticed from all three, Nick, Michelle, and Josh, they've said multiple times that being a good clinician and being a good team member is the foundation of these roles.
So just remember, if you're a staff therapist listening to this, they're not just gonna go out and find you and say, hand you this role or these opportunities. You do want to be the best you can be and do a really great job and make yourself stand out. And if you are. Have that courage if you're not at a clinic where they have these established programs, having that courage to stand up and say, Hey, there, there's an area of opportunity.
If you need help thinking of those, feel free to reach out to Emily and me and we can help you. I'm sure there's plenty of things we can help you think of and if you stand up and you have that conversation and it doesn't go the way you want, that's okay. Maybe ultimately that clinic just isn't ready to take on something like this and support you for whatever reason.
And if that's the case, also reach out to us. 'cause we have plenty of clinics we can potentially connect you with that can help you and give you the opportunities that you're looking for if it's not the clinic you're at now.
Michelle: I'll add one other point to that as well is just that we seem to be, keep focusing on leadership is about being clinic director, which is a key pathway and We'll, and I think for us, we've always tried to make sure that wasn't the only choice. People wanna have options and choices and we should celebrate what those are. If you are someone who is, I wanna be a really good staff PT, and then I want to take three months off to have a baby and then come back part-time. That's good as well. Like what we want is motivated and excited clinicians.
So depending on where you are in your career, there's no right or wrong. It isn't about putting yourself in a place where I'm only, should only feel successful as I'm a clinic director. Not at all. I think for us also, we've tried to make sure that we have faculty positions because we have a residency program, so we've been able to create other opportunities for leadership that are different to being a clinic director.
So there's lots of different pathways out there, and for the individual clinicians out there, figuring out what motivates and excites you. It doesn't have to be being a clinic director. It may be overseeing a special interest group. It may be working part-time and doing a side hustle. All of those are okay, but you've gotta find the thing that continues to help you be excited and motivated and not feel like you're being judged if you choose a different pathway as well.
Adam: I think that's a great place to wrap up.
Mike: Yeah, it's a bummer to have to cut short. But thank you all for joining and doing this today, and thanks for everyone listening.
Nick: Thanks for having us, everybody. Michelle, good to see you. Josh. Nice to meet you, man. Congrats on your success. Thanks, Mike.
Adam.
Adam: Nice.
Thanks everyone.
Thank you.