Lessons from Two Decades of Steady Growth
After 20 years, Elite Therapy Solutions is still gaining momentum. In this conversation, Paul Martin uncovers how founders Patrick Kinzeler and Paul Hecker built their success, and what's next for their expanding team.
Full transcript
Generated from the episode audio and lightly edited for readability.
Good morning and welcome to another episode of Paul Martin's Crucial Conversations. I am Paul Martin, founder and president of Martin Healthcare Advisors. And in today's episode, we are going to continue in our series that has been focused on multi-site privately held physical therapy businesses and business owners. These are the leaders who have successfully grown their practices and continue to drive growth in their communities as well. And our goal is to get inside their heads. We want to learn what makes them unique and really try to uncover this mindset and some of the strategies behind their success.
Today we have two owners. I have known these owners for many years and I am going to tell you this is going to be a phenomenal session. Today we have Patrick Kinsler and Paul Heckard, co-founders of Elite Therapy Solutions. Welcome you guys. Thank you Paul. Thanks Paul. Good to be here. Patrick and Paul have grown elite into a thriving network of 31 clinics, including some hospital contracts in five states, including South Carolina, Georgia, Pennsylvania, Louisiana, and Virginia. So, Patrick and Paul, if you guys are ready to go, let's jump in.
Let's do it. All right. So look, and if I'm talking to you out there, it is only for the purpose of understanding and getting in their minds, but you know, many owners seem just content to stay small, and we don't, you know, take anything away from that. But what was different about your mindset that pushed the two of you to pursue growth when others around you stopped? Go ahead, Paul. Patrick will probably come to this question a little bit more financially, but for me I think it was more about just being competitive in the market.
We felt like, you know, when we started with one or two clinics, we felt like in order to be more competitive in the market, we knew we had to grow. And so from that standpoint, we knew that we kind of had to keep growing, keep building, and provide those opportunities for the therapists and the people that came to work with us. So it was more about opportunity and competition from my standpoint. I know Patrick will probably talk a little bit more from the financial ways of growing a business and making sure that you're going to survive, but for me, it was more about competition and taking care of our people.
So sometimes the best defense is a great offense, right, Paul? That's right. Generally speaking, if you're not if you're not growing, you're dying. And you're right, Paul. I do come at it from a slightly different point of perspective, but I think that's part of the reason we work so well together is you you've got that, you know, we're both extremely competitive, but yes, I mean, at the end of the day is we're a company of balance. Is one of our core philosophies and we have to we have to marry the economic components with the with the cultural components and so if we're not creating those opportunities for our teams to continue to grow then we have to be prepared for those extraordinary talents to look elsewhere for employment.
So, that's kind of how we look at this. And for all of you out there, this is important to know, and you can probably guess this. I should say guess who is the physical therapist. But Paul is a physical therapist. Patrick is not. And I think you said it, Paul, we make kind of the perfect combination. And I remember way back when I first met you guys, how smart are they? You bring a great business mind, a great physical therapy also business mind. You put that together and you can't be stopped.
So when you think back to the early days of your business and we were there for some of it how did you approach planning for growth and how has that planning then kind of evolved as you've grown? I'll start here, Paul. Because this is I think this is important and it's going to touch on some of the conversation later is even from the getgo in the very early stages, it was a methodical routine of discussing the operations, the strategy, the tactics. So, we weren't just looking at day-to-day, it was looking at what do we got to do today?
What do we got to do this week? What do we got to do this month? How is that going to affect the next quarter and the next year? But, you know, your questions kind of sent us down memory lane a little bit. And in our early beginnings, we would have a standing 7 o'clock meeting every Monday night. And it was it was religious every Monday night. And sometimes it was a 30-minute rundown because we'd have everything cooking. And sometimes we'd be there till midnight trying to figure out what was coming next.
Yeah. You know, when you install those kind of disciplines and it revolves around planning, not just what fires can we put out. Which it sounds like those Monday evening sessions were. I'd love to know what your spouses thought of that time of a meeting and especially when they went to midnight. And look, every growth story has something very unique and that what you just told me is unique for sure. But what generally do you think makes your company stand out and how has that uniqueness then fueled your ability to then scale and grow?
I think what makes us stand out, Paul, is our ability to stay independent. You know, to build from within, to have the mindset of a slow and steady growth. And I think that's been kind of our history. I, you know, [snorts] you've known us from the very beginnings when we started and I think we probably picked up around the time we probably had three or four clinics at the time, but it took us a couple of years to get to four, you know, and then it took us a couple of years to get to eight and then it took us a couple of years to get to 15.
And and we've had the ability to take our time with this. You know, we don't jump at every opportunity. We we strategize, we make, you know, informed decisions. We obviously try and build from within and reward those individuals that have been with this company for a number of years and have put in the time and put in the effort and they're rewarded for that. We feel like that helps us build our brand and build what we're trying to represent in the space. I think what stands out with us also is, you know, we're not we don't have outside backers.
We have very low debt. We believe in kind of the model of, you know, if you can't pay for it, then you probably shouldn't have it. But I think even with that said, that has not stunted our growth. You know, have we borrowed money and paid it back? Yes, we've done that, too. So we have immense opportunity in front of us and also taking advantage of those opportunities over the last 20 years. So that's being opportunistic but with a strategy. And as I recall, and if I went back to notes, which are, you know, not in a remarkable like I have now or on my computer, but way back when, I would tell you that when we first met you guys, there was a goal of 20 plus clinics and you guys, you know, have then installed the disciplines to make sure that happened.
But you saw it before you made it happen and I think that's commendable to you guys for sure. But it wasn't always easy, right? No. What would you say are, you know, one or two of the biggest roadblocks, biggest challenges that you had and then how did you overcome those biggest challenges? And I I'll Paul I'll go back I'll go back to precoid well not even co the COVID time I think was a challenge all in itself because it was in a time where we were we were growing at a pretty good clip.
We we had figured ourselves out strategically. We got our disciplines down and then COVID hit and that was that was a brutal that was a brutal time but I think you know obviously we came out we came out clean. But I mean the day it happened, we made our decisions in 48 hours on what we were going to do. It was probably one of the most emotionally difficult decisions because we had to furlow a large portion of our team. We then had to bring them back and like that whole game plan and why I'm bringing that up is a couple reasons.
One, it was it was a testament to the to the strategic plan that we had, but it was also a tip of the hat to who Elite is. Our team stepped up for us. We asked them to do things. We asked them to take pay cuts. We did those things and then we made good on our promises to pay them back afterwards and that type of stuff. But it was it was an a testament to our strategic plan, our willingness to make decisions and a huge tip of the hat to our the folks that were with us and a lot of them continue to be with us.
For their I'll say courage to persevere with us. I think that was one. Paul, you got another example? Well, I was just going to say that, you know, obviously, you know, the housing market, crash back in what, 2008, 2009, 2010 was another one. And, you know, was it as bad as COVID? No, it wasn't as bad as CO, but I think it also gave us gave us some experience. You know, we had only been in business, you know, we started kind of in 2005. Housing market kind of went down and the economy went down at, you know, those dates and we kind of had to circle the wagons.
And I tell everybody, you know, we didn't really take a step backwards, but we took a side step in 2008, 2009, but I think that gave us a little bit of, I don't know, some headiness with COVID. We had been through a downturn before. It was, you know, yes, it was scary for everybody, but we had learned some lessons during the housing market. So, you know, kind of learning from those lessons and being able to persevere through COVID kind of helped us. And now that you know, here we go.
We've been through a couple of challenges throughout our tenure. And so sometimes you have to remember cooler heads will prevail and you have to kind of be that leader to be able to talk your teams down off the ledge and say, "Look, it's going to be okay and we've got a plan and we're going to be able to get through this and here's how it's going to look." And so I think something comes along with that with the longevity of being in practice for 20 years.
You're going to have some things that happen and there's going to be some in the future. I mean, who knows what's going to happen, but we're going to be able to weather the storm. We're going to be able to get through it. So, I think that's important. And Paul, if I can add one more real quick, just because I think this is a scaling challenge. And I think this is this is good for every practice out there to hear that's trying to grow privately is as you as you grow, you want your culture to stay the same.
You have very tight-knit. Hey, I know everybody. I you know that very home, very comfortable, warm blanket feeling, right? And one of the challenges we over the years is figuring out how to continue to demonstrate that culture when you go from 10 people to 50 people to 150 people to 220 people is, you know, the availability and bandwidth of the leaders isn't where they can sit and have lunch with everybody every Friday afternoon. It's not there anymore. So, the challenges of continuing to keep the culture the way you want it, I think it's a never- ending struggle if you choose to continue to want to grow your practice over time.
Yeah. And I heard you both, you know, bring into this that, you know, when you have these roadblocks, the two of you with whether it's 20, 50, 100, or 250 people, cannot do it alone. And so one of the things that you know I wanted to talk about was you know what we see is one of the big difficulties hurdles for multi-site physical therapy groups is creating those leaders beyond the founders and beyond those first you know couple leaders that you have in a new practice.
How have you guys developed over the years strong clinic leaders as well as a leadership pipeline to support the growth that you've achieved? Yep. I think Paul, you know, look, it starts with our, you know, as a PT, it starts with our clinical education and our our clinical teams, you know, with an in-house residency in-house fellowship. It also comes down to our, you know, leadership classes or our clinical manager classes where we're teaching, you know, our, you know, trying to have an open forum where we're going through best practices and things like that.
I think the other thing we're blessed with that I don't know that others are is time and we feel like we're not under pressure to grow exponentially. I feel like we've given these individuals within the company time to mature, time to grow, time to grow up. I mean, we are a young company and I look at some of our leaders now and we've got some very young leaders that, you know, maybe are not ready, but hey, they're kind of we feel like they're ready and we want to make them ready.
We want to put them in those positions and kind of grow into those positions. And I think that helps us as far as a mindset and again growing within that within our company. Yeah, I feel like I rem, you know, just came right into my mind. We were having conversations about some of your people and how young they are and how you guys, but you believed in them. You believed in them. And Elaine and I just full support. I mean, just throw them in the fire, teach them, lead them, and now they're coming out the other side you know, unharmed.
So, great stuff. All right. So, now is when you start giving advice to others out there who have not had the opportunity and the discipline to grow, single clinic, two clinic owner, but they want to grow. What are some of the first practical steps or some of the tips that you might give them? So, I would I would come hot out of the gate with this is plan for the end right out of the gate. There's a book there, Patrick. Yeah, there is. And and my former life before we pulled all this together on the consulting side is you got to plan for the end because it kind of dictates how you're going to exist between the beginning and the end, right?
And so that would be one of my biggest pieces of advice is put that in your in your strategy on do I want to have 10 sites? Do I want to have 20 sites? Do I want to grow up and build this and stay independent? Do I want to build this up and make it an asset? Like those are those are some critical questions because then the tactical plans and the strategies that come after that become crucial in your future history. So I would definitely ask I would I would tell everybody is plan for the end of mind. [snorts] Yeah.
What what great point. We've often and I'm sure you guys do this too. What does it look like? What do you mean what does it look like? What does it look like in five years? What does it look like? Are you still one clinic? Are we five clinics? And my recollection you guys had that vision. You had that end point and oftent times you exceed what you had thought eight years ago. Because you get you get in the rhythm, right? Paul, I tell you, you're 100% right.
Paul and I are we're constantly assessing and reassessing the goals and the targets and our strategies, but even going back to the original question or one of the original questions of what makes us unique is, and this may sound completely crazy, but Paul and I have never had an a true endgame. It's not we want to be a hundred clinics or we want to be a $50 million practice or anything like that. One of the things I think that has made us unique is as a partnership is we're here for the adventure.
And I think that's important because if all you're doing is chasing the number, it gets tiring. And so we enjoy we enjoy working with each other. We enjoy working with our teams and we don't mind the hours putting it in and figuring out how we do this next just to see what we're capable of doing. And I think, you know, if you can adopt that kind of mentality, it takes you a long way. So, are you saying that the harder you work, the better outcome you'll have?
I would say the more you put into it, hopefully the more you'll get out of it. Paul, you're exactly right. That's what I would say to a young practice owner, you know, and I would also add this. Don't be afraid of a 60 hour work week. That's right. Don't be afraid of an 80h hour work week. Look, we did it. 7 o'clock meetings on Monday night every Monday for 10 years after 10 hours in the clinic. That's right. That's right. So, you know, imagine that. Imagine the long hard conversations with my wife after that saying, "What in the world are you doing?" Right.
But here we are. So, you know, you get out what you put into it and don't be afraid of hard work and you'll get there. Yeah. And I would ask you this. You guys love it too, don't you? Every Y. Yeah. Absolutely. Absolutely. So, pretty general question here, but you know, there's got to be opportunities out there for independent physical therapy companies to grow over these next three to five years. What are some of the opportunities that, you know, that you guys have a real eye on for the future or that you would put out there as advice for others and their growth strategies?
That's a big question, Paul. That's right. So, I think everybody out there is aware like you know there there's been a lot of consolidation in the healthcare industry including ours. There's certainly that opportunity is to scale up your asset and figure out you know that maybe you want you want to take that route. For those that are truly independent, you know, I think your culture is critically important. I would say, and this really isn't an opportunity, but I'd say this is, you know, just keep this keep this as a as a potential red flag is as we gain into the world of technology and AI, I think there are some opportunities in that with remote monitoring and being able to play in the rural space a little bit better.
But I also think for the entire PT industry, we've got to be very careful not to allow the technology to start doing our jobs or let the perception of the world thinking that technology can do our jobs because I think one of one of our industry's most competitive advantages is the hand-on face-to-face persontoperson environment that we offer. And if we let that go, that's going to be problematic. But if you can utilize those tools to augment or support those relationships, I think there's a million opportunities out there.
You know, you funneled into that culture and that's one of the words from that statement and from that advice that just jumped out at me. Do do you guys find that by focusing because obviously you focus on building your culture that is a retention strategy? Absolutely. I mean I've always said and I'm kind of a broken record that I'm more in the relationship business than I am in the physical therapy business. And that's relationships with patient to clinician. And that's relationship with, you know, my people that work with me, my different teams, relationships with doctors, relationships with anything and everything across the board.
So if I can maintain those relationships, then I will be successful. And and that's the way we kind of look at it from a culture standpoint. We believe in our culture as a family and we believe that it's a it's a large tinted, you know, large family. So, we want to treat everybody like family and you know that just plays into our culture and what we're trying to do. Paul, let me tell you this. Congratulations because proof that physical therapists can grow and develop into phenomenal business people.
And yeah, what you just said I think was very key and dead on. So to both of you guys personally what have you learned in this business during this journey and how has it shaped the way you think about your role and now the future of Elite Therapy Solutions? Another loaded question. That is a loaded question. There's there that's my job. That's my job, Patrick. Well, you I mean you could look at any point in our in our history and you could ask that question is and this would be this is advice I offer to our teams.
This is advice I offer to anybody who's out there willing to listen especially in our current space is adaptability is key. It it is such a critical character component. Because if we can't adapt, we're going to get stuck. I mean, the world's changing at 100 miles an hour. I mean, right now, we've got models that we've got new introductions of models. We've got we've got always neverending shifts in legislation. And so, if we get stuck if we get stuck with our opinions or get stuck with our single-mindedness is we're in trouble.
And that's like I try to remember that every day when one of our team member comes to us with a new idea is like no let let's hear this out because there might be something in it. And so yeah adaptability has been one of the biggest learning points. And would you say from when you started this company to where you are now that you have become more adaptable, less adaptable, same as when you started? Has this journey brought you to greater levels of adaptability? I [snorts] would say, and Paul, I can only speak for myself, but when we started this, I was 30 and I was extremely opinionated when I was 30, and there was only one way to get stuff done.
So, yes, Paul, I believe well, actually, if our team hears this, they may be like, "What? You're not opinionated anymore?" but I am I'm definitely much softer, much more open to a wide birth of options and ideas than I was historically. Yeah. I can't even begin to think of how much this profession and this industry has changed in the last 30 years. And it's changing rapidly now. It's changing more rapidly now than it did in the last 15. I think, you know, from my standpoint in the growth of, you know, us over the years, I think we're just hitting our stride, which is crazy to think that here we are 20 years in, we've learned a lot.
We we drank from the fire hose for the first 15 years. Now we're kind of getting our stride at 20 and you know there are opportunities there and Patrick alluded to you know we are we are independent. We believe that in this space there should be independence. We believe that there's a place for independent practices in this country. We want to be a light for independent practices in this country. And I think there's something there that we can do bigger together. And so I think there's things on the horizon that are to come.
And we'll see. But I do think, you know, as we alluded to, our leadership teams are young, but they're maturing and they're getting to a point where they're ready to stretch their legs and run. We might be there. And and so I look forward to it. Yeah. Look, that is exciting. And I cannot wait to see what you guys are able to do now over the next 20 years. And we'll have this conversation years down the road and see where we are from 31 and what you've built.
But no, in all seriousness, you guys have done just a phenomenal thing for all of the listeners out there today and have given them, I think, some very interesting and, you know, energetic points that they'll be able to take and utilize moving forward. And so, Patrick Paul, I want to thank you for your time today and the value that you've given our listeners today. Thank you, Paul. Our pleasure. Yeah, thanks for having us, Paul. It's good, great conversation. And so, for all of you out there today who may have a question for myself or Paul or Patrick, do not hesitate. Click below and let's talk. Have a great rest of your day and a great weekend. Thank you all.
Want to talk about your own business?
Marlton, NJ 08053