When You've Done the Work, the Right Partner Is Worth Waiting For
Norene Christensen spent 20 years building Four Pines Physical Therapy the right way, and it showed when it was time to sell. MHA consultants Kevin Anderson and Dave Pearce walk through the full journey, from financial chaos to a sale that kept her name, her team, and her culture intact.
Full transcript
Generated from the episode audio and lightly edited for readability.
Hi, welcome everyone. I'm Kevin Anderson, a consultant with Martin Healthcare Advisors and today we're walking through a real client journey. A business that started working with MHA back in 2005. It's evolved over time but ultimately found the right partner. Joining me today is Noren Christensen, For Pines Physical Therapy owner, and Dave Pearce, Martin Healthcare Advisors consultant. Welcome everyone. Thank you. Thanks. Good to see you. So Norene, we're going to get into your story today and we're really excited about that. And we know you've worked with several consultants over the years and it's because you've been with us for quite some time and we're very honored about that.
But let's start at the beginning. Sorry, Noren. Take us back to when you first connected with MHA. And I think that was back in 2005, right? Well, 2004, I believe, is when I met Paul at PPS up in Vancouver and then I started working with you in 2005. But I had been in I opened up my practice January 98 and I had the skill. I was a great therapist, busy right away, bought on a second therapist right away. Grew to four total therapists with one being in a second location.
And we were busy, but I had no idea what I was doing. I didn't know how I didn't know anything about budgets or what made a successful company. I was definitely under charging for what we were doing. And I was just overwhelmed. And at PPS, I talked with Paul at the booth and was immediately like, "This is what I need. I need some education on how to be a business owner." and so he came in with his team and looked at our billing, our website cycle.
He interviewed each of the employees. Looked at our marketing, which I don't really think there was any marketing except for we skied and climbed with everybody in the community and they knew us by that. And then really helped organize a business for me. Yeah, that's a lot there. A lot there. I'd like to unwrap a little bit more, get into a little more detail on some of that. You know, so a lot of business owners face those same challenges, Norene. And I'm just curious, you know, when you first met Paul, what was the biggest pressure points or the things that you really know knew that you needed to focus on early on?
Really the financial management of the company. Like we were working our butts off. We were super busy. Our schedules were full. And yet I never had any money. And so I didn't understand the rev cycle. We had somebody third party locally doing our billing. So I didn't know how to look at that and evaluate that. I didn't know how to look at my therapists and understand how they were coding and scheduling. I just knew we were busy and there was nothing in the bank account and so I was obviously missing a huge piece of the pie that could keep you up at night I would imagine.
Yeah, definitely. So then Norene so knowing that you know these are things that in your in just intuitively you probably knew what was it about you know joining and starting a relationship with Martin Healthcare Advisors that now made it real where you actually needed to do something about it. Well it was clear objective measures. I was presented with object objective information that I didn't know how to get before nor if I did have it know how to read it. So there was a huge amount of education on business for me.
You know in PT school we're not taught business and when I went to PT school it was taboo to market. You know, it was taboo to have profits and so that the mindset wasn't there. And so, Dennis was my first consultant and he really started to lay the foundation of understanding of business and understanding the rep cycle and the budgets and the finances of a business. And Norene, as you started to see that, did what you want the business to become, did that start to change for you?
Yeah, it did. You know, when you start working with a consultant, you're like, how am I going to pay for this? There's no way I can afford this. And when I talk to owners now who are in that spot, they're like, I can't afford it. And my comeback is, you can't afford not to. Because as soon as I started working with Dennis who was my first consultant, I just started seeing this hockey stick growth in business and I keep stuff from the day I opened and I can see that curve prior to the economy crash.
So you know it definitely helped me grow appropriately working with him. Nice. So it sounds like there was a good plan and with every good plan you need to be able to execute. Yes. Can you talk take us back to some of the things that you implemented early on that you know really got the business starting to move and getting you excited again? Well, one was getting a different billing company and learning how to recognize the or evaluate the reb cycle. So, my initial biller, she just did medical billing, you know, it's like I didn't know any different.
And I found a biller in Idaho that only did physical therapy billing. So, that was really great. And she was extremely educational. In terms of budgets and finances. Dennis gave me a new language to talk to my accountant and so my accountant started working with me differently and teaching me that side of things. Working on marketing and how to evaluate is your marketing working what you know looking at that patient experience. The physicians knew us. I mean, we ski with them, so it's I kind of felt silly marketing to them, but it was just kind of learning that whole business side of things.
Well, it sounds like Dave, now I'm going to bring you in the story. It sounds like they did a lot of heavy lifting, Dave, before you got to start with her. So, yeah, definitely. Tell us a little bit about Yeah, thanks Kevin. Yeah, I came on board in 2012 and I was coming off of having my private practice acquired and moving on to a next phase of life and so consulting was new to me. So I feel like as much as I helped teach Norene, she was teaching me at the same time of how to be the most effective as a consultant in the industry.
And so when I started in 2012 with Norene, she had consolidated down to one location in Jackson. And for those of you that haven't ever been to Jackson, I highly recommend going. But the challenge in Jackson is it it's one of the highest, you know, costs to do business anywhere in this country. And I think Norene, you even told me a stat one time. What was that? We are the most expensive county in the US and we are the richest by a very large margin county in the US.
Right? So those two dichotoies and after, you know, spending a little bit of time with Norene and going out to dinner with her on my visit, I realized that she knew everybody. I joke with her that when she decides to hang up her PT roots, she's probably going to be the next mayor of Jackson because she just she knows everybody and everybody just sings her praises. So I think what I saw originally was, wow, you know, she's built this great reputation. She's got a great clinic.
There's some limitations because of the size, because of the cost. So how do we first and foremost think about maximizing what she has? But on top of that, Norene had great visions for where she wanted to go. And so we started really mapping that out of all right, what does growth look like both internally, externally, and that's kind of where we set off just running and figuring out those steps as we went along. Yeah. So Dave, it sounds like, you know, you had a little bit different strategy than maybe what was occurring, you know, the first several years.
Is that so? Yeah. I think, you know, what I recognize and what I do with, you know, so many practice owners that are working both in the business and on the business. We try to get them to a point if we can, if it's economically feasible to get them out of working in the business as a clinical provider. You know, sometimes that's their passion and they're going to continue to do some of that, but it's really hard to do both to focus on growth and all of the training and training and leadership and all the things that you need for that successful growth while you're still juggling a full clinical schedule.
So that was one of our early initiatives was how do we get Norene out of so much clinical put that burden onto her staff so that she can really focus on the next steps. How hard was that or how easy was that to hear? Norine it was hard because my identity was working with the patients and so many people you know of course it's like you get your dentist you only want to see your dentist. So many people had me as their therapist and I've been seeing the same people since 95 and their families and friends and it took quite a few years to wean people off of me and to trust my team.
But at the same time I was missing that but understanding that if I was going to grow and continue to have a successful business I had to work on the business. I had to have a different set of business values and clarity. As much as, you know, I call it Hollywood treating now. When somebody gets injured and I go into the clinic, it's just a full-on social day for me and they're so excited to see me and I'm in my head I'm like, "No, my therapists are way better than I am now.
I am more." but it was hard. It was hard to change that identity from what do you do? I'm a physical therapist to what do you do? I'm an owner of physical therapy clinics. I'm the CEO of physical therapy clinics. It took me a while to adopt CEO. That's such a great example of a business owner probably understanding that and knowing that to be true, but needing someone else to tell them that or giving them the right to do that. And it sounds like that's that was a pivot that you made, but would have been hard for you to do that on your own.
So, completely. Yeah. Yeah. But I'm just curious, you know, you've been with, you know, no relationship is perfect, and at this point, you've been with MHA for several years. Were there any other unexpected pivots that you needed to make or any other hard truths that, you know, became evident to you just through the relationship? Some of the hard truths were learning to hire properly, not hiring a warm body, getting somebody in. We did have a complete fail where, I was needing a clinic director for a new location and Dave's like, "Oh, I work with this owner in this state.
He's moving to your area. Interview him." I interviewed him. I'm like, "Well, how perfect is this? He's a business owner. That's it. You know, he seemed like a nice guy and about four weeks into it was an extremely costic environment or relationship and I ended up firing him in after four months and even that I had one of my male therapists with me during that meeting because I was threatened by him. My whole team was like threatened by him and so Dave's not allowed to suggest any new employees.
No, no more. And I think Kevin, recover and move on. Yeah, Kevin, I'll just add to that. You know, one thing that Norene honed in on early as we started to grow and expand is she really wanted to build up that leadership from within versus finding it externally. She wanted to train and build those people up. And so what I can say is through her growth through the years, it's really been by and large internal organic growth where she's built up the leaders and then they've gone on to success at other locations that have opened since then.
So, a really good lesson there that the more you can control and the more you can have those leaders ready when you're ready to expand is really key. And that and that situation lent to an opportunity for a really great employee to step up. She was only a year out and she threw her hat in and she's like, you know what, I understand I probably need more experience. She stepped in and we really didn't she just naturally was an excellent leader. So yeah, that just strengthened the look internally.
You know, that's just another great example of how developing your team and investing in your team, how the benefits are there. I don't think there's ever a time when that investment doesn't pay dividends. So true. Dave's been integral in meeting with my leadership team on a monthly basis to help them in their development along with what I what I meet with them about. So it's been very beneficial. Well, you evolved quite a bit as an owner, and I'd like to now talk about and shift gears a little bit to preparing for the next phase, which was preparing for a partner.
You know, at what point did you realize that it might be time to find a partner? Well, one, I was looking at my age and I figured at some point I need an exit strategy. And Dave and I, we talked a lot about that and I just wasn't ready. But over the years, Dave really developed my business sense and my business language. And I finally got to the point where I felt ready where I could have a meaningful relationship with a potential partner, a different company.
I also realized that I only have so much head space to grow so much that I really needed support from a partner that knows how to do this that has the resources that would come off my plate. So, I was free to make these decisions and be creative and think about them and create opportunity. Nice. And Dave, how did you know the business was ready? Yeah, great question. You know, through those years going back to 2012, you know, if we fast forward to what about 2023, Norene had grown to three locations.
So she had her flagship Jackson clinic that actually expanded. You know, she has never been riskaverse and so she took the leap to expand that clinic to a bigger location to meet the demand and that's really paid off. But she also with those rising leaders was able to establish clinics in Alpine and Pinedale, kind of neighboring communities to Jackson. And so she was now in that criteria that really garers the interest from national buyers, national acquirers. And at that point, our focus, you know, working with her directly and knowing what her goals were to optimize, you know, her financials.
So, we spent, you know, probably the next year or two really working on optimizing, fine-tuning, you know, working closely with efficiency and productivity to maximize where she stood financially. And then that it got to the point where she just made the call that, hey, let's get this opportunity out there. Let's explore because I know that there's more growth achievable. She was feeling like she didn't necessarily, as she said, had the bandwidth to continue to do that. And so it was just the perfect time to try to search for the right partner.
Yeah. Yeah. And so Norine, you know, when you're thinking about that partnership, was there a few things that stood out to you that really mattered the most? Things that you just needed to have? Oh, yeah. Definitely. Culture would be the first thing. Definitely did not want to partner with a company that was going to change how we operated within the clinic. Did not want to name change. Basically I'm not very good at being told what to do. So and I think Martin Group and Dave just had my best interest in mind.
They know how I function. They understand the culture and dynamics of the clinic and I really had trust in them to bring me the companies that would fit best. And in the highlevel management meetings I was able to recognize immediately which ones were not going to fit. Keeping my team, keeping my community in mind. Keeping my own sanity in mind. You know, you hear stories of owners selling and they just can't get out fast enough and some of them break their contract and I truly love what I do.
And so then when we got down to the longer management meetings, it came clear that one of the companies was just checking off all the boxes. They had everything corporate level that I needed to take off my plate. They weren't going to change our name. I mean, we're a productive, profitable company. They're not going to change how we function in the clinic. And it's just like back office stuff that we had to change and transition mostly. And I picked US physical therapy and their culture totally matches ours.
They're fun, but they're focused. I did not lose one employee due to the transition, which I think is a testament to the partner I chose as well as the level of communication that I had to break down fears that employees have because you hear about these horror stories in the industry and I just was not going to let that happen and nor was Martin Group and Dave. They weren't going to let that happen either and I trusted that. Yeah. Dave, was there anything else that you went through and when trying to evaluate the right partner for Norene?
Yeah, I think you know both Paul Martin and Tom Carden have done such a great job at Martin Healthcare really since its inception to build these tremendous relationships with the buyer side of the industry. And so we knew that Norene's opportunity was going to be very attractive to a wide cast of buyers. And so our aim was to get that, you know, net out there. And as Norene said, that led to discussions with quite a few groups. And our mission first and foremost is to help our client find the right fit culturally, philosophically, clinically, all of those things.
But that has to go handinhand with what type of, you know, financial offer and terms that they bring to the table as well. You know, we don't we don't shy away from wanting our clients to get the best outcome financially. And so both really go hand in hand. And as Norene said, casting the wide net, you know, we spent quite a few months working through that process for her to really zero in on, all right, this is the group. Let's see if we can get the right deal.
And and we were able to accomplish that. And she's kind of riding off with that partnership until now. Yeah, that really is great to hear. And so, Norene, when you just think about this journey that started back in 2005, is there anything that you would do differently? Because it sounds like it sounds like the perfect story. You know, it truly was. Because I would not be here where I'm sitting now as a business and as a CEO or now partner without the guidance and without the education.
You know, maybe it is a Cinderella tale. Maybe other companies have had issues. I truly have not. And I remember at the beginning going, "Oh my god, how am I going to afford this? I mean, this is going to bankrupt me." Yeah. But it didn't. It just grew the company. And after the economy crash, after COVID, two hockey stick growths and it was, you know, through the guidance and support of Dave. Yeah. Yeah. Is there anything else that you would add to other owners perhaps who are in a position maybe like what you were in back in 2005?
Oh, yeah. I think PTS for one, we overthink things and we get in our own way and then we look at the price tag, but we're looking at we don't have any money in the clinic. How are we going to do that? One, stop overthinking it. Two, maybe there is a reason why you don't have the money in the clinic to afford a service like this and you're going to find your ROI very quickly and it's going to exceed your ex expectations. Yeah. Yeah. Well, great.
Well, I think we're at time. This has been a great conversation, you guys. This has been just true success story of and an example of how building a business, improving it over time, investing in your people, and finding the right partner, you know, can really, you know, dictate the outcome. And so, to both you, Noren, Dave, thanks for sharing your stories and your involvement along the way. And for all of you out there who joined us today, if you have any questions for myself, Dave, or Norine, just click below and we can talk. Thank you all. Thanks for having me. Thank you.
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