Transcription
All right, Tony Marado here with uh, myself, JY McKay. Welcome back to the show. We've alluded to this on a few live streams, right? We're tackling one of the biggest problems, and it isn't or wasn't just one of the biggest problems we saw maybe at PPS, or we thought or felt. Now we're backed by research, Tony. We can point to like a published uh, resource from the American Physical Therapy Association and the Private Practice section, and they they came out with this essentially this this resource that highlighted these statistics, right? That hiring and retaining top PT talent is a big, big problem right now, as we talk in October of 2024. That benchmark report reveals that clinics are dealing with a 99.5%—let's just round it, make it 10—10% vacancy rate, meaning one in 10 positions that you're actively trying to fill is empty, and you can't fill it. That now that's nearly double the national average outside of our profession. So this is a big problem; we're double the average, and not in a good way. And this means, in layman's terms, so people like me can understand, filling positions and keeping therapists on board is a real challenge, and it doesn't just feel bad; it costs clinics money. Now, if you solve this problem, you're ahead of the game by miles.
To help solve this problem, Tony and I are going to come in, and we're each going to share three innovative ideas that we've sort of come up with—they're spit-balled—and how to attract and retain the best therapist for your clinic. We'll go back and forth like we do, six-pack style, offering up practical, but creative—hopefully maybe it's outside the box, or maybe we're stealing from people who've been creative and thoughtful either in our profession or out of our profession, which you should be doing on a regular basis. No need to reinvent the wheel; steal someone's wheels. Uh, so we didn't talk about this. You want to flip a coin? Who wants to go first? You want to go first? You go first? You go first? I'll go first. Um, and I'm gonna do mine in a superhero theme, Tony. Superhero theme. Okay.
So my first one, I'm gonna go with a short-term win, okay? So something you can do that will help to get people in the door quickly, but knowing that's only half the battle; so it's attract and retain. So my superhero theme is Avengers Assemble, like you were waiting through the whole franchise for Captain America to say those words, Avengers Assemble, right? So the idea is um, being able to create your own bonus team. So if could you offer a bonus referral program where staff can refer their colleagues? I liked to work at places with people I liked to work with, and who knows therapists? Who knows who's good? Who knows who's not so good, right? Than the people that are actually working there. I mean, how many times have you seen like a resume come across and you're like, "Hey, you two worked together here, or you went to school together. What do what do you know about Jimmy?" And you're like, "Oh, I'm gonna save you a year's worth of problems; get rid of Jimmy; this kid is a pain in the butt," or, "Oh my gosh, that person's on the market; grab them now." We've said before publicly what what staffing agencies will charge, right? So you can go pay a staffing agency, or you can pay to put a job on LinkedIn or Indeed or whatever. I'm not saying don't do that, but if you know it's worth a lot, why do we offer like 200 bucks or something like that to someone to refer a colleague? Why not put skin in the game and people get serious? So if you want a serious bounty—like if you're in the wild west—if someone had if someone really wanted to get someone else caught, they'd put more money up. So the idea there is a referral bonus program, but don't make it lip service, and you can also like make it real, right? Like double the bonus, or put some contingencies on it that makes sense, like person's got to stay for a year, right? You're not just going to try to get a couple grand out of a company just to bring a friend in, but maybe say like, "Hey, if they stay a year, it's this," and then give them more money if they stay for three years. You found me a home run employee; why aren't our successes tied together? So this is a short-term suggestion to get a lot of apps in, but if it works out, man, what's what's that great hire worth? Is it worth tens of thousands of dollars? So give them some give them some skin in the game.
I I think you're right in the sense that what is it worth? Putting putting something out there. Um, I've just never seen it work. I've never seen, you know, there are referral bonuses out there; everybody's offering… I remember skilled nursing was offering like $112,000 sign-on bonuses and $6,000 referral bonuses. Um, I I basically think that if you're working somewhere and you have a buddy who you know is a great therapist, you're going to try to bring them onto the team anyway, right? Uh, this would be a situation where I I don't know; I just I think it's been done. I I like it; it should work; I want it to work; I just don't see it actually working. Yeah. Um, I'm gonna go kind of—I'm gonna zig when you're zagging—and I'm gonna say, look, I think the solution is going away from trying to find licensed therapists. Now my third offer will be to to attract therapists, but my first offer is, let's go the other direction; let's take a look at what we're doing, and I know we're all in different settings, and I know we all see different clientele and and patients, but for me, there's probably a lot that I could delegate out to a non-therapist. And so if I could build a model—and I've said this before—where I know I can open a clinic tomorrow, I know I could fill the clinic tomorrow, but I don't have a licensed therapist to work the clinic tomorrow, so maybe I look at, well, what's the problem I'm solving? I'm solving shoulder pain or or knee replacement—my niche, knee replacement—um, how do I do that? Maybe I bring a remote therapist in—oh, telehealth—they come into my clinic without ever leaving their home; they do the evaluation; they develop the plan of care; and then I have a non-licensed clinician delivering self-pay services that's following the prescribed protocol. And I think this is where we start to try to define the line that maybe is a little blurry; it's like, well, what needs a therapist? What can be delegated, right? If that evaluating therapist says, "I've evaluated them; they're safe; they need to do this, this, and this," I can train a non-licensed individual to do this, this, and this, right? And when you look at the self-pay cost—so somebody who has a Medicare Advantage plan, they have a $50 co-pay for every visit; they're going to go to an in-network provider for 18 visits; they're going to pay $900—can I get a non-licensed individual to deliver an equal plan of care that's less than $900? So I don't even have to bill insurance for that time. You know, that that's the direction that I immediately go every time I think there's a staffing shortage; what are we gonna do? Deliver the outcome in a different way, in a uh, in in in an opportunity to sort of bolster that idea I mentioned at the top of this video that one in 10 physical therapist jobs was vacant, but it looks like for physical therapist assistants it's close to 20; it's 17.2% of physical therapist assistant uh, jobs are vacant, so you're gonna have to—they they're they're being sought for, but they're not filling those roles. And so I mean, we've talked about this before; I think they're the they're one of the the cheat codes on, can you provide great care? But we've also talked about you need to emotionally let go that you're the secret sauce; that everything you have to do, every single step—if you keep doing every single step—uh, you're going to continue to do every single step forever, and you're gonna get paid like you produce less cars per year versus working in some sort of team or assembly line. And I'm I'm shocked because everybody freaked out when Medicare cut reimbursement for services delivered by an assistant, right? Yet we see the need for assistants now higher than ever. I love assistants; I only work with assistants in my practice these days. Um, but yeah, I I would have been surprised; I would have thought there was a surplus of assistants on the market because of the reduced reimbursement.
All right, my my second suggestion would be uh, pay attention to what people gripe about. We do this a lot in Facebook groups. Facebook groups are really good for gripes; sometimes they're good for solutions; most of the time they're just good for gripes, but people are talking about flexibility, and a statistic I saw the other day—I think it was Harvard Business Review—they asked people, "If I offered you the same exact job, but one was in person and one was remote, what do you value that as? Essentially, if I was going to offer you $100,000 for this job, how much would you be willing to take in terms of less money to do the job either partially or fully remote?" It was close to 10%; so people would take a 10% pay cut for flexibility. So how are you doing that? I mean, I in a previous life worked for Fox Rehabilitation; they looked at this gripe or this problem in a PT's life and said, "We're going to sort of build a foundation on this." They're based on house calls, so like that's messy anyway, and they would like—if we had to schedule this person out like we we couldn't do that; it's infrastructure—so you do it at the end of the week or month; you've got to hit this. Um, it wasn't productivity; it was just the number of units, and if you want to do—you want to work 24 hours straight and your patients agree to that—great. So I think my suggestion number two is, how can you make the job more attractive? Again, I just said people are willing to take 10% less if they perceive it as flexible, so that's what people want in 2024. If you're not if you're not delivering on this and advertising—just because you do it—put that in; put that out there on the hook, like flexibility instantly improves work-life balance, or at least gives the person the opportunity or the illusion that it does, making your clinic more attractive to job seekers, so you'll get more people in the pipeline; that doesn't mean better; it just means more. But to me, if you want to attract and retain, work with me. Remember, if you own a clinic, your job is to sort of make my life easier so I can go make those patients happy, and those patients come back and make you money. Yeah, we we know that therapists are motivated by more than just the money; it has to be um… forever. Like we started our private practice in 2002; from the first therapist to the last therapist, everybody we've ever recruited, we've always said the same thing: "I cannot pay you as much as home health is paying; I cannot pay you as much as skilled nursing is paying, but what I can do is I can offer you other things of value." So for us, I have a therapist that's going to a football game; he needs to take Monday and Tuesday off next week; no big deal; he can do it; like he moves his patients around; we're not doing mobile; this is in the clinic, but it's still fine; he can treat patients and and vacate his Monday, Tuesday; he doesn't even have to use PTO if he doesn't want to because he has that flexibility. We have other therapists who are like, "I love outpatient; I love Ortho; I love the stuff that I'm doing at Tony's clinic, but I'm not making as much money as I need," so I say, "Look, take Fridays; work 4-10; take Fridays and go work at skilled nursing or home health, and you get the increased income, but then you got the satisfaction when you're working here, and your dollar cost average and overall you're going to make up 10% or more in that time." Yeah, so having that kind of flexibility would be amazing, and I think we can do it in smaller practices, privately owned practices. Hospital, skilled nursing, these other facilities just aren't going to do it. You think so? They're going to throw more money, maybe, yeah, but they're never going to give you that flexibility. Hamster wheel, man. I mean, yeah, you solving the money is a short-term fix, and it attracts the people that are attracted by money; it's going to attract good, but it's also going to attract equal parts bad, and in terms of bad—like not a good fit.
So my number two is gonna be, okay, number one was let's figure out a different way to deliver the outcome and the service, right? Number two is, let's consider treating a different population. Like I know a lot of clinicians that are amazing lymphedema therapists, oncology therapists, pelvic floor therapists; these are therapists that are seeing a population for long—really, really long—plans of care, right? That becomes high-risk because the longer you're treating someone compared to your peers, the more chance of a Medicare audit or third-party payer audit. Um, we know that typically 4-unit follow-up visits tend to be less profitable than shorter visits or evaluation visits; there's all these complications that come in choosing to treat a patient demographic that's highly complex, especially if you're not adding in any self-pay services on top of it. So what if you took 20, 30% of the uh, available slots and said, "Okay, if we want to treat this special population that we're uniquely trained for, why don't we take 20 or 30% of our schedule and just focus on the high-margin, high-profit, you know, lowest-hanging fruit?" And for me, even staying in insurance only, these are like single-visit evaluations; prescribe a home exercise program; discharge with RTM in place, and the patient is done. These are the high-functioning geriatric individuals; they're playing pickleball, and they're golfing, and they're traveling, and they're squeezing in a physical therapy evaluation just to make sure there's no major red flags, but really this would be a 20, 30-minute session—single-visit plan of care—I do the evaluation; I screen out any major complication; I prescribe two or three simple home exercises and put them on an RTM program to continue to advance and do their home exercise. I would typically generate about 200, 200 to $300 for about 20 minutes of my time. You know, you put 20% of my case load or my schedule doing that; now I can afford to pay the expertise for the better therapists that are doing the more complex cases, even if I'm losing money on those other cases. Yeah, it's so funny where therapists—and I love—we can talk trash because we are them, right? Like that's like the biggest hall pass; it's like, "I have more education; I have more skill; I have more knowledge; I'm more niche," but third-party payers don't care, and they say like, "Well, how do we make them care?" And I'm like, "Spoiler alert; I want you to look—come here closer—deeper into my eyes; they're never going to care; they're never gonna care." This is a way to say, "How can I leverage that?" And so so ultimately, like the the final part in that loop is you're going to pay—pay those people more because you're making more with them, so it's the the rising tide lifts all ships, which is, let's figure out ways—again, people have to um, sort of sever that emotional—"I need one-on-one care for an hour every single visit"—do you like… I remember as a student, I watch some really great clinical instructors like do a lot more with a lot less—a lot less words, a lot less motion, a lot less instruction—like the right ones. So if that's you, I don't care what discipline you're in; are there ways to make that more profitable? Yes. Are there ways to make people get better faster? Yes. Can all these things be true also? Yes. But you have to think outside the box; you can't just wait for someone to pay you more because you think you're better and smarter; you have to sort of do more. I'm going to correct you on just one thing; my number three, which I'll get to it after yours, is how to pay more. The number two is not about paying more; the number two is about giving the therapist the freedom to treat long, more complex cases without penalizing them because we know if they're going to other busier practices, they're not going to have the freedom to do what they want, how they want, as long as they want. So this is more of a, "I want to be this type of PT," but okay, got it; perfect; awesome.
All right. Um, I'm gonna go long-term impact, and I'm gonna say shared victory, and I've seen this work and I've seen this not work, which is bonuses, in my opinion, are like too much like a treat for a trick, right? Don't treat your therapist like a dog. Um, I heard a great line which is uh, "You know, I ran today, which means I can eat this doughnut." It's like, "Dude, you're not a dog; you don't do tricks for food." I don't do tricks for money, except I would do tricks to feel like or I would do a little bit extra work or think outside the box if I feel like I'm investing. So my third suggestion is, can you share the victory, right? The idea here is, can you implement a profit-sharing or performance-based bonus so that your therapists feel invested in the clinic's financial success? So when I feel like my little things are adding up to big things, and like, "Why don't I get a part of that," right? We talked about it on a live stream just the other day; they said some of these big chains will do that: "Hey, we're opening a new clinic, or you've hit your ceiling at this clinic, and the person above you—like we love them, and we don't want to like get rid of them, and they don't want to go any higher—so let's move you laterally, but let's have you invested" instead of like, "Well, I get paid to unlock the door and make sure the therapists are here." The rising tide lifts all ships. So this would be like a more of a long-term profit-sharing, performance-based bonus so they understand what needles need to be moved because this is a business, and here's the MW—it's a dirty word—money. If this organization makes more money, why shouldn't you too? So profit-sharing would be my third suggestion; let's get—and that I mean there's—and there's that long term; let's keep those good people around. If those people are getting poached or they're getting emails like, "Want to come work for us," good means you have a good person; give them a reason to stay.
And my number three grows on that: in order to profit-share, you need profit. Like most of us are operating with virtually no profit. So this is where I'm looking at this, and one of my favorite YouTube channels outside the profession of PT is Jared the plumber—it's not called Jared the plumber, but his name is Jared, and he's a plumber on YouTube—okay, excuse me—and he talks about paying his plumbers, his contractors, twice what they get paid anywhere else, and he said as soon as he did that, his business exploded because now—and this goes to your first uh, recommendation—when you're paying literally double—so imagine the going rate for a therapist these days is $70 an hour, and you're going to pay 140, and no increased expectation of productivity—like standard productivity applies—but you're going to pay double every single one on your team; especially once they realize you're doing this for real, they're going to tell everybody else about it; everybody's gonna want to come to you. So now the question is, how the heck do you do that? How do you pay a therapist double what they would have been making? Well, there's a couple options in here; you guys know I love the social media side of things. I shared a YouTube video where it was an 8-minute clip; I think it generated like $500 in Google in YouTube ad revenue. I had another… yeah, yeah, it was a TENS unit video; I was showing a patient how to use a TENS unit; recorded it in real time; posted it to YouTube; generated $500 in ad revenue; generated another $500 in affiliate income from TENS units that were sold on Amazon; this year generated $800, like 50-something dollars from TENS units that were sold last year. So that eight minutes of a 60-minute treatment generated over $1,500. Um, and you know, I said you can't do this with every every session, but why can't you? Maybe you can; maybe maybe we can capture that content; monetize it across multiple social media platforms; affiliate links; paid content; RTM; all of these other things; and now you don't have a therapist that's generating one hour, $150 in revenue; you have a therapist that's generating hundreds of dollars every single month for the one hour they gave you, you know? And that's where I think we can go and double the rate because now we're creating celebrities; we've talked about this; now we're creating information, education, and and we're finding other consumers of that uh, information and content. YouTube is a consumer of that content because YouTube is buying that content and selling it to advertisers; Amazon is buying that content and selling it to product sales cycles; like there's other ways for us to monetize that hour of time which would allow us to pay double, which would allow us to recruit the best in the area and just create a vacuum that just sucks all of these amazing therapists into our organization.
Do you uh, when you approach a patient and you're say, "Hey, do you mind if I record this?" Um, like what's the what's the ballpark batting average? Like do most of them say yes? Is it 100%? I have never been in a situation—in in all of my time recording—where someone said no; absolutely not. Now, full disclosure, there are those patients that I know ahead of time they're not going to be a good social media patient; they don't want it; they don't—you—they have zero interest, so I'm selective; I pre-screen, but seriously, like if I think somebody's inclined to saying yes—I just did this twice, yesterday and today—I said, "Hey, here's the deal; we're getting a new device in the clinic; it's a shockwave therapy device; this is how it works; this is what it does; I want to record you receiving the the treatment intervention for the first time; you could be totally transparent; you could be real; if you don't feel like it helps, I want you to absolutely tell me, right? But I want to share this with other people on my YouTube channel." Every single patient is like, "Yes, that'd be awesome," even the ones that are embarrassed secretly love it, and they all sign the media release; it's all HIPAA-compliant; they all have the right to refuse; they all have a chance in the future to tell me to take the content down. Um, we do it properly, but they all love it; they all love being the celebrity of their story. Yeah. Uh, so that's our six suggestions; some bonus ones that I didn't, you know, get into my top three because we're supposed to be limited, but this is our show, so we can go beyond three. Um, in-house residency or mentorship programs; a lot of people are coming out of school and saying like, "Do I go residency? Mentorship?" Like at a—like really honestly, put some time into that because they're looking for that, right? And people can sniff this out if you say this on an interview or or or a posting, like, "We have mentorship," like—but be good consumers; explain that to me; what am I going to be getting? Because that is the—that was the buzzword of a year and a half ago, which was mentorship and uh, professional development. And then beyond the mentorship, what are you giving me beyond that? Like so you should always be comparing salary, but like flexibility, schedule, what's responsible. Um, go beyond the benefits package, which is really important; I know when you're 20 years old—I didn't care; I was just like, "Salary is there? Insurance? Yes, great; check." Look into those different things; does this come with CEU money? Like because I'm going to need to stay up to date; can you solve that problem for me together? A lot of large organizations will approach MedBridge and they'll get a group discount; smart on MedBridge is part, right? And now for for pennies on the dollar or a little bit less, they're that they're able to use that as bait. We asked this on a on a previous episode: "Would APTA membership—if I—my clinic paid that for you—would that be valuable to some people?" And some people like, "Okay, I guess that's nice, but I'm never going to see the value." So pay attention to what they ask for; what they're paying for themselves; can you deliver that for a little less and then use it as the on the value side instead of just focusing on the price side of that of that seesaw. I got the I got my seesaw; it's going back and forth; just focus on one; don't always focus on one side of that seesaw. Any other bonus suggestions that come to mind before we uh, before we hit hit stop? Yeah, heck yeah. Since you got bonus, I'll get bonus. I would say, you know, most clinicians tend to be uh, the personality type that avoids conflict and avoids risk, right? Risk-averse. So I know when I'm looking at making a major investment, I want to know what's my exit strategy. If I'm starting a business, what's my exit strategy? If I'm getting into a relationship… I just did an onboarding call; I was like, "This is amazing; best onboarding call I have ever had," but how do I get out of this if things don't go well? I always want to see the exit in a situation like employment. I think a huge value-add, if nothing else, is just to say, "Look, I don't expect you to be with us for 40 years; you're early in your career; you're late in your career; you're in the middle of your career; whatever it is; I understand there's going to be a time for you to be here to grow, to thrive, to excel, and then you're going to leave, and that's okay, and I want to plan that conversation before you even start because I want you to know that I expect the best people to outgrow this position, to expand and go into other things; it's totally fine." Because I think a lot of us feel guilted into staying into a position way longer than we ever would have simply because we like our we like our co-workers; we like maybe the managers; maybe we love the patients; we don't—we always feeling that obligation, or we don't know how to properly break up. Like how many times have you been somewhere you're like, "I don't know how to get out out of this; like there's no…" This goes back to—and I've given Jamie Shrier—who we just saw PPS uh, on the fly there last week—um, the one of the greatest questions I've ever heard on an interview; it's so great; it it's—it's—I call it a ricochet question, but apparently it's called a framing question, like in real talk, which is um, "If you were to take this job and three years from now you were to leave or quit, what do you think that reason would be?" And whatever that person says, that's the thing that they're worried about or looking for, and if you don't have that, be upfront; don't take that person on, even if it's for you know, even if it's for two years, because remember, when someone's ramping up, they're not as productive; they don't know a lot, right? And when they're ramping down—and you never—you know, when they're ramping up because they've just started—you never know when they're ramping down, right? Because when they're mentally checked out, they're going to be requiring more resources, or they're going to be dragging ass, or they're going to be, you know, pissing people off in the organization. So I like that question because it says like, "Well, I don't—I want to open my own clinic; well, actually, my year plan—I want to—I'm going to open—I'm on a second location, so this might be a good match," but that's not on the application. So I love that cheat question from Jamie Shrier: "If you were to leave, what would the reason be?" I think this is and will be…
A problem for the next, for the foreseeable future. I think AI apps, RTM, can help all these things, but I think the basics are going to win. The organizations that pay attention to what people are looking for, and I know it's the now, we're—I feel like I'm in the age of these kids today. They want something different. Yes, they do do. And the organizations that will create that for those people in the next generation—it's not you anymore. I'm in my mid-40s; it's not me in the in the middle of the bell curve anyway, of the of the biggest portion of this 10%. Um, in terms of uh uh um lack of positions being filled, pay attention to what the next generation is. It's different than the one that we just came from.
Sounds good.