How Thoughtful Growth Really Happens in Multi-Site PT Practices
Paul Martin is joined by Jon Dooley, founder of Greendale Physical Therapy, for a conversation on growth and leadership while building a multi-site practice.
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'm Paul Martin, founder and president of Martin Healthcare Advisors. Today's episode, we're going to continue. I know we've taken a little bit of a break, but we're going to continue in our series on focusing on multi-site, privately held physical therapy business owners. Notice I didn't say companies, I said the owners because we want to get in their heads. These are the leaders out in physical therapy land who have successfully grown their practices and are continuing to drive growth in their communities.
And our goal, as I stated, is to really get inside their heads, learn what makes them unique and try to uncover the mindset and the strategies behind their success. And today I am real excited to have with us someone that I have known for a long time, John Douly. John, welcome. Thank you, Paul. I'm very happy to be here. Now, John is a physical therapist and he is also the founder and owner of Greenale Physical Therapy. John has grown Greenale over the years into a thriving network of seven clinics in Worchester, Central Massachusetts.
Did I say that right, John? Worcester. Worcester, Central Massachusetts. You got it. You're not alone by saying Worchester, but it's Worcester. Correct. Worester, Central Massachusetts. All right, man. I had one shot and I got it wrong. But anyway, let's jump in if we could. Absolutely. All right, so John, many owners are content to stay small, and we may have some of those in our audience today, and there's nothing wrong with that. But what was different about your mindset that pushed you to pursue growth when others around you may have stopped?
Yeah, absolutely. You know, I think, you know, our, you know, particular situation is that, you know, we've grown to, you know, seven locations and we have a an eighth location coming in quarter one of next year. So it it's always been something that we wanted to do. You know, growth is important to a business. But we've always want to do it purposely and and just just be purposeful about it and thoughtful about our growth. One of the things I had a a patient who was a very good businessman and he would he would say to me say he says he says John you know growth is the easiest thing to do.
The hardest thing to do is to do it right. And we just try to be really I usually I kept that on my mind and it's totally true because you know anybody can you know lease space and open up space and just do clinics here and there but it just takes the right you know ability and thought process to do it appropriately and thoughtfully. Absolutely. And and I will remark to the audience that Greenale physical therapy, these are not, you know, single clinic with one physical therapist, no front desk.
I mean, the these are these are thriving clinics. So, you know, congratulations on how you've been able to build one by one within the mold of your first. When you think back to the early days, you know, kind of just getting started, how do you approach planning and how has that planning as you've moved through the years, how has that evolved as you have grown? Yeah, you know, talk about the early years. I think, you know, Paul, you and I are very similar in that, you know, we started our clinics about a year or two a after school.
And and it's you know sort of a thing where you know in the beginning it's you're just trying to survive. You know for me it was it was a situation where I started and I was just looking to make a job for myself in the in the beginning and you know I it was back in a time where it's hard to imagine this but there was a time where there was a lot of pts out there and there wasn't a ton of jobs and I was just and I was in a job that wasn't something that appealed to me and I had the opportunity to start and in the beginning it was just making a job and surviving.
But then as things grew you know it got to a point where you know we had a great infrastructure and we had a great team and we were able to you know grow and we and we were really you know like I said thoughtful about our approach in terms of growing. We had you know situations where you know we had a therapist that wanted to open up their own clinic in their local town and it was just a great location and a great person and we went for it and get it.
You know situations like that. There was a ton of situations where, you know, I had the opportunity to, you know, buy a practice or, you know, buy a location that we that we passed on because it just wasn't the right situation. It wasn't the right timing. And and I think that has served us very well. And that we've been able to concentrate on being good at the locations that we're at. And obviously your planning and your growth also had a level of discipline within it. Given that I just heard you kind of walked away from a potential acquisition.
Yeah. Yeah. It's you know it's something you need to do and you just got to be very thoughtful and and I think I've seen a number of my you know colleagues get excited about you know adding a new clinic and or having the opportunity to acquire a practice and maybe overextend themselves and and and get into trouble or become even less profitable. Able than they were before because it wasn't the right situation or they weren't able to staff it you know appropriately that type of situation.
So so you know one of the things I keep in my mind you know in terms of growth is you know Warren Buffett would say in the investing world you get you know a thousand pitches and you can choose which one you want to do and that's sort of how I see you know the physical therapy there's so many opportunities out there you know and you just got to determine which ones are the good ones and which ones the bad ones and you have that ability to you know cherrypick the good ones.
So absolutely. Well, every successful growth story has something unique about it. What do you think makes your company stand out in your markets and how has that uniqueness fueled your ability to continue to grow? Yeah, I think you know one of the things that we've done recently is you know we had been a standard you know outpatient sports orthopedic clinic you know for years and years and years and that's what we did and that's what we you know focused on and one of the things we did about a year ago or so is we started the first of its kind in central Massachusetts it's a neurological balance and vestibular center and we started it literally right across the street from a brand new you know sports orthopedic clinic and it's and it was a risk.
We didn't know how it would work out. But it's a unique situation. And it and it's really worked out very well. So here we are in Worcester. We have literally two very large clinics right across the street from each other. And they're both surviving and in and thriving. So it's I think We're unique in that way. And I think, you know, we're also unique, like I said, in that, you know, our primary identity isn't growth. Our primary identity is being good at what we do good for our team and good for our patients prior to prior to growth and that has allowed us to grow properly.
Absolutely. And and it also showed with your niche that a niche practice and a somewhat more general practice can both thrive across the street from each other. Yeah. Yeah. It's it's worked out really well and and we may be interested in you know sticking with this neurological balance and vestibular brand and and bring it to you know other markets that we're in. That's exciting. Yeah. What were some of the biggest roadblocks one or two that you faced as you went through your growth and most importantly how did you overcome those roadblocks?
Yeah, I think that's a that's a great question Paul you know I appreciate that. You know, I think, you know, one of the challenges that I had, you know, you know, growing up growing with the business is sometimes getting the wrong people on the bus, the wrong people in the in the situation. And that sort of, you know, hindered our growth, hindered our progress, and, and I had, you know, at that time maybe low standards for, you know, what I expected in people. And I think you know as I grew you know with the business you know my standards grew and what I expected from my team grew.
So I'm very deliberate in terms of you know what I expect from my team and also who I bring on board with my team. You know for example you know we interviewed you know a ton of therapists last year and you know and you know how difficult it is to you know find you know physical therapists but there there's a number of them that we turned away because they just weren't the right fit or that there was something about them that was a red flag and we know in from past experience you know bringing the wrong person on the bus is much more detrimental you know in the long term they might be nice to have a therapist short term you know but you know having the wrong person is not a good thing you know yeah so and then another challenge as you know is just you know just staffing you know and I think this is across the board you know with you know pretty much all clinics across the country or most clinics across the country and last year I made a cognizant you know, thought to say, "Hey, we're going to do whatever we need to do to bring some therapists on board." and and I'll just share with you there's I was at the private practice section conference a couple years ago and there was a keynote speak speaker and he was from a reality show that went across the country and just did random things and what one of the things that they did was this is I thought super cool.
They say we want to play basketball with President Obama. And they worked every single angle and every single thing that they could do to play basketball with President Obama. And these are a bunch of Canadian kids that had nothing to do with anything. And they did it. They they worked every angle and they eventually got into play basketball with President Obama. So where I'm going with the story, Paul, is that the term that they used when they did that is relentless. And and I think that philosophy over the past year or so when it comes to recruiting therapists has been how we've been so successful recruiting therapists where others haven't been is I made a list of about 10 different areas where you can recruit therapists and just basically worked every angle and was relentless and we were very successful.
Yeah. And that is relentless in a very specific issue as you have talked about that has caused a lot of private practices not to thrive and to struggle. I heard you give mention back in the beginning of that question to seats on the bus and the people on the bus. John, we got to give a little bit of a shout out to Dennis Bush who many years ago, I guarantee walked through with you his strategy as it related to the people on the bus. Is that is that the case?
It it must be him. And and it was a what book is it? Good to Great. Was that the book? I can't I can't I can't recall. You read so you read so many of them. They they sort of go into each other. But we'll give we'll give credit to Dennis Bush for sure. There you go. There you go. Yeah. You know, one of the biggest hurdles for multi-site physical therapy companies is creating leaders beyond the founders. How have you developed strong clinic leaders and a leadership pipeline to continue to support growth?
Yeah, again, Paul, that's, you know, another great question is, you know, we had a challenge, you know, a number of years ago where we had people that did not want to go into management. We had so many therapists that just wanted to treat patients and be the foot soldiers and not get into management. And we created a in response to that we created a role within our company called the clinic supervisor which is sort of a manager light type situation. So they don't have the full you know you know responsibilities of a clinic manager but they get their feet wet in in the management role and that's that giving them that opportunity and sort of let them feel it feel it out and get used to it has been really good in terms of getting people into the management structure.
So it goes you know for us it goes clinic supervisor, clinic manager you know regional manager type situation. So there is that progression and people can see that progression. And obviously you know pay is commensurate with you know what they're doing. So there's that benefit as well. So that that's one thing that we did is just sort of lowering the threshold of what a manager is has been successful for us. And then another thing that we do which I think is key for you know developing managers, keeping them engaged is we do what's called a leadership lab.
And we do that twice a year. And it's basically getting our executive team together with our clinic managers and supervisors. And and each clinic manager and executive team member does an educational moment. They talk about their wins for the year. They talk about their plans for the upcoming year. We just did this last week actually. And then which is really neat is they bring their problems to the table. And they amongst themselves are problem solving their management problems you know with them. It's not John Douly saying hey this is what you got to do.
This is what you got to change. This is this is how you do it. Is they amongst themselves you know figure out for themselves how to how to how to manage their clinics better. And it and it's worked out very well. Yeah. Two really unique strategies as it relates to this whole leadership idea. And I think the idea of a clinical supervisor prior to a clinical director, clinical manager, whatever we may want to call it, going from clinician to now I'm a clinician, but I got to manage all these people.
I got to manage doctors. I got to manage the owner. I mean, it's a big step. And so I think what a great idea and to have that as a part of their pay scale as well. John, that's unique. And we've talked to companies with three times as many clinics as you have that don't have that system in place and the leadership lab is just genius. What a great idea for them to work together and not to have you looking over everything. Yeah, really great strategies.
Yeah, thank you. I appreciate that. So, if some folks are out there and they have one, maybe two clinics or maybe even three but they really want to grow, what's the first practical step or tip that you would give them? Yeah. You know, I would if I'm talking to people and I and I have talked to people in that particular situation and I you know, I tell them I says, you know, what is what is your reason for wanting to grow? You know what is what is your purpose for doing this?
Is it just to add another clinic so you can say you have three clinics or four clinics or whatever? Is it to grow your profit? Is it you know is it a good location that you know you think it's going to do well? And just sort of identifying you know is it not to dissuade them from doing it. I mean I don't want to dissuade anybody from growing. I in fact I encourage people more so than dissuade them. But is it an opportunity where maybe you can do same store growth and get the same you know the same return within the two clinics that you have?
Are you maxing the capacity at the clinics that you have before going into you know adding a third or fourth clinic? So I just you know tell them to be a little bit more tempered in their approach and not dissuade them. I mean, I definitely like to see people grow. But just be careful about it. Just not in Worcester, Massachusetts, right? Just Yeah. I mean, we got we got competitors coming into town, but we're doing fine, you know. So, yeah, we got we got people coming.
And I wanted to say it right, too. But what? Yeah. Say say it again, Western Massachusetts. Yeah, you got it. You got it. All right. I'm getting this. Okay. Yeah. Well, you can you can come visit Massachusetts and be okay, you know. You just got to take ours out of here. Yeah, you got it. So, so looking kind of broad scope here, where do you see opportunities for independent physical therapy companies to grow looking out over the next five years? What are some of the opportunities that you're keeping your eye on for the future?
Yeah. So we one of the things that we're working on and I think you know a number of clinics are working on is you know working you know directly with employers I think that is not going to be you know a massive you know market but I think it's going to be enough of a market where you can you know get a premium you know per visit reimbursement that it'll move the needle in terms of you know profitability and basically what This is working with employers that are self-funded or self-insured and and the your physical therapy clinic being the first point of contact for muscularkeeletal care.
And if you can do that what your goal is for them is to reduce the cost because you know as you know Paul you know physical therapy is very inexpensive compared to imaging and orthopedics and surgery and that stuff. So for $1,000 or $1,200, you can get a course of physical therapy where you can get amazing outcomes, you know, for a real inexpensive amount of money. So if you can you know, show that to these employers and get and get them to buy into it, I think there's a lot of opportunity wi with that in the future.
Yeah so John you bring up a really good strategy and we are seeing you know across the country in certain pockets you know companies that are working with hospital systems where they have you know the breadth is that direct to employer contract is going to be I think really valuable in the future. You know, if you were ever to look to, you know, join a larger partner, trust me, those direct to employer contracts are going to be valuable. Yeah, that's good. That's good to know. And, and, you know, I will I will say, you know, we talked about a little bit, but the neurological balance and vestibular center.
I think there I mean, there's a whole new world of, people that you can treat aside from orthopedics and sports. So I think there's a lot of opportunity for more specialty services as well. Absolutely. Absolutely. So, last question, John. Let's get personal, right? Let's get personal. What have you learned as a business owner during, you know, let's call it the rehab business journey and how has it shaped the way that you think about your role and the future of your company? Yeah. You know, I think, you know, when I started back in a 600 square foot space, you know, so many years ago, I think it was your job, right?
That was just your job. It was a job. It was a job. You know, you're the technician. You know, you're doing everything. And you're answering the phones, you're doing the payroll, you're doing the treating the patients. And and I and I think as I've grown throughout the processes, I found that there's a ton of other people out there that are so much better at that stuff than I am. You know, there's better therapists that can treat patients better. There's better people who can do human resources.
There's better people who can do you know, events and marketing and that type of thing. So I think what I've learned you know through the process is you know the you know finding the who not the how is just you know finding the right people to work the business and my role I see more so is you know steering the ship and you know being the leader for the company you know the you know figure out the strategic you know avenues for where I want the clinic to go and then also I think at this stage in the game just finding stuff that, you know, I enjoy doing.
You know, you know, one of the things I enjoy doing is interviewing therapists and, working with new grads and there's some marketing initiatives that I really en enjoy and get into. So I think the combination of, you know, steering the ship and, you know, doing the stuff that I'm passionate about, I enjoy, is where I've gone. Yeah, John. Hey, I can cannot tell you how much I appreciate and I am sure our audience appreciates the time you spent with us today. You have given them a lot of absolute just, you know, down and dirty hardcore lessons on how to grow your business.
And I believe that seven clinic John Douly Greenale is going to continue to get to that 8 10 and continue that march forward. Because I you know some of the systems and strategies that you have used are gold and I congratulate you for that. Yeah. Thank you Paul. I really appreciate you having me on board and it's great talking to a leader in the industry like yourself. Oh thank you. So, for all of you out there today, if you have any questions for John or myself, don't hesitate. Just click below and let's talk. Have a great rest of your day and a great weekend and thank you for tuning in.
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