A Q&A with Jerry Durham

Paper airplanes
As told to Craig Phifer, PT, MPH

What factors drove you to get into private practice?

Like most clinicians, I entered the industry simply wanting to deliver great patient care, thinking that my skills were the “difference maker.” But it didn’t take long to realize that I wanted to make a bigger difference, and that would eventually lead to practice ownership, consulting, and now The Client Experience Company.

I had the same beginnings as everyone else in the business, starting out with the same old story (“I can do this better!”). Yet, in hindsight, I realized that the only things that I could do better were deeply connecting with patients and helping them get better. What I really couldn’t do well was run a business! I had no idea how to manage and walk a patient throughout their entire treatment cycle within my practice. I knew how to tell my team to “just get people scheduled,” and I knew we needed to maximize billing, but that was the limit of my business acumen. So, for 10 years I ran and grew what I thought was a business, until the day I made the decision to go out of network. That was the day my personal business education started!

What were the barriers you saw to starting your own practice and how did you overcome them?

There really were no barriers and still truly aren’t. All you needed was a table and cellphone (which might be part of “the problem” in physical therapy and health care in general today). In reflection, my lack of knowledge and lack of experience around “what is a business” should have been a barrier, but physical therapy curriculums simply don’t include business operations as part of their programs.

So, ultimately the lack of barriers to entry gives us all a false sense of security. The ease with starting the business and putting new patients on the schedule is really nothing compared to systems built to target clients and patients who will arrive, pay, stay, complete a plan of care, and then do your future marketing for you! That is a real business. It puts the patient first, and, honestly, most of us are doing it poorly!

Describe your thought process as your career transitioned from staff PT, to practice owner, and now to multifaceted entrepreneur.

You use the phrase “thought process” as if I actually had one in advance? My process was mostly hindsight and reflection. As I mentioned previously, 10 years ago I was thinking that I was running a business because I was doing marketing, scheduling new patients, and optimizing our billing. It wasn’t until I went completely out of network with all insurances that the true business model was realized…again, 10 years in! And that education and mindset and implementation took me an additional 10 years to fully realize.

When I was a staff physical therapist, I truly believed that I was the only thing that truly mattered in getting people better. I believed the end result was entirely within my hands, with zero regard for what was going on outside my personal clinical intervention. Also, I had no real regard for therapeutic alliance or expectations research.

Once I moved on to practice ownership, over the course of the next 10 years, it was still ALL about the provider. The rest of our team was looked at as simply being “non-revenue generating.” All of my focus was on our providers at every step of the way. I had no awareness of the role of the team and the leverage that the front desk brings to the equation. I was only concerned about the patients when they were physically in our office. Once they had been discharged (or after they self-discharged) it was “out of sight, out of mind,” and no further thought given.

Once I took our practice out-of-network, I quickly realized that our back-of-house operation needed to change, and fast. When my business mindset and entrepreneurial side kicked in, the real on-the-job training started! I found business coaches and mentors, started reading more business books and joined the Entrepreneurs Organization, which was a huge tipping point in my personal business education. I met with and learned from dozens of other business owners and some of the very best leadership gurus from outside of health care—people like Simon Sinek, among others. I very quickly realized that ALL businesses have issues that were basically the same as mine and all the solutions to those problems were almost identical! This realization is where my journey of patient-focused and patient-first began, and that realization then expanded into understanding the patient experience and how that cycle is the key to overall practice success!

The central theme in your career has always been putting the patient first. You have now developed a systematic way for practice owners to do that with your client lifecycle. What went into the development of that system?

When I started, I thought that the secret to business success was simply counting new patients, tracking cancellations, and figuring the cumulative number of visits. It was only after struggling for years that I realized that the overall health of my business came down to only one very important metric: completed plans of care. The other metrics did nothing to grow a business long-term. All those other metrics are simply short-term indicators of internal issues and will never give you a solid, overall view of what your business’s future looks like.

If you really want to know how strong your practice is, measure the ultimate metric: the first point of contact to completed plan of care ratio. That one is the killer. It will tell you if every system in your practice is optimized. Sadly, almost no practices measure either metric, much less calculate the ratio.

This understanding came from repeatedly working with other business owners who had grown their businesses focused on a complete and total 365/24/7 focus on their customer and orienting service to the customer’s point of view.

Always focus on retention. It’s far greater than getting a new patient lead. Create yourself a 10-point checklist for what defines a happy client, because a happy client ultimately results in happy employees, a happy business, and a happy bank account.

The people best-suited to embrace this concept and lead the team on that journey in any practice are the practice managers or front desk supervisors. These folks understand the connectedness of all the steps of your business as they live it every day, and they know what success looks like, provided they’ve been trained to understand the correct target. They just need some strategy and guidance. Sadly, though, in most cases these folks are caught in the middle. They’re not empowered by ownership to “own” the situation and must keep the clinicians happy, which isn’t an easy task, either.

Many therapists have become familiar with you through social media, particularly on Twitter. How has this platform helped guide and transform your career?

Social media has been both an incredible journey and massive learning tool at the same time. I started on Twitter in early 2009 and I’ve spent the last decade blasting out all my San Francisco Giants World Series wins and my Golden State Warriors Finals wins!

Honestly, Twitter has been a true goldmine for me. The relationships I have built with people both within the profession and from the greater business world have been incredible. It has also given me access to people I may not have otherwise met. I have connected with dozens of like-minded people who share my passion for building an exceptional patient experience, like Maxi Miciak, Chad Cook, Jason Silvernail, Mark Bishop, and Joel Bialosky. I’ve also been surprised at how international my connections are, with a lot of interaction from Europe in particular. I have also had the opportunity to form two businesses with people I initially met on Twitter and absolutely would have not connected with them otherwise.

I believe that my personal keys to social media involve leveraging all of these communication platforms for good in the community, and I’ve tried to avoid the evil, and we all know that there is a lot of evil. I also approach my social feed as a daily networking event, by connecting with folks with questions and then staying connected with those whom I can give value and or receive value in return. The hardest part is to avoid (or overlook) all the negative, but that skill is always going to be a work in progress.

Because I receive so much value from social media, I have learned to shrug off the negative more easily and reap the benefits of meeting and engaging with amazing people from all parts of the business world!

What advice do you have for current practice owners and those who are considering entering private practice?

Let’s keep this short, sweet, and to the point: Business success isn’t complex, it truly comes down to my six key maxims:

  • Understand exactly who you will serve
  • Understand how you will serve those clients
  • Understand your specific client cycle
  • Get yourself a business mentor and coach
  • Measure the right metrics
  • Most important, lose your ego 

Jerry Durham

Jerry Durham, PT, is a long-time PPS member, former practice owner of 20 years, lover of all things patient experience! He can be reached at @JERRYDURHAMPT on Twitter, Instagram, and Facebook.

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