Entitlement vs. Ownership: What PTs Need to Hear About Their Careers

0:10 Good Chicago morning to you. Live from some hotel in Chicago because I don't need any of you yahoos calling and waking me up with like a like a prank wake up call. I've had that before. It's super early here, Dave. I know we're live at eight thirty eastern, but seven thirty eastern or seven thirty central is where I am right now. How you doing? No Tony today, by the way. We appreciate you waking up an extra hour early. And yeah, no Tony today. No Tony today. Tony is out. Is he at the fishing hole or something like that? That's what he's doing? They're at an undisclosed family lake house, I think it is. Oh, good for him. That's good. All right. We have a problem with YouTube. I'm trying to get us live on YouTube right now.

0:50 Hang on a second. But I will talk about us and what we did last night. And by us, I mean me. I'm in Chicago. I went to this event. There's a photo from it. I am not a great photographer. I feel like if you're at a cool event and you take a picture, it always looks like there's three people at the event. I'm just not a good photographer. But this event was full. It was the health to tech event. I flew all the way to Chicago for it. because I think it's a stunningly simple and brilliant idea and this guy alex came up with this idea and he's like a tech ceo he's got this like startup and he's worked in health tech for like thirteen years interview coming out with alex I interviewed him yesterday before the event and he's sitting there probably thinking like hey how do I get more people who might be like influential to my organization's success But then he went one step further, which is like, well, to help my success, I actually should help other people.

1:46 So he throws these impromptu like pub nights. where the formula is pretty easy. If there's a speaker, he's about to introduce the speaker last night. She spoke on using storytelling in your communications and marketing to a room full of tech people. And I remember like a lot of them were like, hmm. When I talked to her, I grabbed her, and I'll have her on the show too, because she's smart. I said, how is this usually received by tech people? And she's like, they love it, but they never do it. And I'm like, right, right, right. Everybody agrees it needs to be done, but then they're like, oh, we don't do it. It was a great event. I loved it. The bumpability, which is what we talk about after the event, was fantastic.

2:29 The bumpability for this was... The people in the room that you want to be bumping into on LinkedIn, except now you're giving them you're having eye contact. They're handing you their business cards. I got a pile of business cards like these are the these are the exact right people you want to be in the room with. And it's anti LinkedIn. Right. Alex goes into why in the interview, why it was why it's really successful and all the reasons that you and I would probably point out. people were starved for in, in human contact, uh, in person contact during COVID. This thing comes back. He has them at like this place called the yard. Do you, are there places? They told me the staff there told me they have locations in New York. It's like a cool.

3:10 We work. Have you seen this? Like a co-op? Yeah. A non, we were co-op. Yeah. They're new. Um, staff was there it was very nice it's called the yard and I made several milkshake jokes and they did not understand them I think the staff is too young I think I have aged out of milkshake jokes and I'm like this is great you guys should have milkshakes and they're like oh yeah that we'll put that on a list yeah ice cream whatever because you want to bring more people to the yard and she was like yes yeah so you can pass our cards out and I was like never mind so I wanted to retell that joke here because at least I got a giggle out of dave anyway This brings up what this made me think of was I think the number was thirty two.

3:51 Somebody wrote a book called The Thirty Two Immutable Laws of Marketing. And I've talked about them before without ever maybe referencing a list, which is if your thing is big, how can you make it small? If it's small, how can you make it big? If it's visible, how can you make it invisible? Just all the vice versa. I think health to tech events work because they are the opposite of LinkedIn. They are the in-person LinkedIn. Great event. He's doing more of them. There's one coming to New York. I did not want to wait to scope my first one out. That's why I flew to Chicago, because I think this is a stunningly great idea. And here's what I want people to do who are in health tech. I don't want you to come. I want you to come because I want to take all the good vibes and all the meetings for myself.

4:33 So don't come to these events. Don't go to health the number two tech dot com and see where the events are. So he pretty much does Boston, New York, Philly, D.C., Chicago, and then he just rotates. He has different frequencies for different cities. New York, I think he does every month. So if you're in health tech, don't go to these events. They'll be horrible for your career because you'll have way too many people to talk to. So it was a good event. I loved it. Alex, again, kudos to you. Another backstory I'll say before we move to the next topic was he's a Ukrainian refugee. He left during the war. I mean, this guy was like – he could have just done – you know, just survived, but he didn't. He came to the U.S. on a visa. And I don't know, in my opinion, there's no way to measure how many connections he's fostered so far or how many he'll do in the end, right?

5:20 There's really no way to really measure this, but this will be the meeting for several things that will happen and blow up in health tech in the future. It'd be awesome. So that's the event. Kudos to Alex. Episode out soon. See, and this is the beauty of in-person anything compared to virtual anything. And this is why, for multiple reasons, like I always jab Tony because Tony comes up with these like virtual, you know, telehealth, you know, video visits and virtual programs and this and that. Hold on, Tony's not here, so I'll be Tony. How did you find out about this? I'm like, I'm LinkedIn. And he's like, right. Yeah. But, but now I used to go to these in the city here in, in, in New York through like diff, like meetup and these different other platforms.

6:07 And it was very, it was similar. It was like when I had initial and it was like a couple of different people would talk about their software companies or they'd have a speaker or whatever, or they'd have it like an investor that's speaking. There was pitch nights. There were, you know, That's a cool idea. Pitch that. You could submit your startup, your business plan, your mock-ups, whatever. And there's a huge difference between that. I don't want to get too far into it, but I went to this one. This dude pitched. This was this was twenty fourteen or fifteen. This dude pitched like it was like the Instagram for health care images. So it was like imaging and things like that. It was called Insight Medi.

6:49 Long story short, we met in twenty fourteen and and I, we have our honeymoon in Spain in twenty fifteen. I messaged him on Twitter, DM on Twitter like, hey, dude, like we met in New York and you pitched like you didn't win or like whatever, like he he was hard on himself. I was like, dude, that was a great pitch. We met up in Spain a year later and like we've gone to Spain and Germany multiple times to see him and his family just from one of these events. Like, we – and he'll come to Brooklyn. He stayed – him and his family have stayed with us. We're good friends. We just spoke. They're moving somewhere else in Spain right now. He can't do that online. And that's just relationship building, like, you know, peer-to-peer, colleague-to-colleague.

7:32 And this is – regardless of price, regardless of insurance – This is my opinion, why there is no ultimate value in doing some virtual thing where you're trying to help someone either out of pain, out of an injury, get them back to sport, get them back to like, there's so many constraints to the virtual. And these are some of the anecdotal non-clinical stories, right? Like that guy, Alex, has a tech company. You're in a tech company. You have tech offerings. But then you get a room full of technologists that are meeting in person because their whole world is virtual.

8:14 And then they do this. That could have been a Zoom call. Why was it in person? You know what I mean? It's just fascinating. it's fascinating like the the commonalities and the differences of like virtual work or play and in-person work or play or recreation you're gonna hate the next thing I'm gonna say though so alex is all about he got first the alex is all about the in-person events he is the one fostering the anti-linkedin right the in-person linkedin alex is also a tech ceo I wasn't planning on doing this I was going to save it for his interview but I'll pop it out This is his product that he has created. So Yod, your online doctor diagnostics, he is creating a tool that you're looking at here if you're watching a live stream.

9:01 It looks like one of the handheld thermometers, like the forehead thermometers. Yeah, and it's going to diagnose what? So what you do is his goal, his vision is everybody in America or everybody in the world has one of these things that has multiple attachments under their bathroom sink. And when you need to triage, do I go to the emergency room? Is my kid that sick enough? Or they just need to take, they can write a script. You telehealth call your doctor. Boom, there's a Zoom call. But now the doctor needs more information. They might need to know temperature. They might need to look in their ear or your throat. They might need an EKG. I don't know so he's got this multi-tooled thing that bluetooth's so now when you plug it in the doctor's like all right mom like put that in the kid's ear oh yeah that's inflamed like boop that's an ear infection got it let's just get instead of waiting for five hours in the er the multiple attachment tool so it's an extension of the provider used by mom or dad or somebody not to prevent, not to replace them and not to replace an ER visit.

10:07 But gosh, if you could knock ER visits down by twenty percent at three o'clock in the morning. So this is example of like someone who embraces both. So I don't disagree with you, but in some cases it wouldn't be bad because I've done telehealth to triage my dad, not dragging my dad into a doctor's visit when I didn't need to. So that device, it makes sense to be an extension of a virtual visit, of a telehealth visit. Because when you do a telehealth visit, you don't have those components. You have nothing. To relay to a physician or a nurse practitioner or whoever, NP or a physician assistant or whatever. A stethoscope so they can hear the cough. That's just cool.

10:48 So he's at, like, he built a website. It looks beautiful. It's designed well. But, like, I'm assuming he, like, has he raised money? Is this a new development? Um, I ha I would have to ask him again. Yeah. I mean, he held me, he handed me one. Like he has a, he has a working prototype at the event yesterday. So, and he has competition. He mentioned who the competition was. He's like, we're not the only people to do this. There's another one, but their price point is, you know, five or six times higher than we'd like it to be. Alex, in my head, I was thinking, what would I pay for this, right? I started thinking like, Dave, what would I pay for? Are people gonna pay for this? He wants to make it, he wants to make it two digits, ninety-nine dollars or less.

11:29 Because I'm like, that's the way you get it underneath everybody's kitchen sink. The amount of money to build this thing that's actually accurate, that can do all the vital signs is going to be astronomical. I wish him the best. I have a twelve month old son. I would pay one hundred dollars right now for it. I would pay one hundred. I would pay I would probably pay a couple multiple hundreds for it right now. But if it worked, the amount of money this thing will need to get in front of consumers across the country is going to be raising like tens of millions, if not hundreds of millions of dollars. I hope he can do it.

12:10 Someone's going to do it. Or he gets bought. Right? Or someone's like, you're- I mean, Amazon bought one medical, right? So if they don't already have it, if they're not already working on it, then either it's not a big enough market, it's not enough where they can get the price down to sell to everyone who has Amazon Prime or whatever. I'm just being a realist. Like if he were to pitch me on investing in this, let's just say, like, I'm not saying he is, I don't know. I would not invest in this because this is, this is, going to take a ton of money to actually get done. And then they get it into some different consumer portals so that more people find out about it, know about it, whatever.

12:52 And then it's one of these things where it's, you have to buy it when you don't need it. And then when you need it and you don't have it, it's like, wait, now it's going to take two days on Amazon prime or it's going to take seven days to order it from his website or whatever. So it's one of those, it's one of those things that is more like a, what's, what's the analogy? Like it's more like a vitamin instead of a painkiller. It's like, I, I don't have like, yeah, yeah, yeah. So like you'd have to order it ahead of time and when you don't need it. Uh, fascinating, really interesting. Um, I just don't think there's going to be a mass. Let's just say, I don't know, in twenty five years, I don't think there's going to be a huge change in the amount of in-person that we do versus telehealth and virtual.

13:35 But anyway, that's my bias. Tony's here. Tony was on a lake right now. He's already out on the lake. Good. It's early. If you're on vacation, dude, you have a certain amount of hours. So he's in the back of a boat. He's wearing Crocs. So I'm about to make fun of him for that when he gets back. But hey, listen, you're on a boat, dude. You could be made fun of. What do you want to talk about next? Do you want to talk about... the thing that I brought to the group chat, the thing in New York, or do you want to talk about the guy that you have the thing in the live show? I have both ready. Let me see. Let me, well, you started off with the Alex thing. Let me go with, how about the Greg Todd rant?

14:19 that I sent in the chat. Yeah, yeah. Okay, so Greg Todd on his story yesterday posted a, I guess, so this is a post from Physiogram. Salary discrepancy, experienced physical therapist here. Annual billing, three hundred forty K to three hundred sixty K. Annual pay, one hundred and five K. So they're billing three hundred forty to three hundred sixty thousand dollars per year. sounds like an in-network practice but could be out of network as well but probably in their work their annual pay salary compensation whatever is a hundred five thousand dollars they just receive a generous point five percent merit-based raise which honestly felt like someone and I'm just quoting this this post which honestly felt like someone tossed scraps off the corporate table and called it a reward I'm curious maybe the clinic owners regional managers vp ceos can help me understand the sustainability model here how is capping a pt's financial growth while squeezing maximum billing from them, supposed to work long-term.

15:16 PTs aren't neither blind nor dumb, and burnout isn't just a buzzword. Would love some insight from the top, preferably someone other than, thanks for all you do, and pizza for lunch. Because pizza, you know, yeah. So to be clear, this wasn't written by Greg Todd, but Greg Todd screenshotted it and then was commenting on it. Well, yeah, and his comment in text form was, nobody's going to tell this person the truth. They actually get paid too much, which I was like, whoa! And then the next story of his was him verbally saying that this PT that's making one hundred and five thousand dollars per year somewhere in the U.S., is entitled.

16:00 Now, before I even say if I agree with this or not, or if you agree with Greg Todd or not, any thoughts or takeaways on the post? Got to love a nice anonymous post. Got to love it. Well, yeah, the anonymous posts. And I have flipped from being like, what's the problem? Unless you're a whistleblower. Right? Then it's fine. Or it's a legal matter or something. Other than that, I'm sort of... Now I'm anti... I got you. I got you on my side. So what is my... I mean, they're at least trying... Because in this post... That's the wrong one. They're trying to get... someone to like say like real information right they're saying like someone from a top I'm gonna hear someone from the top except this person's being anonymous they want someone else to like give them real info it's like well transparency worth both ways but right um what's the multiple what is the what as an owner three so if you want to make a hundred thousand dollars you have to bring in three hundred thousand dollars at least or or three and a half yeah well that's where they're at that's what that's what this person's doing exactly yeah exactly so so so here's a couple comments like Therapists, and I thought I knew as well, but I didn't.

17:12 Therapists, or it doesn't even matter if you're in physical therapy or healthcare, you're in some other, I don't know, you're in HVAC, you're in, I don't know, pool cleaning, yard maintenance, whatever you're in, whatever, sales, like whatever. it's at least three point five x difference of like what you bring in and then what you're actually paid whether it's a fixed salary or it's hourly annualized over the year or sal or a commission based or what or some hybrid of some combo of those things so staff physical therapists including myself when I was a new grad or when I was you know working with ed meerschen motion pt and all that and then they kept growing after I left I thought I knew my overall value and the value exchange of what I'm bringing to the table and what I should be making and what I should be getting paid versus what I'm doing.

18:06 And this therapist and most therapists don't understand how challenging it is and all the costs, all the risk to run a business and a practice, especially if you're in network. Greg Todd said, in that verbal the next slide he said you know when you're billing three hundred forty k to three hundred sixty k per year that practice might only be making sixty percent of that so I don't have a calculator in front of me but that's what's that two hundred k or something sixty percent of what of of three hundred and sixty in the in the window of three three forty to three sixty you take say three fifty three hundred fifty thousand what's sixty percent of that Uh, two, two, ten, two hundred and ten.

18:50 So they're making a hundred grand on you and you paying you a hundred. Right. So that's like... And any of the denials, any of the bad notes, if the therapist writes a bad note and they're not getting coached on writing better clinical documentation, whatever, the owners and the CEOs and the regional, whoever owns the practice, the stakeholders, me in my practice, I'm taking the risk. I'm paying you a guaranteed or an agreed upon rate. But if you're not delivering the proper notes or if there's an issue, if there's something with... uh a patient wants to report us to the board or try to sue us or whatever like the owners take all the responsibility all the risk and the staff physical therapists take no risk at all because they're being paid a salary or hourly.

19:37 Some of my therapists actually taking some risk in terms of being paid per visit, but then they might have dips in compensation when people are being discharged, our patients and clients are traveling and they're being paid per visit at a higher rate, but it's not a consistent paycheck, right? So physical therapists, and Tony knows this, Tony would agree, most likely that therapists are typically fear-based and they're risk averse and they want to have like a consistent pay. They want to have a consistent paycheck. One hundred five K. I mean, I know from some insider talks with owners recently in the New York City area, Spear Physical Therapy is paying a lot of their therapists, seventy, eighty, ninety K per year to be full time staff, staff, physical therapists in Manhattan, in the New York City area.

20:24 Now, it doesn't mean that they live in Manhattan. They might live in Queens or Brooklyn or New Jersey. That's a hard one. Right, right, right. Or they might live uptown, they might live in the, you know, Harlem or the Bronx, I don't know, wherever. But if this physical therapist is making a hundred and five thousand dollars and they're getting a point five percent merit based raise on their base salary. The problem is they're saying like, I deserve more. Like, why am I only getting paid a hundred five K when I'm billing, three hundred sixty thousand dollars a year. And I don't understand like, why not look at it as like, how else can I bring value to the practice?

21:06 Can I bring new referral sources? Can I do more new programs? Can I do what Jimmy did? Can I go and do some of these, you know, tech meetups and maybe, I don't know, start an ergonomic program for all these technologists that are all these companies, bring more money to the table and then say, hey, Can I get twenty five or fifty percent of this partnership deal or whatever? Then that's more money for the staff physical therapist. We know that reimbursement is capped or declining and there's no wiggle room there. So why fight that? So it's a psychology thing. Number one, you were taught in the brochure that you're gonna be a doctor of physical therapy when you walk in this machine. And when you come out, there you are, you have the degree. And then someone goes to US News and World Report and reads rankings of the happiest professions or the best schools or the average salary.

21:53 And you're like, great, I'm gonna be, that's what I sign up for. And that is one person to interpretation. Why don't these things happen? Or why if I bring in four to three hundred and fifty thousand dollars, am I not getting two hundred fifty thousand dollars? Fifty to sixty percent of overhead is wages. So that front desk person that preps every patient or takes a phone call, you have to pay for it. You have to bring in money to pay for Cindy. um rent and facility any any of the aids any of the the non like non-revenue producing team members billing people billing people we'll get to that if you have marketing how did you get that patient did you physically go out and with a sign no you didn't you either paid on someone to run online ads right amen so amen so fifty to sixty percent of total revenue is salaries everybody in the room yes whether they are revenue generating or not they like to get paid because they have to pay rent for their own apartments number two rent and facility costs it's usually a huge major fixed cost medical spaces too are commercial they are going to be more than the square footage that you're living in now third comes back to the first one benefits and payroll taxes I know that like a hundred thousand dollars is what you look at.

23:05 But when an employer offers you health insurance, they are paying that. To Dave's credit, he called the next one billing and revenue cycle management in-house or outsourced. It's usually a big deal. So saving a point or two or getting a better one is a big deal so that could be four to seven percent I've heard as many as I've heard some people doing ten or twelve percent could you imagine that twelve ten or twelve that's not that crazy but people don't know because people haven't talked about it uh insurance your emr ehr so technology like that that could be uh like what ballpark emr costs a hundred dollars per provider three hundred dollars I've heard I've heard some wild ranges of emr costs per provider per month Yeah, a hundred, a hundred.

23:52 I mean, I think prompt, I've heard prompt nowadays is more expensive. But yeah, in that range. You see all these things that come to fruition, yeah. Absolutely. Overall, as a review, there's like three main buckets, right? So you said like the personnel and the labor side, right? And like you said, fifty to sixty percent. Call it fifty-five percent. you got overhead at around twenty five percent, which only leaves twenty percent profit. Now, there's not a lot of there's not a ton of practices across the country that are even at twenty percent. So then there's more you take, you know, maybe there are ten, eleven, twelve, whatever, fifteen percent. So the other percentage points there that are not in the profit bucket are already in the personnel bucket or the overhead bucket overhead would be the rent like you said the utilities all the you know all the fixed costs the equipment buying new laptops buying new treatment tables building out construction building you know expanding your office opening up the next office whatever it is so yeah personnel labor uh fifty five or so percent overhead twenty five ish percent probably more I feel like Dave will agree with Dave.

25:04 Dave Cohen chiming in saying, building and revenue are two different animals. I didn't understand this, but you have to understand that different words have different definitions. Building and revenue are two different animals. Salary should be a percentage of revenue. not of billings agree with greg todd this person is in fact overpaid and it's not what they're not saying is this person isn't worth more but they haven't brought it in yet we kill we sorry we eat but we kill as a pack hey everybody let's figure out how to hunt better Instead of, and I'm not saying this, well, I don't know. I can't say this person is entitled or not because I don't know them well enough. But what you might say is, hey, why is it this way?

25:45 And then someone, a good owner will sit you down and be like, okay, my man, let's talk about numbers. Like be John Taffer in Bar Rescue. Let's break open the books. Did you know that we picked this location over that one because of this? And then this costs four dollars more per square foot times all this. You want to have, you know. a grass floor a turf floor we can do whatever that costs money that floor costs money over and over so yeah I think more I think we need more education and more transparency This is where even if I'm not going to be a business owner, me understanding how businesses work will make me go, oh, okay, I get it. That's why I can't make two hundred thousand dollars. They don't want to give it to you. These are a lot of ex clinicians who would love to make other clinicians more money.

26:28 And they're not laughing their way to the bank all the time. Sometimes they are. They get paid last and they are. Their salary is very variable from month to month. Imagine that. So good call, David. Yeah, and none of the staff physical therapists understand that. Well, I shouldn't say none. A lot of them do. I feel like more people understand. They understand that the owner sometimes gets squeezed with this profit, right? So if there's extra, depending on capacity and referrals and team members and all that, the personnel and the overhead bucket, it's easy for those buckets to be bloated. It gets taken away from the profit bucket.

27:09 There's three buckets. um it's saying uh base salary plus a percentage of collected revenue adds safety for the owner absolutely how like how how what a great motivating factor would that would that be it's like okay you're that's how sales works a lot of times there's different ways for sales like base salary but if you really want to make money my man go go hunt like let's go hunt um but that's it's a mindset shift across all the Facebook groups, across LinkedIn, whatever, like all the physical therapy groups that, that I've basically have gotten out of everyone saying, I would say everyone, like almost all these staff physical therapists are like, you know, I deserve more.

27:50 We, we deserve more because we're DPTs because we're doctors, physical therapy. We deserve more because we have all the student loan debt. None of them ever say, um, I'm going to bring in this extra fifty K or one hundred K in revenue from running groups, from partnerships. I mean, there's some there's some practice owners that have partnerships with like big companies like with on running and Strava and different brands and stuff like Adidas and stuff like that, like that. Now, of course, that takes effort. Yes, that takes effort. It takes time. And that could be you mentioned behind the scenes, Jimmy, like how how could a person in an organization like Should they ask the CEO or someone for permission for this type of stuff?

28:33 Should they ask the owner or should they just go and try to do the thing and ask for forgiveness or permission later? A lot of the therapists are not going out and being proactive and saying, how could we start a new program? How can I, as a therapist, bring more value into the practice And because I have a cushion of a fixed guaranteed salary, so they don't have downside. They don't have a lot of downside. They're asking for more upside without any cut in the downside, right? But they're not bringing any of these programs or these ideas or these partnerships, revenue, profits into the practice and saying, hey, if I bring this in, can I get fifty percent of this?

29:19 Like, cause I know you're going to have the overhead of actually rolling it out and like onboarding all the therapists. If it's a new thing and educating our therapists, like here's why we're doing this partnership with Strava or on running or whatever. Here's what we're going to do this run club. We're going to, I mean, there's a ton of personal trainers that are eating our lunch with doing like workshops and talks and running groups with like ASICs. And they're going to like the ASIC stores and the personal trainers are talking about Foot types and different shoe styles. I mean, physical therapists should be doing that. It's insane. I always say, when PTs... I forget who the guy was, but he was in a Facebook group. And he was like, look at this trainer.

30:00 This person's teaching... He was a trainer... teaching offering a certification class or a continuing education class for other trainers not a pt and this guy screenshots it drops it in a google at a facebook group and of course it's like me with piranhas yeah yeah and he's like his his bone to pick was he listed all the pathologies that this would be able to help he's like he's using all these terms for the people we help and I just chime in and I go Do we have some sort of proprietary ownership of treating people with those? If those people with those conditions want to see that person, medical license or not, this is America, baby.

30:40 They're going to do it. Are you mad he's doing it or mad he's doing it better than you? because he clearly communicated if you do this you will be more confident and competent in working with these people the dude was I'm gonna now I'm gonna be stereotyping the dude in his profile picture a little bit old older so I'm guessing he had a solidified world view I need you to have a more liquid world view that would be my hot take right so I understand that you are offended that you're not making more Tough, let's do something about it. This is not a bunch of owners sitting on a hill somewhere giggling as all their minions. Maybe there's some jackasses like that, but most of the people are bleeding hearts.

31:21 They did it because they were like, all right, this is my path forward. And this math doesn't math. A lot of these staff physical therapists, they want a boost in their base salary, this guaranteed salary, but they also don't want to go do these talks at seven, eight p.m. at these gyms, the ASIC store, whatever. You want extra money but you don't want to actually bring value to the table like if I if I had team members or therapists say I want to do this I want to do this I want to do this like then our name and our branding and you know we're getting out there more in the community like and then show me like let's track it like you did a talk you did a presentation whatever we got how many leads we got how many new patients they spent what dollars The problem is that second part is tracking it.

32:10 Well, I'm going to go do this and this and this. And then you as an owner are probably saying, okay, let's walk through how that's going to bring us business. You're just saying, let's go through the process. What if you do it ten times and it only brings us thirty percent of what you thought it was going to? Then the owner and the staff physical therapist, we can share that thirty percent. Because you are now at the same level of risk and downside. You did a bunch of work. You did a bunch of time at six, seven, eight PM after your workday to go do whatever, to do talks, to do running works, whatever. And it didn't work. And so you're only going to get paid what that... brings in so if it brought in you know thirty percent of the projection then yeah yeah let's split then I'll take the fifty fifteen percent you take fifteen percent of what it brought in uh because I had no extra time or risk my risk is shared with your risk and I didn't have any extra time other than it was your own time to do it sure now now let's look at that I'm cool with that This has been a mind, like an even more, like I understood that from running radio stations.

33:17 I would have people pitch ideas to me. And then I would have on-air talent pitch an idea for a sponsorable feature. Hey, I'm gonna do this thing every day at twelve. We could probably get someone to sponsor it. Can I get some of that money? And I'm like, absolutely. But now you're in on it with me through the whole process. Because now a salesperson has to go pitch that. That salesperson has to get paid because that's their job. They're going to take a cut of that. And then everybody in this room or some of the team is going to help produce that. That's part of their revenue. So what I don't want people thinking is, I brought in an extra hundred grand. Where's my extra hundred grand? My man, we got to pay for the machine that allowed you to do that. I had a kid who would not be able to understand this. He's like, if I...

33:58 help you sell a sponsorship for ten grand a month. I want ten grand a month. I'm like, my man, you don't own the radio station. We have to pay for this machine. Exactly. I love the fact that you're like what you're thinking in ten grand a month. Awesome. I will happily make this part of your job and you get a cut of that. But dude, I have to keep the lights on while you're doing extra money? No, you're part of it, which means you get part of it. Oh, the thing I was gonna say was, this has been a cool mindset shift for me in my new job. I'm in partnerships. So it's different than an affiliate code, right? We've all had like us share this affiliate code. That's not what partnerships are.

34:39 Partnerships are cool. And I'm just starting. I'm two months in. Cool. Here's why though. So I don't want two hundred partners working with me because I look at myself. I'm Jerry Maguire. Help me help you show me the money, baby. I will. But help me help you is first, which is I'd like to have, and I'm making up a number, because once I hit my limit on partners, like Jerry Maguire said, it's not just more and more athletes. It's deeper connections with fewer athletes. That was the thing that he wrote in his hotel room where I am now. The things we want, the things we think but do not say.

35:19 That was his thesis. That was his clarion call that got him fired. By more, what was it? Jerry Moore. Jerry Moore. So here's how partnerships shifted. Here's maybe how clinicians should look at it. I'm going to facilitate a relationship with someone, right? But then it's your duty after you sign that partnership, it's now two ways, right? So I'm looking to get twenty five or thirty partners. And then one day a month is Jimmy's responsibility to get a call and say, how do we now become successful? I don't expect me to sign a partnership and have that person just go bring me business without me doing a part of it. Now, yes, me paying that person or giving them a fee is part of it.

36:01 But to me, I like the relationship build part of partnerships, right, which is not sponsorships. It's not affiliates, not affiliate codes. It's a little bit deeper. Now that we're in partnership together, my first question should not be how much can you bring me? What can I help you do? Like this guy, Alex, like in theory, if he were to become a partner, I'd go, great, Alex, you've got a bananas idea in this in-person event. How does Jimmy help you get more people there? How does Jimmy help you, you know, he mentioned he has two podcasts. he doesn't have two podcasts he has two podcasts just on youtube and I'm like my man you got to be on spotify all your stuff your interviews are bananas but let me help you let help me help you it's all jerry maguire I'm going to take my entire career in partnerships all the leadership uh if from from jerry maguire and I did make a jerry maguire reference the other day in a meeting and it also got missed half the room didn't know it was like I think I said, help me help you and show me the money.

36:59 And I had people like, yeah. And then they were like, And I'm like, oh, it hurts my soul. But that message should still resonate with your team members, even if they don't know the movie Jerry Maguire, right? Well, yes, but I think the people that resonate with it. It's very obvious. Help me help you. You're in partnerships. Right, but help me help you is a cliche, but because it was in the movie, it's an emotional cliche. Right, right, right, right. Somebody who understands and agrees, why don't we think this way? I think Jerry's saying, I think he's saying, why don't we, the profession, think this way? And this was a few minutes ago, so I don't even know what his record was. Also, Jerry Durham's Giants beat my Phillies two out of three. I was talking smack online, and I have to eat my words because they won the series.

37:44 On the road, it was in Philly, so shout out to Jerry and his SF Giants. I saw JT Real Muto got called out on a called strike that was four inches off the plate. The robot umpires are sitting off the snake going like, all right. I can't wait for the robot umpires. Not robot physical therapist, but I want robot umpires. At least robot umpires helping on, like, didn't we do the whole tap the helmet thing? Is that not happening now? I just want, real quick, I just want a digital home plate. It just lights up green or red. Green, like a strike. Red for a ball or whatever. Or vice versa. But I don't want any, like, I had an issue over the weekend with a game and a bad call in a game with an umpire.

38:27 I was sliding headfirst in a home. I was safe. My whole dugout erupted because I was called out. we don't need human umpires for baseball at any level full stop full stop we do we we do need folks like jimmy and partnerships though partnerships help me look look right in the camera help me help you um I found this online yes yeah on linkedin the digital version of networking because I can't walk around new york city uh it's called a walk in new york reinvent your neuro rehabilitation so like right off the bat love the website like great makes me intrigued a little confusing because I'm like what is it but then it says a new kind of private practice combining self-balancing exoskeletons immersive virtual reality and personalized care start your rehab journey So this is a practice online.

39:16 There's that free discovery call, which breaks my heart. It's the only way to get in. I couldn't give you money if I wanted. I'd have to do a free discovery call. All right. I'm interviewing the guy or one of the guys behind this or somebody involved with this. And I was trying to figure it out just by looking at the website. It looks like they come to you with an exoskeleton to your house. So it's like concierge care in New York if you are a neurologic physical therapy patient, a patient of neurologic physical therapy. There is no way they're lugging this around to do house calls. There's no way. I thought they were on Park Ave South. I thought it was brick and mortar. I thought it was coming to you. Meet the team. Hold on.

39:56 Go back up a little bit. It doesn't say why you should come to us. These things? No, no. Go back a little bit. Who should come to us? Stroke spinal cord. These are all conditions. But I thought he said we come to you. Who should come to us? Come to us. I thought the first thing I saw in his LinkedIn post that led me to this a while ago. So this is a good thing. And I'm not busting chops here, Josh. But if you actually bring an exoskeleton to someone, if you lug this thing around, I've been in one of these things. They're cool. They're heavy though, right? Yeah, but you know how it is. I mean, I played with one two years ago.

40:38 By now, they might be like half as light or I don't know. It might fly at this point. Who knows? If you go to the very bottom and I think there was like an Instagram button and then you could look at their Instagram, there was a brick and mortar office. Yeah, there is an address. There is an address. Yeah, just click on that. There's like two posts on their Instagram, and one shows like a street-level office on Park Ave South, which that brings me to my next point in a second about, yeah, that first or second post, whatever that is. This one? The one, yeah, where you can see the taxi cab on the left. Yeah, and they're using an overhead harness system, too.

41:18 right oh see in the beginning I thought they were bringing exoskeletons to people in new york who couldn't get them which I don't know man I feel like a lot of people would ask for that not easy simple but not easy that would be like let's get into the like quick financial like nerdy business stuff real quick so the space looks beautiful the technology looks awesome on the website though it says that we're you know that they take a lot of in network or they take a lot of insurance including you know medicare and like some of the other payers right on the website so but on here it's a one-on-one visit it looks like where obviously I mean, at least in this video, there's a professional, I'm assuming that's a therapist, with a patient or client that has a neurological condition that's in the exoskeleton.

42:07 And also, they're on Park Ave South. Jerry says, bring on the robots. I hope he means talking about MLB, but not for physical therapy. He does. He does. Yeah. Finally, Jerry and I can agree on something. Free discovery for everyone. It's foolish. I agree. Yeah, well, let me just hammer this point for a second. So they're on Park Ave South in Manhattan. That space is pretty big. I would say, I don't know, that's at least, that's at least a K per month, a thousand dollars a month, but it's probably, it's probably ten, fifteen, I don't know, K per month. And how, if you're doing one on one visits like this, Meaning, cause there's a professional or a therapist with the patient in this exoskeleton How can you accept all these in-network insurances, including like Medicare and make a hundred or one hundred and twenty per visit?

43:00 And how can you make this business model work? Maybe we need to hear more from Josh, the founder and the physical therapist that works here. How can you cover the overhead? We're already talking. We're talking about the personnel, the overhead and the profit overhead. That overhead harness system isn't cheap either. Not at all. Like not cheap. The amount of money that they get to even put to buy the exoskeleton, to have the overhead harness attached into the. attached overhead. So it was already installed. So it looks like this practice has put a lot of money up front to get them running. The clinic was beautiful. It looks gorgeous. I love the aesthetic of it. So, yeah, I didn't even realize they were that expensive so that yeah I like maybe he got a unit that's like used and it's free or it's part of some I don't know uh some study yes something like that maybe that but even that you still have the overhead of that space the the address that's on their website Park Ave South not cheap at all but this store for storefront location not even like on the third floor eighth floor through an elevator storefront Sidewalk location, Park Ave South, very expensive.

44:10 How do you make this business model work? I'm fascinated. Maybe we need to have one in the future. Can I show you how you make it work? And this wasn't planned. This is different, not the same. These guys cut the PTs out. And I commended him for it. So this is somebody I had on the show a long time. I'll bring Yanni back. That's Yanni right there. That's Yanni Corey. Yanni was a Georgetown athlete. Yanni was playing beach volleyball in California and dove in between matches to like cool off spinal cord injury. He hit a sandbar. So like prime of his life. There's Yanni right there getting swole. Yanni then went through the system and was like, dude, we can't afford this. Or I get neuro rehab like once a month because of whatever insurance and costs and availability.

44:53 Yanni started next step, which are gyms, gym set up square footage and machines, baby and trainers. But obviously they have things like vibration plates. They have things like not so much exoskeletons, I think, but more like, like FES bikes and So a gym for people with neurologic rehabilitation. I won't even say neurologic physical therapy issues. And because Yanni was a smart dude and he's like, admittedly, he's like, I have connections. He's like, I'm a Georgetown grad. I got people with insights and connections and money. And getting this to work is still not easy. It's a brilliant idea. Yanni's goal is a gym in every major, one of these in every major city in the US and then spread.

45:36 So- I want to make sure we don't – I'm not dumping on Josh, though, from walking New York. They're doing it. I want to see how. Because let's learn. Let's steal their good ideas and give it away and see how. But I think next step – this is what Yanni figured out. He went through the system. He saw that. Park Avenue South. And what's red? What's a nexus going to cost? He's like, we're never going to get this. So he starts gyms. Yeah. I don't know if I'm a fan of doing this type of, I mean, it's different if you're, so it's a gym, but a lot of the electrodes that they're using, a lot of that, I mean, they're using right here. There's two, three people. Yeah.

46:16 I understand. I understand. Yeah. I understand. It's cheaper labor basically. Right. Well, they have PTs though. Come in and train the trainers. that's that's that's I mean I don't know if I don't know if I'm a fan of that I don't know well no I know I know what's what's better what's worse Trainers are smart. We're not geniuses because we have a PT degree. We know some stuff and we can teach them stuff. They only need to know how much do you need to know to get someone on an FES bike? Well, you need to know where to put those sticky electrodes for like the FES and all that. I figure I passed the test. Anybody can figure this out. Yeah. Don't hear. Hey, listen, you're an adult. Don't screw up. And there's insurance.

46:57 Don't screw up. And we'll fire you if you do. I like it. It's interesting. So I'll get Yanni back on. He did a ride across America. But Tony, you can't do that type of rehab. You can't do that rehab gym online. That can't be virtual. No. Well, here's what you know about neuro. It's repetitions. That's what they know. Right. He did a ride across America. He rode essentially like a jacked up wheelchair, like an off-road wheelchair across the country to raise money. He's done this multiple times. San Francisco to like DC, wild. Yanni's like, yes.

47:38 Yanni's a messed up kind of guy. I like guys like that. Where he's like, I piss a lot of PTs off. He's like, a lot of PTs will find out about us. And like, there's no PTs on staff? He goes, no, you're too, because you want a hundred and fifty thousand dollars. But also, the folks that have those neurological conditions, they have a lot of other expenses. They're trying to buy their own FES bikes at home, whatever. And they probably can't afford the one-on-one visits. The insurance won't pay for it. Exactly. The insurance is like, I'm out. You could cut different parts of it. They cut the therapist out. It's interesting. Correct. Yeah, they cut. We just said the overhead. They cut the most expensive part. You can't do that. They did. They said, fuck you, I will.

48:18 And they did. And you know who cares? PTs are griping about it. And I'm saying, look at that. Look at the face of the person who's working out right now. They look pretty damn happy. And what does that do for their entire life and their entire solar system? It shouldn't be that way, but it is. That's where Yanni's like, fine, if you're not building it with me, I'll build it myself. I love stuff like that. He's awesome. All right. What else is on the list? We have twelve minutes. You're up. Let's see. Do you want to... You're up or you are up? Oh, I was like, you're up. We're going across. How about this? I sent you the... We either got the Bo thing or your LinkedIn post about the...

49:02 What do you do in your workplace to foster excellence across your team? You want to do that or you want to do the Bo thing? Talk about Bo. I'll go find the other LinkedIn post so we have it. So start talking about Bo. I'll go click around to find my LinkedIn post that we're going to talk about. All right, this is a physical therapist, Dr. Boba Banco. I screenshotted his LinkedIn post. I'm sorry, this is the Instagram post. And it's got a QR code. It says movement assessment, one hundred ninety nine dollars with his phone number, his email address and his website. And Bo put in the caption targeting. targeting an older population for movement assessment in in person or virtually any thoughts, colors, spacing, etc. So, so Bo is a good friend of mine.

49:43 I love it. He's, he's posting this out there that that prospective patients might actually see anyway. But he's asking for help on designing this or our thoughts on this type of a banner flyer for this offer. All right. I'm stuck. And this is probably a longer, we should, I feel like an entire episode or a chunk of one in the future should be taking phrases that PTs use and using better one. Because a movement assessment, I don't, I understand what you're saying because I'm a PT. I'm worried that people are like, I'm not a dancer. I don't know what a movement assessment is. Like Shirley Sarman in the movement system, I don't know, words matter, dude.

50:26 So like, that's why I'm like not making fun of Bo. I think Bo is using phrases that others have used. I'm trying to figure out what a movement assessment is. If I'm even a PT, is that a physical therapy assessment? Is that a treatment or something different? And I think in the public that is confusing. Yeah, I mean, maybe we should hold this for a longer episode. So your dad had a stroke, right? Would he say, I need a movement assessment or I want a movement assessment? Or would he say, I want a balance better plan or a walk better plan? fix me fix my fix my walking like well yeah like and and that's that's the thing I've had I've had therapists um get mad at me and write to me because of stuff on my website around like find the root cause of pain fix the root cause of pain or like you know the word fix and you know oh well you can't fix humans we're not we're not cars you know we're not mechanics we're not broken but that person feels something is broken I just, I, you, I want to use my target customers.

51:34 Words. I agree. Like Google ads. I spent a ton of money on and back in twenty sixteen, twenty seventeen, like when I first started doing home visits and they were like, oh, yeah, we found you guys on Google. And it was like, oh, cool. Like what? Like what did you type into Google? It was, you know, it was just like a couple of days ago. Right. Yeah. Reversing. They're like. in home physical therapy or home physical therapy, Manhattan or home PT in NYC, whatever. So I was like, Oh, all right. So like just use those and have run a ton of money through them to make even more money. That's what they Google. But when they see concierge pain relief, they go, Oh yeah, that's what I meant. So it's, it is this wide net to a narrow funnel.

52:15 They don't have to necessarily Google concierge pain relief, but when they see it. So if we took that parallel and, fix, help after stroke, and then you see something, what's the next thing? I don't know if a movement assessment does it, That tells me what you're doing as the therapist. It's not, it's not, uh, so Bo works with a lot of like active folks. So I would say each post or digital flyer or whatever should be calling out each, like a specific person or whatever their main issue is. So if it's, if it's crossfitters, it's either like low back or shoulder. So it's either low back pain or shoulder. Maybe you have one flyer that's like, uh, so hundred ninety nine dollars, uh, shoulder uh shoulder tune up for crossfitters or crossfit shoulder tune up or assessment or whatever but I don't mind by crossfit and the condition yeah crossfit tells it that's your who because if you're a golfer you're like I don't need this guy right unless he says golfer crossfit tune up yeah I sort of need it because I was stuck on movement assessment as the drill and would talk people that sell the hole in the wall don't sell the drill And this is selling the drill, yeah.

53:32 But the funny part is CrossFit tune-up is selling the drill too, but for me that makes – I like that more because I can picture what I get out of a tune-up. I don't know what I get out of an assessment. Like a tune-up, broken, then fixed. So, yeah, that does sound – never mind. I know we're talking about the tune-up, which is the process, but I know when I get tuned up, the car runs better, and that's my goal. So I see it. I think it's a shorter distance to – Like, don't create chasms in your messaging that are so wide that someone's going to need to do mental gymnastics and burn a lot of calories. That's what I think the problem with movement assessment is. Then what? Well, then we put together a plan. That's too big. So then sell the plan. They'll tell you all the time, three steps.

54:14 Come to bow. Get assessed. run through a brick wall. Like you need to like do it in, if you can do it in two steps, like be like Bo. How Bo doesn't use, he did for a while. He needs to use more Bo knows. Cause if he's aiming at older adults, they- Oh, he was using Bo, he has been for years. It's a podcast. Podcast, Bo knows this, Bo knows. And it was such a great idea because Bo knows would stay the same. He's like Bo knows neuro rehab, Bo knows CrossFit, Bo knows that. I mean, if your name is Bo, You do that. All right, I found my post. Let me get this off the screen. My post, let me zoom these in here. It's on LinkedIn.

54:55 Yeah, so I took a crazy statement. We talked about how you write viral tweets and stuff. And I took a crazy statement. Mediocrity in healthcare is something we should just accept. And of course, what? We could never accept mediocrity. And then I go on to say, we didn't go through years of schools, clinics, and sleepless nights just to punch a clock. And yet- Patients still walk away disappointed with their care. Why? And instead of blaming the patients, I say, here's the real question. If you're a provider who refuses to settle for average, but what do you do actively to raise the bar, not just for you, but for your whole team? And then I use the LinkedIn poll. And for the podcast audience, I had four options. Lead by example, celebrate great care, mentor and teach peers, set up and uphold standards.

55:41 And I'll give the results or I'll give the, there's four days left in the polls. It's pretty evenly split. Right now, it's pretty evenly split between three. Lead, mentor, and uphold standards. So lead by example, mentor, peers, set and uphold standards. Celebrate great care is at four percent. So it looks like you selected lead by example, like that was your answer. I think so, yeah. So for me, I selected set and uphold standards. If I had to pick one, lead by example, of course it makes sense, but like are there there's a there's a therapist in the clinic there's a the clinic director like they lead by example but for each of the therapists like they they don't their onus is not on them to follow that like they're just they might look at it they might be like yeah that's the leader or whatever but the owner the clinic director the manager whatever has to be setting and upholding the standards because that's like okay jimmy like like person by person therapist by therapist staff member by staff member here's your roles and responsibilities here's your role scorecard here's how you're gonna be assessed here like when you come to ask for more money or like a pay raise or whatever we're gonna look at your money we're gonna look at like you know your patient satisfaction scores your google reviews like Here is how we're going to set and uphold standards.

56:56 And here's how we're going to keep you accountable. And here's the weekly calls or meetings or whatever. We're going to check in with you over time to make sure, Hey, are you, are you, cause upfront it's the manager, the owners to, it's the responsibility to set the standards and then uphold them over time. Like here's how we're going to keep you accountable to these standards over time. So that's why I selected that as the response. I changed my answer. You can do that on a LinkedIn poll. I hit undo and I changed my answer. Well, I brought this up. No one saw it. That's okay. No, but changing your answer is not a sign of weakness. It's a sign of strength in my opinion so what you made me think of was that line that I talked about the other day from adam grant what he says is the nineteen words you have to say before you give some feedback I'm giving you these comments because I have high expectations sorry very high expectations and I'm confident you can reach them but jimmy you've been doing this let's let's so that is I think setting and upholding standings might also be leading by example because if you set and uphold you're showing I picked lead by example first because I thought it was show not tell And to reinforce it, it's like lead by example is great, but it's like, it's like vague.

58:08 Like there's, there's nothing in like a standard operating procedure where you can be like, you know, like they lead by example is subjective. Set and uphold standards is objective. You either did it or you didn't do it. Got it. Okay. I changed my answer. All the other stuff is great, too. Like, they need to be mentored and taught and trained and coached along the way. That's important. And then celebrating great care, like, oh, like, you know, we have a team meeting and, like, you know, Jimmy wrote a Google review about, you know, Dr. Tommy. Like, let's read that Google review out loud. Like, let's, as we're talking, like, as a team. let's read some of these google reviews let's read some of these comments let oh mary you know sent us a handwritten thank you note or a card like let's read that out let's show let's pass that around yes you want to celebrate great care and the experience if you could only do one setting up whole standards because they're repeatable no doubt and measurable and what gets repeatable and measurable Amen.

59:03 All right. Sixty seconds. This is good timing. Parting shot. We are crisp today. We are crisp. Parting shots. Let's go back to the Greg Todd thing. I didn't say it earlier if it was not clear. A hundred percent agree with him. I don't know if I have enough information to say that they're overpaid, but I do feel like there's some amount of entitlement there. And the parting shot would be if you want to be paid more, You have to think of ways. You bring ways to the table. You bring ideas. Here's a game plan. Here's a strategy. Should I test this out? Should I go do this on my own time, whatever, at nights, weekends, whatever?

59:44 How can I bring more value to the practice? Can I bring more patience, more revenue, more partnerships, whatever? physical therapists out there watching, if you're listening, watching, think of that, bring that stuff to the table. Don't say like you're in this in-network model where everything is capped, so there's no more meat on the bone there. You gotta go find meat somewhere else. The meat is at the gym, it's at the running shoe store, it's at the library maybe, I don't know, the CrossFit gym, wherever it is, at the coffee shops, the yoga studios, the Pilates, other business owners in the area. How can you help the practice owner transfer some of that value?

1:00:26 And then they should absolutely be open to giving you a bigger slice of that pie. My parting shot will be Jerry Maguire, right? Help me help you. Help me help you. Should be your mindset. Be the agent in Jerry Maguire. Be the partnership guy. When you lead with that, look at Alex from my event last night. Dude's like, I'm going to create a space for others to succeed. And then Alex gets to ride that wave. Like, dude's a smart guy. And then every once in a while, my final parting shot, we'll speak for Tony's. Every once in a while, unplug, do nothing, be on a lake, and be comfortable wearing Crocs. We'll see you guys on Tuesday.

1:01:06 Follow Learn Medicare Billing, Dave Kittle Show, and PT Podcast. And maybe we'll come to New York. You want to come to the next event with me? It's going to be in New York. In the city, yeah. Let's do it. In the city. We'll do it. All right. Anybody else want to come?