How to recruit and retain quality employees.
By Kim Stamp
James Collins, in his bestselling book Good to Great, said, “Great vision without great people is irrelevant.” I would take that a step further and add, “Without great vision, it is difficult to recruit and retain great people.” Creating an effective recruitment and retention plan is vital to the success of our private practice clinics.
Hiring in today’s physical therapy market is significantly more difficult than it was even five years ago. A September 2015 Forbes magazine article included physical therapy as one of the top 10 toughest jobs to fill in 2016. This makes hiring good therapists a challenge and retaining our current quality staff members a top priority. Let us look at how we can create an effective recruiting strategy and an innovative retention program for our current staff members.
Over the years, I have participated in numerous interviews, and without fail I find that one of the main things physical therapists are looking for is a place where they feel uniquely valued as an employee. My experience has led me to believe that seasoned therapists are looking for a company that will allow them to treat patients according to their passion and expertise, and that new grads are looking for a company that will take an active role in mentoring them.
We are living in an age where large national institutions are buying up smaller private practices and transforming them into clinics that pigeonhole physical therapists into their corporate system. This gives private practice clinics an opportunity to build a staff of exceptional practitioners who care for patients on a more individualized level. This diverse treatment approach is enticing to physical therapists looking for a quality company to work with. At the same time, hiring a new grad and mentoring them into a quality therapist can be a wonderful way to build your staff. Recently graduated physical therapists are usually more open to learning a particular style of treatment than those who have been practicing for several years. So, if your clinic specializes in a particular treatment approach, consider targeting new physical therapists that you can shape into the type of practitioner who will mesh well with your clinic’s style.
Creating effective strategies for attracting, recruiting, and retaining quality candidates is both multifaceted and immensely important. In today’s market, we must find a way to make our clinics stand out. In order to do this we must first be clear on our overall company vision. As mentioned at the beginning of this article, it takes both great people and great vision to be successful. Narrow down what your company values and then create a vision statement that concisely expresses what you believe and what you are looking for. It may be helpful to ask yourself why someone would want to work for your company. If you cannot immediately and clearly answer this question, you have some work to do.
Now more than ever, we have to sell our company to prospective employees. Knowing what your company values, and being able to concisely communicate those values, is paramount. Once you have become clear about your vision, make sure to insert that into your job announcement. More than anything else, you want your job ad to capture a therapist’s attention. Take your time when crafting your announcement and do not hesitate to look at what others are writing so that you can stand out in the crowd.
Another recruiting strategy to consider is accepting student interns in your practice. There are many positive aspects to being a clinical instructor, and one of those is having the opportunity to evaluate whether the student is a good fit for your company. In addition, the student has the opportunity to see what it would be like to work with you and the rest of the team. It is difficult to evaluate whether someone is a good fit just by doing an interview or two. Having a student intern for a few months will give you a clearer picture of how that person will function if they were to be hired. Reaching out to area physical therapy schools and offering to take interns is a good tool to use when trying to build your team.
Retaining quality staff is just as important as hiring the right people, and investing in our current staff is money well spent. Consider offering a monthly or quarterly incentive bonus based on patient feedback, revenue, productivity, or any combination of these or other factors. Another tactic is to increase the amount of time and money you designate for therapist’s continuing education each year. Or consider paying for the therapist’s license and/or professional dues over and above their continuing education. Last, take time to consistently recognize your staff in tangible ways. Whether it is with a monthly employee appreciation award or handwritten thank you notes to your staff, make it a priority to encourage, support, and reward your team. Therapists want to feel valued by their employers, not just for the revenue they generate but for the hard work of giving quality care to their patients.
Staying competitive in today’s challenging job market is difficult. As private practice owners and administrators, it is imperative that we become both strategic and innovative in our recruitment and retention practices. By following these suggestions, you can attract, and keep, quality employees for years to come.
Kim Stamp is the regional business manager for South Sound Physical & Hand Therapy in Olympia and Tacoma, and the vice president for the Washington State Physical Therapy Managers Association. She can be reached at email@example.com.
Create the right environment to keep your exceptional employees on board.
By Stephen Anderson, PT, DPT, and Lori Dillon, MPA
As private practice owners, we continuously navigate turbulent waters. Reimbursements and expenses fluctuate, regulations change, treatment approaches evolve, patient needs and demands grow. We rely on different resources to achieve success (at minimum, sanity and stability), the most significant being our valuable team members. Arguably there is nothing more important than skilled and loyal employees and partners.
We all know that sometimes employee turnover is positive. If you are seeking a culture change, dealing with a disgruntled underperformer, or your business needs evolve, you might intentionally devise a turnover plan to reach your ultimate goals. Most often, however, the turnover we experience is not in our control and has a devastating impact on our business. Much research has been done on the costs (direct and indirect) of employee turnover. Estimates are 1 to 12 months’ worth of an employee’s pay, depending on the role and experience spent to replace that person.1 Losing a good employee takes a toll on us and our business financially and emotionally. To avoid this, we try to proactively hire the right people.
The Right Seat on the Bus
Most of us have heard Jim Collins’s reference to getting the right people on the right seats on the bus2 in relation to great business practice—ensuring that the skills and experiences of our teammates align with their roles and our business needs. This is what makes recruiting so important—and time consuming. Though not foolproof, at our company, we have found that investing time and resources at this stage in the process reaps rewards. Ten years ago, we hired a dedicated recruiting specialist to facilitate this process. You may not have the resources for that, but there are other things you can do. Set aside time in your schedule to dedicate to these tasks, or delegate to a skilled teammate and ensure that they have time to focus on this work. Add hours and recruiting responsibilities to a current employee’s schedule—especially if it is someone you are mentoring to be a leader for your organization. Acknowledge when and how to use an outside recruiting company (perhaps for temporary coverage, or to maximize your exposure if you are in a rural area), but know that you and your teammates are the best spokespeople and relationship-builders for your business. You are poised more than anyone else to define the seats on your bus and attract the right people for them.
When it comes to interviews, do not rely on just one point of contact, especially for key positions.
- Consider multiple meetings. Maybe start with a Skype call so that you can get a feel for each other’s personalities without the full investment of an in-person interview.
- Have trusted team members interview candidates in addition to your interview.
- Invite the candidate to shadow in the clinic for part of a day.
- Use the interview process to observe and confirm behavioral patterns. Anyone can present a persona in one interview; it is more difficult to fabricate behavior over multiple engagements.
Get deeply curious about what drives your top candidates so that you can craft an enticing offer. Of course, pay and benefits are crucial to meet basic life needs. However, we know that our practices often run on thin margins and relative to other industries and settings, our base pay ranges will likely not be at the top of market scales. We have to get creative. At our company, we offer programs that attract the kind of motivated people we want to hire: a structured one-on-one mentoring program, Orthopedic Residency, and a 4-level Leadership Development Program designed to build leadership skills in every employee, at every level of our organization. We encourage all employees to develop a personal education plan, and we support their goals with continuing education dollars (sometimes even for learning endeavors not directly related to their role, but purely to enhance personal growth). We attract many entrepreneurial people to our company because of our equity ownership model, the opportunity for a motivated therapist to become a clinic and company owner one day. Your clinic may not be in a position to offer what we do but you will benefit from identifying what makes you unique. Figure out how to maximize those qualities for new hires. Think outside of the box and beyond the pay and benefits that your market competitors offer.
Research has repeatedly shown that money is not a primary motivator for most people.3 The promise of camaraderie, support, trust, and respect in the work environment is what draws people in (and keeps them around). Take the time to demonstrate this to your top candidates. Connect with them beyond the interview process: send a thank you note following an interview, email links with resources that you think they might enjoy, offer to connect them with other people in your clinic (or even past employees) who can share personal stories and answer questions. If you have not seen Simon Sinek’s TED talk “How Great Leaders Inspire Action,”4 we highly recommend it. In it, he argues that people are motivated to take action—make a purchase, seek services, choose to work somewhere—not because of the details and data, but rather because of why the company exists. People want to be a part of something inspiring. Show them why you are great.
Whatever you do, do not hire out of desperation. We have all done it . . . and it never works out well. Waiting for that right person can pose short-term pains but almost always leads to far surpassing long-term gains. Good companies are picky. Hire slow and fire fast. If you weed out people who do not fit, that is good turnover. And the ones you end up hiring often turn out to be legacy-building teammates.
Keeping the Right People Engaged
After we have the right person hired, our work has only just begun. Avoiding negative turnover relies on strong leadership and fostering a positive clinic culture. Thanks to resources like Daniel Pink’s book Drive, we know that an ability to direct our own pathways, to learn and create, and to support and advance ourselves and those around us are profound human motivators.5 Likely these factors are at the core of why you got into private practice in the first place. The people who make your company great are those who seek a culture that allows them to have autonomy, achieve mastery of something, and live for a greater purpose. Give them opportunities to continuously have these things.
The best way to do this is through regular conversations. To really understand the needs of your team and truly support them in meeting those needs, you cannot rely only on an annual review. The best leaders dedicate time to these kinds of dialogues. Often what we discover in these talks not only helps us support an individual employee, but also uncovers other opportunities to celebrate or investigate in the clinic. Additionally, we know that millennials (the generation that many of us are hiring nowadays) want coaching, mentoring, and frequent feedback. We have found that even a few minutes of daily check-in and acknowledgment of a job well done can go a long way toward their satisfaction and loyalty.
Mentoring has become a buzzword within our profession. We believe that true mentorship is building skills, but more than that, it is about building leaders. Innovative companies recognize that successful leadership development for the future relies on the collaboration of diverse individuals who bring different perspectives, giving individuals ownership over their own development plans, and encouraging “vertical” versus “horizontal” development.6 Horizontal development is skill-building (to use a metaphor, it is filling a glass with water). Vertical development is supporting an individual through the stages of how they make sense of their world (transforming the shape of the glass of water entirely). Vertical development is when problem solving and complex thinking evolve. We know that the health care landscape is complex, and the future of our profession relies on innovators who will be able to work collectively to seek out, explore, and solve problems that may not even be on our current radar. Cultivating these skills in our teammates not only retains good people, but grows our profession. Our company encourages vertical development through investment in a yearlong development program for our directors. Annually, a new group of directors meets once per month with a facilitator to discuss and strategize challenges and opportunities in their roles. This program has not only grown participants’ skills, self-awareness, and confidence, but has also positively impacted our overall company culture. None of this is easy. It takes time and consistent work. It requires us as business leaders to do our own self-reflection and energy recharging. But if we can get these things right, those turbulent waters that we navigate on a regular basis will feel a lot more manageable.
1. www.forbes.com/sites/edwardlawler/2015/07/21/rethinking-employee-turnover/#7456f3db1496. Accessed April 2016.
2. Collins, J. Good to Great. www.jimcollins.com/books.html.
3. https://hbr.org/2013/04/does-money-really-affect-motiv. Accessed March 2016.
4. www.ted.com/talks/simon_sinek_how_great_leaders_inspire_action?language=en. Accessed March 2016.
5. www.danpink.com/drive. Accessed March 2016.
6. http://insights.ccl.org/wp-content/uploads/2015/04/futureTrends.pdf. Accessed March 2016.
Steve Anderson, PT, DPT, is chief executive officer of Therapeutic Associates and past president of the Private Practice Section. He can be reached at firstname.lastname@example.org.
Lori Dillon, MPA, is director of professional development for Therapeutic Associates in Seattle, Washington, and can be reached at email@example.com.
Ways to retain and reward your staff.
By Michael Vacon, PT
When I started out as a physical therapist 25 years ago, I was very excited to embark on a career that would allow me to help people . . . and maybe even make up to $50,000 a year. I remember looking at the back of the old PT Bulletin and seeing all those glamorous jobs offering those “huge” salaries and thinking that someday, if I worked really hard, I would get there. My first job paid me $28,500 a year and I had one of the highest paying jobs from my graduating class. Boy, have things changed in the last 25 years. Back then, $30,000 a year was a good salary and $150 a visit for reimbursement was pretty normal. There was only one insurance offering that I can remember that had a copay ($3), so we never even thought to collect it. Now the starting salary for a new graduate doctor of physical therapy is closer to $65,000 (depending on your market), the average reimbursement is hovering around the $80 to $90 a visit range, and the average copay is somewhere between $20 to $30.
With all these big changes in payment from insurance companies and increases in salary, have there been any big changes in the way physical therapists are being paid? Are employees still expecting to get a 2 to 5 percent salary increase every year, just for being a good employee? Can you afford those employee raises each year as other costs continue to increase for health insurance, rent, and supplies while your payment stagnates or decreases? Your largest expense every month is most likely your employee costs, so how do you keep that in check and not turn over your entire team every few years as they seek other employment?
Knowing there is a ceiling on what we can pay, what are some alternatives to just a straight salary? Does your practice offer incentives to your team to help challenge them? Have you “gamified” your practice? Do you have a profit sharing plan? Do you have clear accountabilities set up so your team knows what success is? Knowing how to design a plan that can motivate your team and keep your bottom line healthy can be an important tool in retaining key employees and maximizing your business.
Before opening my practice, I spent a number of years working for a large corporate physical therapy company. People were locked into specific salary tracks based on years of experience, and annual raises were tied directly to the score of your annual review. Every employee expected to get the highest available score on their review so they would get the largest annual raise. The culture rewarded them for having another full year of experience under their belt, but not much more. There is value in experience, but should years of experience be the only way to increase your salary and is it the only way we should be measuring our employees? If you look at the actual earning potential of a physical therapist, it does not necessarily vary based on years of experience. A new graduate could easily see the same number of visits over a year as a physical therapist with 10 to 15 years of experience and therefore bring in the same amount of revenue. Should they not be paid the same? That would be a tough pill to swallow for a number of practices and therapists. What about moving to a mode where you compensate on measurable performance metrics?
Imagine a salary structure where every physical therapist, regardless of experience, starts at a much lower base rate, but then is incentivized on the actual profitability of the facility and their contribution to that success. Clinical staff who are your better producers make more; people who are producing less make less. Simple, right? Direct profit sharing at its finest. Team Movement for Life has moved in this direction, and they have a large amount of success to show for it. Their president shared the details of their “out of the box” approach. Basically, they have a base salary generally in the mid $50,000 to low $60,000 per year range and in addition, they can earn a percentage of the clinic’s profit for each patient treated over an average of 12 patients per day. The bonus is calculated monthly and is paid in the following month. For them, it is all about transparency. The team knows what the bottom line is each month and is focused on making sure that the clinic remains profitable. If the clinic is successful and makes a profit then so do they.
Does your clinical team know what the bottom line is in your office, or do they think there is an endless well of money to draw from? Do you share this information with them? Are you comfortable doing so? John Vacovec, PT, owner of Physical Therapy and Sports Rehab Inc., decided that transparency was important for his entire team. After trying a few different methods to incentivize his team, he decided to keep it simple and just have a profit sharing plan across the board. He knew what the bottom line was for his practice to be profitable, so he established a monthly gross receivables goal for his team to hit. If the office exceeds this number, they get a share of every dollar over the goal. This is not limited only to his clinical team either . . . all employees in his office are rewarded for accomplishing the goal. That gives him a dedicated team, focused on success. They know that every visit means something to the bottom line of the practice. In turn, you see peer-to-peer accountability: Cancellations and no-shows go down, patient satisfaction goes up, and everyone benefits.
Maybe transparency of your profit margin is not comfortable for you. In that case, designing a plan to focus your team on key business metrics might be a way to go. Many years ago I started an incentive plan based on the key metrics I used to gauge how my business is doing. On a weekly basis, I measure and share the number of visits, number of new patients, the cancellation rate, average visits per referral, and the units per visit charged. Looking at these numbers on a daily, weekly, monthly, and annual basis gives a good “dashboard” of the practice and also helps me to see if there are any anomalies that need to be addressed. I developed benchmarks for all these metrics and incentivized my clinical staff on achieving them. My goal was to educate my team on important business metrics without focusing on a bottom line. I assumed that having targets to shoot for would be enough to motivate people to “win” by hitting those targets. I could not have been more wrong. Having too many metrics just confused people and in some cases made them focus on areas that were not really that important to what my end goal was . . . to motivate them to help make the business successful. In the end, I scrapped that program and went with something much simpler: I had them focus only on average visits per day. I was able to get the clinical team focused on what actually was important to help the practice grow and keep the bottom line healthy, while allowing them to share in some profit.
In speaking with Sturdy McKee, PT, MPT, CEO, of San Francisco Sport and Spine Physical Therapy, I learned that his team went through a similar issue. When he and his business partners started to implement incentive programs to motivate employees for success, they made the “mistake” of thinking that their employees were just like them and that they would be driven by what drove them. Very quickly they found out that this was not the case. What they decided to do was retool their program and ask the employees how they wanted to be compensated while sticking to, and building, a culture of accountability. This led them to develop a program that focuses on a few key metrics as well as core values and accountabilities for their team. Every employee knows exactly what the expectations are, and they also have the opportunity for small salary increases three times per year if they are meeting the trifecta of metrics, accountabilities, and company core values. They feel so strongly about their program that it is published on their company web page under their Careers section. Instead of just creating a team focused solely on numbers, they are creating a team that shares a strong belief system, and they have truly implemented an alternative to the basic review structure to help reward their best employees.
Our profession will continue to face challenges of increasing expenses and decreasing payment. We will need to learn to do more with less. Finding alternatives to the way we pay our employees can help us reward our key people and help keep our practices thriving. These are just some of the many ways that you can try something different. Consider implementing a creative system in your practice today!
Michael Vacon, PT, is the managing partner of Blue Hills Sports & Spine Rehabilitation in Massachusetts, which is part of the Pinnacle Rehabilitation Network. He is a PPS member and also a member of the Impact magazine editorial board. He can reached at firstname.lastname@example.org.
Strategies for fighting physical therapy commoditization.
By Rick Jung
I travel a lot. It is one of the most meaningful parts of my job. I love visiting therapists across the country and learning about the problems they need help solving.
When I am on the road, I sleep in hotels, eat food I do not normally eat, and wake up at different times. Despite the many things in flux, there is always one constant: a Starbucks cup of coffee.
No matter what state I am in, or what airport, I know that I can put down my $2.10 and get the exact same cup of coffee. It is a commodity; I will pay no more than $2.10 for a grande cream/no sugar, regardless of how many barista awards the person who served it has won. A strong cup of coffee is a strong cup of coffee.
After nearly three decades of working in health care, I have observed with great concern a similar commoditization of the physical therapy industry.
The PT Commodity Box
A commodity is a basic good or service that is interchangeable with other goods or services of the same type. The quality of a given commodity may differ slightly, but it is essentially uniform across producers.
Many referring physicians and payers view physical therapy the same way: as an easily repeatable service with little variance in value and, therefore, cost . . . like a cup of Starbucks coffee. Given this inherent uniformity, who would want to spend more than the lowest possible amount for it?
Signs of physical therapy commoditization are popping up everywhere: in reduced reimbursement rates, in the overemphasis on therapist productivity (instead of optimizing their time and taking burdensome administrative tasks off of their workload), and in the replacement of local physical therapy groups with national chains for managed care contracting.
While physical therapists have seen their incomes fall and their clout with insurers shrink, perhaps the biggest pitfall of physical therapy commoditization is the erosion of the patient/therapist relationship. For many physical therapists, that connection is the most treasured part of their profession.
Because insurers and employers pay the lowest possible price for a service that is perceived as a commodity, physical therapists are forced to maximize patient visits. That is a significant loss from the patient’s perspective, too, as getting them to complete their course of care depends largely on trust. But commoditization limits that face-to-face time, carving away at a patient’s comfort level and devaluing what services and counsel the therapist offers.
The stakes are high. Unless physical therapists distinguish their services on the quality front, they will be forced to compete in a commoditized market on price alone. This will inevitably lead to suboptimal care and the marginalization of the physical therapist as a key decision maker in overall population health management.
Physical Therapy as an Interchangeable Good: How Did it Come to This?
By definition, commoditization occurs when goods and services lose their differentiation across their supply base. The erasure of differences in physical therapy has been decades in the making. Two major historical events in the larger health care industry set the stage:
- Grouping Prospective Treatment into Homogeneous Units. Though it is a relatively new buzzword, the move toward greater commoditization started nearly 30 years ago when Medicare established its own fee schedule for Part A hospital services. Rather than continue paying hospitals based on their costs, Medicare created the diagnosis-related group (DRG) system in the mid-1980s and paid hospitals a flat rate for per DRG admission. In effect, the new model paid hospitals a predetermined, set rate based on the patient’s diagnosis. Over time, the ensuing cost cuts were devastating for small and medium-size hospitals, which had no choice but to consolidate. This consolidation expanded to all points along the continuum of care and gave way to commoditization, which is still going strong.
- Paying for Effort, Not Outcome. The arrival of DRGs in health care pricing was soon followed in the 1980s by Resource-Based Relative Value Scores (RBRVS), a system that determines how much money outpatient providers should be paid on a fee-for-service basis. One of the fundamental problems with RBRVS is that it determines payment based on the amount of effort expended, with no regard for whether that effort produces a favorable outcome. As a result, complex and costly interventions are often overused instead of effective, lower cost treatments like physical therapy. Today, RBRVS is the basis used by Medicare and by nearly all commercial payers to derive fee schedules.
These two pillars of our modern health care system helped lay the groundwork for today’s reimbursement shifts and consolidations. In this health care environment, despite the Affordable Care Act, there is little correlation between price and quality. Payers and referring physicians perceive little differentiation among therapy services and thus cost—not value—becomes the driver in physical therapy utilization. In other words, all physical therapy visits are equal.
We know this is not the case. Low back pain is a perfect example, with the cost of treatment creating a major economic impact worldwide. In the United States, patients with musculoskeletal conditions incur total annual medical costs of approximately $77 billion.1 Numerous practice guidelines have been developed for patients with low back pain. Some approaches produce inarguably better outcomes and are more cost effective than others. Physical therapists should be at the center of making treatment recommendations for musculoskeletal conditions, not at the periphery as a second thought after surgery and other specialists.
But how effectively are physical therapists communicating the differences in their treatment value?
Fighting Back: The Power of Data
Historically, outpatient rehabilitation providers were not required to track or communicate therapy outcomes. As health reform transforms the industry, this is no longer the case. Payers are increasingly searching for value, and physical therapists are being required to demonstrate clinical effectiveness along with low costs to participate in many insurance plans.
Yet, while the ability to demonstrate outcomes is more important than ever, physical therapists must consider the following best practices for using this data successfully:
- Report on Functional Outcomes. Physical therapists have been largely set up to fail in defining their value. The communication system is traditionally set up to track medical problems as dictated by insurers, which often means that there is a code for relieving the effects of low back pain, but not a means for measuring it according to real-world function. The effectiveness of medical care is easier to measure than the effectiveness of physical therapy care. Diagnosis codes and procedure codes are a much more accurate descriptor of the problems treated by physicians, and of the procedures they perform. In our disease- and injury-centric medical system, physical therapists do not have a way to describe and classify their work in returning people to full function. To demonstrate effectiveness, physical therapists must standardize around proven outcomes instruments and performance-based patient tests that demonstrate true functional progress. This type of data has not been embraced by the physical therapy industry because it is not needed in a fee-for-service industry.
- Report Clinical and Financial Data. Private physical therapy practices typically keep financial and clinical data in separate silos that can only be analyzed through human interaction or complicated processing. These architectures are no longer defensible as the industry responds to federal quality reporting requirements. In order to rapidly analyze metrics across large population groups, develop evidence-based therapy guidelines, and better manage care for chronically ill patients, outpatient rehab providers must integrate clinical and financial information systems. The technology is out there to help therapists understand and communicate the clinical effectiveness and financial efficiency of the treatment they provide.
Redefining Physical Therapy in Population Health Management
Population health management uses data from across the health care continuum to improve quality of care while gaining efficiencies and reducing cost. Traditionally, health care has been rather disconnected across settings and providers from both an information technology and a process perspective. This makes it challenging to achieve coordinated care, often to the detriment of the patient.
Physical therapy can fight commoditization by integrating into tightly integrated networks that utilize outcomes and cost data. Armed with that invaluable data, physical therapists can become an appropriate point of entry in health care, and direct patients toward the most appropriate providers as necessary, such as outpatient clinics or urgent care centers, and be at the center of the continuum of care—not sidelined to the periphery as a commodity.
No effective payment system should treat everyone equally. I am the first to argue that low-quality and high-cost providers should be held accountable. In order to differentiate value and reverse the commoditization trend, physical therapists must show their own compelling value in vivid detail with clinical and financial data. Moving forward, we, as an industry, must take back our power.
1. Gaskin DJ, Richard P. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research Appendix C, The Economic Costs of Pain in the United States. www.ncbi.nlm.nih.gov/pmc/articles/PMC3843519. Accessed April 2016.
Rick Jung is chief executive officer and chairman of Clinicient. He has spent 25 years working in health care services and has extensive revenue cycle management expertise. He can be reached via Twitter at @RichardGJung.
Define and implement your marketing strategy.
By Sturdy McKee, PT, MPT
Merriam-Webster defines marketing as “the activities that are involved in making people aware of a company’s products, making sure that the products are available to be bought, etc.” But to what end? How do you fit that into your business or practice? How do you know where to spend your money, time, and effort? And how—with that definition—can you measure results?
Marketing is not just information sharing and improved awareness. Successful marketing should result in lead generation, not simply education. It should drive behaviors that result in people calling your office, booking appointments online, visiting your website, and sharing your story with their friends, families, and patients. Great marketing results in warm leads, which converts to paying customers. Otherwise, what is the point? When we spend time, money, and preparation to go to a health fair, do a seminar, write a blog post, or buy advertising, what is the desired result? Is it more incoming inquiries and ultimately more patients? If so, and if that effort does not achieve the desired result, then was it worth it? Should it be repeated?
People are looking for solutions to their problems. In our case as physical therapists, that is often real pain and lack of function, or not being able to run, walk, lift, bike, swim, or participate in their desired activity. They will look for tools that serve to achieve their solution. So, awareness is certainly a component, just not the whole thing. And most people do not want to buy more tools for the sake of buying tools. In other words, nobody wants to buy “physical therapy.” However, that is what our marketing efforts entail. We are often educating people about physical therapy. Yet people are only interested in the services of a physical therapist insofar as it helps them overcome their problem.
To test how effective our approach has been so far, let’s use low back pain (LBP) as an example. This is a population that the right physical therapist can help the vast majority of the time. Low back pain accounts for 2.5 to 3 percent of all physician visits in the United States.1 Yet only 7 percent of people who consult their primary care provider for LBP are referred to a physical therapist in the first 90 days of an episode.2 There is varying data on how many people skip their primary care physician altogether and go instead to a chiropractor, acupuncturist, massage therapist, or do not go at all. However, we know more than just “some” do. That means that fewer than 7 percent of people with LBP each year avail themselves of the services of a physical therapist. Since we know that not all people with LBP go to their primary physician, 5 percent seems to be a very conservative estimate of our market penetration.
The tragic component around how we, as a society, are treating LBP is that opioids are “now the most commonly prescribed drug class” for this population.3 Many more people are taking opioids for LBP than accessing a physical therapist.
So, is what we are doing working? Why are we only helping less than 5 percent of the LBP market, when we are often by far the most effective and least expensive option to help them solve their problem? And what is our responsibility to the public and society to educate them around how we can help when many of them are taking opioids to mask pain and thus are not moving closer to the solution of their actual problem? And this brings us back to marketing.
Bill Bishop, author of The New Factory Thinker, says that physical therapists “need to differentiate themselves from the competition.” The competition, in this case, being everything the other 95 percent is seeking and using to (ostensibly) solve their problem. He goes on to say that through the use of “articles, blogs, videos, podcasts, webinars, and presentations, physical therapists need to market themselves as experts, instead of simply promoting their services.”
Chad Madden of Breakthrough PT Marketing agrees. Chad says, “When I first started in private practice, I thought marketing was branding . . . my logo . . . my slogan . . . my website. What I found was branding alone does not work. What does work is ‘content marketing.’ Content marketing allows us to position ourselves within the marketplace as experts by providing value through videos, reports, books, or workshops.” Chad goes on to say, “Content marketing allows us to be scientific, or evidence-based, with our marketing spend.” Again, he is focusing on results.
And to further expand our lack of market penetration, 51 percent of males and 56 percent of females in the United States report having “musculoskeletal conditions.”4 What percentage of those people is accessing a physical therapist? How many of these people can we help and how many know that? What if even a quarter of these people wanted to schedule with a physical therapist? Will you be able to fit them all in?
So what do we do?
Eric Keiles, founder of Square 2 Marketing, emphasizes “strategy before tactics.” Content marketing may sound great and positioning yourself as an expert is fine advice, but how? “Like anything else in life, a good plan is essential,” says Keiles. “Most practice owners do not take the time to develop their unique message before they build a website, start a blog, or do email marketing.” He explains that your unique message should answer the question, “Why should I do business with you?”
“When you develop a great story, it is easier to create the tactics and, as a bonus, patients share your story,” says Keiles. “That leads to referrals, which are the best kinds of leads by far!”
This is an important point. Many physical therapy practice owners have based their businesses on referrals, many successfully so. If you look not just to your top referrers, but to the new ones popping up from time to time, ask yourself (or better yet ask them) why did they begin referring to you? What is your story that they understand and are telling? Is it their patients’ stories and how you played a role in their success? Is it something about your vision, mission, and values and why you started and grew your practice? Can you take that same story and begin sharing it with others?
“Perspective matters more than anything else,” shares Bill Gallagher, a serial entrepreneur and founder of Humanisteq, business coaching. “We tend to think about what we are building, what we can do, what we need, and what we have,” our practice. “It is all from our own perspective. But our clients and prospects do not really care about us. They are worried about themselves.”
“So, try to think from their perspective, and try to get into their mindset. When will they look for you, how, and where? What matters to them? What will they trust and what will they question?” asks Gallagher. “What is it really like to work with you, for them? What is it like for them to deal with your practice? What do they love, and what are they sick and tired of? What could they care less about? Who else do they buy from and work with that is not in competition with you?”
What could you accomplish if you took the time to sit down and answer Bill’s questions? Would it help you in your new marketing strategy and planning?
Jim Neumann, vice president of marketing at Clinicient, agrees with having a strategy, differentiating your practice, and telling your story. How you get your story out is also an important part of your strategy. “Social media—Facebook, Twitter, LinkedIn, etc.—can be an incredibly valuable tool,” says Neumann. “If satisfied patients are willing to send a post to their friends celebrating their speedy recovery, the ‘endorsement’ power of such posts can be very effective.” And while setting up and maintaining a Facebook page takes time, it is free. So, there is a huge potential return on your investment.
Marketing needs a plan. Your plan should include audience, story, messaging, channels, and goals. The more specific you are at each point, the more consistent you will be in your delivery and the more fidelity your message will carry forward when it is your staff, your patients, and your referring providers sharing your story and message. Just like treatment, you will want to set clear and specific goals, and track them. When you are not achieving your goals, again just like treatment, you will want to revisit your plan and interventions, and adjust them to more effectively reach your goals. Above all, reach out to an expert for help. You are an expert in your practice and your particular niche. You have spent a great deal of time, energy, and money becoming the expert you are. There are people who have spent just as much time, effort, and money as you have becoming experts in their fields. And many of them are happy to help.
Sturdy McKee, PT, MPT, is a chief executive officer, entrepreneur, physical therapist, and business coach who can be reached through www.SturdyMcKee.com and on Facebook @ Sturdy.Coaching.
1. Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: estimates from U.S. national surveys. Spine 2006;31: 2724-2727.
2. Fritz JM, Childs JD, Wainner RS, Flynn TW. Primary care referral of patients with low back pain to physical therapy: impact on future health care utilization and costs. Spine 2012;25: 2114-2121.
3. Deyo RA, Von Korff M, Duhrkoop D. Opioids for low back pain. BMJ 2015;350: g6380.
4. www.boneandjointburden.org/2014-report/ib0/prevalence-select-medical-conditions. Accessed March 2016.