All right,
good morning to PT Breakfast Club,
the only show of, well,
physical therapists who are
talking mindlessly in their
kitchens and various rooms.
Health for misfits who
believe that live shows
should be faster than your
EMR and hopefully twice as fun,
depending on what you're looking at.
The big idea today when Dave joins,
Tony is still on school chaperone duty.
When Dave joins,
the topic I want to talk about
is scale and I think both
tony and dave would agree
with me that the funnel has
been flipped over forget
the ten location empire the
pendulum is swinging back
to tight boutique and
intentionally small I was
talking I was listening to
someone talk yesterday
about one of the reasons
for maybe the difficulty in
hiring physical therapists right now
And they would point to cost of education,
shrinking reimbursement,
student debt going high.
So salary expectations are
equally as high.
And all those things are valid.
And this person had a really great point.
And I don't think the first
person to say it, it's just a reminder.
I'd heard other people say it,
but it was just a reminder
that I am noticing.
And again,
it might be like the red Jeep theory.
When you notice something,
that's all you can see.
But I'm noticing a lot of
what this person called
one to one and a half person clinics,
meaning, as Dave joins,
meaning one to one and a
half person clinics,
meaning these people are saying,
I don't want to build a
business that's going to scale.
In fact, I don't need to,
because what they're trying
to do is build a life.
So Dave, I'm setting up the first topic,
which is
Big is the new small,
small is the new big.
The idea being that the death of scale,
why small is the new smart in healthcare.
Things get a little bit out
of control when things get too big.
Where is too big?
We're seeing certain
physical therapy
organizations at the national level,
stock prices are going down fast, right?
At some point,
some of these organizations
were a lot smaller before
they started merging and
acquiring clinics.
At some point,
They were good, right?
Before,
so maybe some of our colleagues
would just instantly start
calling them a PT mill for
no other reason.
They're too big.
They're a mill, right?
But the idea here is what I'm seeing more,
and I'm trying to make sure
it's not just confirmation bias,
but what someone was
pointing out yesterday is
the rise and the popularity
of one to one and a half
FTE employees,
one to one and a half
full-time employee
businesses because it's easier to manage.
The person wants to be a
small business owner,
which is different than a
large business owner.
They understand what they're
getting into a little bit more.
a little bit more some
people not everybody but a
little bit more today than
they maybe did five or ten
years ago and they're
understanding that they
want to create a business
around their lifestyle and
not necessarily I want to
get to ten or twenty
clinics do it over twenty
years and then sell what
are your thoughts so are
you are we talking about
the are we talking about
the micro practices so
you're saying one to one
and a half providers
And there's nothing in the middle.
It's either you're that or
you're the big corporate.
Because I would say I
strongly disagree with the
micro clinic emphasis.
OK, why?
Well, I want time freedom.
I'm an entrepreneur.
I spent a ton of years in
the trenches treating patients,
doing outpatient physical therapy,
then doing mobile home visits.
Right now, probably for the past,
two, three months or maybe longer.
It's been several months
where I'm seeing one
patient visit per week.
So four patient total visits
per month because I have
other therapists treating
patients and I get to do
whatever I want as a business owner,
because I spent a ton of
time and effort to set up
the processes and I'm still
improving that and the
whole playbook and the whole thing,
all the processes and SOPs
for the business.
If you are, any therapists out there,
if they wanna be a micro
practice owner as a solo practice owner,
that's fine, but you're creating a job.
So when you get hit by a bus,
there's no asset to sell.
When you go to retire,
there's no asset to sell.
So many owners have reached
out to me over the years
about partnering or buying their clinic.
And I'm like, all right, yeah,
so tell me about it.
So is it like how many FTEs
and all this and front desk person,
how many patients per day
or per week and per month and all that?
And it's just like, oh, no, no, no.
It's like I'm just I'm
selling my practice like I'm retiring.
But like it's the practice there,
like all the treatment
tables and the equipment and all that.
And but there's no front
desk person and there's no
other therapist or PT or anyone.
And guess what happens to those clinics,
Jimmy?
Nobody buys them.
They just go away.
Exactly.
They shut down.
They literally shut down.
Then you see the post on all
the Facebook groups that says like, hey,
selling these old tables
and these old Chattanooga
units and the old UBE and
all the other equipment.
So it's sold for pennies on the dollar.
And they can't even get
money for their book of business,
like their past patient list, the names,
phone numbers, emails, all that.
So I would actually say the
gold is in the middle.
The gold is...
multiple therapists and
that's where therapists can really thrive,
grow, expand, charge whatever they want.
They can raise rates if
they're out of network or out of pocket.
But I actually am strongly
against an individual
therapist who wants to be
their own boss and treat
patients solo for the longterm.
I'm talking, you know,
if that's like they're
between now and when they retire,
if that's their main goal,
it's a horrible idea.
Yeah.
I think it's a horrible idea
if that's what you're looking for.
I think what I was trying to point out,
maybe I wasn't doing it as
Tony is joining from a tour bus in D.C.
I want to see a picture, Tony.
Email me a picture so I can
put it on the screen.
Email it to me.
Don't text it to me.
Email it to me.
I need to see a monument.
Lincoln, Jefferson's my favorite.
The Meritata Monument.
Jimmy did get his ears lowered.
That was about a week ago,
but thanks for noticing.
I think I just...
So let me,
let me try to re-communicate this.
I agree with you a hundred percent.
All I'm saying,
all I'm noticing is a lot
more people are treating
their PT license.
I agree.
Like a break.
They're just like,
here's my Instagram account.
And I don't want to call
people out because I don't
disagree with it.
You're right.
I think they're being more savvy.
I think maybe we can get
into psychographics,
and this is all guessing.
This is all speculation.
I think some people of a
generation who have gotten
their PT degree in the last
couple of years, even five to ten,
are saying,
that's not the bag I wanted to be in.
I wanted to show up, be a great clinician.
put money in the four Oh one
K and be able to afford it.
I can't, I'm willing to trade that.
Cause that sounds horrible
working in that situation
for someone else.
I also don't want to start
running a business cause I
know that's not my strong suit.
So I'll just be a brand.
And I'm seeing them start
very successful Instagram accounts,
as an example, and then saying,
I'm the dance PT in San Diego.
And they do that full well
knowing the minute they
stop wanting to do that or
when they want to take a vacation,
their income stops.
they're trying to build those.
I see people also saying, well,
I'll build digital assets
or I'll do telehealth and
those things working,
but not as well as like the
financial porn bros going,
it's passive income, bro.
It's passive income.
I'm like,
I think it's a great idea in theory.
Um,
I had so many people years ago being like,
teach courses and yada, yada.
And I don't disagree.
I think if you're good at it,
I have a lot of knowledge.
I sat down to start teaching
courses in podcasting a
dozen times and I hated it.
So I was like, why am I doing this?
Because people in my DMs are telling me to,
that they would pay me to
teach them how to podcast.
And I was like, well,
then pay me and I'll teach
you how to podcast.
I don't like recording.
Look, we're doing this stupid thing live,
right?
So I think the underlying
idea here is as long as you
understand what you're
actually getting into,
I think that's good, right?
Understand that this might
not be most probably the
one to one and a half FTE business.
is not going to necessarily
be valuable five, ten,
twenty years from now.
It's not.
I think most of them know
that and they're just okay with it.
I was looking at it from a
perspective when people say,
where are all the PTs?
So many people leave in the profession.
The student debt,
the shrinking reimbursement,
not disagreeing with you.
I think one of the things in
there is also people
looking at those things.
My debt's high.
reimbursements low,
the salary from one of
these companies isn't going
to light me up.
Great.
I'll take less money or I'll
take more risk and I'll
just do this Instagram
brand clinic type thing.
I don't think they're taking
much risk by doing that, by the way.
Maybe a little hard effort
here and there with Instagram brands.
But we joked about it before,
therapists that have five, ten,
twenty thousand followers
reach out to me for a job.
Isn't that interesting?
Well, yes.
I mean, also,
it's the highlight reel mentality.
How many followers you have
does not equate income.
It doesn't.
I know lots of people who are like, well,
I grew my Instagram account,
and they'll come to me too.
Those people are coming to you for jobs.
They're coming to me being like,
how do you make money with
an Instagram account?
I don't know.
I run a podcast.
I happen to also be on Instagram.
To me, that's tertiary.
People are like, I don't understand.
You're saying you have this
many downloads.
I'm like,
I will open up my dashboard right
now and show you how many
downloads I have in the podcast.
That also doesn't matter.
So let's shift this.
I didn't think this was
going to go this direction.
Real quick.
Tony did DM us on Facebook Messenger.
He didn't email it.
That's fine.
He understood the assignment.
As long as I could get on the computer.
He said it extremely fast.
As soon as you said it,
he is absolutely watching live.
Yeah.
All right,
I'll download those while you're talking.
Did you want to make a point, or Tony,
what was your point?
That was it.
Okay, so what I was getting into was,
watch this, watch this,
because it's the same in
Instagram as it is on Twitter,
as it is on Facebook,
as it is in podcasting,
as it almost is on YouTube.
Almost.
Here's what I'm going to say.
If you have a wildly successful,
and some of these social
platforms will monetize,
like they will pay you
what's called a CPM,
which stands for cost per milli.
I don't know why it's cost per milli.
It's cost per thousand.
It should be CPK,
but don't get me started on Latin.
They will give you a rate.
They decide the rate.
The platform decides the rate.
YouTube decides the rate
based on your niche.
And they will say for every
thousand views you get,
we'll give you something.
It's crazy low.
Like I understand people are monetized.
If you are saying I'm going
to get to a million,
ten million followers and monetize,
you can do that.
It's less than you think.
It's a lot less than you think.
So this is where I need
people to shift what their
product actually is.
Here's what I mean.
If someone says I have a
hundred thousand followers on Instagram,
Instagram is my product.
You're wrong.
Your audience is your product.
So, sorry, Tony,
thousand doesn't start with
K. Kilo starts with K. Latin,
everything should be Latin.
No, you meant thousand, you meant K,
like if you say, ten K,
it's ten thousand.
I know what you meant.
Kili, kilo.
Thank you.
So your audience is your product.
So I don't charge... Dave,
have you ever listened to
PT Podcast before?
Have you downloaded it and listened to it?
Of course.
Have you ever paid Apple or
Jimmy to listen to any episode?
No.
No, you have not.
Because I understand you're my product.
Now, I then turn to...
brooks institute of higher
learning and I say you have
residency and fellowship
programs in pt and you need
students and they go yes
and I go are you in the
business of knowing how to
go out and get those
students to pay attention
to you to maybe consider
giving you lots of money to
then do a residency and they said no
And then they say, no.
And I say, well, what do you do now?
They're like, we go to CSN,
we put up a table.
Does it work?
Sort of.
And I go, cool.
I release five episodes a week.
I'm in people's ears,
forty-five minutes a pop.
We get between twenty and
sixty thousand downloads a month, I think,
right about now.
So I'm like, do the math on that,
how much attention we have earned.
And now a simple podcast can be –
more time spent in
relationship than your
gigantic booth at CSM.
Even if you went to CSM
every day of the year,
that doesn't mean those
people are actually paying
attention to your booth in
the back corner of the expo hall.
So this is what I try to explain to people,
that your audience is your product.
How you get them is a
podcast or funny little
dance videos or whatever.
But then flipping,
converting your dance video
followers who are there for
the giggles into a sale is
a monumental chasm.
It is a large, large leap.
I do not trust this person for this.
This is why someone like Joe Ranke.
Do you know Joe Ranke from Fitbox?
A little bit.
He's been on the show a bunch of times.
He's a financial guy.
But he's chosen student debt
and student loans as his hyper niche.
The riches are in the niches, right?
That's like the quote.
Must be true.
It rhymes.
But he said,
I understand that my knowledge
is how I get people to pay attention.
I give it out freely.
He's got a YouTube channel.
When he gets your attention, eventually,
you're like,
I feel like if I'm going to
pick somebody to help me
navigate my student loan repayment,
this is the guy.
And then he has a product at
the end of it.
Now, Joe did it himself.
You don't have to do it yourself.
Look what I do.
I don't necessarily have a product.
I understand that
How I get people is giving out content.
What I can do with them is
now go one step further to
somebody who wants that attention,
is willing to pay for it,
and ask them for money in
exchange for that attention.
And that is the model.
So back to the clinic,
I understand that getting
ten thousand Instagram
followers is great.
But if you're only treating
in San Diego and you have
followers all across the world,
that's a big chasm to give you time.
And Tony might say
telehealth and we would say, yeah,
but I don't know how far
it's going to go.
So what was the impetus
about the whole microclinic
talk this morning?
You saw or you're seeing
more posts on Facebook or
Instagram or LinkedIn.
Like where did this come from?
And I'm reading this.
So this is a book called Unscaled.
And it's written years ago.
But I didn't read that book either.
But I think the solo practice is like –
too unscaled.
Like that book probably says,
do things like I've done, right?
With my practice.
Like when it's last year,
it was like October, or something.
We had two,
one of my therapists had two patients
with a birthday on the same
day he was seeing one of
the patient one of the
patients on their birthday
and he was seeing the other
person like a day or two
after her birthday and I
you know I did the unscaled
thing of of we talked about
it and I said we don't have
a process in place we don't
have anything automated we
don't have anything where
we get an email
automatically internally
like hey it's jimmy mckay's
birthday let's you know
let's send them chocolates
or a cake or flowers or whatever
so we sent we I told my
therapist bring this guy
bring the male client this
chocolate cake and then for
the woman a bouquet of
flowers I think that is the
in terms of unscaled things
in physical therapy
practice and business maybe
more of that focus but I
truly think that the
individual solo therapist
you can do things that are unscaled.
Of course,
that's like everything you're
doing is like unscaled basically,
unless you're doing things
like creating a playbook, recruiting,
hiring, all that.
So anyway.
Well, so the, so,
so the one step this book
is saying is you can,
you can purchase or create
low to no cost systems that
automate this as a
solopreneur where you needed to,
where you needed to, I mean,
it uses the Walmart example.
Like you had to have
physical square footage in a town.
you had to have inventory
you had to have people
stocking and moving that
inventory and selling that
inventory when you were
closed you made no money
back when walmart first
started before the before
you could buy something at
three o'clock in the
morning and have it shipped
to you um I'm not saying
I'm not advocate just to be
clear I'm not advocating
for any of these models
what I think people are
doing now or I think the
rise of these solopreneurs
is they're saying okay
I can a hundred percent.
It's a scale, right?
It's a spectrum.
I could a hundred percent go
and work for a large organization.
And there's advantages to that.
There's stability.
Most of the time,
not a whole lot of mobility.
Cause what do you do after
you're a clinician?
You become a clinic director,
then you become a regional director.
And then maybe you go into a
side thing like clinical director, or you,
you oversee a particular vertical,
like vestibular care or
neuro or ortho for a big
organization in the middle of
If you're the owner,
it's a lot more risk but
good reward if you're going
to run something that you own yourself.
As a clinician for that,
is there a difference between that?
Dave, if someone owns three clinics,
if I own three clinics and
my employees work for me
versus working for ATI,
there's not really a lot of
difference there, is there?
For who?
For the employees?
The employees.
It's still forty in, forty out, right?
Well, I mean,
you just spoke with Ben Fung recently.
I know he's pretty tight
around employers and
offerings and all that.
I think things can vary.
I think that the smaller
practice that has three or
five or whatever locations
has more of an onus to keep
the therapist happy.
And this is from the
business owners and the
practitioners that we've
spoken with that we've
tried to partner with or
acquire or whatever over
the past couple of years is
the ones that have two or
three or four or five locations
There's more of an intimate team.
Of course, there's a little bit of like,
it is a job and all that, but,
and it's not necessarily a family.
It's more about like, Hey,
we're like a sports team.
Like we want to operate.
We want to, you know,
we want to perform at our best,
but this isn't like,
This isn't family where you
can't fire your uncle,
but I can fire my therapist
if they step out of line or
if they're not documenting
or if they're coming in late or whatever.
I can write them up.
I can try to improve, sit them down,
try to have an approach or
some type of game plan to
help them improve whatever
they're deficient in,
whether it's coding or documentation,
timely documentation, whatever it is.
I think that the smaller, like two to five,
two to ten location
practices have a tight-knit offering.
There's a lot of good morale and culture,
typically, at least on the East Coast.
I'll say from upstate New York to Florida.
Any of the practices that
are two to ten locations
that we've spoken with,
that's what we've seen.
Obviously,
we don't speak to the big
corporates and the
quote-unquote mills out there.
I would bet, though, that
and maybe because I'm also
in that realm of like kind
of in that practice owner world,
I would say that it is on
average better to have a
staff physical therapist
job at the one to ten
location private practice clinics
As opposed to the ATI, well,
I don't know if you want to call them out,
but the big corporates, the big mills,
that's just, but of course I'm biased.
There might be other folks that say like,
oh, I agree with Jimmy and it, you know,
it's forty and forty out
and I'm a staff physical
therapist in either place and they,
you know,
treat whatever they want to
treat and they get in, they get out,
they do their notes and that's it.
I would say I've seen behind
the door or behind the
kimono of a lot of these
practices and what the
practice owners do in terms
of taking them out.
You never see, and maybe it happens,
but you never see with
these large corporates,
you never see the...
CEO or the regional director
taking out the therapist
for axe throwing or Christmas dinners.
It might happen.
Fox was mandatory.
It wasn't mandatory.
There was a budget for that.
So Fox is massive.
They're like in thirty something states.
Tell me what.
So Fox maybe has scaled the
unscalable by doing that.
So go ahead.
So I'll only speak because I
have personal experience with this.
Yeah.
they put their clinicians
like before the patients
which sounds insane but
we've talked about this
before why that's actually
a better idea take care of
clinicians and they do I
don't know what the average
tenure is for a fox
therapist but it was pretty
good and I think they did
it because they were remote
based like you're a
clinician you have to you
have to so what they did
was they put a real
emphasis I think more
organizations are doing
this they put a real emphasis on
who they promoted to leadership.
It wasn't who was around the longest.
It was who can do this?
Who's the seventh guy on an NBA team?
It's the glue guy.
Is he good?
It's pretty good.
Why is he there?
Everybody loves him.
He keeps everybody light.
When we lost four in a row,
he makes a fart joke,
and everybody laughs,
and everybody can start
hitting threes again.
So they did it,
and I can only speak from experience.
I can't speak to what,
and I know we keep saying ATI.
I think we keep saying ATI
because they're the biggest, right?
Or Athletico, any of those.
Their bruise is just easy to
punch on them.
They're just a punching bag.
The funny thing is, well,
that's a different topic.
I'll get into the wheeze in a minute.
So yeah, Fox did make it mandatory.
They did say,
because this was part of my
job when I was there, Tim Fox said,
I want to be able to shake
every person's hand once a year.
And that dude got on a plane
and flew around the country
and they threw like Christmas parties,
but like all year, like there's, you know,
there's no way he could
just visit everybody in December.
Just couldn't do it.
Doing four or five or six of
those a month.
And it was like he'd come in,
they'd rent out a room at a ball,
you know, at a hotel,
like a nice ballroom.
They'd throw orange all over
the place and they'd throw a party.
And that but that wasn't the
only time those clinicians
in that area would see each other.
They did have the axe throwings,
the journal clubs,
but they realized they did
sit there and they go, well,
why would someone want to work for us?
okay let's diagnose the dna
of what people like about
because they were small
like like any any big
organization they were
small they were like we're
jersey and pennsylvania but
what if we hit california
to their credit they said
I think Tim said,
and I'm trying to get the quote right.
Don't unquote me if Tim ever
gets hold of this.
But he said something.
He's like,
the way I'll measure failure is
if someone says,
who's worked here for ten
or fifteen years and leaves,
and someone says, why'd you leave?
It just doesn't feel the same anymore.
He's like, that would be the failure.
Because that's how you keep
good people around.
What brought the good people in...
If you're just recruiting to fill a spot,
I get it.
Short-term benefit.
I need someone to treat patients.
They said no a lot to people
with licenses who could
fill a role because they were like,
it's going to cost us more
and let's just keep looking
for a better fit.
They hired me with no job.
They were like,
we don't understand what
Jimmy's going to do on day one,
but by day fifty,
we'll have a better idea.
So they hired on culture.
I think, yeah, maybe you're right.
Maybe,
maybe small organizations can do
that better because one bad hire at a,
at a ten person,
at a ten clinician clinic,
that's ten percent of a bad,
you know what I mean?
Like ten,
now you have one bad apple among ten,
whereas a hundred bad,
bad apples are around thirty thousand.
That doesn't do any, that's not,
that's not a problem.
So.
I, I love this because this is,
So Fox is a great example of they've gone,
you know, regional and then they've gone,
you know, like the whole East Coast.
And now I think they're
starting to go like more
Midwest and Southwest.
Right.
I know I've spoken to some
owners that have reached
out about like them looking
to acquire like kind of
like in Georgia and something like this.
They just did.
They just they just acquired somebody.
There you go.
And by the way,
that's how they're expanding.
They started organically in Cherry Hill,
New Jersey,
the town next to where I'm from.
And they've grown dramatically.
So much kudos and applause
to Tim and the team.
So that's why.
That's probably one of the
main reasons if you had
some business coach come in
and give an assessment or whatever,
some third-party assessment.
is doing wow it's like most
of the country it's not wow
but so the question was the
question is so I when I was
there I don't think any of
these states here I think
we were like I think as far
west as we were like
illinois I know we were we
were in wisconsin
But the idea was when they were just here,
how do you stay the same?
Like when you're Fritos or
Dr. Pepper and now you're
being – or Sam Adams and
you want a brewery on the West Coast,
how does the cherry wheat hit the same –
In the new brewery.
It's like, well, out West, we don't,
we do this.
So the, you know,
do you ever hear the story about the guy,
the New Yorker who moved to
Florida and opened a
pizzeria and he bought a ship, like a,
like a, like a cargo ship, a cargo ship.
And he went to New York and
he filled the cargo ship.
He just went up to a fire
hydrant in like on the
docks of New York and water
up with water.
And he'd been doing it for
years and he's bragging about it.
He's like, it's free water.
It's like, first of all,
We we pay for that water
that comes from where I am.
That comes from upstate New York,
New York City water.
It comes from somewhere.
But he was doing this for
years until someone was like,
that's an environmental.
You can't just take water.
But anyway, the point was,
how do you actually import the things,
the ingredients that make
the thing that people want?
You have to go further upstream.
This conversation started in
terms of scale, but I think really it was,
I think there's more people
able and wanting to just do
things on a smaller scale
and they're able to do it now.
Where I don't think you,
before social media- Why
were they unable to do it before?
Why were they unable to do it five, ten,
fifteen years ago?
Without social media,
how would you get clients?
If you couldn't run ads to get patients,
you had to rely on the
clinic down the street.
No, you know, no, you if if fifteen,
twenty years ago, whatever,
there were independent
therapists back then.
Sure.
They just popped up their own shingle.
They had a word of mouth.
They had some following
because because they either
worked at a hospital like
like like Ron Miller and
maybe Tony Maritato.
I think I can't remember.
No, Tony didn't.
But there's some owners that
work for a hospital and
they got a reputation.
And then they were like,
I want to make more money
or I want some senior leadership,
whatever.
And the hospital or the mill or whatever,
we're going to call it the corporate,
whatever is like, no,
like you're capped out.
That's it.
And then they were like, all right, well,
screw you.
I'm out.
I'm going to take myself.
I'm going to go open up a shingle,
open up a private practice
nearby that I mean,
that's I don't understand
how it's different now than you're right.
There was no social media.
There was no.
You couldn't have an Instagram account.
There was no YouTube.
There was no videos.
There was no digital footprint.
But back then,
the in-person word of mouth
and the in-person footprint
was the main thing.
That was like, of course, there was no,
I mean, there was,
I was about to say Yelp.
There was the Yellow Pages.
Anyone watching this is
probably knowing and
remembers the Yellow Pages.
The Yellow Pages, they were passive.
I can now be in front of you.
And I'm not saying like
people didn't go get referrals.
That was a way.
But if I want to have a lifestyle,
there's there's just more
ways to be able to support that.
I want to give this much
effort to get this much to
get this many patients.
Because if you were doing that,
I had to just be the PT for
this one doctor.
And the minute that doctor
stopped referring to me, I was dead.
Correct.
So I interviewed a while ago,
maybe last year, Ben, oh my God,
from Star Physical Therapy
in New York City.
They sold to Motion PT, but they had,
and they still have,
the biggest square footage
practice in Manhattan, in New York City.
The biggest practice that's
not affiliated with any
Rusk or NYU or whatever.
So they...
They left the hospital.
Ben Gelfand, I remember,
Ben Gelfand and Mike Fox,
they left the hospital jobs that they had,
and they were so good.
They had such a good reputation,
such good word of mouth
from all the hospital-based physicians.
They went out on their own.
They told all the surgeons
and all the physicians, hey,
we love you guys,
but we're going out on our own.
We're going to make a go of it.
This was twenty, twenty-five years ago,
maybe thirty years ago.
way before the internet.
And they got,
they had all the word of
mouth from the physicians.
So the mass,
the masses of patients seeing
all these Mount Sinai, HSS, you know, NYU,
whatever physicians refer to them.
And that's how they built their practice.
And it's public knowledge
that then he made like
seven million dollars, you know,
selling his practice.
So it absolutely happened
with the word of mouth,
like the patient to
physician marketing and all that before.
How long did they practice
before they did that job?
I think it was maybe a good
five or ten years before.
So they worked somewhere for
five or ten years, probably, most likely.
That's a lot.
Sam chiming in saying,
he's talking about Fox, I believe.
They got the culture down, then scaled.
Not scaled, then scaled.
You can't do it the second way.
The second way, I love this example,
because this comes up a lot.
I baked a cake,
baked a birthday cake for a friend.
At the last minute,
I realized I didn't put any
sugar in the mix.
So I just threw five times
as much sugar on top.
And it'll take time.
You have to bake it inside first.
You cannot do it the other way.
It does not taste.
It's not the same thing.
People will eat that cake and be like,
well, it called for three cups of sugar.
I did fifteen.
It should be.
The icing was a sugar bomb
and then inside was bland.
It doesn't work.
And people will recognize it.
Like,
I don't know what I don't like about it,
but it sucks.
I don't know what you did here,
but it sucks.
All right.
Real quick with Sam Kellecate.
So he's a physical therapist in Sam.
I can't remember if you left
Philly and I think you
moved to South Jersey,
but he's from we play.
Yeah,
we played baseball together growing up.
We went to the same hit
doctor indoor training facility.
And then like years later,
he becomes a physical therapist.
I couldn't believe it was amazing.
We talk all the time and I'm
going to have him on my show.
And I also want him in the coming weeks.
to come on here live.
He agreed to come on here
live with you and Tony as a
sidebar right now because
he has done some digital
programs where he's
charging patients and
clients like multiple
thousands of dollars.
It's usually around like
headaches and migraines, I believe.
Very niche.
Yeah, very niche.
He gets great referrals from
neurologists and other
folks that specialize in
headaches and migraines.
And I always, you know,
I always come on here and I
poke Tony and I bash the
whole digital stuff and the
virtual care and all that.
And then Sam, you know,
sends me a DM on Instagram
or a text message or whatever.
What was he saying?
Clinic in Philly.
Yeah, live in New Jersey.
So yeah, he's back in South Jersey.
Okay.
That's what I thought.
OK, so in the coming weeks,
we're going to have him
back on all four of us.
You know, Tony,
Tony will be able to have
one under his belt in terms
of another therapist doing
virtual coaching and virtual care,
whatever you want to call it.
But I can't wait to have him
on and share what he's doing.
Where in the world is Tony Meritato?
I don't know.
Oh, that I thought I was like,
what is this like?
Italy?
Is this?
Tony, have you been elected Pope?
Have we seen white smoke?
Have we gotten?
If you're not, if you're not watching.
I thought it was black smoke.
It's white smoke.
Black is no good, right?
Is that what they don't have?
I don't know.
I haven't watched the Tom Hanks movie,
Da Vinci Code, in a while.
Or Conclave.
He's not at the Vatican.
He is at... He's not at the Vatican.
That must be a Smithsonian.
He's... The Meritato.
No, that's the Washington Monument.
Washington, yep.
Now, today,
being renamed the Meritato Monument.
Meritato Monument.
It looks very good.
All right,
so we got ten minutes because I
got to go play in a golf
tournament today.
Oh, lucky you.
That's why I'm wearing my golf shirt.
I don't do polos very often,
but I do sometimes.
So here's something we want to talk about.
So I have an intro for Steal This segment.
It took me eleven or twelve
minutes to make this intro,
so I'm going to play.
That's it.
Steal This strategy.
So I think the strategy goes
along with the big topic today,
which is opposites.
I think five, ten years ago when COVID hit,
we were forced to go digital and virtual.
I think we've hit peak Zoom.
In fact, yesterday,
They retired Skype.
Skype was a verb.
Skype is dead.
It's no longer.
Zoom is still around.
Who owned that?
Microsoft?
Microsoft, yeah.
They sunset.
Because now they have Teams.
So, of course,
they're not going to keep Skype around.
But, yeah, we just sunset.
And half the audience just went,
what the hell is a Skype?
Nobody wants another
eight-hour virtual summit.
with bad slides nobody wants
that nobody wants to come
to your webinar which we
all know is a thinly veiled
sales pitch to buy your
coaching or to buy your
product so the question is
what's winning now or
what's going to be winning
three six nine twelve
months from now I think it
is curated real life micro
events that actually in the
room create trust buzz
loyalty fast listen
In the sixties,
there were these pants and
they were called bell
bottoms and everybody wore
them until everybody wore
them and then they weren't
cool anymore and you
couldn't wear them until a
couple of years ago,
bell bottoms were back in
and they were everywhere
until they were everywhere
and then we're back in.
The world's a pendulum,
I need you to understand that.
So I'm looking at this and saying,
Zoom fatigue is real.
I don't even think you need
to... That's not a debate.
Like webinar fatigue, less engagement.
Everybody wants a connection
that feels real.
This is why UGC, user-generated content...
is being shared more.
It might eventually go out,
but right now it's the thing.
We're not looking for a
Marvel or Avengers level
quality video all the time,
sometimes when it's appropriate.
So what I'm saying is,
how could you use this in your business?
I'm saying,
instead of trying to get a
hundred people on your
webinar for your clinic or
your business or your
podcast or anything you're trying to sell,
think fifteen to thirty people.
the right people,
the right psychographic and
demographic for who you want to talk to.
So that requires you thinking,
not just get as many people
as you want in a room and
hope one of those things hits,
to have higher value conversations.
It doesn't mean you need to
be selling something that's
valued at thirty thousand dollars.
These are higher value on
your part and their part conversations.
More dinner party, less trade show.
Tony,
I kicked that idea to you yesterday
and I still owe you video
clips from when you came here.
I just remembered that we shot that thing
Yeah, yeah, yeah.
My couch.
Beautiful living room.
It was great.
I was trying.
The problem was we hit
record and we talked for
like an hour and a half.
And then I tried to upload
ninety minute long video clips.
And my editor kept saying,
I'm not getting them.
And I'm like,
so I'm going to hand deliver those.
So I will get those.
We will.
They're the lost sessions.
Yeah, that was.
Did Connie have some of those?
The lost mixtape?
The lost sessions.
Or Jay-Z or Dave Chappelle or something?
Yeah.
So back to the idea,
how could you use this?
So if you're like, yeah, man, I get it.
I agree.
So this is what I like to notice.
Like,
what are the big brands doing and how
do you steal the strategy?
That's the point of this whole segment,
which is if we know that
Zoom fatigue is real,
how do you play with it?
Even if you weren't doing webinars,
it doesn't mean stop doing webinars.
It's like notice what the
world is tired of.
Give them the opposite.
If the world is tired of bell bottoms,
give them skinny jeans, right?
B, go to skinny jeans first.
So my idea for Dave,
and then we can expound upon this, was,
hey, who are you?
So who are you looking to talk to?
You're in New York.
I'm just up the street from New York.
Who are you looking to talk to?
Who are your people?
Clinicians, practice owners.
No, practice owners.
So I know we mentioned,
can we mention a few names?
I'll mention a few names
that I want to meet in the city.
And I think you could maybe
help me with it.
so dan dan ruttenberg ceo of
spear they have I don't
even know close to fifty
locations he started he
started with one obviously
he was like the same thing
hospital based job I
believe and then went out
on his own um so dan
ruttenberg is one and and
really I'd love to meet
practice owners that have
uh I mean most of the
practice owners that have a
solo location I pretty much know them all
So the ones that have like
two to five or five to ten-ish,
like the ones that I don't know,
I would love to meet them.
Like Paul Zion that owns
Zion Physical Therapy.
I think they have like five locations,
like four in the city or New York area,
one in Connecticut.
There's owners like that, that like,
I'd be, I would love to meet, uh,
break some bread with,
and then at the same time,
like if we do it together
and maybe it's some, a fellow's collab,
then you get, you get, you get some,
you get in front of them at
the same time.
And we do it in a way that's
very authentic.
We can, you, you pitched,
we maybe do like a little chat,
little interview.
We record it, whatever.
We can kind of talk about
the same stuff here.
Like, you know,
reimbursement issues and
staffing and hiring.
And like, we all have the same challenges.
Who's doing it better.
You know what I mean?
Like, hey, how are you solving this?
So this is,
we're going through this paradigm.
You just described your who and their what,
that yellow part of that Venn diagram.
What are their problems?
What are their whatever?
And then their next question is like, well,
what do you bring to the table?
It's like, well, we have an audience,
number one,
so we can record some of this stuff.
If you want exposure to other PTs, great.
Even if you don't,
what we're doing is we're
saying we're doing the work of getting,
I mean,
we can't take a hundred people to
dinner in New York City.
You can take a hundred
people to dinner for the
same budget in Iowa,
but you cannot take a
hundred people to dinner.
You can take two people to
dinner in New York city, the same budget.
We should go to Iowa.
We would slay in Iowa.
We always make fun of Iowa.
We should do a show in Iowa
to say thank you.
But the question here is in
the middle of that Venn diagram is like,
why is someone like Dan
Rutenberg or Dutch Rojas or
practice owners?
Like we're just naming people,
but like it's the person we
don't know yet.
That's who we want to meet too.
That fits that.
Let's come together.
Even if you're not going to necessarily,
and I'm using air quotes here,
buy what we're selling.
The funny part is success usually comes,
the road is people.
You network.
This is why you're networking.
The idea isn't network to
have a little number under
your picture on LinkedIn that's high.
Look how many followers that person has.
No, you're doing it wrong.
I'd rather have five hundred
really good tight
connections that people
that I get value from and
give value to than five
thousand people that sort
of know who I am.
So that's the idea,
which is could we do a
dinner in New York?
We should do it before the
summer because no one wants to.
Everybody gets out of the
city in the summer.
Right.
True.
The west side of Manhattan.
Could we do it around?
And then my question is,
it would be fun to do like
a video session that people walk away.
Listen,
you got some great content video clips.
They're yours.
Keep them whatever.
But then there's that elbow rub.
Who are you sitting next to at dinner?
Who are we meeting?
And that person you meet in
twenty twenty five in
twenty twenty eight.
You're like, you know what?
That person, you know,
we could now that person is
done is doing this thing.
We could connect and it's wild.
So I want to try that.
I think it's a good idea.
I stole this idea.
It's called steal this strategy.
I'm stealing this idea from someone else.
Picasso said.
Good artists borrow, great artists steal.
So that is my suggestion.
Small, curated for clinic owners.
It could be,
I want to take ten parents in
my area out for dinner.
Parents of baseball players.
I want to understand what
travel ball is really like.
Why don't you tell me?
What are the problems you're
seeing with it?
If you want to treat baseball players.
It seems like if there's no
conversion at dinner, there might not be.
But there could be a whole
lot of conversion.
down the line so that is
down the line for steel
slow play the slow play all
right I gotta go play golf
poorly so parting shots
what does dave have for
parting shots are you I
don't want to break any
rules here I have this
funny post from uncaged
clinician can I as my
parting shot can I read
this yeah and foreshadow
that we will break this
down and respond to it on a
future episode yes do you
want me to show the image
is this the image that we
were sharing or no
The one about the cameras in the clinic?
Show it real quick.
Is it that?
No, no, no.
No, it's not.
No.
Okay.
No,
then I don't know what you're talking
about.
Go ahead.
I didn't send it.
All right.
So Uncaged Clinician Facebook group.
This is a post that is a
little interesting and I
think we could break it down.
Love it.
So here's the post.
I worked at a private
practice that had about
four cameras in the open
gym treatment area.
I was wondering if they need
to inform patients they
have cameras or even the staff members.
I asked because one of the
owners was texting me
before I was ready to leave.
I ignored it as I needed to
be somewhere and left the
clinic after my shift.
The next day,
They basically used the
video to tell me they saw me sitting,
talking to the front desk
person and looking on my phone.
I told them, the owners of the practice,
I told them I didn't see
their text at the time,
which I only saw the
notification of the text,
just wondering if this is legal.
Now, first of all,
it is legal to have in most states,
I think,
to have cameras in the open gym area.
And maybe they require a
certain sign or it's just
it's in the open area.
We're not talking about the private rooms,
which I think is not legal
or you need like written or
express consideration or whatever.
But.
that's the post.
I, we don't have time.
You got to run, but that's something,
that's something,
that's something for all of
us to break down.
It made me think, you know,
when there's like a hockey
game or an NFL game and
there's like a call and
then they just like automatically,
like they're like, here's the play.
And they bring in some
retired referee and they're like,
what do you, and they're like,
before the call is made,
we need a lawyer on speed
diet and be like, okay, Hey,
we're talking, what's the deal?
And they're gonna be like, all right, well,
what state is it?
I need to see where the camera,
like we need like real,
So I'll just preface this by saying,
I'll hold my take, but I have a hot,
I have a very hot take on that.
I want to just go right in there too.
We'll do it, Tony.
All right.
Parting shot is pick your heart, you know,
and it could be, listen,
I want to go work for a big clinic.
I want to have,
I know I'm going into that
with less flexibility,
but more stability.
We'll want to have a lot of
flexibility with no stability.
This is hips and shoulders.
I did hips and shoulders.
This is a shoulder.
This is a hip.
I know, but Joyce, I promise.
But understand what it is
before you get into it.
Because if you get into it, you're like,
this isn't what I thought.
You didn't ask.
These things are very
obvious and very transparent.
If you're going to work for
a big organization,
there's some flexibility in
terms of growth and a lot of stability.
So you're sacrificing one for another.
And there's a happy medium.
And which one is good depends on you.
Your great might be my awful
and vice versa.
So understand, pick your hard.
All this stuff's going to be hard.
It's going to be a lot
easier to stomach and get
out of bed and do when you
like that particular heart.
Tony is back and he'll be
wearing his papal helmet
since he has apparently been elected.
He's been elected Pope.
He is touching up the Sistine Chapel,
it looks like there.
He's just putting touches on the artwork.
Or as I saw someone do in a
comment of that photo, they were like,
is this a subtle ad for
nose hair trimmers?
Because you nailed it.
Like, so I think.
We wish you well.
Have fun at the Capitol there.
And we'll see you guys on Tuesday.
And I will report how many
golf balls I lost at this
golf tournament.