Stepping Back to Lead

Time to step back from patient care and step up to practice management.

By Chris Wilson, PT, DPT

Most of us became physical therapists to help people and to change lives. We are “doers”, so we chose to “do” physical therapy; however, our vision for how we would change lives can vary vastly. For some, the vision was to open one’s own practice from the beginning. For others, the vision grew while observing areas of practice on which they could improve. The challenge rests with how we define “doing” and staying true to our “why”—changing lives, not our “how”–being a clinician. The challenge is stepping back to lead.

As a munitions officer in the Air Force, it was very clear that I was not to regularly partake in the day-to-day buildup, breakout, and storage of munitions. As a project manager for an information technology (IT) company, I was asked to lead and manage software developers, despite lacking personal experience in software development. But the profession of physical therapy is different. A common theme for those opening their own clinic is that they can “do it better,” and yet, the flawed assumption is that the “do it better” has only to do with clinical excellence—a belief that couldn’t be further from the truth.

When you think of successful companies like Amazon, Pixar, Apple, Microsoft, more than likely you associate those names with their leaders. While Jeff Bezos, Ed Catmull, Steve Jobs, and Bill Gates were certainly the early driving forces in their companies, they all transitioned into leadership roles and ceased to perform day-to-day operational tasks early in their companies’ histories. Whether their leadership qualities were innate or learned, these business leaders realized an operational focus was a micro perspective limiting their macro impact. To create a truly successful enterprise, to drive change, and touch lives beyond their individual reach, they had to step back and take on the strategic role of a leader in order to guide others and be a force multiplier. You may be better than most physical therapists in the clinic, and with focus you might become better than most managers. But you aren’t better than a coordinated team. To be successful as a leader–owner, practice manager, supervisor, etc.—you must embrace inspiring others to be great with you.

I believe this is where we fall short. We too often feel that to give the best care, we must be the one doing it. We eschew leadership, mentorship, delegation, and practice management to attempt to do it all, and thereby fail to reach our full potential within the company. We fail to realize that success in helping people on a large scale requires specific focus on practice management to develop others to carry out our vision. If you joined the profession to help people and you think you have a better way, it’s time to step back and share your vision and those skills with others while (gasp!) spending less time with your patients! It’s time to build on your leadership and practice management skills.

DEVELOPING A BUSINESS BLUEPRINT
If you think a shift away from focusing on clinical skills and clinical product is crazy, let’s review the success you can have with a strong business focus in the absence of clinical excellence. In 2013, Dr. Oz featured a physical therapist on his show who had a successful physical therapy practice with a clinical product far from best practice. This therapist advocated ultrasound, bumpy balls, and tiger balm as cutting edge physical therapy. The evidence clearly did not support her practices and yet there she was, featured on Dr. Oz. What she may have lacked in clinical skills was far exceeded by her focus on the business of physical therapy. And make no mistake, no matter where you work—whether it be a small independent clinic, a physician-owned or hospital-owned physical therapy service, corporate physical therapy, for profit or nonprofit—physical therapy is a business!

The reality, of course, is when you start a practice you are typically the one who is doing it all initially. And while that’s okay, have a plan! Develop your business blueprint and stick to it. Recognize your revenue is not likely to grow as fast as you want, and expect to incur unplanned expenses. Schedule hours dedicated to the clinic and hours dedicated to practice management. Create a plan for professional development and identify at what point to begin your own shift away from clinical practice, as well as when to hire more staff and what to look for in job candidates. Successful organizations like Southwest Airlines follow the mantra of “Hire slow and fire fast.” No matter how much you think you need support, hiring a “C” team member can ruin your practice while waiting a little longer and finding the “A” candidate can be key to sustainable growth.

Practice management is a complex skill that requires dedicated effort to master. It is either ignorance or arrogance that leads us to open a practice thinking clinical skills are enough. What are the costs of your fringe benefits, and how do they compare to your competitors? Do you know your revenue and costs per square foot? Do you know your overhead and general and administrative (G&A) rates so you can determine what your billing rate needs to be to be profitable? While we know insurance contracts limit flexibility in setting a billing rate, understanding what it needs to be is critical to understanding your business’s sustainability and viability. It can aid in making decisions about the future of your practice, finding a new location, growing or retracting, and/or a need to shift your business model altogether.

LEVERAGING TECHNOLOGY
Have you considered your technology needs? Most people are familiar with Domino’s Pizza, but most don’t realize Domino’s is now a booming technology company that happens to sell pizza. That kind of transition doesn’t happen if the CEO of the company is busy making pizzas all day. The same thing goes for you as you manage your practice. How are you leveraging technology to share information and educate your consumers while promoting brand loyalty? Do you make a conscious effort to understand and leverage search engine optimization (SEO), reviews, blogs, newsletters, and other IT platforms? What is your exit strategy for your current electronic medical record (EMR) system to avoid becoming trapped? Did you think about leveraging technology to build direct access pipelines and then reframe your value proposition to traditional referral sources by becoming a referral source for them?

THINKING IN THE LONG TERM
Are you considering health promotion strategies for cash income and loyalty through the lifespan? Are you thinking long term about the inevitable role of remote physical therapy services while following trends within and outside of the profession? Are you reviewing the language of your contracts with insurance companies to find ways to add revenue without breaking any laws or violating the code of ethics? The opportunities are endless, but they can’t be executed without someone to take a step back and analyze the strengths or weaknesses of the company’s future.

I think you can start to see the importance of practice management and stepping back to lead; and that’s before even touching on compliance, Stark laws, cash practice and Medicare, insurance rules, practice acts, the Health Insurance Portability and Accountability Act, the Medicare Access and Children’s Health Insurance Plan (CHIP) Reauthorization Act, and all the nonclinical minutia that can crush a practice if it is not followed, monitored, and implemented.

An aside for the students and early professionals: If you are interested in business but don’t feel ready to open a practice just yet, there is plenty you can do to prepare for the future. And exploration of skills outside of the clinic can help set you apart from other young professionals. A simple starting point is to set up your own social media profile, begin creating content, develop followers, and create a market for your services. Practice management at this level is about you, your brand, and how you can market it to companies. You have demonstrated an ability to go the extra mile and truly be a self-starter. Build on that by mixing in continuing education courses that are business and practice management focused with those that are clinical skills oriented. Explore management and leadership professional development and begin to understand what it means to run a practice or manage a group. In doing so you can begin to learn about how building your clinical brand is important while also understanding its limitations.

Bottom line: Managing and building a successful practice goes much further than clinical expertise and is clearly outside of our entry-level degrees. You need to understand your strengths and weaknesses as they relate to your vision for the future. You need to be able to identify how you will differentiate from other practices and identify a niche, and that niche doesn’t have to be clinical. It can be in the aesthetics and environment of your practice, how you mentor other physical therapists, your approach to exercise or manual therapy, the manner in which you leverage technology, and so on. But no matter what niche you choose, you must know the ins and outs of your practice beyond the clinical product. You must be able to manage the dollars and cents, execute the decision-making process with respect to adding equipment, staff, and locations, provide sound leadership that unites your staff, and you must be able to understand the overall health of your physical therapy practice.

Take away
Managing a successful practice requires success in leadership and practice management. Time to either step back from a clinical focus or find someone to fill that role. You can do it!

Recommended Resources

Dr. Oz Show: www.doctoroz.com/videos/cutting-edge-solutions-back-pain. Accessed January 2018.

APTA’s Response to Dr. Oz show: www.apta.org/Media/Letters/2013/2/5/. Accessed January 2018.

Domino’s Pizza becomes a tech company: www.npr.org/sections/alltechconsidered/2014/11/04/359829824/dominos-becomes-a-tech-company-that-happens-to-make-pizza. Accessed January 2018.

Call to Action

• Review your professional development course selection over the last one to three years. If you see an abundance of clinical courses, set a goal to shift your course selection to a mix of courses on physical therapy and management.
• If you have a business plan, check to see where you stand and if the plan includes preparation for a shift away from clinical time.
• If you don’t have a business plan, develop one and then hold yourself accountable.

Chris Wilson, PT, DPT, is a PPS member and former chair of the Membership Development Committee within PPS. Chris previously owned thinkPT, a cash practice in Ohio, prior to moving to South Carolina. He recently launched Forge, focused initially on providing physical therapy via telehealth platforms. He can be reached at wsuperdiesel@gmail.com.