10 Tips to Stay on Fire

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Don’t let burnout extinguish your drive to succeed.

By Scott McAfee, PT, DPT

Too many people wear “workaholism” like a badge of honor. Our society accepts busyness as a constant state of life, esteems lack of sleep as a sign of success, and likens relaxation to laziness. In our work-centered culture, we’re constantly pressured to keep working harder, making it better, or doing it faster. But we forget that burning through our fuel faster than we can replenish it can only last so long. At this unbalanced pace, our strong fire for success in the clinic, classroom, or business may ultimately burn out.

Succession Planning

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Starting with the end in mind.

By Ann Wendel, PT, ATC, CMTPT

“What Are Your Goals?”

As physical therapists, we ask this question of our patients every day. In our initial interview with a new patient, we want to know what activities our patient wants to do when he or she has completed their course of care. We then work backward from the end game to develop short- and long-term goals, which provide feedback along the way about whether we are on track to meet that final long-term goal. We are expert problem solvers and excel at gathering objective data to measure our progress.

While we are skilled at applying this framework as clinicians, we are often not very adept at applying the same thought process to our businesses. In my conversations with private practice owners, I find that many owners are so overwhelmed with the day-to-day operations of their business that they forget to develop a plan for the end game. Many practice owners continue to treat patients while attempting to run the practice, and are so busy working in their business that they forget to work on their business. Without a road map to the destination, private practice owners are at risk of feeling constantly overwhelmed and anxious instead of confidently working toward their goals.

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Jamey Schrier is a great example of a physical therapist with a long-term goal and a plan to reach it. Jamey recently sold his two-location private practice in order to focus on his true passion—coaching business owners. As an aside, I have known Jamey for 28 years. We met as freshmen at the University of Delaware in our undergraduate program. Even then, Jamey and I both had a vision for where we wanted to go in our professional careers. It was my absolute pleasure to sit down and talk with Jamey recently about the road map he created for himself to reach the goal of selling his practice. The innovative thought process he utilized will be helpful for private practice owners at any stage of the game. It is never too early (or too late) to start thinking about succession planning.

The Vision Was Not Always Clear
Jamey explained that in 2001 he started his private practice, Schrier Physical Therapy, with the goal of providing excellent care to his community. He started as a one-location clinic and handled a full caseload in addition to running the practice. He recalled that three years into owning the practice, he began to feel constantly worried and anxious about the business. As his practice became more successful and he hired staff therapists and administrative staff, he began to feel more and more overwhelmed. He worked six days a week and did everything from scheduling appointments to managing the accounting for the practice. He felt that his energy was constantly being sapped by what he refers to as low-energy activities, tasks that he did not like to do and was not good at performing. Even though he had a front office coordinator, he found himself continuing to answer the phones and schedule patients because he wanted it done a certain way. In a state of complete frustration and anxiety about the lack of time he had to do the meaningful activities he wanted to do, he sat down and asked himself some hard questions.

Jamey realized that the core of the reason that he was trying to do everything was that he did not trust his staff to do their jobs. This included everything from not trusting that his office coordinator could properly recruit new patients on the phone to not trusting that his therapists could provide excellent care to his patients. He realized that he was not leading his team in a way that would empower them to build the practice, and that he needed to make some changes. He asked himself two very important questions:

“What would need to happen for me to be comfortable allowing my staff to perform their jobs without my interference?”

“What type of training would my staff need to empower them rather than devalue them?”

These questions led Jamey to begin the process of systematizing and automating his practice, which was the key factor in making his practice attractive to potential buyers in the future. Jamey finally understood that creating systems for his practice would begin to automate the day-to-day operations, giving him the freedom to pursue the goals that would allow the business to thrive, as well as freeing up time to pursue his other interests.

Developing a Road Map to Reach the Destination
Over the next nine years, Jamey developed systems for his practice. He explained that as the owner of a small business, you can either be self-employed (a job that pays your bills but requires you to be present every single day) or you can create a business (where the owner can leave for two weeks and the business is not affected). He shared that the difference between being self-employed and having a business is the systems you put into place and the people you bring onto the team.

As he began to develop systems for the way the phone was to be answered and the scheduling was to be done, he was able to successfully train his staff and then trust that they could be effective in their jobs. Taking these small steps in the beginning allowed Jamey to see that he could begin to take himself out of the day-to-day operations of the practice. He then made a list of all the tasks he did not like to do; these included tasks like bookkeeping and accounting. He shared that he normally did these tasks on the weekend, which caused him to miss family activities. He also shared that since he was not very good at these tasks (because they drained his energy), his books were always off every month, which increased his stress exponentially. He made the decision to hire a bookkeeper and looked at that as an investment in his business.

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We discussed the importance of viewing hiring decisions like these as an investment, rather than just a cost to your practice. Jamey explained that many practice owners are hesitant to invest in their practice because they are not clear on what they want. Even as practice owners get clarity on what they want, they do not always know how to get there. Jamey explained that if an owner at least knows what they do not want, then they can figure out what they do want, and reverse-engineer from the goal to develop the steps to get there. This process sometimes involves working with a business coach, as it is difficult to solve your own problems with your own thinking.

As Jamey began to trust his staff more, he empowered them to function at the highest level possible. The systems he put into place standardized operations across the two clinics, while the outsourcing of low-energy activities to qualified employees (both on site and remotely) freed up time to develop the vision for both the practice and Jamey’s other business interests. Jamey explained that he knew he needed to stop treating patients in order to free up time to lead the company. This was a difficult decision at first, because Jamey had built the company’s reputation with referral sources based on his care. He gradually took himself off the schedule as he assured referral sources that his staff was very qualified to continue the level of care he had always provided.

Systems and Organization Make a Practice Attractive to Buyers
Schrier Physical Therapy began to thrive during this time as Jamey put into practice the systems he developed. Additionally, Jamey began to thrive as a businessman as he freed up more energy to put toward his passions. His coaching business grew quickly as he shared his experience with other practice owners. He proudly watched as other owners went from frustrated and burned out to fulfilled and successful. He made the decision that he wanted to sell Schrier Physical Therapy to fully focus on his new goals. Again, he realized that he needed an expert to help him reach this goal, and he hired a company to assist with the process. He explained that a private practice owner must know exactly what they want when they begin to look for a buyer for their practice. He knew that he wanted a purely transactional deal, where he would have no interest in the practice after the sale. As we discussed different options for the sale of a practice, Jamey stated that there is a big difference between wanting to sell your practice and staying onboard to help run it because that is your passion versus being forced to stay onboard because there are no systems in place for the buyer to continue day-to-day operations without disruption.

Jamey shared that being organized and having systems in place made his practice very attractive to potential buyers. He shared that a potential buyer is buying your team, your reputation, your relationships with referral sources, your systems, and your consistency because it would take them one to three years to build that in your neighborhood. Because Jamey was organized in his bookkeeping and had all of his documents in order, he was able to share all of his information quickly with the potential buyer. The due diligence process that normally takes three months took him six weeks to complete. Jamey was able to show the buyer that his systems were in place, that the clinics ran without him on site on a daily basis, that the financials were predictable, and that the business had the potential to continue to grow. The fact that he had taken himself out of the daily operations of the business several years before the sale made the purchase even more attractive. The buyer knew that Jamey could complete the transaction and walk away, leaving a capable team in place to continue running the practice in a profitable manner.

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Jamey was able to attract a buyer who was committed to continuing to uphold the quality reputation he had built for his practice. He sold to a small company with experience in owning and operating practices, and the transition allowed his staff to stay onboard. He explained to his staff that the new owner would be able to provide more opportunities for growth for the team, and his team chose to stay with the company. He reassured patients that they would continue to receive the highest quality of care from familiar faces. Having the courage to know what he wanted and the ability to set short- and long-term goals allowed Jamey to complete the transaction and move forward toward his new goals with confidence.

Price Is What You Pay, Value Is What You Get. ~ Warren Buffett
As is the case in all business transactions, a product or service is only worth what a buyer will pay for it. As we have discussed, private practice owners can take concrete steps to maximize the value of their practice for a future sale:

  • Start with the end in mind: Know your exit strategy from the start of the business. There are many different options when an owner is ready to sell, and knowing what you want makes it easier to work toward that goal.
  • Develop and maintain systems—everything from answering the phone to your intake and evaluation forms should be systematized. This ensures that staff knows exactly what to do and how to do it, and frees the owner from micromanaging on a daily basis.
  • Empower your staff by training them in your systems and then allowing them to do their jobs. Involve staff in the development of the systems when possible—they might surprise you with their innovative ideas!
  • Delegate tasks that you either dislike or are not good at performing. Technology today allows you to outsource many jobs remotely, which may be much less expensive than you think. This frees up you, the owner, to work on the business rather than in it every day.
  • Know what you want and develop a plan to get there. Just as you perform a clinical evaluation and develop goals to reach a good outcome with patients, you need to do the same with your business. Bring in objective assistance in the form of a business coach or mentor when needed.
  • A potential buyer is paying for your company culture, systems, staff, and reputation. Focus on these things to make your practice more attractive.

By beginning with the end in mind, private practice owners can create a business that is enjoyable and profitable to run, while preparing for the future.

Ann Wendel, PT, ATC, CMTPT, is a PPS member and owner of Prana Physical Therapy in Alexandria, Virginia. She can be reached at pranapt@gmail.com.

Jamey Schrier, PT, DPT, is a PPS member and owner of JameySchrier.com. He is based in Rockville, Maryland, and can be reached at Jamey@JameySchrier.com.

Come Together Right now

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By Terry C. Brown, PT, DPT

Physical therapists work in many different settings and operational structures. During my career, these settings and structures have changed over the years and continue to change today. When I graduated from physical therapy school, therapists expected to work for someone and had abundant choices in location and specialties. The expectation was for a good paying job with ample opportunity to learn from mentors and a patient load that would allow for generous one-to-one patient time. It was also expected that the salary would afford an improved lifestyle and cover the payment of their low-interest student loans. Most of us went to work for hospital systems of one type or another. There weren’t many private practices available and few new grads went directly into them.

Today, there are still hospital systems providing good opportunities for new grads but also a plethora of other options available. Physical therapist entrepreneurs offer a host of opportunities for new grads while advancing practice options far beyond what was available to me. There are so many options in private practice today to consider: cash based, contracting, traditional private practice, large corporate practice, and joint ventures to name a few. These and all other options have the potential to offer a fulfilling career with advancement opportunities.

We, however, have challenges as a profession, and as Private Practice Section (PPS) members. The emphasis on cost containment and required documentation has created an atmosphere that does not support the very reason that most of us went into this field in the first place: “patient care.” It places increased administrative demands on private practices along with diminishing payment that prevents us from offering competitive salaries. It also detracts from the young therapists’ willingness to go into private practice. Student loan debts compared to starting salary make a potential physical therapy student consider other options that have better financial outcomes. In general these two issues, administrative burden and diminished payment, have placed many private practices in an unfair position in the marketplace.

What is to be done? I believe that private practice physical therapy is the greatest value in the medical marketplace today. We must engage payers and providers in mindful discussion of the value proposition we offer. We must have vision of a payment system that is fair and has value to the patient, provider, and payers, and we must lead the way in putting this vision into practice. We have good data available now, and we must continue to mine new data that supports our value.

How do we do it? PPS is engaging with outside resources and with the American Physical Therapists Association (APTA) to drive this discussion. In the past there have been differences of opinion that have created division in our ranks. This has created an environment that has impeded progress toward a better system. It is now time that we all work together to create a vision of what payment will look like five to seven years down the road, a system that will create fair payment, less administrative burden, and improved patient access. No matter the size of our practice, the ownership structure, or the type of patients we see, this will allow us all to prosper and provide quality patient care. It is time to put our differences aside, come to the table under the umbrella of one organization, and truly work together to assure the future of private practice physical therapy.

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Begin with the End in Mind

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By Stacy M. Menz, PT, DPT, PCS

You will see the quote from Stephen Covey, “Begin with the end in mind,” mentioned quite a few times during this issue. Considering this issue is about succession planning, that quote makes sense. It also resonates with me at this moment. This is an area that some of you reading may struggle with as well. How are you supposed to determine the end? Doesn’t that limit your vision for your practice? What if you miss out on opportunities because they don’t line up with your end plan? These are all questions that may go through your mind when you start to figure out what the end result is for your company. Yes, I do suffer from “analysis paralysis” occasionally, and this is one of those areas where it occurs. I’m sure I’m not alone! Don’t worry, I have a plan if I get hit by the proverbial bus, but beyond that I just have a lot of ideas that I am pursuing.

This issue includes some great information on how a business owner can move forward with their succession planning. Paul Martin provides some great steps for you to follow if you want to take advantage of the current market in mergers and acquisitions. Even if this isn’t your preferred route, there are definitely tips that you can take advantage of to enhance the health of your practice.

Ann Wendel takes the time to interview Jamey Schrier, and during their conversation they highlight the importance of creating systems and not just creating them but implementing and using them. Even though they relate this to making your business attractive to buyers, my personal thoughts are that good systems support your business regardless of the size. It allows for standardization and a way to decrease errors. I also like the ideas of creating short- and long-term goals for the business. This is what we do for our clients; do we treat our business the same way?

Deb Gulbrandson shares the perspectives of several practice owners who have each handled succession planning differently. One of the owners she spoke with, Patrick Myers, made a comment that some of you may feel describes where you and your company are at. He said that he felt like his company was in middle school and either needed to grow bigger or get smaller, but they couldn’t stay right where they were.

Little did I realize how much this issue would resonate with me when we chose the topic over a year ago. I hope you each find your own words of wisdom as you continue to navigate your path in private practice.

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Happy Customers

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How to create a positive patient experience.

By Kim Stamp

In today’s ever-changing health care market, owners and managers can no longer rely solely on the relationships they have built with referral sources to grow their practices. Even five years ago physicians largely dictated our referral patterns. Today, hospital-based clinics and physician-owned practices are aggressively attempting to keep their patients “in-house.” At the same time, patients have begun to take a more active role in their health care decisions. These shifts have forced private practice physical therapists to look for creative ways to enhance the patient experience to attract, and keep, new patients.

Companies like Nordstrom, Starbucks, and Disney inspire me for their models of customer service. These companies motivate me to think outside of the industry box when considering how we can offer our patients a better experience. In my practice, we want to connect with our patients so that we can capture their loyalty for years to come. We are aware that patients can choose to receive therapy wherever they would like, and it is our mission to win their trust as they embark on their healing journey.

Let’s take a brief look at how we can effectively and perceptibly improve our customer service practices. I want to note that there is an inherent difference between employing great customer service techniques and creating a customer service culture within our clinics.

First Impressions Are the Foundation for Lasting Impressions
First impressions, whether positive or negative, are powerful. We want to create a positive experience for each patient even before they walk through the door. The first phone call with a new patient will set the tone for how that patient perceives our company. If the front office coordinator is short, or rude, a clear negative message has been sent before the patient arrives for their first appointment. Simple things like making sure the front desk and waiting room areas are clean and uncluttered, and that our front office staff greets each patient by name, go a long way to setting the foundation for a positive experience.

Create a Culture of Connection
Contrary to what many believe, we are not here to “fix” a patient; we are here to partner with them in their rehab. We strive to engage with each patient on a personal level, and we seek to educate them that their visits are a continuously connected journey, rather than a series of separate appointments. If patients believe that each visit is a connected part of their healing process, they will be more likely to make it to all of their appointments. One way we can cultivate that sense of connectedness is by verbalizing a summary of what we did at the end of each visit, as well as giving the patient a preview of what they can expect at their next appointment. Finally, we can reward patients for “graduating” from rehab. We do this by giving them some type of gift at the end of their treatment and letting them know that we are here for them if they have future rehab needs.

Capture Your Patient’s Loyalty
As we have already mentioned, the health care climate has shifted considerably in the last five years. Patients are taking a much more active role in their health care, and this includes choosing where to receive therapy. Ultimately, we want to win both our patients’ trust and their loyalty. Quite simply, we want them to become patients for life, and we want them to refer their friends and family to us. One way to cultivate loyalty is taking a few minutes to write a thank you note to new patients after their first visit. Another is to hold monthly “perfect attendance” drawings in which the patients have the opportunity to win prizes for making it to all of their appointments each week. If your clinic has a Facebook page, you can post a picture of the winning patient along with their therapist and the prize they won.

In many ways, what we are attempting to do is not only to treat our patient’s physical condition, but also create a meaningful and positive experience for them. In doing this, we cultivate a lifelong relationship with our patients which in turn helps to keep our schedules full!

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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 kim.stamp@irgpt.com.

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