The PTA Myth That's Costing PT Practices Growth
Paul Martin joins Katie Sutton, PTA, host of the PTA Plus podcast, to unpack how one PT practice grew from 3 clinics to 21 and where PTAs fit into that growth story.
Full transcript
Generated from the episode audio and lightly edited for readability.
Your practice is essentially break even. You're not making any money. You're generating a lot of patients, you're seeing a lot of patients, you're getting a lot of referrals. You're doing a great, thing for the community having this on the corner of Church and Main and where they can come in.
But you're doing this almost as a non-profit, and you're not a non-profit.
So now, on to today's conversation.
So we're gonna take a spin here, and I'm gonna ask you all to put your thinking caps on. So there comes a point in the growth of every physical therapy practice When being great at patient care isn't enough. You have to think about people, leadership, culture, operations, and ultimately, what makes a practice valuable and sustainable. And that raises a question that we don't always talk about enough, and that's where PTAs fit into that equation.
Because the PT-PTA relationship isn't just simply clinical. When it works well, it can affect capacity how much work that took for you to do that. But before entering really a strategic partnership with another clinic, I believe it was NovaCare.
And in 2000, he founded Martin Healthcare Advisors, where he has since helped hundreds of rehab business owners grow their own organizations and navigate partnerships, mergers, and acquisitions. Today, we are asking what, out of all of that information that he has learned over the years, how a PTA can contribute to these organizations.
But absolutely that we take our... We have our own stakes in success, right? So joining me today is the founder and president of Martin Healthcare Advisors, Paul Martin. Paul, welcome to PTA Plus. Thank you, Katie. I'm excited to be here. Yeah. Thank you so much. I'm excited to talk to you. I think that this is gonna be a very different spin from what we normally have on, but this is something that I have really been trying to cultivate on PTA Plus is, of course, I want PTAs to think beyond their title and to think of what's possible and what they're actually capable of.
And I think that there is a misconception that PTAs can't really do business. But I think what I've learned and what I hear from all of my PT colleagues is there's all these things that we're not taught in PT and PTA school, right? I wasn't taught how to run a business in PT school."
I can tell you right now as a PTA educator, there's so much information jammed into two years in a PTA program. Business is not exactly something that we have time for. Although I know that I do talk to my students very deeply about risk management and, of course, the day-to-day operations of a facility and how even somebody who is, what they like to say, "I'm just treating patients" they are contributing to the bottom line of that facility in one way or another whether they like to believe that or not. So Paul, when you look at a healthy, growing physical therapy business, where does a PTA fit into that picture? Yeah, first- Clinically, a PTA is trained and is licensed to carry out physical therapy care, to carry out treatments for patients.
And the more autonomous that they can be within that the more productive a practice is going to be allowing the physical therapists to be able to, have the time to do evaluations to direct and set a plan of care which a physical therapy assistant can carry out. And they have their specialty.
Their specialty is carrying out treatment plans, and I firmly believe that, a real good, solid physical therapy assistant can be trusted to carry out that treatment plan as if it was the PT license that was carrying out that plan. Certainly, there are ways to monitor and create interaction between the PT and the PT assistant.
Every number of visits, the PT is checking in, et cetera. But I think so as a part of that clinical team, which carries right into the operations team physical therapy assistants are extremely valuable to carry out a plan of care. So if you were advising an owner who had never integrated PTAs into their model before is there a way that you start that conversation with them?
Yeah we usually start it with
your practice is essentially break even. You're not making any money. You're generating a lot of patients, you're seeing a lot of patients, you're getting a lot of referrals. You're doing a great, thing for the community having this on the corner of Church and Main and where they can come in.
But you're doing this almost as a non-profit, and you're not a non-profit.
And in order to become more efficient in delivering a plan of care, a PT assistant can be integral in that if, and only if, there is, phenomenal communication between that PT and that PT assistant. In, in large practices, we create teams of PTs and PT assistants.
It could be one PT, one PTA, and potentially a tech. It could be two or three PTs, a PTA. Whatever that is a team, and the, the plan of care should be developed as a team. So the physical therapist does the evaluation, the team gets together. Now we go and we carry out that plan of care for the patient, and it can add to your productivity significantly.
As we all know, PTAs do not command the salaries that a PT does, especially in an insurance-based business where for Medicare and some other payers, they're only getting somewhere 80 to 85% of the full reimbursement. So that's where again, they need to be utilized in very efficient ways.
And I think for practices, most practices that come to us that just cannot generate a bottom line are, "Stop. We're not gonna use PT assistants. We believe PTs can, do that treatment better." And we don't believe that at all. Very interesting. So what is it about a practice that uses...
And I'm gonna go beyond the PT/PTA team, but just simply uses their team really well. Like what happens to that, that clinic that has figured out the team-based model, the culture? Like, where do you see them excel? Yeah. These are businesses and clinics that are really good at modeling out what are our objectives. And within our, number of visits, number of units visits per day, and beginning to look at all the metrics that truly drive a physical therapy business.
When you can plan that and you're... so you're first, you're planning and you're creating targets, and these targets are reachable targets, reachable within the confines of what your license allows you to do and also without having somebody, at the end of the day fall over backwards and take 100 notes home.
No, you set targets based on, guidelines that have been set out by PTs by PT physical therapy businesses. And you- so you're first, you're measuring and you're creating targets. Then you monitor every week where you and your team are compared to those targets. So we first set targets, we then monitor and measure, and then we react and respond.
Why were we, why did we not meet our, new patient target last week? Why did we not meet our units per visit, which is whatever, 3.75 or 3.8? And but if you don't do that, the practice just continues to move along, and the first place you see it is, "Why aren't we making any money?" Because you gotta get to the front of it, where you're actually setting targets and getting buy-in from your PTs and your PT assistants on these targets, then you're, you're monitoring results.
I love the concept of the buy-in from the entire team. I was talking to somebody about leadership and followership the other day. Have you ever heard of that term, followership? I have not. I have not- Okay ... but I like it. I'm gonna write that one down. I didn't come up with this, so I can't take credit for it, but there's a, a PT from Ohio that I have learned a lot from in the last couple of years, and he did a, a whole talk about followership.
And I think that- ... the PT and PTA are the perfect example of this, where, you know- Yeah ... you have your leader- Yeah ... everybody knows what leaderships are or leadership is and who our leaders are, but you have to have the followers to make the thing happen. So we have our leaders. They point us in the right direction, and they're driving that ship forward, right?
But it's the followers that bring that energy, that kind of take things across the finish line, that they bring ideas and they bring, new opportunities to that leader to execute the whole entire task. So when we're looking at a team-based model, it requires both of those. You can have really good leaders, but if you don't have people who are championing that that goal and that target, then it's not gonna matter.
So you have to kinda have that, that mix of the leadership and the followership. So that's just a little sidebar there that really has nothing to do... That was not in any of our- No ... discussion points. But it's a great point because the followers like to stay on task. And they like to know, are we on task or are we not?
And if weeks and weeks go by and we've never come back to, we did set those targets. That was three and a half years ago. We've never looked at them again. So we believe weekly, and it's a meeting that is a standup meeting. It's not a sit-down in a room. It's a standup meeting, and you look at the metrics last week, and you compare, and then we take off into this week.
So it's just, it's that discipline and followers like that discipline, and leaders need to create that discipline. Yeah, it's all about building that culture. And you know a little bit about this. You went from three clinics to 18 clinics in three years. Is that... That, that's correct, right?
That's true. We added 18 more, so we were in... We had been in business for three years, we had three, and then in the next three years we added 18 more. That is still an insane amount of growth very quickly. What did that experience teach you about growing quickly without losing that culture and the people that really helped made it successful in the first place?
Because that's rapid growth. Sure. And that can happen, right? Like how do you not lose that? Yeah. No, first and foremost, it was planning. And literally, we carried out our plan. I was all the development side, and so the acquisitions and the startups were all on me.
And a year went by, and nothing was there. Where's our new startups? Where's our... And then all of a sudden it just came flooding. So as it came flooding in, we then needed to plan, how do we manage and operate these new clinics as well as these acquisitions that, It was actually two years, 'cause we went a whole year and didn't add another clinic and didn't, we created the plan. But anyway that is when communication from the top down needs to be absolutely at its highest levels, and you need to create leaders in every single clinic. So there was a clinic director in every single clinic. We had two clinics that the clinical director was a physical therapy assistant.
So out of the 21- ... two were physical therapy assistants. And we felt like that was really important because we had a model that we used PTs and PT assistants. And the PT assistants were very good at running those, those weekly meetings that I described and talking about, you know, measuring, monitoring, and then reacting and responding.
So it was all about planning and then, heavy, very diligent creating leaders in every single clinic and continuing, that discipline that we had of measuring and monitoring our metrics as well as our, numbers and targets on just volumes, whether it's visits, new patients, et cetera.
That weekly discipline then we brought clinical directors together. Every three months we would have an in-person all together planning session. And that's how we were able to do that. So what do you see is typically the first thing to maybe break or to slide when a clinic grows too fast?
Yeah. Is there something that you can identify that you say this will happen if you don't go slow"? Yeah, you lose referrals. Because when owners are present and, there's not a concierge team of folks that are doing nothing but scheduling patients and, they go to one clinic and, "No, we can't take them.
No, we can't take them. We can't take them." Two days goes by and the patient's gone. So that's one of the first things that you need to really wrap your arms around, which is, who are taking those initial calls? What is happening with every one of those initial calls, and where are they getting, where are they getting placed?
And what is the time from the initial call to patients getting scheduled? Waiting lists just are killers. They're killers to practices. And, it's another reason why the PT assistant, utilization of PT assistants needs to continue to ramp. Physical therapists should have no fear of physical therapy assistants becoming really good treaters because when you have a, clinic full of therapists, all who are doing evaluations and all who then don't have any more room in their schedule for evaluations you lose patients.
And when you lose patients- Yeah ... you lose your reputation, and when you lose your reputation the, the, the bank account goes down and down. Yeah. So what would you say to those frontline clinicians who are treating patients every day, who are the ones who are saying, "Leadership and the business part is not mine, but I'm gonna come in and I'm gonna treat my patients"?
What do those people do to really protect the culture? Like, how can they continue to protect the culture while you're going through that kind of shift and change in how it's evolving? Yeah. And you're speaking of when you say shift and changing from what to what? So when you know that this business is growing and it's it's starting to take off, and you have your frontline clinicians who are continuing to treat, but maybe not necessarily in a leadership role- Yeah ... how can those people contribute without, feeling left behind? Got it. Got it.
Or maybe- It's a great question ... maybe they're okay with it. No, it's a great question. We, we are steadfast that as clinicians, whether it's a PT or a PT assistant you have a clinical role, and that is your top priority. You have a clinical role in the business where you work. Notice I said businesses, 'cause they are businesses, right?
You also have a business role in the businesses where you work. And in order to understand and for a business to move forward they have to be willing to learn that business side of the business. Understanding how you measure and monitor metrics, understanding what metrics mean to, the the end result.
Does it mean we're sharing profit and loss statements with all of our therapists? No. But there are things on the front end that if you do them right, the profit and loss statement takes care of itself. If there is levels of productivity we can map out exactly what levels of productivity you need in a practice in order for that bottom line to continue to be at a level that keeps the doors open and keeps the business running and allows you to hire new therapists.
They have to learn that business side and we don't, we shouldn't have to dance around that with clinicians. And I think that companies that do, you come and you work here and we heed to the clinician. Whatever you feel as though you need to provide to the patient, doesn't work. It doesn't work.
There has to be guidelines. They have to know by insurance type what they should code for, what they shouldn't code for. Does not mean that you're coding for something you didn't do, but there are so many gray areas of that, that they need to know how to take that gray and turn it into black and how to take that black and turn it into green so that they're, billing the right codes- Yeah
for, to make sure that they're getting paid for the work that they're doing. That makes a lot of sense. Are there... Could you like narrow it down to like maybe two or three concepts that you could say like every clinician, PT or PTA, needs to understand these two or three things about business?
Yeah. If you could put it into- Yeah ... a couple of buckets, what would you do? Yep. Every clinician needs to know the top five payers within a practice and exactly how and why they pay what they pay. And not adjust the clinical care that they're giving and providing, but adjust where and how you're billing for it correctly and fairly and by the law, okay?
But not, you've done therapeutic activity, but somewhere down the road somebody told therapists that they should only bill for therapeutic exercise like they're doing the patient a favor. I was getting therapy at a physical therapy practice in Florida and this gentleman I had a bad knee, and we were doing balance, and it was awesome.
And I said, "I'm just curious," 'cause I saw him write. I said, "What did you just bill me for?" "Therapeutic exercise." I said, "That wasn't therapeutic exercise. You're working on my balance. You're working on my coordination. You're calling that therapeutic exercise?" "Yeah, but it's gonna cost you more." I said, "I'm not gonna report you to your owner."
"I'm gonna be very nice and say, please bill me for what I do, and let the insurance company take care of the rest." So I think that is one of the keys. Second is to understand, and I'm saying this, but I say this a lot, how to use a physical therapy assistant properly and willingly how to sell your patient that Katie is gonna be taking over after I do your evaluation.
"Do you know what I'm really good at, Mr. Jones? I am an unbelievable... I do patient evaluations better than anybody, and I develop plans of care along with Katie. Katie's gonna carry out that plan of care, and she is the best at that. And I'm gonna be checking in every three visits to see how you're doing and see what your progress is."
I could sell that to any patient, okay? Cash-based patient may be a little harder. Yeah. But- But we're gonna get to that. We're gonna talk more about that I know. But my point is that, that's the second thing, is utilizing the team around you to get the results. It's all has to be based on what are the results?
What are the outcomes? If I could be more efficient in getting the same outcome, why would I not do that for the practice that I work in? Whether you treat those patients or I treat those patients, as long as... Now, we're gonna measure outcomes. If the outcomes start to go down, then we have a problem- Yeah
and we have to rework on our plan of care, blah, blah, blah. You said two or three. I think the third one is to truly embrace what I said before, that there's a clinical component that is so important, but don't think for one second that this is not a business. There's a business component.
And take it in, learn it. Learn it. As a PT assistant, you can... Many states, you can start a practice. Yeah. Whether it's a PT or a PT assistant, and if you ever wanna be in a practice, you have to learn that business side. Yeah, absolutely. And I have interviewed multiple PTAs on this podcast that are clinician owners, or clinic owners, I'm sorry in that they might be co-owners or whatnot.
So it does happen. It is absolutely something out there for PTAs that it's allowable in your state if it is. So definitely don't discount yourself if that's something that have a dream of doing in the future. But I wanna talk a little bit more about cash-based physical therapy, because this is the way, right?
As the, the, in The Mandalorian, "This is the way", right? We were talking a little bit of a, about this before we hit the go button earlier, but what is it that you wish that more clinicians, PTs and PTAs, understood and knew about cash-based physical therapy services right now? Yeah. Yep. First, I think for a clinician that has full belief in their skills and is frustrated in a clinic where they may believe that they're not able to spend as much time as they really would want with a patient I think it's a great outlet. What history will show because, I can go back 10 years and PPS conferences, CMS, they're all talking about cash-based, cash-based, cash-based.
As of today, of all of the single clinic owners, that means it's one owner, one physical therapist who owns a business of all those businesses in the United States, about 19% of those are cash-based. Wow. Maybe you get two therapists, maybe you get three therapists that can stand up to the pressure that you have as a cash-based business.
The difficulty with cash-based businesses is that they are extremely hard to scale, and I can only count on one hand the number of 10-plus cash-based businesses in the United States today. There is one that is a franchise. There's a couple others. There's some on the fringe of that. But it's very hard to scale because it's very hard to attract and find enough therapists.
Therapists are a shortage as it is. That's its own problem. Yeah. And it's a high pressure when people are reaching into their pocket at the end of every visit and putting down 150, 200, $250 that what you've done is, so can it happen? Yes, it can happen. But it's very rare.
Of all, again, all the business in the United States, it's only 2%. So it's growing. Now, as, in terms of ever being able to sell a cash-based business really hard. If you go to any of the large acquirer websites, you don't see, "We have, one of our modules," or, "One of our, lines of business is our cash-based business."
They don't have that. Where they get that, additional cash that they may believe that they need, they're doing it to, in, direct to employer. And do they have little pockets that may have businesses that came in that had a portion of them that were cash based? They may and they might, but they're not looking for cash-based businesses to buy and acquire.
So you're seeing more of a mixed model where people are doing insurance and cash base or, like- Not a lot. No? We do see a little bit of that. And we've questioned acquirers 'cause, we'll get a call from a month or two ago, seven clinics, all cash based. And one or two of the acquirers said, we would take a look at that.
We would first value it-" ... taking on the reimbursement of our business. But we've also looked at having maybe, over here to the side." It's just, it's really hard because it doesn't fit with any of their other clinics. You can't take a therapist out of an insurance-based business and have them go cover at that cash-based business because it's very different.
I'm getting treated right now in a cash-based business. It's very different. It's just, it's a totally different model and one that's very difficult to scale. Do you see many PTAs contributing to a cash-based model? And then- I don't ... if you do, like what ways? I don't, but I haven't been inside enough cash-based businesses.
Got it. But there is an enormous opportunity for PT assistants who believe that they have the, the people skills to really impress a, they're not even patients, our clients. Yeah. The patient or the client. That's- and they will look boldly into a physical therapist's eyes and say, "I can treat patients as good, if not better than you can- after you create the plan of care. Our patients in your facility were gonna wanna come back. There's gonna be a line outside the door for me because I have the people skills and the therapy skills to do it, and I'm willing to learn whatever you need to teach me." That's very interesting. You got, they gotta get paid more.
They have to get paid more- Yeah ... in those environments. How does, 'cause, you've been, you've... You're teaching me during this conversation, I've never run a business not like that anyways. But what is it that it does to the clinician when they understand how the business runs?
Like, how does that change the conversation that they have- Yeah ... when they start to understand these different components? Yeah. There's a wide range on that. You know- ... there is a select, there is a, a, a portion of them that the, the, the, the eyes light up and, we truly understand what goes on back there in the closet when you're billing patients and you're collecting and you're arguing with the insurance companies and you're going out to direct pay to the employer.
So we have found if the owner and/or who, who would ever be teaching, these therapists, kind of the business side, that they're enlightened, that they're actually sharing what kinda goes on behind the closed doors and what we really need and why we need to see however many patients per day, however number of units per visit- how that, really falls, is a... And it's what enables us to have a piece of equipment over there on the corner that costs $25,000 that you get to use with your patients. It's why we can go and have a picnic every summer with, 100 staff people, and we all bring... Because on the business side of that, you understand that.
You know that. And the biggest thing I believe is we create targets, we measure, we monitor, we react and respond. If you don't do that they'll never learn because "Hey last year it looked to us like you did not bill therapeutic activity more than... wait a minute, what patients did I see last..."
As opposed to, "Last week it seems like, a lot of your patients were all therapeutic exercise. Let's walk through those." Now they understand. Now it clicks. We've worked with practices that they bill 10% of their charges are neuromuscular re-ed and therapeutic activity combined. 70% therapeutic exercise.
We've worked with practices that therapeutic activity neuromuscular goes to 50, 60%. Therapeutic exercise gets down to 20 to 30%. Are they doing something wrong? No, they're actually billing for what they're doing, and they're giving the patient the care that they deserve. Yeah. Go over and get on the bike.
Yeah. It's not the care that they deserve. Yeah. Yeah, it's very interesting. I just actually recently started doing PRN work myself. I have... I've, I work in education. I haven't had the opportunity. I've raised two teenage boys that are almost- ... they're on the verge of adulthood. At least they think they are, but- Per the law, one of them is. They're going to find out. But, yeah. I just simply didn't have the time to do it, and now I'm at this different spot in my life where I'm stepping back into patient care and I'm really thinking about this a lot more. And yeah I talk to students about this stuff all the time, but this is what I always tell students is, "This is the value of clinical education, is I can teach you on pen and paper how to pick billing code, how to pick CPT codes, right?"
Yeah. But until you're in the clinic and you're seeing it happen- it'll never happen ... it isn't going to make sense. Absolutely. And this is the value of being in that clinical environment because exactly what you're saying. And I'm sitting here for the first time in years going, "Did I really only do therapeutic exercise?
Because I'm pretty sure I did something that was more along the lines of an activity- Sure ... to produce a functional outcome of something that I want this patient to be doing other than just pure therapeutic- ... exercise." So I really- ... enjoy this conversation and that was another sidebar that was not a planned conversation, but- Yeah
It- You're gonna do what the others in the clinic are doing when you come to that clinic, and you're gonna, you're gonna fit in, and if the others are not billing therapeutic activity, you're not gonna do it either, and it's natural, and it happens in so many businesses across the United States.
So it's time for us to start and not necessarily questioning the system, but- But maybe challenging. Isn't there another path? Is there another path forward? Because if we don't ask the question, then it doesn't change, right? Yeah. I think, I believe our patients deserve skilled care.
And therapeutic exercise, there's a reason why it's billed at a much lower rate than therapeutic activity, therapeutic... Or neuromuscular. And so I believe they deserve skilled care. They also deserve to have it billed as skilled care. Yeah. Because you're robbing your own, who you work for when you do something and you don't bill for it.
It's literally like somebody coming out of a grocery store and the person at the exit says I know it's 100, but give me 80 bucks and we'll call it, we'll call it even." It's the same thing. Very interesting. Very interesting. I'm doing all this work for you, like the gentleman did for me- Yeah ... I'm not gonna charge you for it, though.
It's not cool. That's a good analogy to help people understand. And of course everything you're talking about is from an ethical perspective. You're talking from a legal and ethical perspective. But yeah, we do tend to kinda lean on the nice guy side where we're like, "Oh it's enough."
We did the thing, and..." You know- It's fraudulent. Yeah. Yeah. It's, when you use that word- Passive care. Yeah ... yeah, it gets PTs and PT assistants shaking a little bit. Very interesting ... but they should be excited because if we don't bill for what we do, what's gonna happen to our profession?
Reimbursement's just gonna keep coming down- ... and down. Yeah. Yeah, we have to challenge those systems in those ways. So you've helped literally hundreds of rehab owners build value and navigate partnership sales. Like, when someone looks under the hood, like if we're gonna use an analogy, we're using an, a car analogy.
I don't know enough about cars, so- ... but you can tell me anything and I'd believe it. Sure. But if you're gonna look under that hood of physical therapy, what makes a business valuable, or what gives that business value? What does it look like to you? Yeah, I think that, there's a couple things.
Number one is growth, whether it's internal growth, you're adding therapists, you're adding... your business is growing year over year. 5, 10% improvement in referrals, visits, units, charges, revenues. So first and foremost, companies out there that are valuable are growing, and businesses that are acquiring want to acquire growing businesses.
I think the second is, generating real cash flow, in the business. And that's, their EBITDA, earnings before interest, taxes, depreciation. It's the bottom line of the business. Many businesses that we, value their EBITDA could be less than 5% it should be 20.
And so we work with practices then to, whether it's charge capture, schedule management in terms of how many just unit management, how many units are they billing? Are their therapists billing for everything they're doing, et cetera, et cetera. And the last I think, is leadership. Most businesses are looking for owners to come with the business.
But they also know that in many cases, that owner is the most vulnerable on who's gonna leave, 'cause you've just handed that owner a check for $3 million or $5 million or however many. So you don't sell your business to work for another 20 years. That's really important because if I can show that I have three folks here that are leaders in my single clinic or three-clinic business, and if I went on a vacation for three months, they may call me once a month, but other than that, they can run this business.
It's really important, and the only way you do that is to create a leadership group- ... to actually meet with that leadership group, to teach and train that leadership group, and have them truly be the leaders of the company. I love that description that you gave, the whole, if I can go away on vacation and feel comfortable knowing my staff has everything under control, I have leaders in the group that know what to do.
That's a really good feeling as a business owner, isn't it? That you have established that your team has grown, that they are comfortable in their own shoes, that they can take care of those kind of situations, and I think that's a great, Yeah ... great perspective to have. It gives you choices.
You know- ... not everybody wants to sell their business. Not every physical therapy business owner will sell their business. But when you build a team, now can I just back down, 20 hours per week, and then maybe I back down less. And so that's an alternative, and then obviously the other alternative is go out and find a partner.
So it gives you alternatives, it gives you choices, and that's what you want in your business. I think anybody who gets to a position where they have choices, that's power. Yeah. Choices. PTs and PTAs want choices. How much of this has anything to do with the whole location? Do you see that plays a role into this?
Rural versus urban versus suburban when it comes to the success of a business? Yeah, for sure. We have a 10-step road that we have companies follow to do a new startup and/or to start their own clinic. You go through those 10 steps. First and foremost, you gotta have referral sources.
And just counting on, patients coming direct that's secondary. That's something you should push, but you have to have referral sources. It should be a growing demographic. You should outline, who are the competitors and what- ... what kind of market share do they have, and what's really available as the market share within a driving distance a catchment area for your business.
It's something, this is a, a service that we do for people. We go through those 10 steps to really show them, okay, in this market, there's a 5%, there's 5% left in market share. In this market, there's 70% left in market share, and it's a growing demographic, and you have referrals. Many of those questions need to be answered.
And the biggest one is to go live in the community. So if you've already have a an established clinic but you want to move to the next town over don't just rely on the fact that you've driven through there and it looks really cool. You need to go to the local coffee shops, to the churches to the schools.
Really find out, the municipalities to find out really what's going on in this market before you would put up a new clinic in that market or your first clinic. I started my first clinic in the town I grew up in. It just made so much sense. The high school, every teacher in that high school still knew who I was.
Physicians, knew my dad was an orthodontist and, they may have known him. So it just made so much sense because there were referral sources. But the next one and the next one and the next one and the next one, that, that was all, not just a leap of faith a leap of a lot of data pointing to the fact that this could be a successful new clinic.
So do you see that there's anything that PTs and PTAs can do for themselves to make themselves valuable enough that clinic wants to keep them and wants to retain them? What does that look like when you're pouring into your staff, your PTs and PTAs- Yeah ... versus if you maybe are not so much?
How does that play into- Yeah ... value? Your staff needs to be aligned, and if there's not alignment of that leadership group, there won't be alignment of staff, and depending upon your size, So your staff has to be aligned, and if you went to any one of your staff, whether it's a, a tech, an assistant, PT assistant, or a PT, or a front desk, and you said to them, "Describe the culture here," they would be able to describe it first.
And secondly, it- there would be a lot of positive things. We're a culture of change. We're a culture of pressure testing. We're a culture of patient-centeredness. So I think that for, for them to become, truly valuable within that organization they truly need to embrace those things that make the business valuable.
And in a market where a lot of PTs, PT assistants can typically just... there's, PT assistant, PTA, PT openings across the country. If you don't have therapists and therapy assistants in, in, in your business that is not driving that culture people are gonna leave, and they're gonna go to some place where there, there is a strong culture.
It's not just recruiting, it's also retention. So this wasn't one of the questions that you and I had initially- No ... talked about, but you brought it up earlier with our staffing shortages, right? Like we have this PT shortage in the profession right now. This is something- Yeah ... that we've discussed greatly at an association level.
What's your take on that and how do you see us remedying this and steering that ship in the future? Yeah. We say ABR, always be recruiting. 9 times out of 10, with just a little bit more push to physicians that you have openings, you can fill that so you always are recruiting. We find that the companies that invest, make investments in going out to physical therapy schools, whether it's them as the owner as well as the therapists who went to many of these schools, going out, driving solid internships, as well as teaching there's always a, a, a class that can be taught by one of your therapists or by you as a business owner.
So going and really making an investment in your local physical therapy schools. Every, there's an APTA, Connecticut APTA, New Jersey. Go to your local APTA meetings, set up a booth, talk to physical therapists, there and bring some of your therapists so they can, hear from the owner that we have a great culture, but then you can go talk to Katie who's over there- and she's also said there's a great culture. And then outreach. Yes, you can do email outreach. Yes, you can if you have text numbers or whatever. But we find that, written correspondence out in envelopes, so they have to open it up and they have it in their hands, they're gonna put that in a file or they're gonna put that up, and that, that direct outreach to therapists within a certain radius is also a great way to, get therapists into your business.
And then you gotta retain them and I think that all comes down to your onboarding, your training, their development opportunities, and how many friends do they have at work? All, you know, if all you ever do is treat patients with the folks around you- ... it's really hard to make friends that way, especially in a busy practice.
So the owner has to, drive that culture by creating opportunities for people to talk and mingle outside of just the very typical workday. I'm gonna emphasize something that you mentioned that I wanna make it extremely clear to the audience that, that is listening, that solid internships, I like that you said that.
As somebody who works very close to students and who works very close to the clinical education piece A good internship can be so valuable to that PT or PTA in ways that you have no idea in the future. Those students continue to talk about those experiences. Those students learn a lot from those experiences.
They learn behavior. They learn what's appropriate, what's not appropriate. They learn how to make connections. It is so extremely valuable. If you're not currently taking students in your clinical environment, I would highly encourage you to do so. It is definitely a way to have a five, six, seven, eight, nine, 10, 11, 12-week interview with that person, right?
But you also- Yeah. That's a good point. Yeah. That's a really good point. Like, you've trained them, you've onboarded them, you've shown them that internal clinical culture that you've built, and I think that there's a lot of value that comes to that. And I can tell you right now that every PT and PTA school who's knocking on your door that is asking you, "Hey, would you take a student for us?"
Yeah. You're gonna do a lot more for that student than you think you will beyond just helping your local community school out. So I deeply appreciate that. And development opportunities, right? Pouring into your team, helping build their skill. PTs have their pathway through fellowship and residency and board certification.
PTAs, we have the, the proficiency pathways, the advanced proficiency pathways for PTAs, which is the, the closest thing that PTAs can get to board certification or, it is almost like a little mini-fellowship as well. Sure. So highly encourage PTs and PTAs to seek those opportunities out.
If you feel like you have the ability to make decisions and changes in your job, you're gonna be more satisfied with your job. For sure. Just- Yeah, no, I- ... probably. Even if your interns go somewhere else eventually they're probably gonna come back. But I think culture is, we are a teaching and a learning culture here, and we are growing physical therapists.
Whether they come back and work here or they work somewhere else, it's a part of what we do, and it needs to, it needs to flow through everyone. You can't have just one or two therapists. They're the only ones who can do internships. No, every therapist can do an internship, and every therapist should do internships.
It gives you, A, it gives you a helper- ... and let's not forget that. B, who doesn't like to teach? We love to teach. Yeah. Yeah. And yeah, I just think it's a great opportunity not only for recruiting, but to drive your culture is, with these internships. And not every business that does internships do them well.
It can be a negative. Yeah if an intern comes and you're not running your... It needs to be a program- Yeah ... that internally someone is running and driving it. Absolutely. And whether that's a PT assistant, I don't think it matters. Somebody needs to run that program and make sure every student gets everything they should have gotten, and you'll get, you'll get more therapists that way, for sure.
I agree 100%. Yeah. Pour into that program and it will return in, in reward to your clinic in some way, shape, or form. Even if it's simply, I hear this a lot whenever people graduate from programs and they say I don't wanna be a clinical instructor because I didn't have a very good experience when I was a student."
Ah. And I'm like, "This is your opportunity. This is how you make change," right? Then go back and teach that clinical instructor that didn't give you a good... yeah. This is your opportunity to make change. Yeah. Take it and run with it. Great idea. So yeah, there's so many ways that you can influence the next generation of PTs and PTAs.
Okay, so now I'm gonna ask you, this is a tradition we do on the show every time. Everybody gets a plus point, so this is your opportunity to give a piece of advice. You can get on any kind of soapbox you want. You can start a fire in the profession. Yeah. It's the, the mic is yours, Paul. Okay. What would you like to tell everybody?
You're gonna think I'm just giving you and your show and what it's all about, what you would expect. But I am calling out to all physical therapy business owners to engage in setting up physical therapists, physical therapy assistants, a team approach to treating your patients, and making sure that in in, within that, you are measuring and monitoring outcomes in addition to all the operating metrics and things you're doing on the front end.
You're measuring those outcomes. So at that point, therapists that, will come to you, and I think there are many therapists out there, "I wanna treat my own patients." Okay? Not here. Not here. And what I'm gonna show you is we get the same outcomes, better outcomes than the business up the street because of the communication that we do, because of the training and teaching that we do.
So I really think... And it's an opportunity to drive your bottom line in a way that maybe you've never been able to in the past because you're an all-therapist business. And because I, again I really have a belief that on the outcomes, that you're gonna be amazed. Your outcomes are either gonna be better or, at the very least, just as good.
So that's what I'm... That's my cry out. I love it. Thanks, Paul. Okay, Paul, where can people find you and find out more information about not only you, but about Martin Healthcare Advisors as well? Sure. Yeah. Best way is right on our website. Www, it's our name, .com. martinhealthcareadvisors,
with an S, .com. You can reach out to me directly if you would like, and that is I will put my cell phone number out there. And so yeah. We have consultants and folks all over the country that you guys could learn from, so we're happy to engage any conversations or outreach that you guys may want.
I love it. I will make sure all of that information is in the show notes. We really appreciate your time. Like I said, this is a conversation I don't get to have very often on this show, so I appreciate the difference and the nuance and like the niche route that we took here with us today.
So I really appreciate your time, Paul. Yeah. Thank you, Katie, and you do a great job with this. Oh, thank you. And happy to be a part of it. Thank you.
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