Because You Have Hired Them

By Tannus Quatre, PT, MBA

It is the ultimate privilege to earn the business of a new client. The effort, time, and money that goes into landing a new appointment on your schedule may be overlooked by some but never by the business owner. New clients are a precious commodity and the lifeblood of your business.

As such, every time we earn the business of a new client, we should be grateful, but we should not count all of our blessings quite yet.

Not every client is going to be a good fit. It is your job as the business owner or clinician to “hire” the right clients for your physical therapy practice.

The requirements necessary to achieve desired physical therapy outcomes are not unlike those required to achieve good business outcomes. Both require teamwork, and teams cannot be randomly or haphazardly selected. They must be hand picked, molded, and led.

In business, when a team is not working, the leader needs to make changes. Expectations must be clearly set, and when warranted, bad seeds must be removed for the greater good of the operation.

The same applies to the clients you choose to do business with. Difficult as it may be, you must make the choice to free your schedule of clientele that do not allow you to deliver your best work. If you want to be the best, you can only afford to hire the best.

Though the definition of problem clientele will be different in every physical therapy practice, here is a list that you may want to avoid hiring if you are committed to delivering the best care in your community.

The Uncommitted. You can only help those who want to help themselves. Uncommitted clients will waste time and resources that can be dedicated toward clients who are committed to their care. There are only so many hours in a day, and those hours need to be focused on those who want to use them.

Deadbeat Payers. You may choose to provide charity care through your practice, but unless you have an unlimited supply of funding, your business cannot be run like a charity. You must have good payers on which to build your business. If a client (or their insurer) does not pay timely and according to your policies, they will cause your boat to take on water.

Negative Nellies. Physical therapy is about living life to its fullest. While rife with circumstances that may occasionally dampen the spirit of those who need us, negativity for the sake of negativity is different. You simply cannot afford to expose your positive clientele and staff to those whose existence in your practice is a whirlwind of drama and negativity.

The Unsatisfied. Despite your best efforts, you cannot fix or please everyone. Different from the “negative Nelly,” the unsatisfied client is one whose expectations exceed your ability to deliver. The genesis of their dissatisfaction stems from an unrealistic expectation, and in this case it is better to cut bait than to risk a negative online review (or worse) by keeping them in your practice for too long.

Remember that only you can determine which clients are right for your physical therapy practice, and no single list or rule will apply to all situations. It is important, however, that you realize that it is your job to hire only the right clients for your practice. Doing so will allow you to deliver the most rewarding basket of goods to your clientele, your team, and yourself.

Have an example or want to share the right or wrong type of client for your physical therapy practice? Shoot me an email at I would love to consider it for a future article.


Tannus Quatre, PT, MBA, lives at the intersection of physical therapy and entrepreneurship, spending his time helping physical therapists build and operate successful practices through his company, Vantage Clinical Solutions. He specializes in marketing, finance, and business planning, and authors and speaks regularly for the APTA and PPS. He can be reached at

The Gift of Constraints: The Key to Getting Things Done

By Tannus Quatre, PT, MBA

At a recent lunch with one of my business mentors, we discussed the importance of execution: getting things done. Despite the best of intentions, it is hard to do.

For entrepreneurs, ideas are a dime a dozen. They are everywhere. If you own or operate your physical therapy practice, you know what I mean. The scarce commodity is execution—what my mentor coined “the gift of constraints.”

Handed down to him from one of his mentors, “the gift of constraints” is the application of parameters to any task with the specific intent to limit the scope so that something meaningful is accomplished on time, but not necessarily perfectly.

Perfection (or lack thereof) is a topic for another article; however, it is important to note that perfection and execution do not correlate. Perfection is about you—completing something that meets your definition of ideal. Execution is about everyone else: You accomplish something so that others can move forward with their needs.

And the gift of constraints helps us achieve this.

The gift of constraints is a parameter or limitation that allows one to focus on execution, not perfection. The constraints require it. You cannot spend two weeks to get this done, because you have been given two hours. You cannot write a 10-page plan, because you are constrained to just one. You do not have $1,000 to complete the project—you only have $100.

The gift of constraints is a powerful mindset. It forces one to be better: faster, more creative, and results driven.

For me, constraints are liberating—they remove the infinite iterations from the realm of possibility and actually force me through to completion.

Here are some examples of constraints you may choose to use in your practice. I would love it if you would share with me some others you will be using:

  • If you want a proposal for your new program launch, require that it be delivered to you on one page. This will cut down on the time necessary to draft and proof the proposal, and will require that each sentence carry significance.
  • If you want ideas for how to recruit for your next staff member, ask for three specific ideas by the end of the day. The ideas will not be perfect, but they will be building blocks for launching a recruitment plan as soon as possible, rather than when having free time.
  • For your next marketing campaign, specify your exact budget in advance. We should all do this, but we do not. Providing a specific budget constraint will limit the possibilities (especially if it is a low budget).
  • For your next staff meeting, require a three-minute update from each of your clinical leads on new program development, training, and personnel. This requires efficient and relevant information only with no space for tangents.

Place a hard stop on your team meetings so that all items must be covered in the time allotted. Meetings will always fill the space available and you may be able to cut your meeting times down significantly.

The gift of constraints is a powerful tool that can transform execution in the mere statement: “You have X to work with.”

Try it out and let me know how it goes.


Tannus Quatre, PT, MBA, is a physical therapist and entrepreneur dedicated to improving the profession through innovative business and marketing solutions. His work can be seen in such projects as PT Pub Night® and He is president of Vantage Clinical Solutions and can be reached at

Jeff Moore, PT, DPT, OCS, FAAOMPT, Cert-SMT, MTC

Jeff Moore, PT, DPT, OCS, FAAOMPT, Cert-SMT, MTC, is owner of The Institute of Clinical Excellence and clinic director at Back In Motion Physical Therapy in Kingsford, Michigan. He can be reached at

Locations: We presently have a multidisciplinary staff of eight clinicians: three physical therapists, three physical therapy assistants, and two athletic trainers. I have worked exclusively in outpatient orthopedics since graduation and am currently in my eighth year of clinical practice.

What or who is the most influential book/person/event that enhanced your professional career and brief description of why? Dr. David Coletta, owner of Excel Physical Therapy in Bozeman, Montana, took a chance and hired me straight out of school. For three years he set an incredible example by focusing on offering the highest possible quality of care and constantly fanning the flames of my desire to learn and grow. Perhaps more importantly, he was an exceptional role model outside of the clinic. Striving for excellence in his role as a husband and father, David was always there to remind me that family comes first and that how we perform in our role at home is ultimately more important than our clinical success. David remains my primary model in how to bring new grads on board and maximize their potential.

What have been your best/worst/toughest decisions? In the midst of a great many mistakes, I have made two excellent decisions that have been central to shaping my career. First, I signed up for the Evidence In Motion Fellowship program. The three-year program completely restructured my clinical reasoning process giving me an ability to consistently obtain clinical outcomes with an efficiency that is light years beyond where I was before fellowship training. The second decision was launching my continuing education company, The Institute of Clinical Excellence, in 2012. This company has allowed me to travel all over the country teaching motivated and talented clinicians who are going to become our profession’s future. Teaching has pushed me to a deeper level of expertise because the clinicians at weekend courses ask great questions that force me to examine in detail the current state of evidence on different topics.

How do you motivate your employees? I do not spend a lot of time motivating employees. We tell prospective employees that working with us will likely be more demanding than just about anywhere else. We are going to require a lot of unpaid time after hours volunteering in the community to carry out our cause, which is essentially to raise the movement quality of life for our entire community. Additionally, while the pay is decent, it is not excellent. What the employees get in return is a great deal of one-on-one mentoring and the opportunity to work with a group of clinicians that want to be a central part of the modern physical therapy movement. Unmotivated employees do not tend to seek out this type of gig; it just is not a very comfortable environment for them.

What are your best learning experience/s (mistakes) since inception of your practice? Management needs to insist that highly motivated employees take a reasonable amount of time off. Our employees are quick to do extra work and not quick to step away and recharge. There have been several occasions where I have allowed one or two employees to get burned out because I was not monitoring their time off and encouraging them to step away from the clinic and decompress. Letting someone overwork themselves is great for short-term profits but is ultimately a misguided long-term vision.

What are the benefits of the Private Practice Section (PPS) membership to your practice? Having just joined this year, I have not had a chance to explore everything PPS has to offer. Yet, I have already enjoyed Impact magazine and am looking forward to attending the PPS annual conference—the tweets coming from Orlando had me wishing I could have been there this year.

What new opportunities do you plan to pursue in the next year? Next year will be less about “new” and more about growth. I want to further develop the virtual mentorship program that Gene Shirokobrod and I have developed for new grads and doctor of physical therapy students while expanding my continuing education offerings to include all regions of the United States. I will also be teaching a number of courses with Evidence In Motion, including my favorite conference of the year “Manipalooza” where I get to teach alongside Dr. Tim Flynn—always an amazing learning opportunity for me.

The Wow Factor


Enchant your patients to create lifelong relationships!

By Connie Ziccarelli

It has been said, “If you do not take care of your customers, somebody else will.” This most definitely rings true in our competitive world of health care today. Not meeting the needs of our patients can lead to detrimental consequences in the form of the complainer—the consumer who leaves your office dissatisfied and proceeds to tell 8 to 10 people about their dissatisfaction with your services. In our competitive industry, this is a mistake we cannot afford to make. Consumers feel that all of their health care services are the same: The medical doctor experience they had will mirror the next visit, and this pertains to their physical therapist experience as well. In their eyes, one experience will be the same as the next. To reverse this thinking, we have to formulate a way to stand out from the competition by exceeding their expectations. Not only is it imperative to meet our patients’ expectations, but also we must “wow” them to the point that we have created raving fans.

Shifting further into quality care as an industry, our business has placed a larger focus on patient satisfaction. Many nights we have all laid awake wracking our brains on how we can better our Yelp and Google reviews and patient satisfaction survey scores. Oftentimes, subconsciously, we can tumble into a pitfall of pressuring our patients into providing high scores. The reality remains that satisfaction is simply meeting an expectation or dealing with a problem or complaint to their liking. Do we really only want to “satisfy” or is it in our best interest to shine identical to the brightest star out there? In order for that to take place, the emphasis needs to shift from striving to satisfy to delighting the customer. Delight is often termed engagement and loyalty, but the key message is that your customer must feel as if they never want to go elsewhere.

Implementing the value-added service of delighting our customers is the edge we need to ensure the chance of becoming the patient’s practitioner of choice. We must create a spark and trust as we delight them, and in doing so they have the opportunity to become our number one marketing tool; sharing their positive experience with family and friends. The challenge lies in navigating how to delight patients when they are coming to us during the most intimate times in their lives: after suffering an injury, illness, or chronic pain. How do we delight them? How can we provide a service that is normally dreaded and make it delightful?

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Ensuring a delightful experience for our patients means being available to impress our consumers at every touchpoint possible. I have seen successful practices that have created raving fans through acts of value-added service such as offering patients who have waited more than 10 minutes for their appointment a water bottle with their logo, or issuing their graduated (discharged) patients a certificate of achievement and a gift bag to celebrate their accomplishment. There are other small things that delight patients, including prioritizing that they reach a real person via phone as opposed to an answering service. Having a front desk administrator hold the door open as patients are coming and going. The little things add up to big differences, which make memories that your patients will take home with them—and more importantly into their communities.

Creating raving fans and lifelong customers means moving away from the days of settling for customer satisfaction and embracing the WOW factor of delighting our patients. Focusing all efforts on creating that shining star experience could be the difference between success and failure. By delighting your customers you have the remarkable opportunity of creating raving fans and lifelong partnerships.


Connie Ziccarelli is the chairperson of the PPS Administrator’s Council. She is also the cofounder, principal, and chief operations officer of Rehab Management Solutions in Sturtevant, Wisconsin, where she manages, grows, owns, and operates a nationwide network of private practice physical therapy clinics.

A Prosperous PPS

By Terry C. Brown, PT, DPT

Welcome PPS members to 2016. The new year has arrived bringing opportunities and challenges that make our profession great. I wish you the excitement, passion, and drive that will result in 2016 being your best year yet.

You might note that you will be reading my column a little less often this year as I will be published every other month. In the alternate months you will be reading from another board member or committee chair to enlighten you on the exciting things that are happening at PPS. We hope you will enjoy the change as we meet your needs over the next year.

I want to briefly look back at 2015, as it has been a busy but fruitful year.

  • We began the year by developing a new strategic plan that included changes to our Mission Statement and Vision and set the parameters for the Section’s efforts over the next three years. This document drives the direction of all committees and board of director efforts.
  • We had a Key Contact Education and Advocacy meeting in Washington, D.C., bringing in more than 80 PPS key contacts for training and Hill visits to push our issues to the forefront. Ongoing success is being achieved in expanding the highly effective key contact program.
  • We received the resignation of our Executive Director and completed a search for her replacement, resulting in the hiring of Allyson Palmer who continues to “wow” us with her skills and work ethic.
  • Following more than two years of expert task force study and comment, the board developed its Position on Business Models and published the results on the website.
  • Peer2PeerNetWork launched and will take networking to the next level through structured meetings that focus on each member’s individual success. Got to to join.
  • A Leadership Development Task Force formed to bring recommendations to the board on leadership tracks for our members.
  • A Health Care Policy and Regulatory Issues Task Force is in place and ready to advise the board on using outside resources to help with payment issues for our members.
  • The PPS board has led the effort in communication among stakeholders regarding payment policy and the ongoing efforts of APTA.
  • We have rolled out a new learning platform where you can find an ever-growing array of educational opportunities designed to meet your needs as a PPS member.
  • We are in the process of designing a new website to enhance your access to PPS information and benefits.
  • All of our committees have been productive, brainstorming and developing new ideas and member benefits that will help you reach your goals.

As you can see it has been a busy year and the fruits of our labor are evident. I want to thank my board colleagues, committee members, staff, and each of you for your commitment to the section and to the great success we have enjoyed. It is together that we succeed and I look forward to this next year as we make it our best year yet.


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