Transcription
I thought this week I would talk to you about the five best ways to scale and expand your practice for growth. A lot of practice owners will reach into us, and they're very interested in how they can be more successful in their practice. And then there's another group of people that come in and say, "Hey, I'm really happy with the way things are going, Brian. I really don't want to change anything."
So I wanted to just have this conversation with you and pass along some of the recommendations and suggestions I have given in the past that have been proven very successful in ownership. I think for myself, way back in the beginning when I was first becoming a physical therapist owner, I was thinking about things a lot like an employee. I was thinking about what would I like, and what do they want, and how can I appease this person, and how can I make that person happy? And you know, before I knew it, my practice literally was paying full-time benefits and pay for people working 32 hours a week. Therapists were only expected to see one patient an hour, and on top of that, they were given five hours a week of like note time with full benefits.
I think if you start running the math on something like that, you'll see what I did was I backed myself into a corner as an owner, and I lost sight of why I opened my practice. I didn't open my practice to be a full-service, you know, buffet to my clinicians who were coming in. It became a one-way street, basically, and I lost sight of the idea that when you go into business, the greatest value you have to offer is to improving the quality and experience of your patients; enhancing the environment and happiness and satisfaction through increased challenges and growth opportunities for your staff; and giving back to your community in terms of your referral sources and your social betterment programs for those that are within your community.
And in order to be successful at doing that, you quickly realize, no matter what business you're in—if you're a coffee shop or a physical therapy practice—that you have to outpace yesterday. You have to continue to see some trajectory of growth. So let's clear up this definition of expanding and scaling first. Scaling is: if I opened up a 2100 square foot office, I start with myself and an office manager, and then we start seeing patients. I get the 40, 50, 60 patients a week coming in, right around that area, and I sustain that for three weeks. This is the 85 percent rule for those of you who have seen this before in one of my earlier podcasts or in some of my lectures. Once you get to 85 percent of your maximum, you sustain it for three weeks or more; it's time to have that next hire. The next hire you need is a therapist—okay, that's the very next hire, a DPT, not a PTA, a DPT. Now that DPT comes in, you dump your schedule; they're moving on. And this is called the compliment. As they're moving on with a 45-hour schedule that they walked into, all new evals go to them; you take the overflow. We quickly get an administrative assistant/tech, and so on, and I can keep going down the ladder of the compliment. Okay, so the compliment is a very important successful action for you to know about. In what order should I hire, and at what number of volume should I be hiring at? There's a specific number within that clinic based on a size that should trigger your next hire. And if you want to know more about that, reach out to me, and I'd be happy to talk to you about it over the phone or over Zoom, um, if that's something that you're running into. Your payrolls out of balance with your income? You know, we have this whole thing as a payroll is a percent of GI is one of our statistics that we teach our executive clients to track. So if that's out of whack for you, let's have a conversation; I'm sure I can help you with that. Um, we do that all the time.
So once you start running that compliment and you start bringing people in, you're scaling inside your practice. If you add Pilates, massage, you add cash-based services of dry needling or laser or anything like that, you're scaling inside your four walls. So you're really scaling and growing within your walls. The minute you open up a satellite clinic in a gym or satellite office, you know, 30 minutes away or something like that, now you're expanding. So expansion is what happens outside your four walls; scaling is what you're able to do within your four walls. So let's just keep those two definitions. You need to assign a senior anytime you're going to increase your business model through a new income vertical, a new service or product. You need to assign somebody over the top of it; you need to make someone responsible for it. Everything trickles from the top down. If your staff members come, and you have two PTs and they're really interested in starting a women's health program—whatever, great—you're going to sit down with them; they're going to be part of the pilot program building process. One person is going to be the senior person responsible; they're going to hold the meetings; they're going to set the schedule; they're going to track the objectives, the targets being met, the budget, the dollars coming down. You have to empower one senior terminal over it. Now that doesn't mean it has to necessarily be another person; it may actually be you. You may be actually coming to your staff and saying, "I want to start a vestibular program; I'm very into it; I very much love helping our stroke rehab patients; I think we have a demand for that, and I think we will become a very, um, in-demand niche practice in our community for this specific need or service." Then you hold it, but you can't drop the ball because you get busy; you can't not have meetings; you can't not program it out. You've got to literally target and timeline that out. If you need to build a Gantt chart on it, Gantt chart it out. That's another thing we have in our startup accelerator program. We have a 21-step timeline sequenced action plan on how you actually go from being a staff therapist thinking about going into private practice to actually swinging your doors open and being in private practice. That's why we've never had a startup fail under our watch ever, going all the way back to the beginning in 2006. We've never had that happen because we do have this ability to know exactly what needs to be done, when it needs to be done, and how long it takes to do so. We help our owners march right on through that—no justifications, no falling off the rails—and it's because we put you in charge of being the senior over that startup rollout and not getting distracted.
Last but not least, play your own game. You have to play your own game. If somebody comes to you and says, "Hey, I want to do, I don't know, um, you know, big toe therapy. I think there's a big need; there's a there's a ton of bunion situations going on in this area. We live in Florida; we need to be the niche and, you know, post-bunionectomy rehab or whatever." Look, if you're not feeling it, if that's not in your heart of hearts, if that is not in your business plan for the next two, three, five years out, then don't do it. I mean, I know we have to take the ex—meet the expectations of our staff, but sometimes the staff members' expectations do not align with your company philosophy; they don't align with your mission; they get off the rails, and then you feel like you have to bend, twist, shape, and mold yourself into some morphed clinic that meets the needs of this one individual's heart-strung thoughts and ideas. I'm telling you that's not going to go well; that's just not going to work out very well for you because it's not your game; you don't have the passion. There's going to be this unexpressed resentment when the resources are going into something you don't really believe in, and typically it won't really land on its feet; it won't do so well. Talk to that staff member; think about in your heart of hearts, in your mind, what it is you're trying to achieve in this practice and see if you can come together on something that's actually going to forward your mission, that's going to forge your passion, your purpose, and align with theirs as well.