From startup to midmarket: Building a practice that runs without you

Marla: [00:00:00] Welcome to the Practice Growth Podcast, Josh. It's such a pleasure to have you today.

Josh: Thanks for having me. Look forward to, uh, sharing more about R2P

Marla: Great. And we recently just did a series about growth from zero to five clinics, and what you have to do to invest in that and get that started and running.

Um, you are now a enterprise organization of 15 clinics. I, I call it mid-enterprise organization, and you did that without any investment, um, any private equity. You've really done it yourself. So today I want to talk and dive into more about how you went from that 5 to 15 mark, and what's different, and really how you can get there.

So start with those of you who don't know you, most people know Josh Monk, but if they don't, tell me a little bit about yourself and how you even became a owner and founder of a clinic.

Josh: M- yeah. Uh, I'm a parent right now, which is the most amazing part of my life. Um, so that part's awesome. I have a 14, 15-month-old at home.

Marla: Amazing.

Josh: Um, and he is just amazing, uh, addition to my life, and really I think puts me in a situation where, uh, I'm fortunate that I've gone through this climb. Um, I am very good at this point at what it is that I do, uh, and feel very, very fortunate just to be in a situation where I get to sit and have an amazing conversation with you all and spend time at, uh, Prompt HQ.

But, uh, getting back to your question, um, I was a college athlete. I had an [00:01:30] unbelievable experience with my rehab. Um, I was able to avoid surgery. I was able to stay around my team. I was able to actually still play through the injury. Uh, and I came home and I realized that there was just a significant gap from what I got to experience and what the general population got to experience.

So I pulled early influence from places like Athletes' Performance, which is now EXOS for anybody who's familiar with that, places like Fisher, uh, Fisher Physical Therapy, um, which is now with, with Spooner. Um, and wanted to utilize some of my personal training background, um, teachings through people like Eric Cressey, Charlie Weingroff, Mike Boyle, um, package that in a way that I felt like, uh, actually resonated with the consumer.

Where I largely felt like the healthcare that I experienced and what most people experienced was more of a crunch purchase. It was a, "I have to go to the physical therapist. I have to go to the doctor. I have to," versus being in my situation where when I was rehabbing, I was like, "Oh man, I'm showing up early.

It's awesome. It's engaging. It's a little bit loud. Um, I feel like somebody's actually listening to me. They're working me through plans and process. They're keeping me connected," and putting me in a situation where I never really felt like I was like, you know, withdrawn, broken, hurt, disconnected, um, and never really felt like I had to do anything.

It was just like a part of the process and I wasn't able to do what I was normally able to do, but I [00:03:00] was still, could still do all the things, and I could see where, uh, the byproduct of my work was going to take me. Um, so what did I do? Went to PT school, graduated, um, and then worked for three years before opening Rehab to Perform.

Um, and much like many business owners, I get put through my paces, um, during the first couple of years. Um, but you get to a certain point where you have one location and it's rocking and rolling. You get the second one open, and you realize you know nothing again, and it's a complete disaster. I will always say the second one is, uh, you know, forever and will always be the, the worst location to open.

Uh, and then after that, things started to get easier for me. Um, feeling very, very fortunate where, you know, we are here today, and yes, we have 15 locations and we're making our mark on the, the DMV, the DC, Maryland, Virginia area.

Marla: Oh, that's what DMV stands for. Okay. Uh-huh. I love that. Um, and so you said that, that second one really was one of the hardest ones to open.

Can you tell me a little bit reasoning why the second one was such a hard location to open?

Josh: I had relied on having really, really good hires. We had an amazing team, an all-star cast, um, people that are still with us, and then some people that are in professional sports at this point. So, you know, we had, we had done a really, really good job with our roster.

Um, and when you open a second location, uh, you quickly realize that the strength of your roster, uh, doesn't matter as much because you're in two places. And, uh, we did not, uh, have the [00:04:30] ability to have conversations just kind of naturally trickle amongst the four walls because now conversations had to be able to go from A to B, and that's where the word documentation comes in mind because, uh, quickly realized we didn't have SOPs, we didn't have ops manuals, we didn't have cheat sheets, we didn't have scripts, we didn't have all of these things that allowed us to be repeatable.

Um, instead, we had a significant amount of variance, um, and I needed to quickly learn, uh, a way to put things in a way that not only I was able to understand them, but when I wasn't in the room, that other people were able to understand them. Because not only is it important it, important for you to document, but it's also important for you to do things in a way that others are able to be autonomous, right?

Because at the end of the day, we're not trying to create a situation where people are regularly reaching out to us for the answers. Um, most likely should be as a result of, of group think, but once you have your SOPs and cheat sheets and scripts and all of these manuals in place, then you have a repeatable business and it makes things a lot easier for you.

Um, ideally decreasing friction for your staff, but also having, you know, at the end of the day, what we're looking to really accomplish, but a repeatable, uh, client experience.

Marla: So you put all that great knowledge in your head and like you said, those really strong hires who were there building that first clinic, you got to put that all down and create process and procedures so you felt like you can start to scale.

Josh: Yes. It was really boring early on. Um, you know, largely in Google Drive, you know, it was a great place to share some of [00:06:00] these things. Also, paper finder manuals, you know. Uh, little, uh, sticky notes or sometimes taped, uh, documents up at the front desk. You know, whatever you could do to provide people with information in a way that was very, very easy for them to go through it.

Um, and also recognizing that anything that you create is a living, breathing document. We still say this all the time at the company. Every single time we onboard somebody new, it's an opportunity to reflect on what we have and ask the most important question when things don't quite go your way, right? I could go to you and I could say, "Hey, this is our intended outcome.

We didn't end up there. What would you change about what you were provided to make sure that you can always end up having the intended outcome?" So I think that's a, you know, incredibly important question. Early on, uh, I didn't do a good job of, um, you know, really taking my own advice. Um, but I got better at it as we went, especially recognizing that sometimes, um, we're a little bit unique in the way that maybe we think about things.

And I think the more that people have a chance to go through things that we can kind of collectively iterate, the more likely you are to come to some kind of like bell curve of what best practice is.

Marla: Yeah, living, breathing document, that's a great way to put it because like you said, everybody that you hire on is gonna contribute and make it better, and that's actually a beautiful part about the practice for sure.

Josh: Definitely. And also thinking about multimodal learning. Like, um, you know, I am somebody that definitely does better, uh, with visuals. Um, if I'm hearing things, I mean, [00:07:30] that's I used to have struggle in class if I was, if I was just relying on auditory learning, like that wasn't necessarily the best way for me to take things in.

Some people need, uh, text, some people need more diagrams and kind of explanations. Uh, some people do really well in lectures. Some people do really well self-paced. Uh, some people do really well one-on-one. Some many-- Some people do really well small groups. So I think the more that we have a multimodal, uh, learning environment, especially as people are going through the words, uh, onboarding and mentorship, the better off the people are.

Marla: So tell me about the infrastructure you put in place that you put in, let's say, when you were starting to grow to that one to three clinics, and then the next pivot point where you felt like you almost had to redo infrastructure again, if there was one, to then grow past that five, six, seven clinics.

Josh: Yeah. I mean, I think, uh, you know, w- sure we can get into a lot of, uh, you know, tech talks and stuff like that, but I think that really the biggest piece from especially three to four was me recognizing and honestly being forced out as a result of the pandemic, uh, but forcing me out of the clinic. Um, when I was able to get out of patient care, um, which largely happened when the pandemic happened, it allowed me to actually actionably, uh, work on the business in a way that somebody would expect a business owner to, to work on.

Instead of me being consumed by patient care, uh, and going through your visits and productivity and, uh, being billable, I was actually able to change the trajectory of the company because I actually had a clear schedule. [00:09:00] Um, why did I get forced out? Well, if everybody can remember back a handful of years ago, that sometimes feels like it was forever ago, but then sometimes also feels like it was yesterday, um, if somebody were to get sick at a clinic and I was at that clinic and I was splitting between clinics, then I would've had to have shut down two clinics.

So instead, I took a step back and said, "I'm not gonna be in any clinics, and if anything happens to anybody, I will step into the clinic." That's huge. It allowed me to work on things, um, during a period of time where, yeah, like everybody, we took our lumps, um, financially, take your lumps with regards to awkward conversations when it comes to furloughs, but I got to be the best critic at R2P as well.

Um, and some of that was myself, some of that was also pulling in information from our team on what we needed to work on that I probably had been neglecting for a long period of time. So I'd say the, the biggest part was if you wanna get serious about expanding, at some point you have to realize that your biggest constraint, uh, is yourself.

Um, we're a big thumbs first, finger second company, um, and in order for us to get where we wanted to get to, I had to start to reevaluate how I was handling, uh, my roles and responsibilities at, at Rehab 2 Perform.

Marla: So you said that was around two to three clinics that you became truly the CEO, not just the, the business owner and the PT in the clinic, really the, the CEO, founder, and driver of, of process procedure.

Do you think that's about the right time, or would you have done it earlier? Would you have done it later?

Josh: It's hard to really like- [00:10:30] I don't know. I, I, I, I try to just make decisions and move forward. I mean, I guess it, it, it, it could've been done earlier, but we also ... I don't know if we would be where we are right now.

So, uh, for one reason or the other, it seemed like a really good time at the moment, and obviously given the fact that the pandemic was going on, I really didn't have a choice. But, um, I think the people are out there. I, I think one of the things I got really, really good at was, um, actually saying that over a certain amount of time I needed to be able to do X, Y, and Z to defend my job, um, as the head of the company.

And I don't think until the pandemic I really took that on myself as having the utmost responsibility for saying, "As the leader of the company, I need to do things that are defensible and that this company is regularly moving in a direction that is positive so that people feel comfortable saying, 'I wanna put my time and energy here.'"

Um, before that, it's not to say that I wasn't working hard and that I wasn't locking arms with my staff on a regular basis, but I don't know that if I was looking at year over year changes if I was doing things in a way that people could safely sit back if, you know ... If, if I'm looking at a company dashboard, Josh is doing what he needs to do for me to feel confident that I should be here for an extended period of time.

Where now we have a state of the R2P every year. We have our company kickoff. I go up there and I literally say, "Here is my dashboard. This is what I did well on. This is what I didn't do well on." Um, those were things that I wasn't regularly thinking about at that given time.

Marla: Wow. Wow. That, [00:12:00] that's great. I mean, that great that you had the time to step back and then realize all of the peaks of the business that you had to work on.

Um, when did you decide that you needed that next layer of senior leadership? You know, maybe it was your COO or your marketing person or, you know, obviously as you ... You're a young business. You do everything.

Josh: Yeah.

Marla: So when did you start hiring those key people to then grow those areas of the business?

Josh: I think the biggest thing, like you mentioned, is early on I was a jack of all trades.

You had to do everything, and I also realized that we had really good people. And I realized that to keep really good people, that I needed to build career pathways for them that they could see that were actually gonna become a realities. So instead of asking what my strengths were or what my interests were early on, it was- Where do you want to go with your career?

And I shed things that other people might have had more of an affinity towards than maybe I did. Um, knowing that I, I felt like I kinda had an idea of what my unique skill set was, um, and fortunately I don't f- I, I don't think it overlapped with a, a ton of the people that we've had move into corporate positions.

But early on, whether or not it was Zach or whether or not, whether or not it was Jamie, um, at this point in time also, I mean, I've been able to pull my college roommate into the mix, um, and we have other people who are kind of stepping into their genius within the company. A lot of it's just having a cadence of conversation, making sure that you're staying ahead of those things rather than being reactive and [00:13:30] being surprised by a resignation.

Um, and whether or not it's in-person meetings or quarterly touch points, end-of-the-year 360s, we are a feedback company, so the more that we have, uh, pathways where people can regularly communicate, um, you know, certain l- leading questions that you might be asking of them, uh, then I feel like you're not gonna end up surprised.

Um, but a lot of times we have really, really passionate, really, really skilled people that are right underneath our nose, so instead of me focusing a ton on looking for elsewhere, it w- it just really relied on me having better conversations with the staff that we already had. And I think over time I've been able to get myself in a situation more and more where I think I can largely isolate to the things where I am best at.

But, um, and I realize that some people might uh, do stuff differently. But, uh, again, it's worked out really well for us at this point.

Marla: So you, you've, you've really developed and grown from within- Yep ... and allowed those people to grow into what they were passionate about. And, and once that business need opened up, they kind of fit into that.

They may have already been doing some of that before, but really focused on that as that need.

Josh: Definitely. And you think about, like, uh, we always talk about career ladders, right? We talk about upward mobility. People put their resume in, like there was, there was nothing on their resume early on. Like, nothing on Zach's resume early on was like, "I'm gonna be the chief clinical officer.

I'm gonna head the residency. I'm gonna head the..." Like, no, none of it. Jamie, right during the pandemic, she started helping me out because she quite honestly looked at how I was doing the student [00:15:00] internships, um, and the organization of it and went, "This is a disaster." And she came in and did it so much better than I did.

Um, not asking of anything, but just recognizing that there was a, a need. Um, and now we have one of the biggest and best clinical internship programs probably in the country. Not saying the best, but we're definitely, definitely up there. Um, and she's been a part of that. And that was nothing that was on her resume.

And I think the, m- you know, not only, uh, uh, are there opportunities where we can acknowledge the value that maybe people are putting into our company ecosystem without necessarily being asked for more, because I think in a lot of situations, um, I, I can empathize with a lot of business owners who are like, "Well, so and so is asking me for, for this role and this job, and I, I don't even know how good of a job they're gonna do."

Yeah, that's really tough. Like, you could imagine that as a business owner to be like, "Why would I hire you for this role? I have nothing on your resume that suggests that you're strong at it, um, and I'm supposed to just allocate time for you?" No. Like, why don't you micro dose it and kind of show me little glimpses of what I'm gonna get myself into, prove yourself a little bit, and then potentially have the conversation.

Fortunately, I've had more of those individuals. Um, and yeah, I mean, we've got people that have been with us, uh, single-digit employees. And, um, I mean, I'm trying to think. Our- With half of our first 15-ish employees, which is awesome, and I think it largely speaks to people either having, uh, trajectories into student internship, [00:16:30] mentorship, residency, uh, opening new clinics.

Um, and I really probably, yeah, we, we wouldn't be here without, again, some of the feedback that they gave me early on, or at least the willing to also like experiment with certain things to prove themselves, um, s- so, so that they can jump into non-clinical care. Everyone wants to get into non-clinical care, but guess what?

Like some people just aren't willing to actually put the time in to like prove to a business owner, this is actually a strength for me, and you could, y- y- you should allocate time.

Marla: So- That's a really good point and suggestion ... and that

Josh: was a separate tangent, but yeah.

Marla: Yeah. But it is a, a good point of, you know, taking the initiative and watching somebody actually just say, "This is what I wanna do.

I, I wanna grow to this," and taking that initiative. So I, I like that model and that suggestion. And you also really do a very good job at intrapreneurial, um, even for your clinicians, so that they can have an intrapreneurial model and be business owners within your company, and love for you to talk a little bit more about that and how that's helped you grow.

Josh: Yeah, and I, you know, you, you hear sometimes like partner models, um, people talk about franchises. Um, I think for us, feel very, very fortunate to interact with somebody early on, Bob Durand at PTSMC up in New England. Um, I don't know if he's a Prompt customer. Bob, if you're not, you probably should be. Um, but we'll handle that later.

Um, he taught me about profit sharing for our founder model. Um, and that was honestly something where I, I just kept looking around the room and just kept going, "There's gotta be a better way to share [00:18:00] in the benefit of opening and running a clinic," where I had heard people that have area director roles and they're overseeing 17 clinics, and I'm like And you're only making what?

Like you're overseeing how many clinics and you're having to drive all over and do all these things all over the place. Well, I know at one clinic we have X amount extra. So if we just allowed you to focus on one or two clinics, would we naturally have more of a pot to share? Um, and what does the next generation want?

They want to feel like they're part of something, right? We're in a situation where we're taking on more debt than ever with regards to school and education. Why would we not for- find more ways to provide some kind of potentially like disproportionate upside? If I work X hard and I sweat a little bit, I know that there actually is going to be a light at the end of the tunnel versus me being in a situation where I don't see any kind of pathway forward.

So it does engage some of your high performers. It puts them in a situation where they have a different way at viewing their overall, um, personal, you know, financial situation, which for many people, I mean, that's a significant topic, topic of conversation. Sometimes I think when we, when we hear the wor- wor- word burnout in healthcare practitioners, they might just be in a situation where they're like, "I don't see this financial situation ever improving for me."

So, um, we have, and I wish I knew the exact amount of, but almost every single location we've opened, there's at, at least one, if not two people that are on from a profit sharing standpoint. Um, and it allows them [00:19:30] to kind of feel like they have an R2P of their own. Um, we ask them to uh, do certain things as it relates to obviously their caseload with regards to leaving the four walls and then some sales initiatives.

Um, and we give them the playbook where if they were to go and do their own thing, that maybe they would have to reinvent the wheel and have an unknown of actually being successful. So, um, it also allows us to be in a situation too where we can continue to make decisions based on finding people who are, are from a community.

Um, we, we, we fit the individual first and then go to a location rather than choosing a location and then just kind of forcing a person in there. So almost every single location that we've opened has been a result of finding a person in our ecosystem first and then saying, "Hey, oh, you grew up where?" Or, "Oh, you're going to lay down long-term rings, r- roots where?

Okay, let's, let's invest in this person," 'cause we feel comfortable with, uh, who, who they've, uh, shown themselves to be during their time with us.

Marla: So you really find the person and grow the clinic around them versus saying, "We're gonna open a clinic here and now I need to find a clinic director

Josh: or-" 100%. Yes.

There are markets that we would have loved to have been in already that we just haven't been able to go into because we don't have the person. Um, and I know, you know, again, some people might like to do stuff differently, but I think for us, as l- a- as long as we continue to find that person first and then we go into the community that they're either from or that they want to spend a long period of time in, um, then it continues to put ourself in a situation [00:21:00] where, um, A, we can obviously have somebody that has the, the community IQ, because community IQ is, is essential for us really having kind of like that micro influencer or that micro celebrity status in an area.

They know how to navigate the community, the seven layers of separation, right? Navigating all of the different, uh, relationships. But it also allows us to bring somebody in, get them to know who we are, how the company operates, and then move them as opposed to choosing a location, bringing in somebody brand new- Brand new

and then putting them in and they've never been at the other places.

Marla: So

Josh: they don't know the culture. No, no, no. Exactly. I'd rather backfill. We always wanna move into a lo- new location rather than hire brand new in a new location, then we backfill behind. It allows us to, I think, really, you know, just have a really good foundation, um, not only at that clinic, but also at, at, at the clinics behind them.

And, and we do. We have people that are excited, right? They're young. I mean, I can think of- Gosh, a handful of our newer locations that have opened, they're under 30, and they're already looking at their financial trajectory differently as a result of, quite honestly, walking into a situation where you have 15 to 20% profits at an office that they are potentially benefiting from.

That we are going, "Hey, we're going into this with you. Here's the upside. Here are the type of things that you can qualify v- in for." There's other benefits and stuff as well. Um, but we think it can, can get pretty appealing, and we have people like Zach and Jamie that have two offices and are working themselves [00:22:30] into a situation where, again, without, uh, a model similarly to this, they might've been one of the people that, that I'm referring to, where they get a area director title and, "Congrats, you get to oversee 10 plus offices."

And Let's just say the earning potential would be a fraction of what the two of them are now, um, concerning themselves with, only oversee two offices.

Marla: Wow. And did you always do that? Was that from the beginning, or did you start that when you were at clinic three- I learned

Josh: that later ...

Marla: clinic four, clinic five?

Yeah, when did you learn that?

Josh: After the second office. Okay. And, and unfortunately it was just a result of a conversation at APTA Private Practice, and I was like, "What are you guys doing?" Um, he was like, "Check this out." And you know, there's different places you can go now. You can go to, uh, I think Profit, ProfitWorks is a good one.

Um, Ownership Works is another good one. So there's different models out there. Some, some people do ESOPs. Um, some people will do phantom interests. Some people will do Class B, uh, equity. We do have some people that have both Class B and Phantom as well. Um, and those are things that we're exploring more and more.

I think that the next generation of practitioners is going to have more and more conversations with people at the places they're working, where they're saying, "I, I see the writing on the wall here. I'm walking in with X. Can you provide me with something that provides me some kind of upside that allows me to attack this?"

Yeah. And I think that's something from an organizational standpoint where we can continue to try to find, um, fit. It's not for everybody. I, I say that all the time. Some people come to me and they go, "I want to open up my own business." And I'm like, "When have you ever been entrepreneurial?" And they're like, "Never."

And I'm [00:24:00] like, "How do you know it's for you?" Because quite honestly, I mean, business does... It takes a lot of people's souls. It took my soul for periods of time during the early part of the business. Um, and for you to also help us open a location, like, you need to sell. Like, you need to sweat for this to work out well.

There are certain things that are asked of you, but at least we can say that if you do X, that you're going to end up in a situation where we know that there is gonna be, um, that kind of, uh, light at the end of the tunnel. Um, and I think more and more young people, again, they should be asking those things if they feel like they're somebody, again, that doesn't want to start their own business, but they do understand that, hey, if I work hard, I do deserve something.

Marla: Yeah. Yeah. Well, it's nice to know those opportunities are out there and that they can, they can find them, because I think that there's all different types, but sometimes people are stuck in a model, and then that's how we lose a lot of clinicians, right? Right. It's good to know there's a lot of different alternative models out there.

Um, what other pieces did you learn as you started to grow more clinics that may be changes you made that helped you double, triple? You know, what, what other, call it, revolutionary process, procedures, or even technology did you add that you feel like you... It was... It helped you multiply faster?

Josh: It's so funny.

I had this conversation with Mike's dad literally right before we got in, but sometimes I walk into conversations with healthcare professionals and I go, "I am not intelligent enough to be here." Like, I literally feel like my brain just operates differently. I [00:25:30] try to comb through stuff and get to the most simple way of moving forward, most palatable way of communicating stuff to people rather than getting, like, so caught up in all of these, like, complexities, and I think that actually allows me to execute at a, a faster level than other people.

So I would say that I have fully embraced the word e- execution and, and being an executioner, and I think that a lot of people struggle to, uh, objectify whether or not they're making progress as a business owner. They're working hard, but they don't have anything where they're looking at a weekly scorecard, a monthly scorecard, a quarterly scorecard, right?

Mid-year, yearly. Uh, and they're not putting themselves in a situation where they're like, "If I provided people with my scorecard, I'm defensible in the position that I'm in." So I think that getting to a point where, uh, on a regular basis I feel like I need to communicate my value and actually, like, proving to myself, like...

Uh, or sorry, proving to the rest of our team that I, that I deserve to be here, that they're in the right position, that they're getting an Apple iOS update on a regular basis. Prompt's so good about upgrades. What am I doing from a leader standpoint to drive that at Rehab to Perform, right? If we're not upgrading as much as, as Prompt is or as Apple is, um, do I have the ability to continue to command a room?

And I think a lot of people are working hard, and they've been told to work hard their entire life, and good things are gonna happen to them, [00:27:00] but if you're not working smarter, if you're not working on the right things, if you're trying to make 87 decisions instead of the right 4 decisions during a given time period that you set, then you are a hamster on a wheel or you're like the old, uh, Road Runner, um, that, you know, Road Runner largely did what?

Spin- spun wheels, spun wheels, spun wheels, and all of a sudden, um, at one point or the other, uh, Road Runner finally got to run wild after Wile E. A- I- Ca- Coyote. But I don't wanna be that business owner that honestly, and I can remember a conversation early in my business journey that said, "Congratulations.

You signed yourself up for a job, and when you add up all the hours, you might as well have just worked, uh, nine to five because you're gonna find that it's not worth the time." And I think of that with a lot of business owners that, you know, unfortunately I have conversations with where they're in the same place year over year, right?

They're just eking out small levels of progress, and I think a lot of that, um- comes back to the owner's level of like personal discipline, their ability to reflect, their ability to, um, you know, if we get into like, you know, kind of regulate and manage and monitor and, and put themselves in a situation where it's actually like objective.

I'm making progress. Um, because in a world where, uh, you know, time is incredibly finite, and I realize that now, I mentioned it earlier as a, as, as a parent like I need to be doing things that are worth my time, and I need to be doing things that are valuable. And I, I, I need to not be of the mindset, or at [00:28:30] least early on, I was like, more is just more because more is, like, somewhat beneficial because I'm gonna learn something through this process of more.

But if you do that all the time, like, you are gonna be this struggling, burnt-out, um, you know, founder that largely is not at your best on a personal level. And if you're not at your best on a personal level, then you can only imagine the professional, uh, cascade that's gonna happen. So I know I, I went in a bunch of different directions, but I think too often, um, business owners are gonna be in a situation where they probably feel like they're working hard, but they're not working on things that are actually meaningful.

Um, and they need to simplify whatever it is that they're doing to things that are, um, again, like recognizable for the entire room to either be helping you with or see the fact that you're making progress.

Marla: So that scorecard you mentioned- That

Josh: was a significant tangent, by the way.

Marla: Yeah.

Josh: No, that- But there's so many different, like, there's so many different directions I can, I can go in with that, so...

Sometimes it's hard doing a podcast conversation to have, like, a very granular discussion in, like, a five-minute soundbite.

Marla: I know. I know. Yeah. Well, that, that scorecard you mentioned, what's on that scorecard that you say you really do measure yourself? De-

Josh: it depends. Yeah. No, I mean, right now we have our corporate quarterly meeting on the 19th.

I know that at any given moment I should be able to look at, uh, things that each of our C-suite members of our team are working on. I should know what the color codes are. I should know what it is that's been done. I should know who they need stuff, uh, you know, to be, uh, or, or who needs to help them. Um, if cer- if certain things are in certain colors, I need to know why something potentially doesn't have a color associated with it.

So I think [00:30:00] setting clear f- frameworks for how people work, I mean, I think that sounds so simple, but, um, part of a high-functioning team is at least, uh, under the belief that we're all working a similar way. It's why if you take something as, uh, you know, hopefully as universally well-known as the sport of football, right?

It's why there's, uh, structured elements of practice every day. It's... Right, right? It's why you have weekly practices. It's why you have games at certain intervals. It's why you have pre-season. So, um, for us, I mean, you know, if we have our corporate quarterly meeting coming up, my dashboard could look a little bit different depending on if I'm talking about Jamie's set of initiatives, or I'm talking about Zach's, or if I'm talking about Matt's, or I'm talking about Janae's, or I'm talking about Sharon's.

It all depends on who, um, I might be talking about. At the end of the day, what is my biggest dashboard? Things like retention, things like enterprise value, things like, uh, growth and revenue, uh, profitability. Um, I am the, uh, chief resource officer, and it is my goal to make sure that the, the ship continues to grow in terms of its attractiveness Um, I could be looking at internal NPS and external NPS.

Um, and I think I probably said probably my, my big six at least. But I realize that I have some level of control over how things look, uh, from a departmental standpoint. Um, but um, sometimes, and I don't know if I got this from my mom, and I did grew up, uh, with a grandfather that was, uh, a colonel, but the amount of structure that I think that I'm able to provide other people, um, [00:31:30] and, uh, to make sure that they are reaching their potential, I think has also been a, a s- a superpower for me.

But, um, to the people out there who are wondering like, "Do you have to do all the things that I just mentioned?" No, but too many people won't have any. They won't even have one. Um, or they will think that they have to be like me immediately, and that's like the person which is like, it's like the victim of just being too intelligent.

You know all of these things, but you don't know how to actually put things in a way that are palatable for not just yourself, but your whole team. And then you're the founder that comes in, and you're like the... I don't know if anybody's ever seen the meme, Always Sunny character, and he's like writing, and he's got chicken scratch all over.

And it's like you're the founder that came in and like you couldn't organize your thoughts for the rest of the room because either, A, you're too smart, or B, you just lack the ability to focus. Um, which are two things that I think most, um, business owners can resonate with at least at some point in your journey, and hopefully it's not something that you're consistently having problems with.

Marla: And you mentioned that data's really important, too. So what are your key performance indicators that you really look at on a regular basis? I mean, I know you're, you're looking at retention. Yeah. Um, what about, you know, anything in the business-wise metrics that you're looking at that you're saying, "Okay, well now I know we have to move this lever to get a little bit better," any of those?

Josh: Yeah. I think big things, I mean gosh, let's go as, um Let's take new, new clinic, right? I want certain revenues per square foot, [00:33:00] so I want certain revenues per square foot, uh, at a bare minimum. If I have a more expensive lease, I might want to change that number. I might want a certain percentage of non-billable square feet to billable square feet in terms of the percentage ratio, in terms of what the clinic looks like.

Um, I'm probably talking about things like reimbursement per visit, which could be a mix of, uh, a variety of different factors, cash, insurance. We have a little bit of a mix of both, definitely heavier on the insurance side. Um, I would wanna know percentage of revenue allocated to certain buckets. So your, your P&L, you might wanna know what percentage of revenue towards clinical, uh, clinical wages.

Could be total comp for clinical. Um, it could be towards rent. It could be rent plus utilities. Um, it could be all overhead, right, that you might be allocating towards an office. I might wanna have my gross margin. I might wanna have, um, my net operating margin. So, um, I think that you could probably have a different conversation with a lot of different people about what matters, but I would argue if you're, if you're planning a new location, you need to have a good idea of, um, what levers or dials you might be turning to change certain things.

Yes, more revenue does in fact help a lot of those things, but to a certain extent, um, you could have certain things kind of go off. Am I overstaffed here? Um, are we in a situation where maybe the staff is burning out here? Are we, um, paying too much, uh, for [00:34:30] things not related to people at an office? Am I paying too much for back office staff?

Uh, transparently speaking, one of the things that we're trying to figure out with the, um, addition of things like tech and AI and international staff, it's like, "Hey, do we have the best, um, uh, optimal, I should say, um, non- uh, non-clinic facing staff?" Right? So, um, I think these are all things where, again, sometimes I think the challenging part with the Podcasts that might have a little bit more, uh, time constraints in trying to communicate things that, um, are relevant for the audience can be a little bit challenging sometimes.

But yeah, at the end of the day, you need to have KPIs, and you have a KPI dashboard. Um, and sorry, that, that probably doesn't answer your question very well, but, um, yeah.

Marla: No, that was great. That was great. Uh, and what about in terms of any infrastructure technology, um, you s- you mentioned AI. Yeah. What are the pieces, and I know you're using Prompt, but what are the pieces that you feel like have really helped?

I mean, there's so much involved. God, another

Josh: question that's so open-ended, that's so hard for me to like- Just give me three- Yeah,

Marla: um- ... maybe.

Josh: Yeah. Ah, God. Um- If

Marla: you, if you had to say-

Josh: I, I, I, here, here's what I say- ...

Marla: three favorite tech pieces ... at

Josh: the end of the day, yeah, I'm not gonna give you the tech pieces- Oh, whatever

'cause I think I could go in different directions there, and I think I could probably, um, uh... Yeah, somebody would feel slighted. Um, let's just say at the end of the day, tech friction and introducing new technology sometimes can be challenging for your [00:36:00] staff, and I think doing it in a way that meets the needs of your team is very, very important.

I think involving them in the process, um, is incredibly valuable. Um- Asking them regularly, uh, what their biggest pain points are. Potentially tiering things based on whether or not, um, their pain point could be addressed by a technology, AI, maybe an international staff member. It probably depends on how easy it is to, uh, perform it in terms of a success rate.

Um, if it's high success rate, high volume, I would view that as something that you could potentially push off. If it is a lower success rate, lower volume, a little bit more intricacy to it, I think you probably would have that for somebody that's a little bit higher paying. Um, so I, you know, I think tech looks all different, right?

You got EMR, you got phone systems, you've got communication platforms, you've got, I mean, something as simple as dictation. Um, I've got technology on my wrist. Um, I think sometimes, uh, you know, people look at tech, and again, it's like there's so many different things out there, and people are feeling like they have to adopt everything, but then largely putting themselves in a situation where they don't adopt anything at a high level.

Um, I think that, uh, if I can think to experiences that I've had with companies that have been really positive, it's they've had clear expectations with us when we've engaged with them. They have their own KPIs that they're judging their own success on, not relying on [00:37:30] me, the customer, to potentially, um, uh, determine that for you.

And I think a lot of people especially like if I can think about fails, like people sign up with way too many marketing agencies, and they don't have anything that they should hold the marketing agency to with regards to like expectations, and they're just blowing money on a regular basis. So you, you should have an idea of what the KPIs and what they're telling you looks like a successful engagement.

They should also provide you with onboarding. I can think of a recent really, really negative experience, um, with an AI company that was supposed to do certain things for us. The onboarding was very choppy. It was disorganized, the cadence that it was occurring on a regular basis, so you need to have some kind of onboarding, uh, calendar.

There needs to be some kind of meeting touch points. Uh, and the one thing that I think that probably doesn't get discussed, uh, about as much from the tech companies that we've worked with, but something that I think is very beneficial for you as a business owner to do, is we just set up a sim-simple Google Doc.

And when you're going through your process of, um, you know, using the technology and you're trying to learn, uh, you are in a situation where questions come up or you have problems, and you just Braindump. Anytime something pops up, you just throw it on the Google Doc, and then we have a set time where leadership is looking at it or leadership is potentially sending it out, and then the questions are getting answered, uh, in real time.

So then everybody gets a weekly, uh, [00:39:00] Q&A that's potentially answered, and ideally that document gets less and less and less as you go, um, because everybody has resourced their own, uh, their own problems. So, um, I know I'm not giving you the, the three tech things. If anybody wants to know my tech stack, you can go on LinkedIn.

I just literally shared it a week ago. Um, and I shared 10 things, not three. So, yeah.

Marla: Great. Um, and in terms of marketing, I know you have to market a ton to grow and- For sure ... some people do a lot of external marketing. They do all these paid Google ads or, um, invest in Instagram. You really have done a phenomenal job marketing.

I think it's one of your strengths. I think it's 'cause you know your product well, you've been able to define it. But what would you say from a marketing perspective that you feel has gone really well for your team and, um, some of your strategies?

Josh: Yeah. I think understanding marketing is an ecosystem. Uh, also understanding that marketing for patients and marketing for talent is something that you have to discuss.

I'd say you have to understand how a marketing funnel works. So you have to understand top of funnel, you have to, so understand bottom of funnel. You have to understand what leads and conversions looks like. You have to understand what the retention and then advocacy and word-of-mouth part looks like. Um, and then beyond that, you can't do everything at once.

I was talking to a business owner today and he was like, "I gotta do a retention newsletter. I gotta do ads, I gotta do workshops, I gotta do outreach." And it's like, all right, well, I understand that you have to do all those, and I would [00:40:30] agree with you. What are you doing well? Just like the rehab process, we're trying to get competency, we're trying to get capacity, and we're trying to get conditioning with the people that we're working with.

And as we go through, we capture variables and we keep them. From a marketing standpoint, if you know that there's an ecosystem out there, you have to capture certain things in, in order to keep them. So start somewhere. For us, if I can think about, like, couple things that we just need to make sure we're checking boxes on.

You have your digital storefront, your website, right? Is my website searchable? Is it optimized for search? We could go two ver- two different directions with regards to Google, right? Your SEO versus your AEO, right? So now, uh, we have all of these different AI platforms that we need to be optimized for as well.

You have outreach. You have cold outreach, you have warm outreach. Do I have a cold outreach process? Do I also understand how to ask people that I already know for a warm introduction, a warm connection? Um, we call that sometimes just hunting your yard. You have people that are literally, like, walking into your yard every day, and all you have to do is ask them for a question.

Then we have things like social, we have digital ads, we've got our workshops, and we've got events. You could probably spoke on other things like direct mailers. You can probably spoke on sponsorships. Um, but that's largely some of the things that, um, we will use on a regular basis. But a lot of people [00:42:00] don't focus on one thing long enough to get really, really good at.

So I don't want to tell anybody that there's one secret thing. I will say that early R2P, we prided ourselves on a handshake and a smile and an elevator pitch. Um, and then when the pandemic occurred and everybody was at home, we lost our bread and butter, so we had to get really, really good at social media.

We had to get really good at digital ads. We started experimenting with, uh, direct mail a little bit that we do do, uh, when new locations open. But at the end of the day, you have to have an ecosystem and you have to have spent long enough time at least to tell somebody, "This is why I think I can spend time on a new thing, because I'm actually good at this."

And if you are outsourcing your marketing, please, please know what you're supposed to be, uh, getting in return, 'cause too many people... It's so easy and it's such a high profit margin business to have an, a marketing agency. I hate to say it, but now we have AI agencies popping up everywhere. How do you think those profit margins look?

What does churn look like on the back end? You're just another customer to some of these, like, businesses. Um, and I use that in quotes 'cause sometimes I think they're incredibly opportunistic. Um, and again, you don't know if this person is trying to be opportunistic if you don't know how to have a good conversation with them.

But at the end of the day, I remember early Prompt, Nolan, and I still absolutely love him for, like, how the onboarding process went at Prompt. Um, he was so good about these things with us, and it made our team, like, so much more [00:43:30] comfortable with making a big switch. I mean, I think you talk about tech, like EMR is easily the biggest, uh, headache, uh, in terms of, uh, friction in a business with all of the different people and all the different components.

Um, so Nolan, if you're looking at this, uh, I know there's other people that are like Nolan, but Nolan, like, holds a special heart. He even got in our kickoff and, like, answered questions on the spot for our team. So some of that stuff goes a, a really, really long way, and he was very transparent also about, "This is what you should expect.

This allows you to know whether or not we are all having success." And I think those questions aren't had enough. Uh, and unfortunately, you do have a lot of people that engage with, you know, m- maybe, maybe opport- opportunistic people or opportunistic companies that, uh, uh, don't value the re- word retention as much

Marla: Yeah.

And I mean, just like you said, it, it's important to... Y- you did it all in the beginning so you understand it all, so you can really dive in and then know, okay, here is... Do I outsource this? Are we doing it better in-house? And when do I hire somebody to do that? So- Yeah ...

Josh: I,

Marla: I think that's a learning lesson for all owners, is when you pass it off or outsource it, and to make sure you're actually getting the best ROI for those different pieces of the business.

Josh: Absolutely. And the word literacy comes to mind. Sometimes just having enough literacy, like I can safely say this at this point in time, I'm not the best at any of our technologies, but I at least know enough to ask intelligent questions, and that's what I would just recommend for anybody who's a business owner, [00:45:00] who is using platforms, using technology, using AI, outsourcing staff overseas, whatever.

Like, you just need to know enough to ask intelligent questions to determine whether or not your money is actually leading to something that's moving the needle for your staff.

Marla: Yes. Yeah. and you brand yourself really well. You, do a great job of actually sharing a lot on LinkedIn and other platforms for other owners.

I, I think that's one of, honestly, such an admirable quality. And a lot of people say, "Why?" Right? Like, you're helping others. so what do you feel is such a great benefit of all that you share?

Josh: I think a lot of times, like, I get really good questions, and it makes me actually, second-guess and, potentially, you know, you're kinda iterating or, like, fine-tuning your own processes, your own messaging.

you also sometimes, you're wrong, right? Which is sometimes really, really nice. I can think of the 85/15 rule that I gave you earlier today, like, in terms of, like, square footage, in a space that I wouldn't have known unless I, like, put something out there. And my friends from Buffalo Rehab Group were like, "Uh, you should think about this."

I'm like, "Okay, cool." didn't, quite think about it. So I think sometimes without transparency, like, we can't get back some of the things that we lose. Especially, like, what's the point of a network if I'm not, like, able to tap into it? So sometimes when I share certain things, um, I get, like, way more than I ever envisioned, outside of the fact that by sharing those things, [00:46:30] I might also have passed on certain things that allowed other people to kinda get a hand up into a new situation.

Or maybe given them a window where they can now ask me an intelligent question and actually we can have a relationship. So I think there's so many different ways, um, you know, the, the, the social network can go. Obviously, there's a, an attention element to everything, and I would have to be lying to you to tell you that there's not an attention element, and I'm aware of that, and sometimes it makes me uncomfortable, but sometimes I also realize that, like, you just...

This is how the world works nowadays, and you just have to find a way to, um, authentically put things out there, and there's- Nothing better than probably like putting out things that I at least deem to be like thought leadership. "Hey, here's thought leadership. Here's what's going on." Like, I think this is gonna, gonna benefit people.

You might go, "Well, you're 85% right." And like, "Okay, yes." After h- having a conversation or somebody says something and I'm like, "Eh, no, like I actually think you're wrong." And sometimes that, that healthy discourse can, uh, reinforce, uh, opinions, um, or potentially, again, facilitate like kind of a long-term relationship with somebody that you never would've had the opportunity to do otherwise, especially realizing, you know, that somebody might have a stronger opinion that either runs counter to yours or somewhat overlaps with yours or is a complete mesh.

Marla: So it's like crowdsourcing. You get a, you get the- There you go ... mentor out of it. That's good. Absolutely. Yeah. That's, that's a great way to look at it, especially as you're an owner of a company, it's good to have all those other people out there and, and it sometimes gives you good feedback and you learn something new.

Josh: Definitely. And [00:48:00] sometimes I look at stuff too and I'm like, "Hey, so and so..." Like I tag people into my team, and like now they get to benefit from my n- networking, right? Mm-hmm. 'Cause at the end of the day, like what is, what is networking, right? That's an opportunity to hopefully exchange ideas, exchange values, collaborate, communicate.

Um, so it, and then pulls them into situations that maybe they wouldn't have been able to be pulled into, uh, versus being in a situation where maybe I'm like the, the hidden founder, right? Maybe I'm operating from a lens of secrecy where my level of, uh, uh, privacy or behind closed doors approach is somehow benefiting us.

But, and I, and I say this, a- a- and I ca- I know I can go different directions, but like I could give somebody our entire playbook and nobody's gonna have the same output.

Marla: Right.

Josh: Like literally no one... You, there are things timing-wise, like people-wise, like societally-wise, all that like had to like come together for us to end up where we are.

Um, so at the end of the day, if like if I gave somebody everything, they still would end up somewhere different. Some would argue it could be better, some would argue it could be worse. But if I share even like small snippets, like hopefully at the end of the day some of that, some of that stuff or all of that stuff led to it positively changing somebody's trajectory.

Marla: That's great. That's great. Uh, and so now that you're at this 15 clinic mark, where do you go from here? What do you see? What's your future path that you're looking at?

Josh: Gosh, that's a good question. I'm a little bit torn to be honest. Yeah, I think, um, I think I feel pretty comfortable saying we're gonna [00:49:30] get to like 20 to 30 clinics and we're gonna like be a region leader in our area, you know?

And I think what- Like, is beyond that, I, I really don't know. Um, I don't know. Do we go elsewhere? Sometimes I sit there and I go, "Do we just... Is that it? Like, is that it?" You know? But then again, if, like, you're not growing or, like, searching for something new, everybody always says, "Well, you are gonna have people move past you."

Well, there's some businesses that have be- been around for, like, generations that do get to a certain point, and they just kinda, like, hold market share. Um, do we do something completely different that we've never done before? That's also stuff that I'm, like, mulling over. But, um, I think we can get to where we wanna get to probably in the next two to three years here, and that by sometime before 2030, like, we're gonna have to, like, have some hard conversations with the leadership room and see what the pulse of the team is and to see, like, what everybody's, like, appetite is for either something new, um, more of the same, which just would involve us continuing to, to grow in the, in the Mid-Atlantic region, um, or do we just stay put?

And I don't know. I think there's, like, just something, uh... Yeah, it feels, feels pretty special to be able to, like, say that, but I really don't know. And I think another thing is so many people focus on, like, five and 10-year plans, but, like, I've tried to get really, really good at just being present. Um, kinda like one-year plans, and that's literally it.

And, like, I kinda have, like, [00:51:00] a, I don't know, like, a macro, "Hey, it'd be really, really cool if in, like, three to five years we were here," but I try not to get too married to that stuff. You know what I mean? Yeah. Like, I try to just, like, um, enjoy, like, the journey and, like, enjoy, like, kind of the ebbs and flows 'cause, like, five years ago, I never would've envisioned, like, being here.

So then I'm like, "All right. Well, five years from now, like, who the hell knows?" Like, do I really know? Like, it sounds good. Like, I can talk about, like, a couple, like... You know, what do you want? Like, oh, I want more money. I want more time with family. Like, I wanna still be, like, healthy, yada, yada, yada. But in terms of, like, really, really, like, fixed numbers and, like, I, I don't, I don't wanna be too rigid.

I've never been a really, really rigid person, and I think at the end of the day, too, um- I don't know why this just came to mind, but like fall in love with walking and not the destination. And like I just really, really enjoy like what entrepreneurship has done for me on like a personal level. And I'm just really enjoying now just being in the sweet spot where I feel like I have a lot of control of my time, and I know if I do certain things it's gonna lead to certain outputs.

Um, which is like also feels like really special and like I'm aware of like how like unique that is. So like, just enjoy it. Like s- sometimes I just gotta sit back and like when stuff happens, um, like quite honestly, like our 15th clinic is like such a cool spot. I don't... Like for anybody out there, like St- the, the St.

James, it's like three, 3,000 like members. They have a indoor field house that's like honestly bigger than Ohio State's. They have a, a private school there. Mm. Like stuff like I would've never imagined. Like I did not have that on my [00:52:30] dartboard. And sometimes when you just do good work and you like just stay true to the things that like matter to you during moments where you're even smaller, like just good stuff's gonna keep happening.

So I have a feeling too, like more stuff will just naturally pop up that maybe that I'm not even thinking about right now. But again, like I just love my routine right now. Like I love what we're doing, and I feel, um, yeah, like I, I could go down any of those three directions, and at some point life's gonna tell me which direction to go in

Marla: Hey, choose your own adventure and you-

Josh: Yeah

Marla: you know, and we, we sort of very similar, um, we have a short-term roadmap but don't have a long-term one because we feel like the industry changes so fast- Right ... that you wanna, you wanna be relevant and you wanna seize the moment. Right. So I think that's perfect plan.

Josh: Right.

Marla: Um, and I'm impressed that you've done this all without any private capital or private equity, um, which just tells to the, the point that you've really invested in your people and your people invested back in you, and you've been able to continue to grow just with that and not needing all those extra resources.

Josh: Yeah. Resources are infinite. I mean, I think really when you- comes to like all the different options out there, um, we have just been friendly with our regional bank, um, and done a mix of like y- at, at times had to do SBA funding like a lot of people maybe who just got started up, and then non-SBA funding.

And that and line of credit can be very, uh, powerful. Um, obviously that involves like eating your own cash [00:54:00] when you open up new locations. You know, new locations are not, uh, cheap, but I think at the end of the day like the staff feels really comfortable with where we're at right now. Um, I think we wanna continue to be a, at least a practitioner-led company.

Um, I think it's no secret there have been some negatives out there, uh, from a services company standpoint, uh, with regards to things that, you know, outside financing groups can, can potentially do to healthcare. Um, I've not ruled out the possibility of at some point maybe doing something. But I will say that if we were to ever do anything, uh, the number one thing would be are you going to allow providers, namely myself unless I get to a point where I feel like I'm disqualified from, um, being the CEO, but, uh, providers are gonna be in the operating position, and that will be something that I hold firm to.

Um, I have not ruled out the possibility of engaging. I know there's, uh, you know, minority recapitalizations, finding strategic partners. I am very, very well aware that there could be some of the things that I mentioned earlier where there's maybe something new or going to, uh, a new area where conversations, uh, may be beneficial for us to do that in an intelligent way that allows us to all collectively move in a way that, um, we get to where we wanna get to quicker and safer.

Um, I also am aware that there's certain things in place where if we can do what we wanna do right now without involving that and we feel very, very confident about doing that, then why would we do it? [00:55:30] Um, we have gotten to this point in time and we haven't needed it. So can we get to a point where we are that regional leader, and then do we get to kind of, as they say, get to a summit and we recognize that there's another summit out there, or we have reached the summit?

I don't know. We'll see. But that's me being very transparent- Yeah ... about just like, kinda like where we're at and what I would be open to. But, um, yeah, just the operating control piece is like, that's a non-negotiable.

Marla: I like that piece. I mean, it, it's, it's something that I feel is very valuable to keep in this industry, is letting those operators be in those positions that are clinicians- Yes

uh, and letting them grow to that path.

Josh: And allowing them to find ways to meaningfully change their, like, personal financial situation, like, is important. I'm not saying we would do this either, but there was a company in the Baltimore Business Journal that the owner was, I think, 60s-ish, and he just...

There's a six-year plan to do an ESOP with all of his employees, right? Or, or, sorry, I guess it was employees that 20, 20, 30 years, like, all of his, like, longer-tenured employees. There's something beautiful about that, you know? And I think of, like, when Mark Cuban, uh, sold, um, the Mavs, right? When he sold the Mavs, and the amount of people that he also distributed, um, money to.

And, and I think of situations where, um, just wealth is shared a little bit more, and I think that that's something that I'm gonna continually try, go- gonna try to explore. 'Cause again, I think there's, uh, there's [00:57:00] challenging positions a lot of healthcare providers are in, and I think that that can be a way for us to also, like, keep R2P special.

You know, when the providers are, like, at the forefront of, um, the level of investment they have or the clinics are because they actually are receiving the benefits of, like, taking ownership there. Um, I think that's a way to, like, continue to do really, really great work

Marla: That's great. Any last-minute advice for practice owners that wanna get to the level of 15 clinics?

Josh: Don't do it. Uh, don't do it. Yeah. It's not for everybody. I'll be honest, it's not for everybody. It's like the same... Like, I was just running a booth at private, uh, not private, right, uh, CSM, right? And people, "I wanna open my own business." I'm like, "Why?" You know? "Oh, it sounds great." No, that's not... Like, I just think that there's stuff that, um, is aspirational sometimes that, like, isn't authentic to the individual.

So, um, I'd almost rather talk to somebody who got it up and going, they recognize they have the entrepreneurial bug a little bit, one location, has gotten to a point where it's a little bit easier for them, then okay, you're the person that we could probably have a, have a, have a discussion about. But if you're aspirational and you haven't even gotten to the point where you've opened up the clinic, it's probably not for you.

And then, like I mentioned earlier, go open a second clinic and tell me it's still easy. Okay? Then when you get to the second clinic, and then it's s- then we can maybe have that conversation. But I do think, and, you know, there's a lot of, like, um, there's a lot of appealing stuff. It sounds great on social media sometimes.

But I will tell you all of the [00:58:30] places where I lost my soul, was financially, like, strapped. Uh, it affected my personal health. It affected relationships. Like, I can tell you all of the reasons why not to do it as well. Um, and I do sit here saying it, I, I think it's all been worth it. Um, but it's not for everybody.

Um, and a lot of that comes to you, you know, doing the deep work yourself. I'd recommend all business owners to have, like, some kind of, like, therapist, to be quite honest, 'cause that's, I think it's incredibly productive, too, to, like, walk that path with yourself. Um, but yeah, it's been a, it's been a very beautiful journey, um, but I do recognize it's just, it's not for everybody.

Marla: Well, find your passion and keep going after it, and as long as you're happy, you're in a good spot. I'd say that's the, that's the, the good take-home message.

Josh: Yes.

Marla: Definitely. Well, thank you. This has been wonderful. Such a pleasure having you on this podcast today and having everybody learn from you and your path, and it's been a very unique one, and I think you really have built something special with all the people around you.

Josh: Appreciate it very much.

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