Transcript
Marla: [00:00:00] Welcome to the Practice Growth Podcast today. Brian, thank you so much for coming.
Brian: Thanks, Marla. Thanks for having me. And this has been an exciting day so far. Many of you don't know, we're shooting this at around what, 1 32 o'clock. I've spent onboarding hearing you guys prompt has really, you guys have not done yourself.
This is a wonderful facility.
Marla: Thank you, and we're really appreciative of you coming in. Especially I've known you for a long time and you are not only a powerhouse in the physical therapy industry. You've been a clinician, you've owned a clinic. You also now have Meg business Management which is a billing platform and billing organization, as well as consulting and being nationally recognized as a coach and consultant.
Brian: Yes. Yes. And that's how, meeting Mike and the whole team here seven years ago, that's how the relationship started, was I realized, helping people become better owners and better educated in how [00:01:00] to succeed as owners, which we're gonna get into. It came with this compliment of a bundle of work that we never went to school for.
You've been a therapist a long time. You've treated athletes yourself and in all different settings, and you've worked in different settings. And what do we all dislike the most? It's all the admin. I'm sure we'll touch on some of that. And with today's technology and all the advancements, it is, in my opinion, the absolute best time to go into private practice for physical therapists right now.
I think this is the best time in our history to actually make a big splash.
Marla: Yeah. And honestly, that's really what I'm here to talk to you about today is to pick your brain and tell us a little bit about how to be a successful startup, and not just any startup, but one that goes from zero to one to five practices and be able to grow successfully and quickly and scale.
Would love to hear just for anyone who doesn't know you, a little bit about your background and how this topic is near and dear to your heart and how you even got into this.
Brian: Okay, so that's a good question. I [00:02:00] think being a startup today is 10 times easier than it was when I got started. I graduated PT school in 92.
I went to school up in Buffalo, and when I got outta school, I just wanted to be the best therapist I could be. You're an athlete. I know you're top level, top shelf performer as a gymnast. And I went and played soccer over in Europe for some time and came back. And so I just had that intrinsic degree of ambition to wanna be the best I could be at whatever I'm doing at the time.
If I was, I remember working at National Car Rental. I wanted to wash the cars the best I could. That's a terrible job. I washing rental cars, but you know what it's like. And so you come outta PT school and I did 33 Con Ed courses out of PT school. I wanted to be the best manual therapist I could be.
But then at some point, you realize that you're made of a DNA that I just can't exchange time for money for the rest of my life and for people who can, that's totally fine. I think that's a, it could be a beautiful life 'cause you have something else going on that you're passionate about. I'm sure.
But for me, I was always passionate about physical therapy and always passionate about you and heck, you're gonna be a PPS given three lectures [00:03:00] possibly. You know what it's like to be an educator. You feel like when you walk off that stage or you're done helping somebody, you're like, man, I've had an impact on that person for a lifetime.
It's not just for the moment. So that's been my history. If I need to put a thread through it all, it's about how can I give back to a populace or a group of people or a profession in a way that. Actually does some good for the lifetime of their journey in that profession, right? And so I've been devoted to that my whole life after starting my own business five years after working for somebody else and then getting to where I am today.
But you know how it is today's more than just, treat the patient and discharge a patient and find a new patient. So there's a lot more that goes into it. So yeah, my journey has been everything from private practice all the way on up to helping people succeed in private practice.
Marla: Yeah.
And you said that now is easier times, so I'd love to know why is now a good time? A lot of people say reimbursement is decreasing and admin struggles are increasing. PTs are hard to find. So why do you think it's a good time now to get into starting your own practice?
Brian: I [00:04:00] think it's a great time to get into starting your own practice now, more than ever, for many reasons.
Probably the one that comes to mind most is when I started, I. Thought or all I observed in the environment at the time was you did everything. You did everything yourself. I ran my own Cat five cable in the wall. I painted the rooms, I set up the shop. I got my own server. I loaded my server.
Microsoft. As Microsoft, I did our own billing. And it was like, that's just what you did. You did everything. And fast forward 30 years now, been a therapist 30 years. It's not like that at all. As a matter of fact, almost no one. Goes that route it, it's become so specialized because heck, we don't even have, we had paper charts then, right?
So you need an IT specialist for this. You need a compliance officer specialist for that. You need a billing specialist to do the billing. Not only that, you need a IVO authorization specialist. You need patient front desk. The state of [00:05:00] rehab report has over 40% of offices. Can't keep a front desk person more than 12 months.
Because it's not a jack of all trades position that you can just keep somebody in for a very long time. You have to separate out some of those roles and responsibilities into their specialized fields, if you will. Like patient registration and tracking and authorization and demographics is very different than meeting and greeting and being a hostess.
So I think if you're going into physical therapy today and today, you have a chance. To have a clinic of your choice practicing as you wish. With all the free will you have, and all you have to have is DPTs, PTAs, and techs, and you can outsource your admin. That makes it extremely easy for people today as opposed to before you got technology.
Look at prompt. Look at what the EMR system can do. Look what you guys have integrated in just seven years. It's amazing. My notes are done as I walk out of the room. You got, transcribed dictation happening as I'm talking to people. So I think when you take everything into account automation, ai, innovation specialization, outsource, [00:06:00] and, do what you do best and outsource the rest, all that combined makes it super, super simple as long as you have the right mindset going into it.
Otherwise you could be a victim of your own circumstances.
Marla: Wow that's a great way to look at it. And the point of view, the opportunities there. You have more resources than ever. And so it really is a good time to, if you want that and you're eager for it to start your own practice.
But you mentioned something really important, which is mindset.
Brian: Yep.
Marla: So what is the mindset shift that you need to make being an employee to an employer? And really, if you wanna take that leap. What is the mind shift that needs to happen to become a,
Brian: yeah, that's a great question. So the mind shift is a i, I would say there's a couple ways to look at it, right?
And I think you've experienced this in your own profession, knowing you and being friends. You've been an intrapreneur. Within an entrepreneurial business, and you've probably done it multiple times from the history that I know of you. And that's a huge win. I can go from employee being told when to come to work, when to go home, when I can take a break, when I can take a [00:07:00] vacation, when I can take a lunch and somebody tell me how much money I can make, which for some people that's totally okay.
But then there's people like, like yourself who said, ah I'm engineered for a little bit more self-driven, self independence. I'm not so sure that ceiling is how high my income should be. I think it could be a higher ceiling. And you've made yourself into an entrepreneur within an entrepreneurial clinic.
So as a physical therapist who wants to create my own entrepreneurial clinic, shouldn't I develop an employment ladder that allows people to have that freedom of opportunity within the umbrella of what I created? So now both of us are winning, right? Both of us are not limited and not restricted. Going back to the mindset of going from employee to employer, I think a lot of people are leaving that employee mindset of, I'm coming to work and exchanging time for money.
And they're saying, Hey look, we had a pandemic some time ago, you might remember. And there was a lot of controlling things that happened and people felt like this heat of control. And I know for myself, I sold my house and moved on a 26 acre farm with 24 chickens and I'm [00:08:00] like, I wanna live free.
I want some freedom and. A lot of people know are doing their own thing. A lot of people are their own entrepreneurs and entrepreneurs because of the freedom 'cause of the sense of liberation that they can have for themselves and they can make their own tomorrow. And so I think that's the mindset I'm really after.
What is that for you? As a matter of fact, the first question I ask people who wanna go into private practice, I say, why? What's your ideal scene? What is it you're trying to achieve? If you can't paint that picture with your eyes closed, if you can't envision it, you can't paint it. So that's a big question.
I know that's a long answer for a short question, but
Marla: Yeah. I love it though. I love it and I love the thinking and the way to be able to picture it and envision it for it to happen for us. Now, from that perspective as well, a lot of people don't have the coaching or they may not have the resources yet that they bill in, where they're, they were currently working.
So what do you recommend? In terms of what different courses they should take, what different books they should read, or any resources that they should do to set themselves up to [00:09:00] be a startup entrepreneur.
Brian: Good. I think if you're gonna be successful in opening up a plumbing company, then you should be a good plumbing.
I think you should start off knowing your craft and knowing your trade, and knowing the ins and outs, dos and don'ts, ups and downs before you venture into it. I often say here's my advice to everybody who's watching. Try to get educated to the extent that you know what you need to know before you need to know it.
Because if I made you a nursing student, I put you on the fourth floor. I'm like it's nursing 1 0 1, and today's your first day with these 24 patients, and we're just gonna teach as we go. You would freak out. So if someone's gonna go into private practice, let's just look at the numbers.
It's gonna cost you less than a Tesla, plaid. So something around a hundred thousand, $150,000 on nor on average should get open. Your only real concern isn't the amount of capital you're spending, but the cash flow that you're gonna make from that capital. So you need to then run a performa. So you should learn how to do [00:10:00] that and understand what might cost center, what's bumped up against my income centers and what's that margin gonna be to break even.
We pretty much know it's about 45 to 55 visits a week will be breakeven just about anywhere you are in the country. So you can move forward from there. But specifically, some people get a little nervous and they'll go back and get their MBA, not a fan. I think you're spending a lot of time on, macroeconomics, microeconomics, none of it's gonna help you at all.
But just knowing and I'll end on the financial side because I think you really have to understand finances. Know that when you go into business, it's not like how you run your house. You and I don't want to ever spend more than we make in our house. We, but in business I'll borrow money and as long as my cashflow margins are covering it, I'm gonna build my business on the borrowed money.
Cash is king, and I'm gonna keep reserves on that. That's what stresses most people out. They don't quite know where to go for the financing, how to manage the financing, and how to get breakeven in six months. That's a real secret to success rate. There.
Marla: A lot of follow up questions for you on that, but I'll start with the [00:11:00] one where you said.
It's about 150 to start up. So do you borrow or do you, where do you get that cash from and what do you recommend? Alone? Family, friends, where do you get that from?
Brian: And those are all the things that are on the buffet, right? I can go to Mel, the dad, I can go with friends, I can get partners. I can take money outta the bank.
Maybe I have an inheritance or I can go get a loan. And if I go get a loan, is it an SBA seven A? Is it a micro loan? Is it a commercial loan? It really depends on the period of time that advice has to pivot and shift depending on the economic times. Currently in this year, most owners that I see are doing much better with commercial loans.
SBA loans used to be the thing. Five, six years ago everybody was getting SBA loans. If you look up on the SBA website, it even says they're not for startup. Therefore people have a cash flow, that people have some work history. I then went and Googled banks for startups, and even when I Googled the banks for startups, two out of 10 said, no, [00:12:00] no cash flow history required.
So you really have to shop. I recommend that a lot. I don't like to mix family and friends in with business. I think that's a little bit of a risk. I think you should hang on to cash that you have. People are like, oh, it's interest free. Not really. 'cause when it's gone. If something is really happening in your business in the early years, you have that cash to shore yourself up.
So I think that's the most secure way to do it. A nice commercial loan, as long as the terms and conditions are favorable and always make sure you have a line of credit, which you can pull from your house. You can have a heloc. Let that sit on the side as your backup if you need it. And last thing I'll say about that is I'm not a fan of partners.
I think there are some partnerships that work really well, and I'm not gonna put that down, but for the most part, you're seeking a partner because you're risk adverse on something, typically, something you don't feel like you can quite handle all yourself. And I often say, look, I've been married 33 years, and I can tell you that hasn't always been easy.
And now you have a partner and it's two marriages in one household. It's a, you have all the same dynamics. [00:13:00] So I usually try to encourage people, get the knowledge, get the training, get a coach so you have somebody to bounce things off of. You have a sound board and then you'll be fine.
You'll do quite well on your own.
Marla: I like that point about getting a coach and having that person to bounce off of. 'cause you have not done it before. So I think that's a great point. And you did say it's okay to actually have more money that you borrow or so forth in the beginning to start up and then your cash flow.
So with that, what do you recommend as the absolute necessities that you need to start up? From a technology perspective or just in general?
Brian: Yeah, that's a good question. We have a thing on our website called PT in A Box, and you guys have a startup thing. There is a certain amount of technology and equipment and supplies that you absolutely need to get off the ground and bootstrapping isn't good either.
I've had people open up clinics and their 300,000 in debt. Day one. Not a good idea. I had somebody open up a clinic on three credit cards. They maxed out one $10,000, rolled it forward to another one [00:14:00] cash on card, and they did it two times over and they got their clinic up and running. Don't recommend either one of those.
I think if you're at about 150,000 and if the space that you're looking at is fairly well built out, let's say it's an old chiropractor office, podiatry office, or an old PT office. You're not gonna spend much on buildout at all. Buildout is what's gonna eat up your capital. So you should look toward the landlord contributing tis tenant improvements to help you with the buildout, or at least give you three to six months rent abatement where you're not paying rent for the first three to six months.
So I would go there. Technology wise, you absolutely has to have some piece in my mind, my opinion, some piece of an industry disruptor in terms of a clinical piece of it. Whether it be the newbie EAM or dry needling, or red light laser, or red light therapy or cold water, something that's gonna, rock the environment a little bit, make you a little bit of a differentiator.
And then administratively, you need a lot of technology. You need a robust EMR [00:15:00] system, which many people watching this podcast already know about. You need AI infused into it. You need automation, auto billing, auto posting, we need to, at the end of the day, open up a clinic no matter, I think it does matter.
Square footage wise, typically 1200 to 2,400 square feet is a sweet spot. Open up a clinic in that range with as few number of people on your payroll as you possibly can. Do it. Keep that payroll down. It's your biggest financial burden and it's your biggest management time consumer. It's gonna consume most of your time and management.
So having. The digital technology like we have here in prompt and having a good piece of digital advanced technology, HRV, newbie, stuff like that out on the floor. You got the best of both worlds.
Marla: Great. And I love that about identifying yourself and having some clinical piece that identifies you, but then also putting the technology infrastructure in place to be able to scale.
'cause you should always be thinking long term as well. Now you [00:16:00] also mentioned that you should do it with as little amount of people as possible. So when do you recommend adding that first person whether it be a front desk, whether it be another therapist, where do you get to as you start to grow to add that next piece on?
Brian: Yeah, that's a good question. At Leg Academy, we have a old web based platform for training startups and specific stir up programs. And then we have a full master's curriculum for people who have already been in business. They wanna open up 5, 6, 7, 10, 15 offices. There's something in there that we've constructed called the Complement, and the hiring compliment literally tells us who do we start with and when do we hire and who do we hire, in what order do we hire them based on the numbers, not based on anything other than the numbers.
And what you'll find is, the numbers I'm speaking of are the revenue numbers and the visit numbers, the volume, so it's the patient volume and the revenue, and you track that. And so normally it goes, PT owner with an administrative person to help me get off the ground. [00:17:00] Part-time works in the full-time.
I already know about 45 to 50 visits a week on the national average of about $83. A visit is gonna be breakeven. Once I start ramping that up, the very next person I wanna hire, believe it or not, is another therapist. I wanna hire another therapist, be not a PTA, not a tech. We wanna hire another therapist because what's gonna happen is that therapist walks in the door, I take my caseload where I'm overburdened.
Now I'm doing 60, 65 visits a week. Let's say I'm gonna be able to dump almost all that caseload on the incoming therapist. About 35% will stay with me. They won't move. The rest will go that, and that person is literally two weeks away from break. Because they took that caseload. Now surely I'm not seeing the numbers that I would see, but now all evals come to this person.
This person ramps up because they're on my payroll. I am the owner. I can pay myself distribution or pay. So I can play a little bit more with that. Get this person up to 85% efficiency, ramp them back up, and then I can start taking the evals again, and I just do it again. And the next [00:18:00] person, no, the next person who comes in should be more like a tech, somebody who's gonna actually help support.
And they're gonna be a little bit of a Swiss Army knife, float to the front, float to the back, and then I can get my PTA, my golden rule of thumb is two PTs to one PTA. That is the secret ratio. And that'll keep it very viable. And now I'm not feeling like I'm doing eval, I'm feeding this PTA all day every week.
You don't wanna feel like that. That's not why we went to school.
Marla: Yeah. Oh, wow. I like that algorithm. I like that process and procedure. And just like you said, you have to have those processes before you start to add those different. Individuals and people. So what processes, what kind of different pieces should you put into place before hiring most people as well?
Brian: Yeah, that's
a great, there's so many good
answers to these questions. First of all, I think, like we were talking earlier, I did not, so let's think, you wanna open up your yourdo, him says, list sister. It, my phone usually rings when somebody's been an employee. They're a clinical director. They've been treating and [00:19:00] I recommend you treat for at least 2 years.
They get it at least 2 years of clinical under your belt My phone rings. They wanna open their door. I say I'm happy to plug and play and help you open up. It's a 27 step process, and as long as you're gonna open in the next 6 to 18 months, that's the perfect window of time. Not too quick, not too far out.
What do you need in place? You're gonna need to know how to incorporate, and then you're gonna need to know how to use a software for your accounting, such as QuickBooks. Then you're gonna need to know which is the best EMR, with the right balance of automation and AI tools for your advantage. So that's simple.
You don't have to think too hard about it. And then once you start getting into practice program, you have to program out everything you need. Standard operating procedures, SOPs, we can't. Go off a whim. You can't pivot and flex because of the personalities or the people you have.
You have to have standard operating procedures across the board, a policy and procedure manual more now than ever before. There's so [00:20:00] much liability and litigation out there in the whole wide bad world. We don't want any of that in our office. So we have to live by our principals. Pay for performance model.
Absolute must. You can't. Or therapist any. I, I had a call two weeks ago. And the challenge that I was confronted with was the therapist owner was saying, I can't hire a PTA in my market for under $65 an hour. Wow. Yeah. That was the challenge. And so I see everything in between, and I have O offices that are averaging $61 visit.
I have offices averaging $140 a visit. So without these SOPs, without policies and procedures, without pay for performance model, without stats, hats, metrics, and products identified that you're running on a 3 week trend, you're the effect of everything you create. And you'll wonder, like my head's spinning and where do I go?
Wow, shields.
Marla: Wow. That's, and that's crazy 'cause you know that is happening and it is really hard to hire. PTs [00:21:00] and PTAs, just people in general. So it's important to put those process procedures in place and be able to set that ground running and really get your culture as well.
Brian: Yeah. And we were talking earlier in your previous employment.
You guys ran by the numbers. You guys knew your numbers. Management by statistics. It's not management by personality. Oh, Olivia's so nice. She laughs at my jokes or she buys me Krispy Kreme. She's my favorite. You can't run a practice or a business or a group or an organization, any. We like that has to be management by statistics, which is why pay for performance work so well.
Marla: Yeah. Now what are, what is the characteristic of people who've been really successful in starting their own practice and growing? What would you say is the overall general characteristic or that you see is in them to really make them successful?
Brian: Few things. Number 1 they're not risk adverse. If you're risk adverse, don't do it.
You're better off being an intrapreneur, which is great. It's fun. I keep going back to our other conversations, but. You are [00:22:00] amazing at developing all kinds of amazing things. When you're in an, when you, if I don't wanna evaluate just going off of our conversation, when you've been put in an environment that is supportive in nature and they cut you loose, you create all kinds of amazing things.
And I think as an employer, people watching this, you should look for that talent. You should look for that person who you're like, you wanna start the women's health program here? I'm gonna give you 5% of the revenue that comes in with that. That's net revenue, net expenses. Why not, right? You wanna start an aftercare program?
Great. Let's do a fee split arrangement on that. Be a little creative, right? Now sometimes people are watching or listening to this saying, yeah, that all sounds great, Brian, and you're talking about the talent, but how do I get the talent to sit here next to me? I don't know. Sometimes you need to do a sign-on bonus, or maybe sometimes you need to do some sort of incentive plan.
Why don't you do crypto? I'll buy you Bitcoin. I Why? Why would I give you like a. Annual bonus of $3,000 come Christmas, that $3,000 is only worth $3,000 will with inflation, is probably worth less even when I give it to you. But if I give you the equivalency of $3,000 in Bitcoin and you [00:23:00] put that in your account, who knows a year from now it could be worth $9,000.
Or I had somebody say, Hey, somebody, I gave 'em the idea. I said, you live in this rural part of America and you need people to wanna buy and die and live in this neighborhood and raise a family here. 'cause this is where you live. Pay a point down on their mortgage. And they're like, wait, what?
I'm like, yeah, why? Why am I giving 'em a cash check? Let 'em come here. Tell 'em to sign a five year agreement. They sign a five year deal, you'll pay a point on their mortgage If they're gonna buy a house, let 'em test it out for a year and then they can test the water and say it's a gift. We'll never stop giving, right?
Just be like out of the box thinking. I think that's what 2025 is all about. So I don't know if I answered your question, but I think the characteristics are. Good communicator, high degree of confront, don't be risk adverse and above all else, spot the reality that you can't manage over disagreement.
If you can't bring about agreement and those that you know and trust around you, then you're working with the wrong people.
Marla: Yeah. Wow. That that's a lot. And the answer, and I love it. And I think those are great points. [00:24:00] Especially, you can't be risk averse. You've really gotta take that jump, that leap of faith.
And own it yourself. So I love that. Appreciate that insight.
Brian: And what if you fail? So you spent a hundred thousand dollars, so what if you fail? It's the cost of a car. Really, you're gonna be a therapist. You're gonna get another $85,000 job easy. So I'm like, what are you really risking?
Really? I don't see the, we've been doing startups for well over 10 years and I think minus one office in that 10 years, everybody's made it to their 30 year anniversary profitable. I don't know, I maybe I have a skewed opinion of it because of that.
Marla: And how quickly should you get to being profitable?
Timeline. And if you do get there, how quickly can you see people scale to 1 3 5 clinic?
Brian: Yeah, that's great. So I think how quick, or what's the timeline for break even very much dependent upon how much you spend on that build out and also equally weighted on where you choose to open now. Let's just [00:25:00] talk about that for a quick second.
What, wherever you land your rent should be 10% or less of your yearly GI or your monthly gi if, whichever bill scale you wanna measure. So get your rent under 10% of your total GI per month, okay? However, if you find a place that's open, it's a nice 1500 square foot office, and a lot of the franchises and big corporates will find these places.
They're right by Home Depot or right by a Publix grocery store, right by a Wegmans. They're in a high visibility spot. That rent may be $10 more per square foot than market ready somewhere else, but that $10 more per square foot is actually marketing dollars. So I don't take that into account on my rent.
I say that part is the part that I'm saving on spending on marketing. 'cause I've got 150,000 people walking by my window every single day. So let's, we look at that now, moving into second office, third office first. I always tell my owners, we have to understand the difference between scaling and expanding.
You have to [00:26:00] scale within your office. So if I have a 2000 square foot office, I need to go around my office and count my production centers. How many people could I have work in simultaneously in the gym at the same time? How many different treatment tables or mats do I have? Add those up. I multiply it by how many patients can I see in an hour by how many hours I'm open and I take 35% of my equation.
And that tells me, per this space I just built, that is the volume that this can support. When I scale up to that volume, it's usually a window of about 20 to 30. When I'm in that window, then I'm looking for my next spot, and my next spot has to be within 30 minutes of this location. So I can have some economy of scale, no closer, no three hours away, somewhere between 30 minutes to 60 minutes.
I try to stay right in that window so I'm not cannibalizing off my first location, but that I can actually start building a footprint. And the funny thing about a footprint, when you get three locations all within a market space, your multiple [00:27:00] valuation just went up quite a bit.
Marla: That's great insight. I love that.
And really helpful for someone who's evaluating, saying, okay, I'm ready now. I've scaled my clinic up that I'm ready to jump on another one. So again, timeframe of your most successful how quickly have people done that?
Brian: Yeah. Just to finish on that and I'll answer that just like we want our therapist to week in and week out, be 85% efficient.
That production center formula tells me if my clinic's 85% efficient, I wanna optimize my clinic, 85% officiate, and then do it again, and then do it again. I feel that if I historically look packed over the last, 20 years of doing this, we're typically breakeven within three to six months.
Definitely wanna be breakeven within three to six months. Typically wanna scale to my second location within my first three years, and then after that about every other year. For a normal family run, you and me kind of person, somebody who's, like this is all I'm gonna do. No, I'm not married, [00:28:00] no kids, no obligation.
I don't even have a dog. Yeah, okay. You can open up a clinic every year. I see that too, and that's totally fine. But it all has to come back to what is your ideal scene? My ideal scene has always been, I want to eat organic. I wanna work out, I wanna have some peace time. I wanna be able to meditate, I wanna be able to exercise, and I wanna have a happy life of financial stability with time flexibility.
So I'm not gonna throw out a clinic every year 'cause that's just not gonna align with my ideal scene. So I think hang on to your ideal scene with both hands and make the business support that don't do it the other way around.
Marla: Great. And you've really brought up a very good point. So love to ask you, what are the indicators of success, not just KPIs, metrics, and financial, what are the indicators of successful startup or scaled clinic?
Brian: Yeah. I think that is so subjective, but in my opinion, I've always felt that I do what I do and I help who I help for the joy and pleasure of knowing number one. If I can go to bed at night knowing that I've done [00:29:00] something, said something, shared something, created something, and forevermore, I could see that's gonna have a positive impact on another human being.
I take a win. If my life just boiled down to that and that was all I was able to accomplish on a daily basis, I would live a happy life. And I honestly, I would want for no more. But I created a business in the healthcare field to try and help masses of kipa. So for me, my degree of measurement has increased.
Yes, I want to have not a number per se. I wouldn't say there's a number, but I wanna have financial stability. I wanna have a degree of financial stability that I feel like kids are good. My, my wife is okay. My retirement's okay. I can afford a hearing aid when I'm gonna need it. I'm all right with that, but it doesn't mean anything if all this has been amassed, but I don't have time flexibility, so I think A plus B equals my ultimate scene, which is free.
And I think for me, my definition of freedom is when I have enough financial stability and I don't have to worry about where my next meal's coming [00:30:00] from or how I'm gonna retire. And I have the time, flexibility to enjoy it with the people that I love in my life, friends and family and my peers.
To me it's not worth it if I have all the money and the I could possibly want, but I don't have a minute to spend it. Or I have all the time in the world to sit on my porch and drink a mish malt liquor, but I don't have a dollar to get me to the movies. I wouldn't be happy in either one of those.
So maybe that'll resonate with the audience. I don't know. But it is gotta, it does have to be some something self-driven, self-determined.
Marla: Perfect. I, and that's great. Financial freedom and also being able to run the clinic you wanna run and provide the quality of care that you even set out to do. I know a lot of therapists wanna go off on their own because they wanna create that culture and that quality of care.
So we'd love to know from that perspective too, how do you advise or coach startups or practice owners to really judge the quality of care they're giving to?
Brian: Yeah, so answering that question in the early one, in the reference frame of reference from a practice owner within private [00:31:00] practice, I think one of the most common things practice owners will tell me is, I did this because I don't wanna be second to anyone in my community.
And I'm like, oh, how do you know that? It's based on my brand. What does the definition of brand what's that definition to you? It's what do people think about your business, your practice when you're not around? What do people say about it when you're not there? I know one of the proudest days of my life was standing in the checkout line at the grocery store and having two senior citizen women, Medicare women talk about her husband's coming home and he had a total hip and he needs physical therapy.
And the woman didn't even know the other woman. And she's I know this clinic, it's Cypress Creek Therapy. It might be a wait to get in there, but. You can't possibly imagine that you would be treated any better than there. And I'm standing there covering up my Cypress Creek therapy local. 'cause I didn't want 'em to see that it was me and I owned the place, but it was like, okay, that I felt like I arrived.
When people have that to say about something you built, that you built with the own two hands and that you've had that much of an influence that the people in the community are recommending. The other people, that makes me think of for a startup owner, [00:32:00] like with a restaurant, same thing with a clinic.
The first 100, I call it the magic 100. The first 100 patients you treat are gonna make or break your clinic. Honest to goodness, that is what's gonna be the do or die moment. Because if the first 100 patients have an overwhelmingly positive experience, you just put your marketing jersey on every single one of them, and that's what's gonna populate your clinic success from that day forward.
So important. So that goes back to our question of success. Am I running a net promoter score of nine or above on every single person who's leaving? Am I getting 75% or higher Google reviews from every patient who's leaving? Am I getting three success stories from start to finish, from eval to discharge on every single patient through their cycle of action within my clinic?
To me, that's what it's all about. It's not about the mechanics, it's about the outcomes. It's about the results. It's about the impression. It's the fact that I have my patients leaving my clinic having achieved optimum health and willing [00:33:00] to talk about it. That to me is the measurement of success.
Marla: Yeah.
Successful discharge outcomes NPS scores, and then being able to infuse that into every therapist that is now working for your brand and having that outcome scaled.
Brian: And it's not just the therapist today, right? Physical therapy has changed a lot from when I got outta school nine two. It's my aftercare program, my personal fitness trainers, my.
I don't know, my Pilates instructor or my massage therapist, whoever I'm integrating my physical therapy care with, I would always bring somebody into every discharge visit. Like it was normally my personal fitness trainer, and they were part of the discharge visit because then people could stay on our aftercare program or pay a monthly membership or whatever, but it's just giving more than they expect.
That's what a blue Diamond is about, right? It's above and beyond the normal. Yeah.
Marla: Now for a lot of the listeners that wanna not experience it themselves and just wanna hear about it, what are the pitfalls people fall into the first year? What would you say are the, Hey, I've seen this over and [00:34:00] this is probably the what you want to avoid?
Brian: Very good question. It's still shocking to me that people go into business without a plan. You need a plan. You need a business strat plan where no one gonna be in the end of the month, the end of the quarter, the end of the semi-annual. Where do I wanna be at the end of the year? You if I'm going to pull up to your house, Marla, and swing my car door open and say, hop in.
The first question you're gonna ask me is most likely, where are we going? Why would you get in the car with me if I don't tell you where we're going? Why don't I open up a private practice if I don't know where I'm going and I can't accurately articulate that to procure you to wanna do it with, participate with me?
Failure of having a plan lack of transparency. Some people hold everything so dear and private. I'm like, transparency breeds trust. So getting that trait and characteristic, having the degree of confront confrontation, I don't want upsets, but I want you to have a good enough skill that you can tell me anything you need to tell me while remaining comfortable in your own skin when you do [00:35:00] it.
These are the soft personnel management skills that I train every owner on a degree of confront. People respect that teacher that was disciplined, not the one that was a dictator, the one that was disciplined, the one that was all casual and anything goes, no respect, right? Can't run your clinic like that.
These people, look, if you think you're gonna make everybody happy by saying yes to everything, you have what, 13 children? Something like that. I don't know. So I have no idea how many children. I just joke. I've got two kids. Let's say I've raised my daughters and I said, while they were eight and under, I said yes to everything for a month.
Yes, you can have chocolate cake for dinner. Yes, you can go to bed whenever you want. Yes, you can watch YouTube. My house is gonna be chaos at the end of the month. I still see owners to this day trying to perpetuate to their staff members. Every women want that. They want, wanna practice like that. So that degree of confront.
And then lastly, communication skills. The art of communication of how to bring about agreement. The senior most important thing, no matter whether you run GM or you run your 1500 square foot O office, [00:36:00] is you're gonna do it with people around you. And you can't manage over disagreement. You just can't manage over disagreement.
You have to find a way to bring about agreement and if you can't keep that person that goes back to confront. Can't do it with the wrong people, that's for sure.
Marla: Plan, discipline, communication. Confront and just having that overall ability to have people wanna be part of what you're doing, wanna buy in and wanna be just as invested as you
Brian: like.
It's like when my kids are like, why did you marry mom, dad? I'm like, dating stopped when I met the woman that if I make her laugh and smile, it gave me more fulfillment than anything she could give me in return. So when you run a business and you get more joy and pleasure out of giving than receiving, whether it be money, patient visits, new pa, whatever you get just more enjoyment out what you're giving to the community and giving to your patients and giving to your staff that fulfills you.
You're in the right.
Marla: Yeah. Yeah. Great. And now I know that AI and technology is a hot [00:37:00] topic, so would love to know what pieces as a new brand, new startup owner or as a scaling, what parts of technology and AI should you use, A, to build your business, and B, to also even be your mentor, right? What do you see as a must have?
This day and age that was probably a lot different than back when you started yours?
Brian: Back when I started mine, the EMR system was just for me to. Send out claims. That's all. That's all I did. And I had to have a separate clearinghouse. So technology, I wouldn't consider an EMR software program out there today.
That's not an all in one. Number one has to do everything. Schedule management stat, like Prediction health, like the dictation portion of it. It's just a must have. Like why would I do my notes? I'm not gonna stay up till 10 o'clock at night doing notes anymore. It has that degree of automation has to happen and what you know so well.
Online scheduling, patient driven autonomy. How much more auto Look, if I need to get my car, oil changed, I call [00:38:00] anybody. I just go online and book my appointment, right? This is the world we live in, convenience. So I look at technology, I look at ai that's gonna give me the human conveniences that I need to complete an operation.
I don't look to automation, AI to, to address something for me. I still want my therapist hands up. I still want to meet my doctor. I still want to talk to my mechanic, right? So for me personally, I still want that human engagement. On the execution of the application of that function. But I want the As assistance, I want the facilitation, I want the AI automation to help us facilitate a better quality of that delivery of the, from the human being.
And I think obviously here at Prompt, you guys put a large emphasis on doing it and you do it very well. So I think that's much appreciated in our PT space for sure. But we have to have it clinically too, whether it be. Underwater treadmills or some of the digital technologies we've already talked [00:39:00] about.
There's just PEMF and HRV and all these cool things that are out there. Now, I think we have to think from an innovative mindset, and I'm sure you have ideas on that too, but also think outside the box. There's five business models. We could be mobile pt, we could be cash based, we could be a hybrid.
We get in network, out of network. There's different things we can do. So you could do a mixture of that. So it's just an exciting time. It's an exciting time to be an A therapist. I always say being a physical therapist is the second best profession in this whole wild world. It's second to a professional baseball player.
You can't, you just can't be. I don't even play in the rain. I don't have to hit anybody. I don't. And yeah, they give me a uniform. It's a great profession, but physical therapy is definitely the same.
Marla: I hope all of our listeners agree with you on that. And I would also take the point of the AI as well is it could also be your assistant.
I know I just read this phenomenal, or watched this phenomenal podcast from Harvard Business Review was how to create an AI assistant just using a free chat GPT or Cloud. And you really can create an AI system and [00:40:00] ask it questions and be your mentor. It can help you create those business plans. And that's really, it's a great alternative too if you've got some questions and you don't have anyone to ask.
Now, don't be fully reliant on ai, but I do think it's a nice avenue to compliment some of the subsets that maybe people out there don't know yet and are learning. So always a good way. Like we said, it should be augmented and assistive in your infrastructure and also in your learning and your growth as well.
Brian: A hundred percent. I couldn't agree with you more. I think the key word in that whole statement is assist, in one form or another. I think automation and AI and digitalization of so much of technology that's floating there around us, use it and use it well and use it wisely to assist.
I don't allow any employee in my company to use AI to construct anything on its own. I have no problem if they construct an email and they hit that Polish button and it, you wrote the email and now it's just helping assist you in the level of communication that you want, the [00:41:00] way you want it, formality or whatever, but not to construct it for you where you don't have to think and you're like, yep, copy, paste.
I'm not a fan of that. Maybe other people love that, but I just feel like it's dise. So I wanna still have that human participation. I like the assist.
Marla: Yep. Yep. Love that.
Brian: Yeah, that's a good way to look at it, I think.
Marla: Give us your top five tips of personal growth as a founder.
Brian: I think as human beings, we are intrinsically better off together, and so my first tip is put a lot of thought and energy into bonding with somebody in your life.
In some way, shape, form, or fashion, whomever that may be. I just think it's it allows us to be more of ourselves when we can give to another human being. So that's just my opinion there. Number 2 gratefulness. I make a point every single day for my personal growth to think of 5 things I'm grateful for.
Sometimes it's just my 24 chickens, sometimes it's the blue [00:42:00] skies and the Blue Ridge mountains that I live in, but. It's important to stop and remind myself that I'm not the center of any really. I'm really just a person who's contributing to everything else that's around me, and I try to lean into that.
I, as a personal growth, I think our heart is the senior feature of my entire humanity, and so I try to meditate, if not every day, at least every other day. I try to resonate with deep breathing to slow myself down. I tend to be quite kind of high energy in some ways. I've been told I tend to speak fast at times, and so sometimes I can run away with myself and just be like, it's all about that.
But life isn't about that. The best things in my life are when personally I can take a moment and come at peace with myself and really inhale everything that I'm immerse myself in and my environment and, that I'm actually able to it, like for personal growth, I wanna be able to [00:43:00] interpret or read the room.
Read the people, read the dynamics, read the what does this setup tell me, and what can I do to contribute to it? I think a lot of people who just can't get outside their own head, they just barrel through. And I think people feel that. Rather than being so evaluative.
I really reflect away from being a evaluative and I try to be it's an old made up British term. It's called aos, and it means I strive hard to observe the obvious. I try to aos and I think when you're living a life and you try to train yourself to that, I think people feel that energy from you.
I think they feel that beingness and they want to be around and contribute to whatever you're into. And my last little tip on that is to hold myself in check. I have a little stat sheet that I have on my phone in my notes section, and I keep a stat for myself. Each Sunday, I review my phone and I keep a statistic on [00:44:00] how many times that I acknowledge somebody for who they are as a person, whatever it is.
Marla you have beautiful hair, or Marla that was really nice of you to do that. Thank you for lunch. Things like that. Acknowledge you for who you are. That's acknowledgement. But do I validate people for what they do and what they bring to the table and what they've created or what they've done?
I just saw you over that with that patient and you did polymetric at a time. I what an ask. Well done, good intervention, great job. And I just put a little check mark there. So I hold myself because at the end of the day. The most important things in our life we measure, right? We all have a scale in our home.
We measure our body weight. Sometimes we measure our BMI, we sometimes we check our bank account balance, sometimes our credit score, our grades in school, the things that are most important in our life will measure. So I need to measure the things that are most important to me, and that's how many acknowledgements and how many validations I can give to others.
Marla: Oh, wow. I love that. Taking that back, need a little more meditation in my lifestyle. Probably 15 minutes, just not long. [00:45:00] And what are your top five professional success tips as a founder?
Brian: Yes. Read, and read some more. There's so many jumps and such a wealth of knowledge out there if you just take time to absorb it.
And what I mean read, audio books for Brian. I am audio book king. I'm in three books right now. I try to get through 50 a year, so definitely expose yourself to that. Of course, YouTube and all that. But stay away from the news, professional tips, knowledge is so important. But.
It's what you can do with it. So it's education, duplication application, and that's what I did with Meg Academy. I took all my years of traveling and all my experience being practiced of the year and selling when I was 38 and getting back in and doing it again. To put together a platform where one can get educated and then they take a quiz or a test or a role play and they have to duplicate it and then they have to apprentice with me as their live [00:46:00] coach for free, no cost to apply what they've learned.
So finding that kind of space or environment where you're getting educated, duplicating it, making sure you've rub it and you can actually apply it. It doesn't matter if I give you, if it doesn't matter if I have the car keys to a super Corvette and I give it to an 8-year-old. You're not ready to apply that.
That's the best tool, but not in the hands of an 8-year-old. It's best in your hands, right? So give you that Ferrari and you're gonna make the most of it because you're educated, you have knowledge, you duplicate what comes along with that responsibility and you can apply it. So read YouTube education duplication application.
And then probably the very most important thing, tip for professional success as an owner is just to literally know that. You have to always be creating the future. You have to out-create yesterday, you have to be creating the future. You can't coast. You can't say, this is good enough, or I'm happy with what I've got.[00:47:00]
Everything around you accelerates. Everything costs more. You have to outre yesterday and have a plan and have a scaled, measurable way to do it. I think too many owners just keep doing what they're doing and they just keep running on the treadmill and think it's gonna be heydays forever, and it's not.
It doesn't work like that. So
Marla: what I hear from you is continue to invest in yourself. You can never invest enough in yourself.
Brian: Yeah. And
Marla: any good books or what you said read any like one or two that you can give us of this really was monumental to me.
Brian: So in terms of books the book that I'm reading right now that I absolutely love is a one page marketing plan.
Fabulous book. I love that. A book I recently finished was How to Live Like a Monk Chetty's book. Excellent book. There's another book the 45 Day Plan. It's about transitioning and what the first 45 days are when you leave one position to another. Absolutely love that book, and I'm totally into quantum physics and quantum shift and.
I'm into the whole, you make your reality. And so Joe, Dr. Joe [00:48:00] Dispenza I'm into, I'm in his one book right now, I can't recall the title, but he's got several. And I'm just so fascinated by the whole physics of like how we can make our whole existence, our whole physical universe, the way we want it.
It's what we can envision. So I try to balance myself between tech. In self, growth books, but also, challenge myself in like leadership books as well. Try to balance it around.
Marla: I've got some new books to add to my reading list. Very excited. And what would you say, just in conclusion, if you were speaking to somebody who has dreams and aspirations of being a clinic owner may be afraid to take that step.
What's your one takeaway or your last bit of tips for them?
Brian: I think we can all look at our life and know that we've had some mentor in our life some way or another. It's been our grandparents, our grandmother, my mom, my dad, somebody, a brother, a sister, an uncle. And what does that mean? That means that through this person's education and their life experience that is out in [00:49:00] front of you, that preet, that's in advance of where you are.
You're the benefactor if you're willing to listen. You're the benefactor if you're willing to contribute to that relationship and participate. So I think my final message would be don't go through life in starting a business or starting a career or starting a family or starting a relationship thinking you've gotta go it alone.
This is a two terminal universe. The way I see it hey, I think the best advice I can give people is find that person in your life, friend, family, neighbor, who. Who you know and trust and who you can appreciate the value that they're providing you and that you can give back an equal magnitude because it's that relationship that coach, that mentor.
I've tried to be that for as many people as I can. I've tried to create a company that does that. Even with our billing, if my billing staff sees your numbers go flat, they call the coaching department and says, one of my clients, their numbers haven't grown in the last three months. They're doing the same.
You wanna give 'em a call? I'm like, sure, put 'em on my list. Let's call. It's just it's [00:50:00] above and beyond just keys stroking. We've met those people and for me it was my dear grandfather who just was, just the salt of the earth. He was the friendliest person in planet earth that I grew up under, and I just learned that's what it's all about.
So whatever you're trying to do and whatever conveyor belt you're on, whatever mountain you're climbing, just know it's always better with another.
Marla: So it's okay to take risks. It's important to invest in yourself and it's good to find and ask for help in the mentors, the coaches, you don't know everything.
And if you wanna start that clinic, go do it and find those people you trust to help you way.
Brian: Yes. Sorry, I say it all the time. I know. I don't know everything there is to know about this, but I'm never gonna stop trying. Love
Marla: it. Brian, thank you so much. I can't thank you enough. This has been phenomenal and I hope that we've inspired some clinicians to go out there, start their own business, and of course call you if they have any need, any help,
Brian: I'm here.
I'm happy to help. I'm just happy to be here and you're wonderful and Olivia, and [00:51:00] setting this all up. And for the listeners, I hope you guys truly appreciate the professionalism and the effort that goes in here because you can't find that everywhere. So I hope this was beneficial to people to actually get out there and do something with it.
Thank you. Thank you, Marla.