Why PT Clinics Must Sell Transformations, Not Visits

0:02 Broadcasting way too early from three separate Wi-Fi connections. It's PT Breakfast Club with Tony Meritato, Dave Kittle, and Jimmy McKay. All right, good Thursday morning to you. Welcome to PT Breakfast Club, the only morning show where physical therapists, clinic owners, and rehab rebels gather twice a week to talk about the business of keeping humans moving. I actually wrote down a note from last episode, so I actually know what we're talking about today, which is rare. That's a lie. I just went back to a transcript of the last episode and asked ChatGPT what the hell we were talking about. Today, we're digging into the big business idea that came out of last show.

0:42 How do you spot the as the two hundred and fifty dollar patient because the truth is some patients come in for six visits and disappear and that's okay others stay with your clinic your business for years they bring their spouse they tell their co-workers they bring their kids soccer Time to become the people who generate the most revenue and the most referrals. Here's the twist. Every clinic only has three ways to make money. I want to reiterate this. This is one of my most watched videos on YouTube. Remember, you can find more people to help. We focus on that one a lot, I think, Dave Kittle. Find more people. We need more people. The industry does, yes.

1:23 Find more people. Get more people. There are only two other ways to do it. Help the same people more often. Help the same people that you found with more things. That's it. I want to simplify it. I got so many great comments from that little reel that I made on my back deck last summer. I need to reshare that thing. But before we kick in, how are you doing today? I'm great. I know we're talking about patient client payments. We're talking about money. I got my green polo money shirt on ready for this. So you think about your outfit. I pick what is physically closest. Oh, not usually, but today I did. Okay. We are one Tony Light. He will be back next week.

2:03 He's running some sort of business, which he's got there in Ohio. Oh, PT practice. That's right. He's probably got us on in the background. He's probably teaching his patients the lessons that we're looking at today. So today we're actually asking, can you identify those patients today? This was prompted by last episode, Dave, where you talked about this one patient who, I mean, you said, and it wasn't a flex. It's just, let's talk about real numbers. This person has generated seventy grand over the last couple of years and has the means, sees the value. And after they give you money and get this, they are happy and happy. They don't have to come back. This isn't a stick up. Right? They understand the price.

2:44 They're not surprised. They want more. They want Mo. They want Mo. So the question is, how do you identify those patients early? And if you can, what should you do differently once you spot them? We also want to make sure that this... And Tony pointed out in the group chat before the show, he's busy running his insurance-based practice or mostly insurance-based practice. This works for both. This is not just for... concierge pain relief clinics of the world. This is human psychology. This is human psychology plus human economics. So let's get this going. Do you want to make sure that we get paid? Because if you're going on a podcast, you have to make sure you get paid for your sponsors.

3:24 So today, our sponsor is the Range of Motion-O-Matic. This episode brought to you by Range of Motion-O-Matic, the world's first automatic range of motion training device. All you have to do, Dave, is strap your patient in, set the dial to, it actually says full send, full send. I don't know. Do the stretching for you. Tight shoulders. Ranger Motion-O-Matic. Frozen hips? Rahm-O-Matic. Ankles that move like concrete? Rahm-O-Matic. No problem. The Rahm-O-Matic gently, repeatedly, and occasionally aggressively moves the joints through ranges they haven't seen since nineteen ninety seven.

4:04 Rahm-O-Matic because if it clicks, it's probably working. Go to Rahm-O-Matic dot com. What do you think of the graphic there, Dave? I told it to give me nineteen nineties infomercial vibes. How does that look? I think it's pretty on target. I was going to say late eighties, nineties. Yeah. Perfect. Marshall's perfect. All right. So that's the Robo medic. That's what we're dealing with. That's what we're dealing with today. Okay. And the, the, the headline or the sub headline there, set it and regret it, which is hilarious. You said it and regret it. You'd regret not owning this piece of equipment. Look at that red, look at that red button. Like it just looks like a Commodore sixty-four kids. A Commodore sixty-four is like a PlayStation, but bad.

4:44 Okay. So now, Some patients come in for six visits, pain relief, discharge, gone forever. Some stay connected to your clinic for years. If you run a clinic or you worked in a clinic, you know these people. I call them frequent flyers. I call people who help you keep a clinic float. How do you spot them right now? There's the million dollar question. Ten years from now, you can look back at the data. But how do you spot them preemptively? And would you do something differently? We had Ben call in and we'll put the phone number up on the screen in case people want to call and give suggestions or you can drop comments. We have some comments coming in. I'll put them on the screen about some suggestions of what to do with people like this, like sort of a reward. Right. You come in often. I mean, I used to live in South Carolina.

5:25 The restaurant manager saw me and my dad coming and we're like, those guys, cheesecake all the time. Free cheesecake. Those guys are great. What are you guys drinking tonight? Cheesecake. That made us feel something, right? Jon Taffer talks about this all the time. I love it. We'll dig into that too. There are just as a teaser, as a little hook, I know we're kind of into the show already, but there are certain, what I've seen, certain diagnoses or conditions or certain avatars, certain type of clients, certain types of services that you're delivering that tend to want to spend more over time and stay with you as opposed to not. Some of them I think are obvious. Some of them are a little less obvious. We can get into it a little later.

6:06 I think we should start with that because how do you spot these people? How do you do it? And then we're going to have some celebrity insights from some professionals in different worlds of marketing and psychology. But what do you do, if anything? How do you do this? I never thought about this when I was in a clinic. This never dawned on me because I was a staff clinician and I was just excited to have a person in front of me. Great. Well, so first of all, disclaimer, we're not treating anyone differently than anyone else, right? We're not picking and choosing. It's not like I'm going to treat someone who's like Tony Meritato any different than Jimmy McKay if we were treating both of them.

6:47 We're not going to treat them any different. However, typically, if someone is going to spend fifteen, twenty thousand dollars a year or something like that with us, and they're spending or they spent twenty or thirty thousand dollars total over whatever amount of time or more. Typically it's someone who's older. They have some amount of discretionary income, or we've had this situation where it's someone who's also usually older. So it's in general, like the older someone is, the more that they are investing in their health and wellness. They care more about longevity. They care more about going from episodic physical therapy to, oh, you know what?

7:27 I want to keep you around. And then that physical therapist is now like a combination of physical therapist, health coach, personal trainer, for lack of a better word. wellness, performance training, lifestyle modifications, all of that wrapped into one person. And it's kind of like, okay, well you got me out of the episodic neck pain or back pain, whatever it might be. And now I would like for you to continue, you know, week by week. And then it just kind of continues over time. Now there's like usually smaller goals set up in between. Like I want to be able to, the client wants to be able to walk outside and get safely in and out of an Uber or a cab or something like that. And then it's like, I want to be able to get back to getting the newspaper or walking to a friend's or shul or church or whatever, like the socialization point is in the neighborhood.

8:19 Then that's the goal. Or walk around the, get to Central Park, first of all. Then it's walk up the steps at the reservoir. And then it's walk around the Jacqueline Onassis Reservoir in Central Park. So it's like, it's a, it's a type of person too, that like they're motivated. We're making incremental, we're hitting incremental goals over time. And they're, and they just are like, okay, well obviously I like and know and trust this person. They helped me with the last goal or two. And it's like, I might as well just keep them around to continue this. Then it's, then it's getting them back to, right. golfing in their you know putting in their living room and then it's getting back to the golf simulator to chip and then it's getting back into the golf simulator to drive the ball you know not just chipping but um you know driving and and ripping off the tee so those are the types of folks condition wise it's usually some combination of balance gait it's some neurological conditions typically but not always sometimes it's um someone who had a hospitalization and then we're seeing them initially when they're like coming out of that, like they're like the first week home from a hospitalization or a big procedure, like a brain surgery, a heart surgery, a total joint, spine surgery, or it was a fall.

9:39 Those are the types of folks. It's usually not a twenty-year-old that has an ankle sprain. Though for us, like I'm not saying this works for this does not work for everyone. So a twenty year old with an ankle sprain is not most likely even in New York City, not going to spend ten, twenty, fifty, seventy thousand dollars with us typically. So I'm going to do avatars. Because this is best to guess, right? There's no magic question, but questions can be magic. So I'm going to break it down to the three avatars. I sat here at my coffee this morning and I said, how would I look for these people? The third one I'll give you is very counterintuitive. And it made me go, huh, I wouldn't have thought that. But now looking at it, I did.

10:19 So that's number three is counterintuitive. Number one is the identity builder. You touched on it a second ago. I just want to put a name to it. The identity builder is I'm a runner. They have an identity built in. I am a runner. Hi, I'm Jimmy. I'm a runner. I can't run right now. That's not okay. Those two things are not in alignment. So I can't run. I'm looking at you. Can you help me run? I need to go with you, through you, to you. And currently right now, I can't run. All I want to do is get back to running or golf or whatever it is. You spot that person, and I want to make sure we have tactical things. So this is what you should look for. I want to play Chris Voss now.

11:00 Listen for things like... I'm working on this. And then they're like, they're watching you. I'm working on that. I'm doing this now. I bought this thing. I changed my shoes. And they're looking for like, what are you talking about? Validation. Questioning. Or to shut something down. Yes. They're putting this there. And at first... You might look at that as like they're confronting me. No. A lot of the times what they're doing is they're going, I'm doing this. What are your thoughts on that? That's how people, some people interact. That's how I interact. So I'm doing this. Here I am. You know my foot. You've seen my Ramamatic and it's not good.

11:41 I bought this thing on the internet. What do you think? They're not questioning you. They're not questioning you or your knowledge or science. They're going, I'm doing this. You think they want our input? Yes. Underrated, overrated. Like you should play underrated, overrated with your patients. There we go. That's great because that's really what they're looking for. Insight. So I'm working on this. What do you think about that? I'm trying to stay ahead of this injury. Like they're coming in with, wherever they are, they're like at a two and they're like, I don't want this to get to an eight because in my brain, eight means I stopped running. I am a runner. Yes. We're at a two. I don't want a four because an eight means I stopped running.

12:21 So they're asking questions that might sound like they're challenging you. They're not. They're not. They begin to see themselves as someone who invests in their body. That's an identity builder. I'm a runner. This is what I do. And if this keeps going, I won't be able to do that. And then what am I? So look for, that's the first avatar, the identity builder. The second, this one is very obvious. The third I'll get to is counterintuitive. This one is obvious in my mind, the referrer. Some people like to be connectors. I am a connector. That's part of my identity. I built a Facebook group, Dave. You know this. And the name of the Facebook group is PT to PT Referrals.

13:05 That's the gag. It costs you zero dollars. I got tired of seeing people in other Facebook groups all over the place going... Hey, I got a patient who's moving a date in Ohio. Anybody know someone? I was like, this is a common question. I'm going to create a Facebook group. Now that's the only thing you're allowed to do in it. I kick you out if you post crap that isn't that. That group, by the way, has made me like, I told you before, I think I've made like ten or twenty thousand dollars in top line revenue from that group. Fantastic. From referrals. Here's what I found. From people that probably wouldn't have found me any other way. All I care about is someone found someone else who's good. The right person in less time who's good. That's all I care about. So avatar number two is the referrer. They send you a spouse, a coworker, a buddy, a friend.

13:48 They like to be the person in the office when someone's like, my back's really... It's like, oh, I got a guy. His name's Dave. He hooked me up good. That person. Hug that person. When a random person comes in, you're like, and you should be asking, hey, how'd you hear about us, man? Was it the Google box? Was it AI? What'd you get? Was it the park bench that Dave's advertising on like this? No. My buddy, Steve, he's in my office downtown. He told me to come see you. Great. I don't know, man. Maybe in your EHR, like the guy who sent us likes... Starbucks, old fashions, whatever. Hey, man. Thanks. Appreciate that. A little like a like a twenty dollar. I see you. See you, man. At that point, you're not just their clinician.

14:28 They've got you on speed dial. You're their trust. You're my guy. Like if somebody has a car problem in my town, I'm like, Justin, don't go to anybody. Go to Justin. Just Justin. Why? Because I trust him. That's what you're looking for. So that's Avatar, too. By the way, that type of person, that's the connector that someone else in the office says that they have back pain. And then you're like, oh, I mean, you have to go see Tony Maritato. He's the best for... I know he doesn't really like back pain, but if he traded back pain like he used to, oh man, you got to go see Tony Maritato. He's great. The person that is making the referral, that's putting themselves out there and saying like, you got to go see my guy, Tony Maritato. There is some... status around that like they they their their ego gets boosted because they have they have the intel that the other person they have some secret information which is i have this great physical therapist that is as excellent or like they don't really advertise because they don't need to and they they do something special right whether it's like for us like sometimes it's like high profile people or celebrities or whatever sometimes or And Tony, it might be like someone could say, you got to go see Tony Meritato because he's like the most popular knee replacement physical therapist on Facebook and YouTube.

15:41 He gets millions of views. I went to him. Don't even balk it. Just go. And now that person gets validation. They feel better about themselves because they're They helped, and they know that Tony is not going to let them down and make them look bad. Yes, yes. They trust you so much, they can't wait to be. And it's also part of them. These people don't do it for a referral payment. They don't. I did this yesterday. I won't say with who, but I was like, hey, man, we got on a call, and I was like, oh, I know three people that can help you. I don't know if they will, but from what you just told me, call these three people or, hey...

16:24 I'll email them and CC you on it. Is that cool? And they were like, you'll do that for us? I'm like, yes, I like being helpful. Look for these people. Those are the referrers. The third avatar. This sounded counterintuitive. This sounded opposite. And then I realized it was my own emotion keeping it out. The question asker. This is different than the identity builder. They are also asking questions. But this person at first feels more... combative with it like you might be like well why is this this person is testing me you as the clinician might feel this person is testing me they're not so they're asking things like why does this keep happening what should i be doing long term how do i prevent this they might feel a little spicier questions or or more or rapid fire than just the identity builder right the identity builder is talking about them I'm a runner.

17:18 What should a runner be doing? Where the question asker is like, why does this happen? Why do people get this? They're asking broader questions. This sounds like they're questioning you as a clinician. They're not. They are the question asker. They want understanding, not just treatment. Here's the thing. If you keep playing a game of tennis with them, the goal is not slam the ball and get it past them and win. Just ping pong it. Let's get it to the other side. The goal is not put the seventy eight page CPG in front of him and be like, I'm doing this because of page twenty six, twenty eight and twenty nine. That's not a win. The goal is not to win against the question asker.

18:00 The goal is to answer their questions. Every time you answer a question and they're satisfied and they might Google it and be like, oh yeah, he's right. Every time you do that, it's another brick that you're building in this castle of trust. I'm using metaphors today. Tony would love this. They go from, this is their journey, they go from curiosity to ownership to adherence to long-term relationship. The question asker is harder to win over. The game is not slam the ball by them. The game is just keep going with them. If you don't know, do not fake it with the question asker. Everything's gone if they find out you're lying or making something up.

18:43 Be truthful in the long game over and over with a question asker, and then that person will become a long-term relationship. So those are three. There are probably more avatars, but those are the three that I came up with as I was sitting here this morning thinking about them. Ben is saying – hold on. Ben is saying – You have to get them in like same day and don't. Oh, yeah. I think he was saying this with if someone like if I'm like, oh, my guy, my guy's Tony. You got to go see Tony. Like if someone calls me, hey, Tony said I should come see you. I think that's what Ben is responding to. You got to get them in. Because you have to like now make it look like Jimmy sent me here.

19:24 Oh, Jimmy sent you? I'll get you ready. Don't worry about it. Let me open this side door. Don't come in the front door. That's for everybody. You're going to go in the side. I got to use this code, go in the side door. Yes. Agreed, Ben. And that costs you nothing. That costs you maybe rearranging your schedule a little bit, which sucks a little bit. It's a little bit. It's worth it. He's right. So the thing, yes, we absolutely pride ourselves in being prompt. we want to get someone in the same day, just like Ben said. The challenge for practice owners and business owners, at least for me out there, is that I am not trying to have any more new patients. So sometimes I'll get a referral and it'll be like someone who already had my phone number, right?

20:05 So they send me a text and they'll send like a joint email text intro without me without even a heads up sometimes or it's an email intro or whatever or or someone someone calls or texts my personal phone number which is fine because that means that that means the existing clientele felt comfortable enough to share my information and i probably said at some point it's it's okay to do that or whatever And then when that person says, oh, I get a phone call or a text from Tom and Tom's like, oh man, Anthony said you're the best and he knows you and all that. I have back pain or whatever. So for me, it's like, I'll handle it, but I'll have to let them know right up front that it's not going to be me treating them.

20:51 Cause I, again, I'm trying to grow the practice. I'm trying to grow the business. So I, the thing with Ben said is I, I do pawn them off to another PT because I'm, I'm saying I'm not treating that area anymore. Dr. Andrew or whoever is treating that area. You shouldn't say that. Rory Sutherland would tell you not to say that. They would say, hey, man, I got you. You're doing low back. I got to be honest with you, though. I'm pretty good at back. I got a new guy on my team, though. Just stole him from a practice across town. This guy's elite at backs. I'm going to put you with him if that's cool. Do you know what I mean? Stupidly dumb. Rory Sutherland's all about the framing. We'll get to that because I'll bring in some celebrities.

21:33 But yes, exactly. But you never say no. You just keep the red carpet thing. Hey, I don't have a table. It was great, right? I can never... All these movies jumbled together. But like... casino all the all the gangster movies jumbled together right because they're all kind of the same vibe but it was like oh we don't have a table and then all of a sudden they put like this tiny table in this like awkward spot but now it's cool why because there was no table we made a table it's a crappy table no no it's elite no one can get that you can't walk in and get that you ever been backstage at a concert before i haven't but i'm sure you have It's the crappiest place to watch a concert.

22:14 It sounds the worst. It sounds the worst. It's the status of being there because no one else is there. There's hundreds, thousands, whatever people in the crowd, and there's a handful or dozens of people back there that all have badges that have the access. When I got back there, I could not wait. I'm like, I'm going backstage at a Lizard concert. It's going to be great. And I'm back there and it smells and there's just crap everywhere because that's where they keep all the cases for all the equipment. And I'm like, where's the lounge? And they're like, I don't know. What lounge are you talking about, dude? This is backstage. I'm like, holy crap, this place sucks. But yes, that's why it was cool. Fun fact, if you want to experience the concert the best, if you're buying concert tickets, here's your life hack.

22:57 Look on the little map. If you can figure out where the soundboard is, sit as close to the soundboard as possible. The person twisting the knobs and making the whole concert sound great is doing it from that location. It's not always in the center, but it should be. Sit as close to the soundboard as possible. That's zero. It's ground zero. Okay. Um, and Dave saying, but that is still some, uh, sorry, Ben is saying, but that is still some of your mystique and shtick. It's, it's a purposeful barrier. Yes. You are the speakeasy in the back of the taco shop. That would be a great duo. I would go to a speakeasy in a taco shop to burn two of my favorite things. I do. I got it. I got to take you in the city. You know, the, the place real quick. Um, oh my gosh, there's a hot dog place.

23:37 A little hot dog in like the village in Manhattan. Okay. You know, like the little places like down a few steps from the sidewalk, down a few steps. And it's, oh my gosh, I'm blanking on the hot dog place. Criff Dogs. Criff Dog Hot Dogs. And inside there, you go through a phone booth and it's a speakeasy. I love, there's one that's in a laundromat. Like you have to go, you have to like, it's like the third dryer from the left. And then you have to put like fifty cents in and twist the dial left, not right. And then the whole thing opens. And then you step through and it's like a disco. It's stuff like that. It's just like the experience. Did you know there's a bar inside Grand Central, like a hidden bar inside Grand Central Terminal? Yeah. It's like the, it's the station master.

24:18 It used to be the station master's apartment. And I went there once and like, believe me, drinks are like twenty eight dollars. But you're like, this is like everything's marble. So you go. We'll go for one. We'll go for one. What would you like? We'd like a vodka soda. And what would you like? No, we're splitting that. We're going to have that. We have that in two guys and the bill right now, please. Right. But that's part of the schnick. You can't come. That's why it's cool. So those those are the three avatars I would say to look out for. None of this is magic. Do not judge people by their clothing or what they do for a living. If someone's like, I'm a plumber, I'm like, my man, you own a plumbing company.

24:59 Stop thinking that way. Stop thinking that way. Don't think. Let me double click on this. Of course, we have some folks that are ex attorneys like they were they were partners they were in big firms they're in they have big apartments in manhattan they're on fifth ave their own park ave yes of course those are those are the identity builder folks yes it's it's fairly obvious to observe as soon as you as soon as we get the street address if we're doing home visits or even if they're coming to our office but we from the paperwork we know they're you know we know their home address so we know where they live So we kind of know like based off of where they live, let's be honest, like in Manhattan, based off of where you live, you kind of can make some of those assumptions, right?

25:43 However, I had someone in a neighborhood in Brooklyn that is not like the wealthiest or nicest. The thing is, is that they were spending like thirty, thirty five K a year with us. but it was the sons and daughters that were paying for it. And there were like eight or nine sons and daughters. So it was probably spread out across them. And that was a little less of, not even any of those avatars, just kind of like, maybe a little around identity, but it wasn't like the obvious one, like the attorneys that we have that are, you know, sixty, seventy, eighty years old.

26:27 Yeah, yeah. So but for us, at least our experience is that most of our clients have spent tens of thousands of dollars with us. Seventy thousand. I even did you hear their story? I put on my show before that we had this ex pharmaceutical represent up representative ex pharmaceutical executive several years ago. And they were doing like seven days a week PT. They were mixing in some soft tissue work massages, but the massages were delivered by our physical therapist at the physical therapy rate. And that guy spent, you guys can go check this on my YouTube. This is another humble brag, but that guy was spending like a hundred and fifty K a year for a couple of years in a row.

27:13 Just one client. Just one client. It was a lot of coordination on my side because I'm coordinating. Obviously, I wasn't doing seven days a week in Manhattan. It was multiple therapists. I was coordinating everything, all the continuity of care stuff. helping them with DME, durable medical equipment, and different safety things. I helped them install grab bars. I didn't do it, but in terms of finding the best grab bars and the positioning and location of them and all that. You keep saying you didn't do it, but it wouldn't have gotten done without a couple. If you're the originator, the facilitator, the installer, it don't get done. I need it done. Half done isn't done.

27:53 Three quarters done isn't done. Eighty-nine percent done isn't done. And you don't get your posture fixed unless you use posture corrector. Three thousand fixture. This is the same guy, the same actor. Yeah, he's not an actor. He's a piece of present. He's a professional product presenter. Fixer. We're not. posture corrector three thousand the revolutionary wearable device it automatically buzzes beeps and mildly shames you who if you slouch bad desk posture text neck rounded shoulders it plays a recording of your pt saying chest up shoulders back you know better now with public accountability mode which loudly announces posture failure detected PostureCorrector.com because awareness is half the battle.

28:43 Humiliation is the other half. Find us online at PostureCorrector.com. It's always a .org because they can't afford a .com because they're not selling enough units. They're not hustling hard. All right, so let's go strategic twist. Halfway through the show, now we bring in the celebrity guests. This is how you keep people watching the live stream. So the question is, how would other big, beautiful minds think of this? So I brought in the power of AI. I said, what would people like Gary Vee or Seth Godin or Rory Sutherland or Chris Voss or Chris Doe do about those things? And here's what they said.

29:23 Now, this is going off their avatar, like the Chris Voss avatar. Chris Voss, famously the former FBI hostage negotiator turned book writer and, I don't know, strategic advisor to companies. Chris Voss would uncover the real fear behind the injury. Chris Voss, of course, would say, if you have five, ten hostages in a bank, I can't just be like, oh, I guess we'll split the difference. So Chris Voss is saying, talk to the person more. Find out the real fear behind the injury. Do that. Get into that. And if the person, if you get to their real fear... Oprah said people want to be seen, heard, and understood. Chris Voss, of the same ilk, if you can see me, hear me, understand me, I will stay with you because finding another person like you is a pain in the ass and expensive.

30:12 Rory Sutherland was the director of Ogilvy, one of the largest advertising firms in the planet. This is where the reframe comes in a second ago when I told you not to say that, but to say this. Rory Sutherland, that's where I stole that from Rory Sutherland. He would say, don't say I'm not providing the treatment. Saying I am going to step out of the way because I have the best back person and I'm going to slide you into them and you'll be appreciative and it'll feel like a yes and and not a no but. Rory would say, reframe physical therapy from repair to optimization. Rory would say, you never discharge. Rory would be one of those people who'd say, don't discharge. He would say, we're going to now continue to make sure you are hardy for life.

31:00 Thoughts on Rory, thoughts on Chris so far. Chris Blossom, Rory Sutherland. The, the thing that Chris Voss, you mentioned, I feel like I know I have done historically and I hope I need to be coaching my therapist better if I'm not already, but definitely we talk about it in terms of the, cause they, cause from the Chris Voss angle, the patient, our clients, they don't care about your therapeutic exercise, your, what type of manual therapy mobilization of the shoulder or the back or the gate training or the, they just care about getting back to what they want to get back to. So a lot of times it's like they, we, we have some, we have with home visits and on demand visits.

31:42 Like we have some people that like, don't want to do gate training or walking in their hallway because they don't want their neighbors to see them look vulnerable. They don't want to, they don't want, they want to stay in their apartment. So sometimes the apartments are big enough where that makes sense. And okay, that's fine. But yeah, It's always best to have like a better runway. Right. So why wouldn't we use the hallway or even like the lobby? But then the lobby is you you might be seen by other neighbors and the doorman who historically you had a higher quote unquote status over like over the doorman. Like it's just these unspoken things. Now, all of a sudden you're in a wheelchair or you're in a walker and you're looking vulnerable, you're looking lesser than.

32:24 if you can speak to how our or your treatment approach, your service, We'll get them back to walking if it's possible. Obviously it depends on the client, depends on the prognosis, their situation, their motivation. It depends on all that. But can you lay out a game plan, a treatment plan that's going to focus around the things that they really care about? So it's like, I didn't even do a great job at this with this particular client that we're anonymously talking about that spent seventy three thousand dollars with us recently, like over the almost in the last year and a half or whatever. it was kind of like episodic, like, all right, you came out of hospital, like, let's get you moving. Let's check your vitals.

33:04 Let's observe your vitals all the time. Then it was like, okay, that's better. That's stable. Your vitals are stable with walking. Now it's, let's work on your balance and endurance. And then once that got better, then it was like walking outside. And then once that got better, it was walking, you know, my other therapist was with him and walking him in the park and around the reservoir. And then it was, he wanted to get back into the golf simulator. Right. So there were, there was like all these incremental steps. Now we might've, we might've through, uh, I don't know, through osmosis, through just being there or whatever, might have given him enough reassurance. And we probably didn't do a good enough job. But if we had laid out those things up front, like, hey, what are your goals? I need to ask you more questions.

33:46 What would you want to get back to, assuming that you're medically cleared and stable and you're ready at those times? And he probably would have said, well, I want to get back to golf. I had I initially was with this guy treating him in twenty twenty four. And we were putting in his living room about four weeks out of open heart surgery putting. I mean, it's pretty low effort, but that was something that he cared about. Yes, we were doing a little bit of, you know, static or dynamic balance. So there's definitely clinical things there that we're actually hitting on. So it was kind of like leading them like, okay, you want to get back to, so you want to get back to golfing. And then we need to go to the golf simulator to eventually in the coming weeks or months to work on, you know, chipping at like, fifty percent effort or whatever.

34:31 And then it's like increasing the exertion. And then it's, when can we do some driving the ball off the tee at the golf simulator? those types of things. It's like laying out like, okay, what is important to you? Why do you care about those things? And when might we be able to get there? And what do we need to do to get there? And, and obviously part of it to get him there or to get them there is the accountability of, we have these visits and we need to do these sessions and we need to do, you know, do whatever. Initially it was four times a week and then it was three. And, you know, maybe these days it's kind of like two times a week or whatever, but that's how it's, I would lay out the whole Chris false thing. It's like finding out what they really care about, laying out a plan and goals that align with their expectations.

35:17 Keep making sure they understand just like the dominoes pizza tracker, where they are in this. Hey, we've had a setback. What does that mean? How far back? Like make sure it's clear. I do have an update. I just got an email from our sponsors. This doesn't happen very often. So the sponsors from the posture corrector, they are already on Amazon. Like look at bang. We've already, we're already selling. Shout out to Ben Galer saying we are, we are two for two on making. There's no, there's no way that's that there's no way that sells a lot. Is there the little line where it says like how many are sold a thousand? Okay. But this is usually globally or nationally a thousand bought in the last month. Thousand bought it last month, man.

35:58 It's three point eight. People are buying this. I know. Look, and all it is, is a little dot thing. My post-traumatic at least looked legit. It was like this back harness thing. This one's just a dot. Nineties legit. What is it? How much is it? I don't want to ask freaking Rufus. Get off the price. Sixty nine dollars. Would you pay sixty nine dollars to look that happy with this apparatus? ridiculous we should start buying these things we should start buying these things and reviewing them as pts and just be like it's some it's it's cost of goods is is the is the sixty nine dollars we'll get more off the youtube revenue that's what tony does he just buys this stuff i'll make fifteen videos no people these companies send these products to tony he doesn't buy them all the time we could get these guys to send us one oh yeah of course i thought you said buy it though Oh, I just meant for faster.

36:54 I'll fire these guys an email and see if they want us to do. I'll wear it during the show and I'll patch it up. Beep, beep, beep. Beep, beep, beep. Beep, beep, beep. Now, my product suggestion for this, could you get Samuel L. Jackson to lend his voice to the prompts? Yo, mother... That's just that would be check your posture. Check your posture. Got to get these this posture off this mother loving train. All right. That's Chris Voss and Rory Sutherland. Seth Godin would go a different direction.

37:35 Of course. How do you find the seventy thousand dollar patient while they're still two grand in Seth Godin would say build a movement tribe and identity groups. I feel like a lot of clinics do do this one. But some people might think this is the flip. Well, if this person's in a group class, they don't want to spend as much. I don't think that's true. Here's my proof. You might say, well, I'll just join a gym and a class because that's cheaper. But if the goal of you is to be being around people, that is of value. Here's my twist. And you've seen this in New York. You had to. You have to have seen this in New York. Do you see those idiots out there wearing spandex suits, riding bicycles?

38:19 I can say they're idiots because I am one of you. I got the spandex. Everyone in Central Park that are cyclists, yeah. Those bikes are not, they're not cheap, my friends. Some of them are. Very expensive, very expensive. Guys, those aren't cheap. And some people do ride alone. Some people ride in groups. A lot of people will ride both, right? Tuesdays and Thursdays I ride by myself. Saturday, that's my day. I get out there. I ride across the George Washington Bridge. I find another bunch of other nut jobs who also have spandex and we ride together. We pretend we're in the Tour de France. We're not. So Seth Godin would say build movement tribes around identity groups. This is sort of the opposite of what Dave provides. I still think you could...

39:01 You could still... If you had three or four high-value clients at Concierge Pain Relief in New York City, you could be like, I'm trying something new. We're going to do a group workout just for runners. You'd fit in this group. That's what you'd be saying to your patient. You'd fit. I got three other guys that are sort of like your level two. Similar speed, similar times. I'm thinking about doing one group workout every week. What are your thoughts? That is an upsell, right? We started this episode saying, if you find more people, you can bring them back more often, or you can give them something different to buy, and that is an upsell. Selling things is not a bad thing. That would be something that Seth Godin would say, build a thing around an identity that would be cool.

39:48 So for us, the folks that have spent the most overtime out of pocket, it's home visits. Yes, yes. I think it's a lot more challenging. Convenience. I think it's a lot more challenging for a brick and mortar. And I would be curious, anyone else watching or listening, any of the cash practices out there, maybe it's tens of thousands or maybe it's five, ten, twenty grand over two or three years or something going to your brick and mortar office, if they like keep buying packages and renewing it and you have premium rates and all that type of stuff. Um, like, you know, what was that comment just now that I know it wasn't not Michael Gorman, but the, but I move, yeah.

40:32 Craig, Craig Lee has a, has a, uh, a franchise through iMove, through Michael Gorman's iMove PT. So like, I would be curious, like with Craig or Michael, like I know for sure, Michael has the brick and mortar. Maybe I think maybe Craig is a hundred percent mobile, but anyone that has a brick and mortar office, I'd be curious anonymously. Like what is not, not, not, not that it's a contest, but like, what's the, what's the highest out of pocket, the lifetime value of, Your highest paying client out of pocket who has come to a brick and mortar office. I'd be curious what that number is. Again, it's not that big of a deal. We're going to treat everyone the same. We're just talking about some of the business mechanics around delivering your service to probably your ideal customer.

41:20 I said this to a friend who had a clinic in a small town and I said, do a run club. He's like, it's a lot of effort. And I go, is it? Get somebody on your staff who likes to run and be like, part of your job two hours a week is to go stand in a parking lot at the head of a run trail. And no one's going to show up the first week or one random person is going to show up the first week. And this is you have to hit the tennis ball back over there. I am we people like us is what Seth Godin would say. People like us do things like this. We show up every single week. I did this with Leukemia and Lymphoma Society team and training. I was a participant for years. Then I became a coach. And people who wanted to be runners but weren't runners are like, we show up at what time on Saturdays?

42:03 We're like, six a.m. And they're like, I might come fifty percent of the time. Couple weeks in, they're there every week. Why? Status. Hey, man, where were you, bro? We missed you. You don't want that. So at five thirty, you open your eyes and you go, I don't want to take the social shaming and I still want to be this thing I want to be. I either am or I'm not. The thing with runners or cyclists or anything is you are that like I could say I'm a triathlete, but Jimmy hasn't done a race in a couple of years because life. So that starts gnawing at me. like am i still a triathlete i did one years ago i don't know if i can say that but if you like every saturday we show up we do a group workout like that seems lower stakes i value that where is that so that's how seth godin would approach turning the ten thousand dollar patient into a seventy thousand dollar patient this is this is a hundred real quick this is about tribes it's a hundred percent possible i just sent you on facebook a dm on facebook don't i don't know if it'll load but if you wanted to share it um this group training place here in brooklyn called badass academy they are they are shoulder to shoulder packed in and guess where this originally started in a in someone's house Think of, think of, think of where it would.

43:31 So it was outside. I won't, I won't, I won't string you along. It was, it started for free outside in a park years ago. Because you said start a run club and maybe no one shows up, right? So it's like they started building a tribe, a community of following. It was free outside in a park. Now, there's basically no space to do anything. There are so many... And by the way, it was not this busy before COVID. They've been around for... i don't know at least ten years maybe fifteen years or something total since they were doing outdoor workouts in a park it got busy after kobe because you took away the the camaraderie and then when it came back you were like i need it gimme gimme gimme go in person yes it was it was never this busy before covid and the guy i was look at the guy in the background in the background when i say now watch him running up the stairs go see like running up the stairs like he's like just doing stair laps i love that like they're taking every square inch of this like you stand over there around the treadmill you do burpees this guy is running stairs i don't know if he's leaving if he's just late for work or oh no oh no oh no there's there's spreading up the steps as part of the workouts yes there he goes yes there's two people there were two or three people on the stairs i love that that's fantastic yes Yes.

44:54 Do you go to a bar because there's a lot of room to spread out? Or do you go because there's vibe and it's busy? Would you like an empty bar that you could throw a hand grenade and not hit anybody in? That's not a bar you'd want to go to. You don't want to go to a bar that's full enough until it hits some sort of limit where you're like, this place sucks. It's packed. Right? Isn't that funny? It's like empty is no good. Packed is no good. There's a sweet spot. Yogi Berra said no one goes anywhere. No one goes there anymore. It's too full. doesn't make any sense which is why it's funny badass academy i mean that that's that gets a follow follow immediately yeah so i used to here's the thing i'm i'm not their ideal avatar though here here's the interesting thing so i love i love the i love the owners i i used to work out there but i have a home gym yeah i i would only go To the owner's private workout at seven a.m.

45:48 on Sunday mornings. And guess how many people were in the workout? Five to eight. Wait, wait, wait. How much did that cost compared to a regular person membership with thirty eight people in a class? This was actually free. Wait, wait, wait, wait, wait, wait. It was free. And that's cool. So they might have just been doing this because they like they probably just didn't like you. But you don't think that was rapport building as well? Yeah, of course. I mean, I've been sending people to the gym for years. I'll tag them on Facebook. They didn't need to send you a Starbucks gift card. They were just like, Dave, why don't you come and work out for me? You're cool. Come in the circle. That's it.

46:28 That's marketing. That is marketing. That's marketing. That's it. Like marketing in the radio station. I was in Northeast Pennsylvania for, I don't know, ten years or whatever. So I'd been around long enough to meet random people and people have my number. And they like when someone would email me and be like, hey, man, my kids Boy Scout troop needs to do a thing. Can we bring them to the radio station? And I was like, absolutely. And they walked in and I would slap them across the face with as much cool as I could. Their name would be on the thing behind the front desk lady. Welcome, Troop twenty seven. And Steve, Steve, the troop leader. And he was like, oh, damn.

47:09 Do you think Steve spoke lovingly about the radio station? It cost me like, seventeen seconds worth of time. And when they walked in, I had the whole routine. We did tours with kids all the time. I had the whole routine. Hey, we're gonna go on the radio as a group, then we're gonna go in the production studio, and we're gonna make your voice sound funny. You wanna make eleven year olds think you're cool? Make them sound like they're on helium, or a monster, just with a couple of dials on a microphone. But understand, that's marketing. None of that was on the air. We didn't record back then. We didn't really put it on social. We'd be doing that now, but that was marketing. Badass Academy. Is this one location or more than one? I think they had one in Queens. So this is Brooklyn, but I think they had one in Queens and it was maybe like a testing ground for a year or two.

47:53 And then I guess they closed. I don't know if it was like a pop-up temporarily or something, but I like it. One main location. It's, There's also a second floor with like, I think it's kind of like personal training area. And then also like, I don't know if you want to, if you go out, I mean, it's not a big deal, but they have like the cycling classes upstairs and those are equally as intense. If you, if you see like hardwood floor, no, not, not that, not that that's downstairs. Like, like if you keep scrolling and keep, I love everything about even just looking at their page, like right there, right there on the, on the right side with the, on the right side. Right there, that's upstairs.

48:34 And these classes are intense too. And every instructor, they blast the music. The music is level eleven out of ten. And there's kind of like the group class, personal training area. And all they're doing is the instructors are yelling over the music. That's eleven out of ten. If you want to be this person like Badass Academy gets it. Just show me the people in progress. But those are the people doing people don't want to go to the gym. They want to have gone to the gym. Right. But we understand we got to go to the gym to earn the have gone to the gym. I mean, my friend Megan Brown has a Pilates clinic in Alexandria, Virginia.

49:19 So like not the easiest zip code to have a business like anything and stay afloat. Brilliant though. She would, she, I mean, she also has a personality sort of like mine and yours, which is like, I'm just going to be friends with everybody. So like, she'd be like Pilates at ten and then biscuits and mimosas at eleven right across the street. And what do you think the biscuits and mimosa place across the street would say? about her. You understand who's who in the zoo, man. Badass Academy gets it. Even without clicking on any of their content and opening, playing the video or opening it, it just all looks... Rubber floors, exposed brick, people during the ergo ski workout and the bikes and the... Oh, got it.

50:01 People like us. This is... Yes. Seth Godin would get... Got it. People like us do things like this. And they figured that out. Chris Doe is the last person. Oh no, Gary Vee. What do you think Gary Vee would do? What do you think Gary Vee would say? If you want to turn a ten thousand dollar client into a seventy thousand dollar client. What does Gary Vee think? Video? I don't know. Make them a star. You want a client? Make the client the star. That's what I try to explain to APTA academies and chapters and sections and now businesses. I was talking to a business owner last night. I won't say who it was. And he was like, we're sort of stuck because we have two people on staff doing our social media.

50:42 And they're great and they have energy. He said, the problem is they see a trend and they're like, ooh, we can copy this trend. So they do. So that gets some views, but no patience. Because it's cute, but it doesn't lead me anywhere. So if you track it, which is what a good business owner would do, where does this lead me? Does this help me? Views are a beauty pageant metric. What does it lead me to? Understand, here's the understanding. If you're a business, an academy, a section, you're the stage. Put your ideal customer on it and other people who want to be like them will see it and go, oh, you're the transformation machine. That's what a clinic is.

51:22 You're the booth that Superman steps into and then out that Clark Kent steps into and out comes Superman. You're the stage. When I say don't be Luke Skywalker, be Yoda. I'll put this in my new slide deck. Be the phone booth. The PT is the Yoda. The clinic is the phone booth that Superman steps into. Sorry, I keep saying Clark Kent steps into, Superman steps out of. So Gary Vee would say, shoot the heck out of everything that that great patient is doing. Pump their ego up with permission, of course. Pump them up. And then other people see that as a lot of comic book reference. They'll see that as a bat signal. Oh, this place turns people like me into people like I want to be.

52:05 Why is my camera out of focus? Right. So Gary would say, turn the clinic into a content engine. How much money do you think it would cost to get Gary Vee to show up to Tony's clinic? A lot of money. It'd be great. What about Gary Vee's cousin Steve? Probably, yeah, probably, probably, probably, probably, probably, probably, probably, probably, probably, probably, probably, probably, probably, probably, One of his most viral videos is someone arguing with him a little bit about, well, how much would it cost for you to design a logo for me?

52:47 And Chris was like, what's the logo supposed to do? He's like, it doesn't matter. And he's like, it does matter. The price matters. If I design a logo for a coffee shop down the street for me, the logo is going to cost X. If I design a movie poster for Paramount Pictures for the next Tom Cruise Mission Impossible movie, it's going to cost a lot more than X. Even if the time is different, even if it takes me, if I can. And so Chris has pushed the guys like, well, you're going to do this logo in fifteen minutes and you're going to charge me ten thousand dollars. And he goes, so you value time like he literally just comes back with him as a chess move. So you value time. And he's like, yeah. And he goes, then I'll take three weeks to do the logo. I'll design it for you in three weeks. Are you pissed that I'm doing this? And this is such an alignment with PT graphic design and PT.

53:29 If I can get you better in three hours. I make less money if you're an insurance-based clinic. This sucks, right? Insurance people know this for years and it sucks. They're right. If I get you better in three hours and the guy down the street takes in twelve hours, they get paid more. And by the way, there are some practices now selling in not even packages, but some will call it either like a program or a protocol, but basically the transformation, right? So if I say, Jimmy, you've had this, you know, you've had this knee injury for so long, it doesn't allow you to play with your friends with ice hockey, doesn't allow you to play ice hockey. And it's, four thousand five hundred dollars and within that it's whatever it's up to i don't know fifteen or twenty four visits or whatever but if you get better in like ten visits thank him then you could bank those visits.

54:25 Yeah, you could give them away or you could just not use them because the main focus of it, the main point of everything was you got back to playing men's league ice hockey, not about me trading time for dollars and tracking every single visit. I was thinking about this the other day and it sounds subtle when we split hairs, but Rory Sutherland would, I think, agree with at least me thinking about this. The difference between a program and a package. A package is exciting when it's wrapped. I mean, you've been nine and you're like, oh my God, under the tree. What is this? This could be, I asked for forty-eight things. I hope it's the thing I wanted the most.

55:06 As soon as you unwrap it, and it is or it isn't, the value drops. As soon as you drive the car off the lot, the value drops. It's a package. A program's a journey. A trip to Nepal. is something you carry with you forever, but a new Bose headset is a thing. I know it seems subtle. I'd rather sell the trip to Nepal, the experience. So sell the program. That's selling more of what Chris Doe is saying, the outcome, and not the twelve visits, twelve hours worth of my time. I'm like, I still need to ask a question. What the hell does that get me? Does that get me back on the ice, halfway there?

55:47 that's ambiguity and confused people don't they don't buy they don't show back up they don't continue confused people don't um so those are all the the strategies from chris voss rory sutherland seth godin gary v christo different strategies same goal in my opinion turn the transactional patient into a long-term relationship uh you're you're big though this is the last question i'll ask and this would be good for when tony does return is It's probably good to start asking certain questions that will lead to figuring out who this person is. You're big on the very first phone call. You're like, I want to say no to you or I want you to say no to me.

56:30 If this isn't right, I don't want to even start the engine. We're recording these calls. We're doing game tape reviews of these calls. We're hitting a ton of questions, objection, not even objection handling, which question, objection handling at the end of the call, but it's objection prevention questions during the call. What do you mean? Let me pull it up. I won't screen share it, but... The fact that you have a list of... I would love to ask, and you can answer anonymously if you want. A lot of people, I bet you their script is, hello? That's not script. Let me just, I know we're at the end.

57:11 I'll just rip through a couple of these. What happens if you wait another three months? If nothing changes, where do you see this in six months? What would you need to be different this time? So this is like if you got burned by a previous healthcare provider, a previous treatment didn't work. We would ask, what would you need to be different this time for you to feel confident? So if you went to a previous healthcare provider, back pain, and your back pain keeps coming back, Jimmy, if you're being honest, did that in-network physical therapy actually solve the problem long-term? And it's like, no, because you're calling us about your back pain. Jimmy, if you could solve this properly and not have this return, how important is that compared to just using your insurance?

57:53 This is a whole episode. Like, I almost want you to just stop. Yeah, I'll stop. I'll stop. I have I have a I have a big list now. These are and they're spousal questions there. Hey, Jimmy, like, like, do you is are you the only one making this decision or would it be someone else? Because later, if we say, hey, it's a transformation package that's four or five thousand dollars, then you're like, well, I got to go speak to my spouse about it. We already hit it. That's smart. You're you're diffusing the landline before you even walk towards the landline. This would be a whole episode. Okay, so what would be the prompt for the episode? Like the ten, we've got to keep it limited, right? How many questions are on that list, ballpark? Ten? No, there's more than ten. Our calls, when we speak, it's a question.

58:37 Like it's a decision tree? It's like if they answer this, go that way? It's a decision tree, and it's not us describing, we're going to do this. We're going to do this technique. You might need this. That's about you. You want it to be me, the person calling. Right. So let's – we'll figure out the prompt, but it'll be like if these ten questions – I'll bring ten, you bring ten, Tony brings ten, and then we'll shake them out and we'll talk about why we do it and what it leads. Because just having a question on there is nice, but what does it lead to? Great. When they answer this, it's like just prescribing an exercise is nice. Great. What is the purpose of that? What is the purpose of asking that question in that way at that time? The order of the questions, very important. Would you like to go out for dinner or would you like to marry me?

59:19 If you reverse the order, you have a red flag, not a date. The order of the questions, my friends, is very important. All right, we'll do that next time. Parting shot. Dave, what do you got? Oh, man. I almost clicked out of the stream yard just now. I was closing tabs. I almost clicked. Before we get to parting shot, this might be the best sponsor we have. The visual, I think you're going to agree. Let's hear it for TheraBand Cannon, resistance training from across the room. Today's show is sponsored by the TheraBand Cannon, the fastest way to distribute resistance bands in modern rehab. Just load the chamber, pull the lever, and launch therapeutic resistance directly at your patients. great so you know you know how they're there there was there's athlete there's people that get hurt and and it's not even not a not funny people have serious eye injuries when their bands rip and break that's why we also hit them comes with goggles Okay, good.

1:00:14 I was going to say, because now with the TheraBand Canon, now actually we're going to know when it's going to hit us in the face as opposed to being surprised. This should not be a surprise. It's coming out of the Canon. This is great for group classes, crowded clinics, or when the band rack is just too far away. Just get the Canon with adjustable tension settings from beginner beige to, oh no, blue. The TheraBand Canon, because walking across the clinic is wasted revenue. Think about it like that. If you could just shoot the TheraBand at them, that's way better. Best use case would be you catch your clients on their phone instead of doing their program. And that gets their attention, get them back doing their drills and their exercises, whatever they need to do. All right.

1:00:55 What's your parting shot? Give me a mic drop. Parting shot is taking a step back and looking at who are your ideal clients, patients. Could you be offering more? It's not even like for us, of course, you know, financially, it's like more of the wallet share. I mean, there's like different ways to consider it. But who is your ideal client? What are their, like you said, avatar labels? How do they identify? What do they identify as? If you speak to those and get them back to those goals or... Show them that you understand them, first of all, and that you have the capability to help them kind of figuratively grab their hand and like take them along this road or take them over the bridge to the transformation that the outcome that they want.

1:01:39 They maybe you'll find that it'll be a lot easier for folks to say yes to more of your packages, programs, ongoing wellness, out of pocket, all that. Because it's clear. My parting shot would be understand that your clinic is the phone booth. that Clark Kent walks into and Superman walks out of. Be the phone booth. Don't try to be Superman. If you're Superman, I don't know where I fit in this story. Am I Lois Lane? Am I Jimmy Olsen with the camera? That'd be cool. I'd be Jimmy Olsen. But you're the phone book. Be the place where the transformation happens. Be the Yoda that helps the hero do that. It sounds dumb and all woozy woozy. It's not. We're back on Tuesday.

1:02:20 We'll break into those question lists. All right, Dave, get out there and ask some questions. That's it. We're out. Boys, what the hell are you doing? Follow Tony Meritato on YouTube at Total Therapy Solution. Find Dave Kittle at conciergepainrelief.com and on YouTube at The Dave Kittle Show. And follow Jimmy McKay at P.T. Pinecast on YouTube, the socials, and wherever you binge podcasts you pretend are for CEUs. And hey, just a reminder, none of this was for advice. This was for entertainment only. Our lawyers say that counts. Thanks, Keith.