All right.
Good Tuesday morning to you.
Do we have listener questions?
Is that what we're doing?
Are we going into the, like,
as they would say,
I'm part of the interruption mailbag.
Are we going into the mailbag today?
We can.
Before we hit the mailbag, Dave,
have you guys started watching blues
clues?
Is that still a thing?
not yet uh we we've done we've done
sesame street we've done uh monsters inc
what are some you know obviously sesame
street if i didn't say that already but
yeah uh blues clues it's it's on the
docket somewhere i'm sure it just hasn't
been initiated well there's a there's a
mail call segment that you'll appreciate
when when you get into it okay go
ahead i missed that one i haven't done
blues clues yet
All right, Dave,
you said you had some listener emails.
I'm going to guess these aren't anonymous.
No, no.
Shout out to our friend,
friend of the podcast,
friend of Breakfast Club,
friend of the Dave Kittle Show,
PT Pinecast and Learning Medicare Billing,
Dr. Eric Broadworth,
physical therapy practice owner out of
Grand Rapids, Michigan.
And we spoke recently and he had some
questions around compensation,
staffing and expectations for staff
physical therapists.
I'll of course,
I'll give my thoughts and you guys can
as well.
So the biggest thing that he was asking
about or first of all,
his his statement was he has some physical
therapists that if he was asking if they
have downtime between visits because
they're mostly one on one,
they do dry needling, they do, you know,
laser and red light therapy and different
things like that.
But they're still predominantly self-pay.
They're looking to potentially go in
network with Blue Cross Blue Shield and
then offer this dry needling and laser and
red light therapy.
components as self-pay add-ons.
His first sticking point or challenge,
Tony, is he was asking me,
do I pay my staff physical therapist for
the downtime between visits?
Let's say there's a gap of one or
two or three
slots on the calendar between patients.
And I told him, I said,
for my therapist,
like regardless of whether they're W-two
or ten ninety nine independent contractors
hourly,
they're my therapist are paid on an on
a per visit basis.
So it doesn't matter if it's in the
brick and mortar office in midtown
Manhattan or if it's home visits.
we pay our therapist for completing that
treatment visit.
That was one thing.
Another thing he was asking about was if
you have, you know, cancel or no-show,
do you then also still pay the therapist?
Because again,
now it's the same slot where there's no
income or there's no treatment being
rendered, the patient cancels or no-shows.
And I said to him, yes,
like we charge the patient because that's
what they signed up.
That's what they signed.
They signed the late cancellation policy.
So, yes,
we still charge the patient in full.
And yes,
we still pay the physical therapist in
full.
Those are the first two.
Let me start with that.
So do you, I forget,
do you collect ahead of the appointment?
So if somebody cancels,
they lose that session or do you,
if they last minute cancel,
do you collect after the fact?
So I know you mentioned this maybe a
year or so ago.
We're getting better at it.
And it's actually a beautiful thing when
you do charge the card like twenty four
hours in advance.
It's a beautiful thing because if
something comes up, you're like, oh, yeah,
no problem.
Like, totally understand.
Like, all good.
Something came up,
but like we already charged the card and.
also we're doing a little bit more
packages recently i i we probably need to
do a catch-up episode on it because now
we have i don't know a handful of
patients that are on packages that are at
different stages of the package so then
you got to follow all that and make
sure like when is everyone finished and
when you know does anyone want to re-up
or whatever
Same thing with the package.
We had someone a week or two ago,
like they had to be out of town
and they already had, you know,
a visit scheduled and they just,
one of those visits just gets removed off
the package.
Like it's, it's,
it is so beautiful on the business,
you know, operation side.
Like there's no resistance because then
it's not a penalty.
It's not the retroactive, like, oh,
you canceled today or yesterday,
late cancel or whatever.
Now,
now we have to charge a card or
whatever.
you know,
when you already have their card charged
twenty four hours in advance or a package,
you just
It's already taken care of.
It's beautiful.
It's wonderful for the flow of things.
And it's almost like there's no bad taste
in anyone's mouth,
as opposed to when someone late cancels
today or yesterday.
Now we're charging them.
And like you've said before, Tony,
like now it does feel like a slap
on the wrist,
bad taste in someone's mouth,
like a little bit of a negative sentiment.
So we're getting into it.
We're getting better at it.
The challenge for us is that some of
our patients are through the out of
network
insurance benefits so like they might have
already hit their deductible and maybe
their copay is like thirty dollars so it's
like how do i charge that person three
hundred or three fifty or whatever
yesterday for today's visit and then if
they do today's visit now it's like a
credit it's a little bit challenging
depending on the insurance like the out of
network insurance and the cost
And we're probably like, sixty,
seventy percent self-pay.
So we're like, we're majority there.
We're getting there.
There's just some sticking points in terms
of the insurance stuff for us.
But it's better than it was before.
Yeah,
so I think it's fundamental to the design
of the business.
You know,
every business has breakage from
manufacturing to restaurants to therapy
services.
You design the business first to deliver
the experience you want to maintain the
profitability you want.
If I'm looking at a therapist and they're
gonna cost me a hundred and twenty
thousand a year,
I have to account for a hundred and
twenty thousand a year.
And it's my responsibility as the business
owner to ensure my systems are in place
so that if I do have breakage,
a cancellation, a no-show,
somebody prematurely discharges,
whatever the thing is that cost me money,
I have enough cushion,
enough profitability to say,
I'm going to pay this person one hundred
and twenty thousand.
I'm going to have my operating expenses
covered and I'm going to have a profit
margin in that.
You know,
and I think this is where the amateur
kind of falls behind and the professional
business owner excels is because they
understand like it's not an ethical
decision.
It's not an emotional decision.
There's zero like
thought that even goes into it this is
what it is it's very black and white
somebody walks in my door they have a
thirty dollar copay you pay the thirty
dollars now if you don't want to pay
it that's totally fine just leave like
there's nothing for me to do um yeah
i would love to give everybody and i
i
I'm going to preface this maybe in the
next segment.
I asked ChatGPT to give me acronyms and
words for free, F-R-E-E,
because so many people are talking about
health care should be free.
We know it's not free.
We know it's paid for by somebody.
So we got some pretty funny acronyms that
ChatGPT came up with.
But bottom line is,
the business has to be designed with
enough profit margin in place so that it
can account for you're going to have a
seven percent cancellation no-show rate on
the year.
You have to account for that.
That's money loss.
There's nothing you can do about it.
Now, if you want to get into, okay,
so then what does the therapist do during
that time you're paying them and they're
not producing revenue?
That's the next phase of this
conversation.
But Jimmy, what are your thoughts on this?
This is unique to me.
I mean,
I've only worked in environments where you
got paid salary.
So you got paid to show up at
a certain time and you got paid to
this is this is both clinical and non
clinical before I was a physical
therapist.
So to me, it seems
I guess it would be hard.
It would be harder,
but better to align goals.
I don't, I don't know.
Like if I only got paid when there
was a treatment and I'm just sitting,
so I'm going to show up at nine
AM and leave at five PM and only
got paid some of those hours.
But then I was told like, well,
the more you work, uh,
and help us on marketing it'll come down
and that feels like trickle-down economics
to me it's like it's not my boat
so that i'm so glad you mentioned salary
and that whole situation okay so the one
thing that eric broadworth about the
mailbag questions we got another one from
him is that he asked specifically about
that he we're talking exactly what you
just said jimmy so
He would show, and listen,
I do this as well.
My friend, Dr. Christian Marshall,
Tribeca Physical Therapy,
he does it as well with a spreadsheet.
He shows his therapist like, okay,
so here's a spreadsheet.
You have options.
Sometimes it's like two options,
maybe three options.
in terms of like,
do you want a salary like here?
Or do you want like pay per visit
where you could actually make more?
Eric yesterday on the phone said,
I show my therapist a spreadsheet and
it's, here's your,
he didn't say what number, but he said,
If you if you take the salary,
the salary is here and that's all you
can make in the full year.
Obviously,
there's no risk like it's guaranteed,
but then there's no upside.
Right.
So he shows them he's like,
or you could make like I think he
said, like,
thirty three percent of revenue that you
treat.
Right.
So he's like,
if you chose this and based off of
the other flow of patients from our other
therapists that have treated patients over
the past year or two, he's like,
you can make six figures with the pay
per visit.
But they still choose the salary and the
salary annually, Jimmy,
is lower
Now, of course,
I know this one has like no risk
is like an NFL guaranteed contract.
And this is kind of like, you know,
a little bit of like the bonus play
a little bit more.
Maybe there's some risk.
And so I told Eric, I'm like, Eric,
this is something that I never understood
either.
I needed Sturdy McKee to tell me I
needed I needed a sage, a guide,
a mentor to give me some information on
this.
And what Sturdy told me,
and I think we've talked about it before,
he said.
physical therapy as a profession and also
physicians and nurses and all that,
The people that are attracted to
healthcare are folks that don't want risk.
They want this guaranteed salary.
Sturdy gave me an example of like some
friend that's a physician in San Francisco
and they were choosing like a,
I don't know, like a, like a.
Two hundred and fifty or a three hundred
thousand dollars salary.
But if it was the pay per visit
or the pay, you know,
the revenue share or whatever,
the physician could have made like seven
hundred and fifty thousand dollars,
but they still chose
The fixed salary, even like,
even though they know based off their
production and like their normal work
habits, like they're going to do X, Y,
Z, like their flow and all that.
So yes, yes.
The therapist or the clinician has to know
or trust what's the inflow of leads and
marketing and what, like how,
how busy can you get me and how
busy can I stay and all that?
Yes, of course.
That's, that's part of it.
I don't think it's PTs or risk averse.
I think people who are risk averse or
risk averse and people who aren't, aren't.
Because I was in communications and
marketing for close to twenty years.
And there were people, salespeople,
who were like,
all I do is make money on what
I sell.
I might go two months without selling.
But when I hit, I hit big.
I wouldn't be able to sleep at night.
Not going to happen.
I wouldn't be able to do it.
But knowing the only thing that they were
able to sell was the thing I created
every single day was fine with me as
long as it's hard to be creative when
you don't know when the bottom of Maslow's
hierarchy of needs is going to come.
Some people are okay with that.
Some people aren't.
I don't think it's as broad as a
profession.
I think some people are okay with that.
And more often than not, those people say,
I don't want to just do this.
I want to open a business.
So I see what you're saying here, Ben.
It's like I disagree, but I do.
I respectfully disagree.
I don't think PTs are risk-averse as a
whole.
I think most people are risk-averse as a
whole.
Yeah,
I could say most people are risk-averse.
I could say the profession of PT does
attract risk.
A larger percentage of those people,
you know,
I've said this for twenty five years that
I've run a business.
I still to this day don't think that
I have ever really employed somebody who
is purely motivated by money.
And I'm sure, Jimmy,
like you're probably one of these people
that whether you got paid twenty thousand
a year or one hundred and twenty thousand
a year, once you agree on a salary,
you're going to put one hundred and twenty
percent effort into everything you do.
And the irony in this is.
like i've never been able to incentivize
somebody to do more yeah um i would
even say some a handful of people they
feel good getting paid less because it
makes them feel like they're a martyr
they're suffering they're working so hard
they're killing themselves they're
thinking about their patients every minute
of every day and they're getting paid less
than they think that they deserve
So it's like that is the reward in
and of itself.
It's like we have patients that come in
and want to hurt because they feel like
that pain in the experience is making them
better, making them stronger.
It's what they're coming here for.
So it's completely it goes back to,
you know,
we do things where emotional creatures
were driven by fears and desires and
anxiety and all that kind of stuff.
But that being said.
There's a fundamental question of why are
you here?
Why do you want to work with me?
What are your objectives?
This business is a platform for your
growth and success.
Do you just want to be here for
twenty years?
Do you want a stable income,
not have to worry, not have to think?
Okay, you're going to pay a premium.
You're going to get paid less than
somebody else who wants to come in,
use this as a training platform.
because they're going to eventually want
their own business you're going to earn
more but you're going to also make me
a lot more money you know and even
if i only get that person for two
years and the other person for twenty
years i there's different value exchanges
on both sides
Good.
Let me pitch both of you the middle
ground, potential solutions.
So potential solution for this
conversation,
potential solution for Eric Broadworth,
since he watches the show,
he's given us feedback and asked some
questions and wanted to provide him some
value here publicly.
So the one thing that I'm actually working
on right now, and I've helped,
I've had help from Sturdy McKee,
and I've actually helped from ChatGVT as
well, which is like,
what would be
the middle ground so it's kind of like
a base salary and then additional pay for
performance based off of what the
therapist is treating per month and per
quarter and the the challenge that i'm at
right now so like hypothetically i kind of
just threw a dart at the board eric
this will be different for you but for
me i started with a ninety thousand dollar
salary and then
the performance pay on top of that.
So right now,
and this is not live with any therapist,
but this is what I'm working on behind
the scenes.
It's kind of like the eighty seven
thousand to ninety thousand as the fixed
rate guaranteed salary,
which if you and that's like treating for
us,
it's like treating like three patients a
day at three point five.
Like it's totally doable.
I could do it in a coma.
Like it's just totally, totally possible.
And but of course, the
There does, at least for my model,
there does need to be the incentive to
go above six figures because you as the
therapist are treating patients,
you're booking patients,
you're trying to evaluate and activate the
spouse or the other people in the
building,
you're trying to meet other people,
all that type of stuff.
So there is a little bit of extra,
I don't wanna say work,
but there is upside.
And I ran some scenarios and some
projections.
And if a therapist with us is treating
patients
five patients a day over six months,
you gotta build in some variability.
A therapist in my model could make
somewhere between a hundred and forty four
thousand to a hundred and seventy seven
thousand.
Again,
depending on the variability of how often
can they maintain a twenty to twenty five
visit per week
schedule so it'd be like five a day
monday through friday that accounts by the
way these numbers account for taking you
know pto ptoa the eight whatever national
holidays some sick days all that type of
stuff so it's based off of like workable
business days per year and that even that
model that pitch
only going to attract some gamers it's not
going to attract someone that just like
wants whatever salary and like knows that
they don't have to like work that hard
they could just go into some office and
just kind of like punch a ticket you
know punch a clock so that's kind of
where i'm at i don't know if that
gives eric any clarity but do you guys
have any feedback on that
I'm going to go the other way,
because just as we spent time saying,
you know,
you have to understand the psychology of
the individual who's coming on board.
You also have to understand the psychology
of the owner.
If we're talking smaller private practice,
something like me or Eric or anything like
that.
I've done, so I've done it all, right?
I've had like bonuses.
I've hit metrics.
I said, look, you do this,
you do that.
You earn this much.
We've also done just a straight profit
share.
We're like, look,
here's our operating costs.
We've been in business,
fifteen years at this point.
Here's the operating costs.
This is what we expect.
This is what we've done over the last
three years.
You increase revenue above this,
we'll give you a percentage of the
increase in revenue.
The problem with all of that stuff
is it also has to match my personality.
I don't want to track all that crap.
I don't want to carrot on a stick.
I don't want to bribe you.
I don't want to insult you.
I want to work with a professional.
If you're going to act like a
professional, here's the deal.
Standard salary is this.
I'm willing to just take the hit.
I know you're going to overproduce.
I'll pay you twenty percent above standard
salary,
but
If you don't perform to what you agree
to, what you say you're going to do,
we got to let you go.
Like, again, objective.
I'm not going to because once you get
into some of that stuff like profit
sharing, you're like, OK, well,
what happens if elections get delayed?
Like,
I want the ability sometimes in November
to hold all of my Medicare claims and
not submit them until January if I want
to defer compensation or income to the
next calendar year for tax reasons.
There are times in January where I want
to hold submitting claims to insurance
companies so that deductibles are met by
other providers.
There are very specific things I want to
do within my business to manage the cash
flow that would negatively impact an
employee
Now you're just getting into all of these
games that, for my personality,
I don't want to play.
So I would just rather say, look,
I know there's going to be cancellations,
no-shows, breakage.
I know I'm going to lose money in
some cases,
but I better make my money in other
cases.
This is what I'm willing to pay you.
This is the time I'm willing to commit
to paying you that money.
And if you perform, awesome.
Like it's gonna work out great for both
of us.
You're gonna make a profit,
I'm gonna make a profit.
But if not, no big deal.
Let's just go separate ways.
Jimmy, you've been in these situations
Yeah, for me, I watched,
I can only speak from my experience,
right?
I want to like reach outside of what
I've seen.
Everybody,
most people that I've worked with were
aware of like their bonus structure,
but they weren't driven by it.
with the exception of salespeople.
And those people were a different breed.
I remember being friends with some of the
salespeople outside of work and looking at
them and thinking,
I have no idea how you go to
bed at night,
not knowing if you're going to be able
to pay your bills.
And they were totally,
one hundred percent OK with it.
And then I watched the people that I
worked with,
the people who needed to have that sort
of security.
go above and beyond and kill themselves.
I mean, in communications and radio,
it wasn't obviously for patients because
we didn't have any.
For me, it was all like,
I want to make sure that someone in
a year looks at the list of people
on the team and goes, well,
we can't cut him because he plays five
positions and he runs out in field ground
balls.
For me, it was always about...
making sure you were on the team and
you were still, you know, uh, in the,
in the world of musical chairs,
when they pulled a chair away,
you were still having a share when the
music stopped.
So I think you,
you have to find someone's personal
drivers.
Like what, what drives you?
We did an entire two year long campaign
at Fox rehabilitation.
When I was there that circled around this
very theory,
they were looking at somebody was looking
at with spreadsheets, uh,
How do we find people and keep them?
And they hired these outside consulting
firms.
And it came down to three things.
Do you want to know what those things
are?
But it's a little bit of a tangent,
but it's sort of not.
Make your own schedule.
Fix salary.
No, no, no.
So these were like a little more like
feely, like internal drivers, three Cs.
But the things that you're saying, Dave,
could go into that.
So what I'm saying is like these things
were like broader terms.
So the three things were craft.
cause community i was going to say
community so i'll unpack these so you can
look at a pt specifically or pretty much
anybody like this applies to everybody and
you say like well i'm there for a
little bit of this and a little bit
of that yes you have all but there
needs to be one main driver
that when you touch on, the person goes,
yes, yes, I want to work there.
If I'm in a room of twenty different
employers at a career fair and you hit
on this, I'm going to go,
you get me, you get me.
But you can't have twenty of those things.
You have to have like three,
and then you can have three campaigns that
go.
So craft, cause,
and community were the thing.
Craft was like,
I am going to be the best.
I am here to be the best physical
therapist, whatever that means to me,
to me autonomously.
I am here to be a PT and
then nothing else matters, right?
Like, yes, my coworkers are nice.
I like community, but like,
I am here to take Con Ed courses.
I eat, sleep, breathe,
and everything is about my craft.
I want to be the best PT on
my tombstone.
Greatest PT ever.
That's craft.
Cause.
This is pretty big.
This is, I want to help people.
At Fox, it was specifically like,
what are we on this giant aircraft carrier
or this big boat?
What are we,
what I'm doing my little part to be
the best craftsman,
but I want to know I'm on the
right boat so that every little paddle
that I do feels like it does.
At Fox, it really was,
they were smart enough to give it a
name.
Yeah.
It wasn't just help everybody.
It's too big.
That's throwing a single dollar bill in a
silo.
It's too big.
It was to eradicate ageism.
It was like older adults deserve better.
I'm giving you better care and I'm always
talking about it.
So they had to give they had to
give the head.
If you're Stephen Miller story brand,
Donald Miller,
you had to give the villain a name.
It was ageism.
So that was that was cause.
And then community is like, dude,
I want to be around cool people who
are dope and like you're cool and you're
good and you're cool.
You're a little more here for the fun,
but I like you.
So who do I do it with?
And again,
if you had a Venn diagram with all
three of those, of course, you're like,
yeah, I want a little bit of this,
want a little bit of this.
I want to solve this.
You want all three of those things.
But one was the main driver.
And they tried to they tried to find
what that was because they realized and
this is Fox is in, I don't know,
a billion states.
Um,
they realize bonuses and signing bonuses
and flexible and autonomy.
Like those are table stakes.
I need you to pay me enough.
Adam Grant talks about this a lot.
I need you to pay me enough.
What is that?
I don't know.
Like you need,
you need to figure out what your numbers
are and know that there's my basement.
Can't go below it.
Right.
If you want to,
if you really want this guy,
cause oh man, he's the glue guy.
What's the glue guy.
I don't,
it's the guy who plays three different
positions or when he walks in the room,
everybody gets excited.
Right.
There's my basement.
If I really want this guy,
cause I understand my team, my small unit,
I need this guy.
I'm willing to go a little more.
Am I going to incentivize them for
bonuses?
Sure.
All those things are table stakes.
Fox was able to do it.
I mean,
there was one girl who lived in New
York city and she had family overseas.
So she'd work essentially.
She'd book her own schedule.
She'd work nonstop for like three weeks
and then she'd go to like Greece and
She'd go to Greece.
She was like twenty four years old.
And she's like, yeah,
I'm going to go to Greece for two
weeks.
How are you pulling out bank units for
like a month and a half?
Fox doesn't care.
Yes, they do.
They care that you did that.
And then they go, go to Greece.
We we want you to go to Greece
because we want you to come back and
work for four more weeks straight.
So find what the whole campaign again.
And I'll wrap it up here.
I promise I'm just not going to go
on a tangent forever.
Was what drives you like Greece?
what do you want to do?
Like, what, what's your thing?
And it was,
it was nice because it was like,
I don't care what you do.
You're going to come through one of these
three doors.
And when you get there,
we understand that that's what drives you.
Yes, we have that.
It wasn't a shock.
love that so the real real quick with
that so i love all that it's fascinating
that you're even you because you were at
fox and now you're not there anymore
you're able to kind of relay that whole
thing like even that that's special
because they kind of plug that into you
potentially like in a way well and then
you're able to i helped craft or you
yeah yeah you know you're creating craft
it
So what's interesting is you didn't
mention anything about dollar amount,
salary, hourly, whatever.
The one thing that my observation of Fox
though,
so the opposite of that young physical
therapist that was banking units,
there is some quota.
And if a therapist does not get a
quota,
and if Fox is not giving them enough
new patient referrals or whatever in a
certain zip code that they're working in,
Don't they get that quota,
some dollar amount deducted from the next
paycheck and the next paycheck if they're
not hitting enough units per pay period or
whatever?
I don't know.
I'm not trying to dodge the question.
Maybe.
I will tell you this, though.
They did a gajillion dollars.
I'm pretty sure.
I don't know,
but I'm almost positive it would be
deducted from the next pay period.
Could be.
um the same would be if you ran
out of uh yeah so what i would
say is that that probably is it i
wasn't on the clinical side there i would
say this though they did a ton of
research before they ever opened a team in
an area they were like do we have
more than enough ways to get paid i
mean they're working with older adults
like it's like you know
Or everywhere.
Do we have enough water?
We're in the Atlantic Ocean.
Yes.
Okay, good.
Got it.
Now what do we need?
Boats.
I don't know.
So they understood they had more than
enough of that.
That's not always the case, though.
I see what you're saying.
So you don't always have,
if you're an orthopedic,
if you're a sports clinic,
you don't always have enough athletes in
an area or maybe you have competition.
But, I mean,
Fox is a logistics company that happened
to put their logistics and their strategy
towards treating older adults.
I mean...
They understood that that's sort of what
you need to be.
You need to be a media company that
knows how to do logistics.
And what are you putting it towards?
Treating older adults.
Instead of I'm a, like Tony said this,
I'm a PT clinic.
Athelas, who I work for, everybody's like,
oh,
they're a healthcare technology company.
They're a technology company that saw
enough big, hairy, scary,
annoying problems in healthcare that were
worth enough to put towards the effort.
But they're gonna work really hard because
they're like,
there's enough problems here.
And we're super good at this.
Instead of I have a bleeding heart,
Let me learn how to become a...
It's the Armageddon question.
Do you want to treat bleeding heart or
do you want to teach bleeding hearts how
to become business owners or teach
business or let business owners run
businesses that employ bleeding hearts?
Do that.
Do you want to teach...
astronauts how to oil drill or oil
drillers how to be astronauts i mean which
one's easier it's actually i mean it's the
opposite of the movie armageddon it would
be how to be oil drillers but of
course don't ask bruce willis that uh
because i'm the best because i work with
the best but that's i mean what what
job are you in
Tony said this before,
and I didn't agree with him at first
two years ago or three years ago when
he said it was like,
you shouldn't be a business owner and
treating in your clinic.
You should be painting yourself out of the
house, right?
Did I make that analogy or that metaphor
up?
Probably.
But I probably pictured that when Tony was
saying it.
That is the best way to go in
terms of a practice owner.
Yeah.
It's too hard.
All right, so any final recap on,
I think we hit everything with the
listener questions.
Was there another question though?
I mean, that was the biggest thing of,
are you paying therapists, you know,
in the downtime,
so it kind of ties into like,
if they're, I mean, if their salary,
then yes, you're kind of like, you're,
you're basically paying them whenever
there's downtime.
And there should be something maybe
written into their, you know,
employment agreement that like,
if they have no shows and cancels,
and there's like dead time,
they need to be, you know,
posting social media videos or doing
something else.
But then the reverse is true, right?
If you say you have to see six
patients a day and you're like, hey, man,
I got eight.
Can you do it?
There's a structure in place that says if
you're doing more than you're being asked,
I'm going to pay you X percentage of
over, right?
Like what you're,
like what Ben was saying with like- So,
yeah, could be.
I mean, my, listen, my first,
my second job, but first job in Brooklyn,
I was hired to be a clinic director.
And there was something around maybe the
ego of that or whatever.
Like we looked at every, you know,
I was there for two years or something
as a clinic director.
and i'm the clinic director with these
other roles and responsibilities yes i was
probably getting paid more than the other
step physical therapist because that's
what i signed up for and i always
had the most visits completed like every
month every quarter like i was treating
more patients
So, but I didn't,
I didn't say to my employer,
I didn't turn to them.
I didn't say to Ed Mears, like, hey,
what's the, what's the performance pay?
Like, you know,
six patients were on my schedule,
but now you want me to see eight
or, you know,
ten or twelve are on my schedule,
but I saw fifteen or whatever.
Like, I didn't ask for that.
Again, I'm built differently, maybe,
and I'm, you know,
I'm different than a lot of the staff
therapists out there.
But it depends.
I don't, you know, I don't know.
What do you think, Tony?
Are we at the point where there's a
lot of Seth physical therapists that are
like,
I signed up for six visits a day,
now you want me to see eight,
and you gotta pay me extra for that,
or what, Jimmy?
There's research around this,
and I'll find it when Tony starts talking,
but the research around this is they
taught monkeys fairness.
They gave monkeys bananas.
I'll find the actual study, right?
And then they all of a sudden,
one monkey,
everybody was getting a cut of banana,
a cut of banana.
Everybody was like, this is great,
this is great.
And then one monkey got a banana plus
a grape.
Do you know what happened?
Like, you didn't get less bananas.
They went ape.
They went batshit.
They lost their monkey minds.
Like I am, I'm not, I don't know.
I'll get to study, but fairness,
you're constantly doing the math and it
doesn't need there.
I don't think that there's an exact like
tipping point,
but there's a range where you're like,
dude, there's the,
there's the dishwashing theory or the dish
breaking theory, which is like,
if you don't want to wash dishes and,
break a bunch.
And then you don't get, you're like, ah,
you're costing us more money.
And then you sweep, sweep the floor.
And like that rewards the person who's a
jackass.
And then people like me are like, oh,
I'm good.
I want to, I'll just wash the dishes.
People who are good.
And there's research on this.
I listened to a lot of Adam Grant.
People who are good at their jobs get
rewarded with more work at their jobs.
This is why the interview process on the
front end is so vitally important to kind
of screen in and out,
screen in the right fit,
screen out the wrong fit based off of-
Well, and there's a trial period, right?
So like, you know, the first two,
three months or whatever should be a trial
period where it's in writing, like, Hey,
you know,
whether it's part-time or full-time,
like we're literally giving this a go,
like let's, you know, in whatever,
this is a trial period this is an
introductory period and let's see in the
working world now are you an actual right
fit do you like our feedback or support
all that our guidance mentorship on both
ends you have no idea until you've until
the sheen is worn off until it's like
become a job let me ask you this
i don't want to backtrack but i do
like backtracking
If you were to answer each of you,
you can only pick one of the three.
Which are your main drivers, craft,
cause or community for each of you?
As I was describing those,
which ones of those for you
like popped up so i'll give you a
review craft again is like if you're a
clinic director you're like i am a clinic
director i'm gonna know my kpis i'm gonna
be able to do like work with people
i'm gonna like everything a clinic
director did or a clinician i am a
clinician i'm a technician i am the person
who's great this cause the bigot like the
organization i am i'm here because i want
to do my part no matter what it
is like the guy who said uh who
asked the janitor at nasa what are you
doing what do you do here i help
put people on the moon
That dude was there for cause.
Right.
And then community is like,
do I love these people?
I don't I don't care what we do.
We might with widgets.
We might make nuclear bombs.
But I love the people that we do
it with.
And I wouldn't want to do it anywhere
else.
And it was probably secondary and tertiary
drivers.
But what's your prime?
What's your I'm interested.
What are your primary drivers?
Oh, this is tough.
I like having to answer this on the
fly,
on the hotspot or on the hot seat.
My initial response is I have some
therapists that are on the last,
the community kind of like,
I have therapists that are like,
I love working with Concierge Pain Relief
because I love your clientele.
I love the clientele because they're like,
they're motivated.
They're like, they're okay.
Like some visits,
like they just talk for the whole hour.
Like they don't even do any movement or
maybe they just walk and you know,
Yeah,
and they still get paid and we get
paid.
It's crazy.
It's bonkers.
So I have some therapists that are like,
I love your clientele.
They're motivated.
They're better than these other Medicare
or Medicaid based agencies that I've
worked for before that are cursing at us
and saying, get out.
And I didn't request home physical
therapy.
But then I also have other therapists that
are the craft that are like,
I want to be like, you know,
I want to bring like the, you know,
the Swiss army knife toolbox into the
someone's home.
And no matter what they need,
maybe they need breathing work.
Maybe they need, you know,
counseling on rest and hydration and,
you know,
recovery and sleep and that type of stuff.
And then others want, you know,
certain manual therapy approaches and
others want,
you
empowerment and an exercise program or
whatever and like my style like our
offering is like there is a little bit
of diversity around the motivated person
that likes our offering and the therapists
that work with us that stay the longest
that stay the last couple years they're
the ones there's many of them that are
more of like the craft like you you
don't know like they walk into whatever
in someone's home,
like they don't know what they're walking
into and they can solve it.
They can figure it out.
They're going to offer reassurance.
They're going to offer some type of
treatment,
whatever the person is seeking and almost
starting the visit and starting the
evaluations of like, hey,
what are your expectations for today's
evaluation?
what are your expectations today for the
first or second follow-up visit like get
pulling those things out and whatever the
person is looking for how can we match
them we're like meet them where they're at
so i don't know if that like i
i'm kind of like stuck in between those
two and i do have a coaching call
with sturdy tomorrow so i'm gonna have to
bring this up to him and ask what
what do you think of this so i
don't know what do you think tony what
what do you have with with you your
your team with those three
It definitely changes, right?
It evolves like all of us.
Like I can remember when it was for
me, craft took precedence over everything.
I was obsessed with reading research,
studying,
like looking up different conditions,
trying to figure out how to solve the
problems.
I go to sleep thinking about patient care
and wake up thinking about patient care.
Then it kind of shifted to bigger picture
cause, you know, I was like, hey,
let's build this business.
Let's make this business about helping the
community and keeping geriatrics
independent and safe and all this stuff.
No, I'd probably say it's community,
like really.
And funny thing is,
it's a community of three.
It's my wife,
my physical therapist assistant, and me.
I don't want the community to grow.
I don't want to bring anyone else into
the community.
Like it's literally,
we enjoy each other's time.
We enjoy what we're doing.
We're good enough at what we do.
We're all on the same page.
So my priority or focus over the last
couple of years is definitely
the people that make the community.
And to a certain degree,
the patients are part of that community.
They're coming in, they're socializing,
they're talking.
The funny thing is,
Jeremy Sutton's on here.
He said, choose the fourth C, cash.
The last person I would ever think is
going to say cash version.
I'm really bringing him along in terms of
the monetary component of all this.
That's where I would say, Jeremy,
if Jeremy were trying to work for me,
I'd be like,
I need to pay you enough that money
is not a barrier.
Now,
it doesn't mean like triple the average
salary for a person to get them on
board.
It means like that.
I want that person thinking about me and
not having a side hustle or working with
me will lead to something where you can
eliminate a side hustle.
Same for me, Tony.
It was definitely craft when I first
started.
You know,
my career was definitely like I want to
be the best at this.
Then it was in the middle,
like definitely community where I was
like,
I just want to like coming to work.
I care what I'm doing.
And I'll get better at it.
But if I don't have these people around
me that I like doing it with,
I'm not going to do anything.
And for me,
cause was always an underlying thing.
I need there to be a cause and
I need to like it.
But I didn't walk through a door like
seeking a cause.
Like example,
like I did a bunch of like fundraising
and charity work.
the american red cross for the leukemia
lymphoma society while i was in radio and
after i didn't really have a connection to
either of those but i was like i'm
glad you do good work how do i
help if i can do my part and
i can just do funny radio stuff and
then you make money to help people great
like that was a good way for me
to uh interact so that was my craft
cause community all right we got twenty
minutes left what are we talking about
next what's the pivot dave you shared
something i thought was interesting the
new york running boom
uh almost a billion dollar local economy
yeah i don't understand it i didn't really
look into it but i guess if you
i mean if you put together all the
people that pay for races and what they
pay for shoes and clothing and all this
you know expensive like lululemon and aloe
yeah
I don't know.
I don't know what total dollar amount,
like all the I guess all of like
the races and the half marathons and the
full marathon.
I don't know where they got to a
billion dollars,
how they got to that number.
But yeah, I mean, there's I mean,
I don't know.
Running has always been big in most
cities, especially in New York City.
Yeah,
but it wasn't a thing like in the,
I don't know, six.
I remember my uncle told me he ran
like the fourth New York City.
No, he couldn't.
He ran one of the first marathons and
it was like people looked at him like
he was going to go to the center
of the earth.
Like you're going to do a what?
Now it's like doing a marathon.
Like, all right, good luck to me.
Like, it's not even a thing.
When I did it,
it was sort of like my first one.
It was like, that's kind of an endeavor.
Now it's like people look at each other
going, hey, have fun this weekend.
Go knock it out.
It's become more commonplace.
which is good buddy.
He is in charge of bringing big athletic
events like that to like the Cincinnati
and surrounding areas.
I don't remember if he's part of the
tourism board or whatever.
But when you look at that, those events,
I mean, you've got the event itself.
Then you've got all the buildup.
You've got the hotels.
You've got the restaurants.
You've got the clothes and merch and
everything that surrounds it.
I mean, it is amazing.
uh and and to think about where again
where physical therapy as a profession or
individual therapist can kind of step into
that role i just went up to a
cross-country meet my seventeen-year-old
sixteen-year-old he runs cross-country you
you had to buy the tickets online they
filled up the entire parking lot and and
started converting traffic but everywhere
along the course there were fleet feet
like flags flying,
they were a major sponsor of the event.
They were there on site,
they were doing their digital scans,
like they did all of this kind of
stuff.
I generally find that most therapists who
go and set up a booth at those
events, it doesn't work for us.
Like we're not going to do anything with
that.
But if you're deep in that community and
you're making connections,
especially at the level of we're going to
bring a, you know,
a three million dollar event to the city.
Now you want to see referrals start
pouring in.
You want to get orthopedics who want to
specialize in athletic injuries reaching
out to you.
Like that's where the real value is in
something like this.
You can't think too small.
You can't set up a massage table to
rub calves.
You have to get in at your levels.
How would you hire someone for that job?
Would that be more of a salary position
to create an event like that that might
be five years away?
Or would you make that a commission-based?
Yeah, no, I mean, it's you.
You're the person you'd hire for that job.
It would be salary.
It'd be, what do you need, Jimmy,
to have peace of mind to know that
you can focus on this full time?
For five years.
You give me the number.
And then I have to know based on
other experiences
If I can turn that number into a
profit.
Correct.
You know,
and that's the way you do it.
And you can't think twice about it.
That's why VC funded ventures are so
common.
Like I was just talking to somebody who
has VC funding behind them.
And they're like, look,
we don't care about the money.
The investors expect to lose all the
money.
Half a million dollars doesn't mean
anything to them.
They put that out there across hundreds
and hundreds of businesses and
We just need growth and we need people
who are going to bring the growth and
one in a thousand will succeed.
And that one in a thousand will blow
the doors off of everybody else and we'll
make the profit.
I'm going to say that's kind of where
we are in on a smaller scale in
our business.
We have to be able to hire five
therapists knowing who are going to lose
us money because one is going to make
twenty times the income.
But that's but that's not possible.
Right.
Because of the current state we're in.
Right.
One one is not possible.
It's not possible the way it's been done.
Right.
Bootstrapped and thinking that you have to
turn every billable minute into a profit.
Correct.
But that's why VCs are coming in and
buying up clinics and private practices
and consolidating and doing all that,
because they are taking advantage in a
good way of the inefficiencies of somebody
who is like, man,
I love physical therapy and I love patient
care and I'm willing to lose three hundred
dollars building this foundation.
And then they're going to come in,
buy it for pennies on the dollar because
it's not worth anything anyway.
You're losing money for three years.
and turn it into something that's actually
profitable.
Something patients are willing to pay for,
something that actually gets positive
outcomes and is profitable.
It's also wild when you look at like,
and I've barely dabbled, I've no...
I'm trying to make sure people don't think
I'm trying to talk outside of my boots
here.
It's amazing when you look across VC
portfolios and they're like, I'm buying,
I'm dabbling in industries that cross
over.
It's like, hey, I bought a...
When you're listening to Shark Tank and
Cuban's trying to buy this company and
he's like,
I own three companies that do the thing
that you pay two dollars a unit for.
I'll get the cost down to thirty cents
a unit.
It's like,
Oh, I didn't think about that.
Like you own companies.
You're not just a bag of money.
You get Mark Cuban's Rolodex plus his
infrastructure plus his supply.
And you're like,
that's when you start thinking in three D
and you're like, oh gosh, I never thought.
I just thought you buy a company and
you paint it and you get the logo
a little better and you get ten percent.
But no,
these people who are investors are
thinking.
six dimensions deep like oh no I know
I know the guy that can do I
know the guy who owns that company who's
giving you that thing for two dollars a
unit you're getting screwed I'm gonna get
that cost down to forty cents a unit
and then your margins are gonna go like
this then we're gonna take the money and
we're gonna roll into this that so it
would have taken you ten years it's gonna
take you two and then we're gonna exit
in five like it's wild this is a
whole new world for me because I was
always a guy just rowing a boat
Well, I mean,
you see the same thing on the patient
care side.
Like you go to Dave.
I tell Dave, Dave, man,
my back is killing me.
He does an evaluation.
He's going to understand six layers deep.
It could be this.
It could be that.
It could be, you know,
five different conditions.
It could even be referred from somewhere
else, whatever,
because he's an expert in patient care and
he understands how to do that.
But you take that therapist who knows that
much about patient care,
they don't know enough about business.
So they think, like Jimmy,
it's a business.
I run it for profit.
This is what I do.
Like, it's so much more complex.
But this is where Tony comes in and
goes,
you're that person who's the diehard craft
person we talked about.
All you care about is making the patient
better.
And you are going to suggest these
sneakers because they want to run the
marathon in seven months.
you don't get anything for that you don't
get that affiliate like that to me is
like well it would be disingenuous no you
were going to suggest that anyway you just
told me you're the craft person but you
can't build a business on that i mean
tony i think you shared a
a graphic the other day that was like
an image of somebody doing a workout in
a gym and you had highlighted,
you like circled like nine things.
It was like, uh,
one of those pictures is like spot the
differences, like the nine things.
It was like, why aren't there links, um,
to all these different things that you're,
you are promoting.
You're wearing the Lululemon shirt.
You're using the biodex thing and you're
wearing the sneaker.
I know it feels if you're the craft
person that that's selling out.
And I think that maybe people will
actually think twice about what they share
in a video in a good way to
say, oh, everything I'm doing,
someone is paying really close attention
to.
Maybe I should only do the things that
I one hundred percent believe.
Good.
Think that way.
But if you honestly believe that,
that is a value because people pay for
that every single day and people would
follow your insight.
And if that's what you want to get
paid for,
you have to give them a pathway.
And if you're not, that's on you.
Dave was on a roll.
He shared another one and we'll use this
to close out the show.
Penn State's charging ten thousand dollars
for a full season access.
Unique fan experience.
Yes.
Practices.
Go ahead.
Yeah,
so the reason why this is interesting is
because Penn State and many other
universities are doing this specifically
because they believe,
whether right or wrong,
they believe that they are losing money
because of that whole landmark settlement
around name, image, and likeness,
the whole NIL thing.
And now that players are making money and
able to get sponsorships...
on the table.
They used to be cash in a duffel
bag under the table.
And all of a sudden,
the player's mom has a new house or
whatever or a new car.
Because of the whole NIL situation,
these universities, including Penn State,
they're like, hey,
we're losing the previous revenue that we
used to have.
And where are they going?
Where are they going?
They're going to the consumer.
They're going to the fan,
the end consumer.
And they're charging some outrageous,
you know, ten grand.
I don't know if that gets us for
all the home games.
So what's that like eight or something
home games or whatever?
Maybe a playoff game,
maybe maybe one of the playoff games or
ball games.
But they get, you know, unlimited
team exposure there's like you know
private they they remove certain um vendor
stands and they added you know different
unique uh fan experiences where the fans
can kind of be behind like a partition
but they can high-five the players as
they're like coming you know before they
get out of the tunnel like in you
know underneath the bleachers and
different things like that so the
universities are like hey how else can we
make money we've been having this like
amazing uh funnel of money for years and
decades and
Let's offer this new thing at some
outrageous dollar amount.
And the parallel is like same thing.
Like there's patients that are paying out
of pocket for physical therapy when they
already have Medicare coverage or they
have a network insurance.
And it's going to be a segment or
a subset of...
the fans out there that are going to
pay Penn State,
the ones that have the money or want
that are obsessed fans,
they're going to find the money to do
it.
If you're a really big fan,
just like some of our patients and clients
that find the money or have the money
to pay for what we do.
And we're very, you know,
it's different than what else is out
there.
If you want to figure that out,
Pay attention to when the interns show up.
So we did that in radio.
When we had bands in the studio,
interns showed up when they weren't
scheduled because they were like,
can I just stand here?
I'm allowed to be in this building.
Can I just hover in the corner?
So this was like a big deal.
Somebody was trying to get elected in the
state of New York,
and he put a real –
case together where it was illegal to do
what's called pay for play a record
company couldn't give jimmy a bag of money
and then all of a sudden i start
playing the new whatever song that should
be illegal and the reason was well it's
a private business who cares i'm using
public airwaves so that's where the
government got involved right so you
couldn't do that
But I started paying attention to like,
oh,
so this is a value because when we
play it, you make money on it.
So as long as I'm playing it and
doing things on the up and up,
it's fine.
So I started looking at when the interns
were showing up and we started figuring
out different ways to make it cooler.
We didn't monetize it as much.
We just made the interactions cooler.
So instead of just having a band in
the small studio,
I took an old old filing cabinet room
emptied the room out,
put a small stage in there.
And now I could have forty people in
the studio when the band was in and
not eight.
And then we were able to do a
giveaway for a month for tickets to that
thing.
And then I took it out of the
building altogether.
The band was already going to come play
six songs acoustic in studio.
I was like,
we're going to do it at a band.
We're going to do it at a bar
down the street, but we're only,
we're going to give people less than
twenty four hours notice to come.
And we're going to we're going to send
them a text message twenty four hours
before the thing.
You've got to be signed up for our
text.
So it was like, find the thing.
Right.
Is someone is someone really,
really important?
Is there a Penn State fan that really
wants to – look what they do in
European football, soccer kids.
There's always a kid that walks out with
the professionals and they hold hands.
I don't really understand it, but, like,
you don't think that that either was a
contest or someone paid for it or there's
a relationship between that club and
that's – there absolutely is.
Why?
Because it costs them freaking zero.
What's it cost them?
In Madison Square Garden,
when the Rangers walk out,
they walk out in a hallway that, like,
you can stand in that's, like,
completely glassed in.
Cost them zero.
But if you're the stockbroker whose kids
are super big Ranger fans,
and now you can just think,
can I take a selfie doing it?
Yes.
Charge for it.
Can I take a selfie doing it?
Yes.
Cameron payola.
It was the big payola skate.
It was the big payola push.
Somebody was trying to get elected hard.
I was like,
you know who the biggest scoundrel,
I'm not saying it was good.
It wasn't good.
You know,
the biggest people who scourges on society
are radio station program directors.
Like think about, all right,
it was illegal, but,
I don't know.
I think there was bigger,
bigger fish to fry.
I love it.
You know,
we've talked about it a hundred times.
Here's a hundred and one coming into the
clinic this morning.
I'm talking to chat GPT.
Hey,
what are some like timely topics for PT
breakfast club?
And one of them was letting patients self
pay as an option.
to reduce wait times, increase access.
And I just go back to, I'm like,
I don't understand.
Even we on our website,
and I just checked because I had forgotten
about this.
Even we on our website have a two
hundred and fifty dollar self pay one
visit option.
You know, it's like, look,
if you if you just need a quick
about pay the two fifty, come on in.
We don't sell them, but they're there.
They're marketed.
We put it out publicly to the world.
and like we know there's a shortage of
staff we know there's wait lists we know
there's all these problems going on and
therapists aren't generating enough
profitability to stay in business what is
the harm in just putting it out there
penn state's doing a ten thousand dollar
offer why not just put out on the
website hey
exclusive offer, five available,
five hundred dollar one time session.
You know, this is what we do.
Boom, boom, boom, boom, boom.
These are the benefits to it.
No way.
Same day appointments, whatever.
Like I would literally cancel an
appointment for somebody else.
Call me evil.
to book an appointment for a five hundred
dollar self-paced session if they called
and wanted to get in today you know
and the reality is if i didn't make
that sacrifice i wouldn't be able to stay
in business if i'm losing money every year
I mean, go to Disney.
You could buy a fast pass.
Yeah.
Same thing.
How screwed up is that?
You can buy a,
you can use money to skip a line.
Yeah.
Go to a baseball game.
Football game comes with parking passes.
You're selling the thing that where would
the interns show up?
I can, I can park here.
Right.
Cause I'm, this is cool.
Right.
Where are they trying to like, sort of,
I can skip the line.
Right.
Like charge for that.
Cause people are doing the math in their
head.
Is this worth it?
Oh, dude, I've stood in a line.
Dude, it sucks.
In Florida, in July, in the humidity,
I'd pay.
I'd pay for it.
Oh, really?
You'd pay for that?
They pass the eyebrow test.
They go, oh, you'd pay for that?
Charge for that.
People will pay for it.
And also at every sporting event,
the closer you sit to the action,
the more you pay, right?
So if you're courtside,
if you're sitting behind home plate,
at any game the closer you are to
the action you typically pay more unless
you got invited by you know a friend
or something that had tickets but the
closer you sit the more you pay the
further away you are the less you pay
same type of thing front of the plane
bigger seats board first baggage fee or
you know like just think like but what
tony said there the magic f word that
tony talked about there or sorry not the
f word you avoided the f word was
benefits and not features
So I'll do my parting shot first.
Here's my parting shot.
I've said this a hundred times in front
of physical therapists, researchers,
and academics.
You have to understand the difference
between features and benefits.
So if there's going to be one hill
that I'm going to die on,
this is one of them.
I have a Jeep.
It is red.
It's four-wheel drive.
And it's got a top that comes off.
Those are all features of my Jeep.
I know that PTs want to,
we would love to evidence-based.
And I'm going to talk about features all
day.
Nobody cares.
They think they do.
They logic their way back into caring,
but they want the benefits.
It's red.
When I pull into a parking lot,
everybody pays attention.
That's the benefit of having a red Jeep.
It's four-wheel drive.
Do you think an upstate New York snowstorm
ever keeps me in my house?
Absolutely not.
That's the benefit of four-wheel drive.
Four doors.
Dude, I never leave a friend behind.
The party's always in my Jeep.
The top comes off.
I can go from covered to wind in
my hair in ninety seconds or less.
That's the benefit.
Talk about benefits and you'll never go
hungry.
All right.
I just had it, but I lost it.
Dave, what do you got?
I'll go.
Yeah.
So going back to the whole employer and
team member employee situation,
just going back to being on the same
page, both sides.
And it's always a challenge, both sides.
It would be great if we can all
just say, hey,
this is what we're looking for.
This is what we're this is what we're
seeking is what we want.
What do you want?
What do you want out of this?
What are the things that will
allow you to do a great job?
What is the support?
What is the mentorship?
What is the compensation?
Is it annual?
Is it salary?
Is it some performance pay?
What is it that you're searching for?
Or maybe you already have your hiring
process dialed in and you're kind of like,
this is the offer,
kind of like what's on Sony's website.
This is the offer.
take it or leave it either way just
i think we all not even just physical
therapy but just in all professions all
jobs that are being listed out there like
there just needs to be a little bit
more transparency a little bit more
openness like just both sides just put
your cards on the table like this is
what i'm willing to pay you this is
the salary i'm willing to pay this is
the upside that i'm willing to pay if
you treat more patients whatever like just
more candid conversations like let's find
out what both sides want and then i
think you'll have better matches and more
team members that stay longer
All right, parting shot.
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