Going from busy clinician to owner of a seven-figure practice means learning skills most physical therapists were never taught. To build a 7-figure physical therapy practice, you have to sell your expertise, design your space for revenue, and develop leaders who can run the clinic with you. Those are the themes of this conversation.
In this episode of the Practice Marketing Podcast, host Neil Trickett talks with Darryl Yardley, a physiotherapist and the chief operating officer of Clinic Accelerator. Darryl says physical therapists struggle to sell their expertise, and the two discuss how to train a team for sales conversations and objections. He describes how he plans a clinic floor for revenue per square foot and walks through the stages of clinic growth. He also covers how to develop clinic directors, whether to fix marketing or systems first, and where he thinks private practice is heading.
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Episode Highlights
- → From clinician to business owner: letting go of control
- → Selling your expertise and showing value early
- → Training your team for sales conversations and objections
- → Floor plans built for revenue per square foot
- → Minimalist build-outs, private rooms, and testing your layout
- → The five stages of clinic growth
- → Developing clinic directors and leaders
- → Marketing or systems first, and why the front desk matters
- → Where Darryl and Neil say private practice is heading
Guest Bio
Darryl Yardley is a physiotherapist, business leader, and chief operating officer of Clinic Accelerator, a business coaching company for clinic owners. In his introduction, Neil says Clinic Accelerator supports over 400 clinic owners across North America. Neil also says Darryl has spent the past decade mentoring hundreds of physios and chiropractors, from new grads to clinic directors and partners. According to Neil, Darryl has hired hundreds of clinicians and built his own seven-figure practice. Neil adds that Darryl has taught business and practice management at four Canadian universities. Those include Queen’s and Western, where Neil says he is now professor of business and leadership in physical therapy. Neil describes Darryl’s superpower as turning complex clinic challenges into real growth strategies without the fluff.
Key Takeaways for Practice Owners
- Step back from full-time treating. Darryl describes owners who work 60 hours a week, with 55 of them clinical. He likes helping them pare back clinical time so they can work on the business. He calls it a control challenge, because clinical work is their identity and comfort zone.
- Show patients the value early. Darryl says that if you are not demonstrating value early, patients are not going to return. He wants clinicians to guide patients through a full continuum of care, not stop when the pain eases.
- Train your team to sell, and to hear no. Neil and Darryl say physical therapists rarely get sales training. Darryl says clinicians also need to learn what to say when a patient says no.
- Design for your full team. Darryl recommends a hybrid layout with private rooms plus an open treatment space. He says to design the gym for when the full team is working, not just one clinician.
- Test the layout before you build. Darryl suggests taping out the floor and asking a patient or two to walk through. He says a half wall he once built blocked space he needed.
- Know which growth stage you are in. Darryl describes a lifespan from new clinician to solopreneur, scaling owner, and exit. Neil recalls five stages, from committed solopreneur to strategic seller.
- Develop leaders before you need them. Darryl says developing leaders who do things better than you is a strength. He says to test a clinician on the challenging parts of the clinic director role before promoting them.
- Fix leaks with low effort first. Darryl says to run marketing and systems together and start with the data. He says to look for changes that take low effort and have a positive outcome, and he says a strong front desk can compensate for a weaker clinician.
- Build around a better patient experience. Darryl says everything should evolve around a better experience every time a patient walks in. Neil says insurance payment has not kept pace, so per-visit revenue has to come from delivering more.
From Clinician to Business Owner: Letting Go of Control
Neil asks Darryl what fires him up. Darryl says it is seeing the wins. Many Clinic Accelerator owners start out stuck in the weeds and putting out fires. As things start to click, he says, one win becomes two and then three, and the clinic moves onto a growth and scale strategy. When Neil asks whom he likes to work with, Darryl calls himself the clinical guy of the group.
“I really like working with that practice owner that’s working 60 hours a week and still 55 of those are clinical, and slowly helping them pare back clinical practice to find time to work on the business, not just in the business.” — Darryl Yardley
Darryl says this is a control challenge for many owners. Being a clinician is their identity and their comfort zone, and they spent years getting good at it. He says the business world then hits you with work you do not like but cannot avoid. Neil adds that clinicians still have to be strong at managing patients first. Darryl agrees. In his view, small business owners often start out wanting to do things better than where they used to work. To go beyond the solopreneur model, he says, they have to learn the skills of business and find ways to deliver the same outcomes at scale.
He shares a recent story about a clinician he knew from a private practice boot camp. The clinician moved to another province and opened his own practice. He later called Darryl for help. Darryl says the clinician’s old practice owners had been pushing him to be more assertive. Once he ran his own clinic, he saw how hard the work was. Darryl asked him to call his former owners and tell them they were doing a great job. He says the owners texted back asking what he had said to the guy, and he told them the clinician had realized it is not easy to run a practice.
Selling Your Expertise and Showing Value Early
Neil asks whether one common mistake frustrates Darryl. Darryl says physical therapists do not sell their expertise, and he says this holds in both Canada and the US. Much of a Canadian practice is cash pay, he says, so patients who do not see value early will not return. In his view, clinicians are good at managing patients early. He says he does not know whether the gap is a lack of experience, confidence, or mentorship.
He describes a conversation with a clinician. The data on these outpatient musculoskeletal patients says they should come 12 or 14 times, he says, but this clinician’s patients come only four. The explanations are usually that funding ran out or that the patient felt better. He wants clinicians to think about a continuum of care. First calm things down, then rebuild, then keep the patient there, and perhaps even exceed their expectations.
“It’s not just about how busy my practice is. It’s how will people respect what it is that we do in primary care.” — Darryl Yardley
What frustrates him most, he says, is a chart that records only less pain and a 60 percent improvement. He asks where the objective evaluation and the functional test are. He asks where the proof is that the patient completed a full course of care with an expert. Neil says that approaching care this way leads to better outcomes and stronger word of mouth. He adds that patients who stay longer also increase visits and revenue. Neil notes that more US clinics are bringing in cash models because insurance is not there anymore.
Darryl adds a test for owners. He suggests asking a patient on the way out why they are coming back next week. He says he would guarantee the patient has no idea, even though most clinicians know where they want to take them. If a patient does not understand the plan, he asks, why would they move from an insurance-covered visit to paying out of pocket?
Training Your Team for Sales Conversations and Objections
Neil says selling yourself has traditionally been the weakest area in physical therapy, and that PTs rarely get that training in school. He describes a sales course for his own therapists that his business coach sold him. A trainer came to the clinic for two days and taught sales from the perspective of doing the right thing for the patient. Neil says he saw more patients keep their plans of care going, with more cash pay. In his view, therapists should tell a simple story. Here is where you are, here is where you want to go, and here are the steps to get there.
Darryl says clinics can take lessons from other industries. One example, which he says suits larger practices, is the plastic surgery model. After the doctor’s consult, he says, a care coordinator who is sales trained maps out the plan and the financing. That keeps the money conversation off the clinician. In a smaller business, he says, the therapist has to have that conversation.
“I hate rejection, but teach me how to deal with rejection, because it’s normal.” — Darryl Yardley
Darryl says he cannot recall a program that taught him how to offer a patient alternative options. Without that training, he says, the default becomes “just come less” or “let’s see how you do on your own.” Time, motivation, and finances are all barriers. Therapists, he says, need to know what to do when someone says no. He also says clinicians should be able to discuss what could happen if the patient does not follow the plan. Neil agrees. He says he tells patients that they will start to feel better but may still have weakness and poor coordination that sets them up for future injury. Those are the conversations, he says, that clinics need to train their teams to have.
Floor Plans Built for Revenue per Square Foot
Neil notes that Darryl has opened and designed dozens of clinic floor plans, and asks for his secrets. Darryl says the most important question is how much of the space can generate revenue. He adds that if you strip out storage and staff rooms, the clinic becomes a mess. He focuses on patient flow. A therapist should have sight lines across the clinic, and patients should be able to see what the practice offers. He says not to tuck the gym away.
Darryl recommends a hybrid layout, with private rooms as needed and an open treatment space that still has beds. He says an open space makes mentorship easier, because newer clinicians can hear how he treats while working beside him. He also likes the idea of moving away from “this is my room, this is your room,” so rooms turn over quickly. He suggests putting pelvic health or massage rooms off to the side, so a squat rack is not clanging nearby. Patients can still see that those services exist.
“So really think about designing that space for when you have a full team, not just when you’re designing your new space and you only have one clinician.” — Darryl Yardley
For the gym, Darryl says to make it stand out, and he has seen more clinics adding turf. He suggests designing the space like a small apartment, with equipment that folds away. As an example, he says a squat rack can fold into the wall, and a small anchor unit can replace a large pulley system. He says he has made a mistake several times: dividing the gym into sections, then having four people in a gym when five clinicians are working. His point is to think about workflow, so a second shoulder patient is not waiting for the pulley.
Minimalist Build-Outs, Private Rooms, and Testing Your Layout
Neil asks about owners who build minimally to save cost. Darryl says he has seen it. Once, he built a clinic for eight treatment tables when he only had three to start, and the space looked like it had not been designed properly. Maximizing space is a priority for him. A clinic can also be built for less than it used to cost, he says, because he no longer needs machines like a Biodex.
Darryl says clinics now need space for objective testing. His example is a TV showing someone on a force plate, so the next patient asks to try it. He says it is fine to build out so the practice looks complete and keep other items on a wish list. For instance, he might hold off on a shockwave unit that costs about $30,000 until he has six months of cash flow. He says the goal is still a really good experience for the people coming through the door.
Neil adds the marketing view. Clinics with lasers, shockwave therapy, or exercise equipment that patients lack at home, he says, are seen as offering something worth paying for. Neil also describes a location his practice built from bare concrete, with a large open gym. In his experience, patients see each other succeed, which keeps them motivated and creates opportunities for referrals.
Darryl says people challenge him on privacy. His answer is to decide who your ideal client is, since you cannot be everything to everybody. Patients who need privacy can use a private room. He says 90 percent of the patients who walk through his door talk to the patient beside them anyway, and he sees social proof in those conversations. He also advises structuring private rooms by shifts, such as an AM and PM schedule, or holding rooms through the EMR. Otherwise, he says, a room sits empty and earns no revenue, or another provider cannot use it.
“What looks good on a blueprint may not work when you actually have the flow of patients, therapists, and assistants in there.” — Darryl Yardley
Neil says clinics can learn from retail consultants who plan traffic flow in stores. Darryl suggests hiring one or two patients to walk through the plan before you finalize it. He also says to put tape on the floor before you sign off with an architect or designer. He says one of his biggest screw-ups was a half wall he put in before he saw how much depth the equipment needed. It removed a runway he had pictured for higher-level functional training.
The Five Stages of Clinic Growth
Neil asks Darryl to walk through the five stages of growth that Clinic Accelerator uses. Darryl says he hopes he gets the phases right. He describes a full lifespan. Clinicians right out of school may enter through clinician-based training. Others arrive wanting to be a solopreneur and open a practice. Growth beyond the solopreneur then gets harder, because the owner is managing people and needs to do marketing without knowing how.
“We’ll take them through that full lifespan, from a brand-new clinician, to solopreneur, wanting to scale, all the way to actually exiting from their practice.” — Darryl Yardley
Darryl says HR and marketing are where he often finds owners at that stage. He says his team tries to pull them back to basics: where is your scoreboard, and where is your P&L? Then come owners in what he calls “scale well,” who are in pure growth mode. They might want more out of the current clinic, a bigger footprint, or three or five locations. Some then start thinking about an exit.
Neil says that, from what he remembers, the five stages are committed solopreneur, stressed operator, growing operator, millionaire CEO, and strategic seller. Those labels are Neil’s recollection on the show, and Darryl describes the lifespan in his own words.
Developing Clinic Directors and Leaders
Neil asks what it takes to become the millionaire CEO and how to develop clinic directors or lead therapists. Darryl says one of the biggest challenges is that owners are sometimes their own stuck point. He says he was in the way far too often, and that he fed off the need to solve everyone’s problems instead of developing his leadership team.
“Developing leaders who can do things better than you is not a weakness, it’s actually a strength and a talent.” — Darryl Yardley
To reach seven figures, he says, you cannot skip meetings or a mentorship or coaching session, and you cannot stop investing in yourself. A clinic director should be developed as a leader of the clinicians, and an office manager as a leader of the admin team. Darryl says the owner needs to give them tools, resources, and support. He also says to choose people who have some skills and some people skills. Everyone needs to understand the scoreboards and the finances, he says, because a clinic director who is a glorified babysitter is not worth having.
Neil asks about promoting a clinician into management only because they are a good clinician. Darryl says that is sometimes one of the biggest mistakes, though not always. A clinic director has performance reviews and difficult conversations to handle, he says, and someone who did not expect that may not want the role. He suggests using your expert clinician as peer-to-peer support instead. For example, you could pair a clinician who struggles with neck pain patients with a colleague who is confident in that area. Darryl says that, as a clinic director, he would tell the owner to expect some lost productivity that week in exchange for more confidence in three months.
He also says owners do a poor job of defining the outcome of the role, and they write fluffy job descriptions. His advice is to work backwards from the outcome. For anyone thinking about promoting someone, he says, test them first with a project that includes challenging interactions. Neil says he thinks the move works about 90 percent of the time when you are clear about what the role involves. That includes evaluations, coaching, and difficult conversations. Darryl adds that the clinic director and office manager roles are especially hard because those people were once colleagues and friends of the team.
Marketing or Systems First, and Why the Front Desk Matters
Neil asks what owners should work on first when they need more new patients, are losing patients, or see plans of care going unfinished. He asks whether they should spend more on marketing, such as physical therapy marketing services, or fix their systems first. Darryl says you need to run both at the same time. Which one gets priority may change. When he adds a new staff member, for example, he says he turns up marketing right away so the new clinician’s schedule is not empty.
He says there are holes to check as patients come in through marketing. One question is what happens when they call the clinic. If the front desk is not operating well, he says, the clinic may never get the chance to help them complete a plan of care. He calls the front desk the engine of the clinic. Neil says he thinks the front desk is the most important part of the clinic, because it gets people to arrive and pay.
“A strong front desk can compensate for a weaker clinician.” — Darryl Yardley
Darryl says clinics that struggle often blame marketing. He says that in his work with thousands of clinics, the data often shows plenty of leads. The call tracking, however, shows missed calls and people who were never called back. He says this may not be the front desk’s fault. They may not have enough training for a sales conversation, or they may be overwhelmed. Some clinics need another person just to handle inbound calls, he says, and that could be a virtual assistant. Neil mentions a chat he and Dee Bills had with some owners about the flow through a clinic and the front-desk staffing model.
Darryl shares feedback from an owner who was unsure she could justify the added expense and later said she was glad she did. He says the new person converted more leads, and then the clinicians got busier. To summarize where to start, he says to follow the data. Put leads on the same scoreboard as discharges. Then look for what you can change with the lowest effort and a positive impact. He says clinical operations take longer to change, because clinicians have to buy into the strategy before they behave differently. He also cautions against pushing staff too hard. HR is a nightmare right now, he says, and a labor shortage means a clinician who quits can put you back in the treatment room.
Where Darryl and Neil Say Private Practice Is Heading
Neil asks where private practice is going in the next five years. Darryl says everything has to evolve around a better patient experience.
“I think everything has to consistently evolve around an even better experience every time a patient walks through that door, no matter what.” — Darryl Yardley
In an urban area, he says, there may be 10 clinics within a few kilometers, so the experience has to be different from the clinic down the street. He asks how AI could help owners work more efficiently so they can spend more time on value and outcomes, and whether it could help clinicians map out a plan or coach. Clinics with a true interdisciplinary model, not just several providers under one roof, are the way people will go, he believes, since patients want a one-stop shop. Patients can now run an MRI through AI, he says, so clinicians should be ready to manage more informed patients.
Neil agrees and says insurers are not paying more, while inflation keeps rising. He shares figures from his own survey. A patient visit paid about 100 dollars 25 years ago and pays about 98 dollars today, he says, and 100 dollars then is about 190 dollars in today’s money. These are Neil’s own numbers. His point is that per-visit revenue has to rise, and the way to do that is to raise the patient experience and what you deliver. If the model is to lower the bar because of what insurance pays, he says, it becomes a dwindling spiral. He says that in his work with Canadian clients, clinics with a hybrid, multi-discipline model find it easier to market and grow.
Darryl asks owners to change the narrative from “I can’t do it in this state” to asking how they could make it happen. He says fee guidelines have to be balanced against accessibility, but owners still have to pay staff a fair cost-of-living increase. If a practice model does not work, he says, look for another one. He says he is watching US clinics grow remote therapeutic monitoring and wishes Canada had a fee code for it. His point is to look for other ways to generate revenue based on quality outcomes. He wants clinics to find ways to raise the lifetime value of a patient without making physio out of reach. He adds that it all has to go back to putting the patient first, so you are not selling something that is not required.
In closing, Darryl says the best way to learn more is clinicaccelerator.com. He adds that the fastest way to reach him is Instagram, where his handle is @darrylyardley.
About Darryl Yardley and Clinic Accelerator
Clinic Accelerator is a coaching company for clinic owners. According to its website, it offers a Clinic Growth Blueprint for the full owner lifecycle, from starting a clinic, to scaling to multiple locations, to selling. The site says it has worked with more than 1,000 clinic owners in the USA, Canada, and Australia. On the episode, Neil describes it as a business coaching program, and he says it supports both Canadian and US clinics. Darryl serves as its chief operating officer.
FAQs
How do you build a 7-figure physical therapy practice, according to Darryl Yardley? Darryl says to demonstrate value early and sell your expertise. He also says to design your space for revenue and develop clinic directors who can drive the business. He says owners should follow their data, run marketing and systems together, and keep the patient first.
Why does Darryl say physical therapists struggle to sell their expertise? He says clinicians are good at managing patients but often lack experience, confidence, or mentorship in explaining the full plan of care. He also says PTs were never taught how to handle objections or offer alternatives when a patient says no.
How should you design a PT clinic floor plan for revenue? Darryl says to make as much space revenue-generating as you can while keeping storage and staff rooms. He recommends a hybrid layout, with private rooms plus an open treatment space and a visible gym. He also says to design for a full team, not a single clinician.
What are the five stages of clinic growth Neil describes? Neil says that, from what he remembers, they are committed solopreneur, stressed operator, growing operator, millionaire CEO, and strategic seller. Darryl describes a lifespan from new clinician to solopreneur, scaling owner, and exit.
Should you promote your best clinician to clinic director? Darryl says that is sometimes a mistake, though not always. He says the role includes performance reviews and difficult conversations. He advises defining the outcome of the role first and testing the person on a project that involves challenging interactions.
Should you fix marketing or systems first? Darryl says to run both at the same time. He says to follow the data and look for changes that take low effort and give a positive outcome. He adds that clinical operations take longer to change than lead handling.
Why does Darryl say the front desk matters so much? He says a strong front desk can compensate for a weaker clinician. He says clinics with plenty of leads may still lose patients through missed calls and missing follow-up. Neil says the front desk gets people to arrive and pay.
Where does Darryl say private practice is heading? He says toward a better patient experience every time, with smarter use of AI, interdisciplinary care, and new revenue models based on quality outcomes. He also says clinics should keep care within patients’ reach.
How can I learn more about Darryl Yardley and Clinic Accelerator? Darryl says the best way is clinicaccelerator.com. He says the fastest way to reach him is Instagram, where his handle is @darrylyardley.
Related Episodes & Resources
- Make PTs and Clinicians Beg to Work for You: Rick Lau and Shaida Rabie on Recruiting With Social Media: another Clinic Accelerator conversation, on recruiting and hiring clinicians.
- 3 Front Desk Scripts to Stop Holiday Cancellations: Dee Bills on Building a Front Desk That Keeps the Schedule Full: more on building a front desk that converts and retains patients.
- The $1,000 Phone Call: What Your Front Desk Is Really Worth: what missed calls can cost a clinic.
- Create a Hybrid Insurance + Cash PT Practice w/ Trilogy PT & Medically Oriented Gym: more on hybrid insurance and cash models.
- 5 Steps to Add Cash-Pay Services to Your PT Practice: Steve Rapposelli, PT, on Building a New Revenue Line: a practical look at adding cash-pay services.
- From PT Intern to Multi-Location CEO: growing from clinician to leader of a larger practice.
- Physical Therapy Marketing Services: how Practice Promotions helps PT practices attract more patients.
- Physical Therapy Marketing Pricing: see Practice Promotions’ plans and pricing.
View Full Episode Transcript (click to expand)
[0:17] Neil: Hello and welcome to the Practice Marketing Podcast, highlighting successful strategies from North America’s fastest growing clinics and experts so you can learn from their wins and power your practice growth. Hi, I’m your host, Neil Trickett, CEO of Practice Promotions. And today’s focus, we’re going to talk about building a seven-figure practice with Darryl Yardley. And Darryl is amazing. I’ve known him for a long time, a good friend. He’s a physiotherapist, a business leader, and the chief operating officer of Clinic Accelerator, where he supports over 400 clinic owners across North America. Over the past decade, Darryl has mentored hundreds of physios and chiros. He’s helped them grow from new grads to star clinicians, clinic directors, and even partners. And he’s hired hundreds of clinicians, built his own seven-figure practice, and taught business and practice management at four Canadian universities, including Queen’s and Western, where he’s now professor of business and leadership in physical therapy. And Darryl’s superpower is turning complex clinic challenges into real growth strategies without the fluff. So, Darryl, welcome to the podcast.
[1:27] Darryl: Yeah, thanks, Neil. I appreciate you giving me the big invite here. I am super pumped.
[1:32] Neil: Well, you’re worth it.
[1:37] Neil: So, I’m sure that as the chief operating officer of Clinic Accelerator, you get to coach a lot of physiotherapists and business owners. So, I’m curious, for you, what really gets you fired up?
[1:49] Darryl: Yeah, I think it’s seeing the wins that people have, right? On the Clinic Accelerator side, we tend to see practice owners just like us, totally stuck in the weeds, putting out fires, can’t see the light at the end of the tunnel. And then as you start working with them and things start to click, all of a sudden it’s one win, two wins, three wins, and next thing you know, their clinic is totally on a growth and scale strategy as opposed to, you know, a dumpster fire.
[2:19] Neil: Yeah, I get it. It’s the same reason that I do what I do. The biggest thing I love seeing is just people grow, right? People win. They have opportunities they didn’t think were possible. And I’ve been around the Clinic Accelerator group for a long time, and seeing the amazing work that you do to help lift up clinicians, give them guidance, give them the clear path, and the results that they get is really cool. So I’m curious, do you have a passion for a particular group or type of people you like to work with?
[2:58] Darryl: Yeah, it’s a good question. You know me, I’m kind of the clinical guy of our group, right? So anytime that I can still hop in and have a clinical debate and turn that clinical debate into business growth and strategy is kind of my wheelhouse. And for me too, as a clinician, there are like 10 excuses I could always come up with for why I wouldn’t do something if I put my PT hat on, right? But if you put your business hat on, you’ve got to figure out how to make clinical and business collide with a patient-first philosophy. So I really like working with that practice owner that’s working 60 hours a week and still 55 of those are clinical, and slowly helping them pare back clinical practice to find time to work on the business, not just in the business. But it’s a bit of a control challenge for a lot of us, right? If you think about going back to your days before starting as a PT, that’s our identity. That’s my comfort zone. That’s what I’m good at. That’s what I spent years developing to get really, really good at what I do. And now I’m in a world of stuff that I don’t really like to do, but it’s necessary because the business world hit me in the [expletive], right? So that’s the group I really like, because you can see such great progress, but it’s hard, and you need to have that kind of humble discussion with them too, to be like, “Listen, I’ve been there. I know what you’re doing. Here’s how I messed it up over the last decade. Here’s how I’d suggest you try not to make that same mistake. But you will make mistakes, and those are growth opportunities.” And that’s the group that I really like to work with.
[4:40] Neil: And especially the groups where we’ve got a lot of clinicians that don’t have really good buy-in, because this is a business coaching program. Business is one component of it. The second part is what do you do to grow your practice? You’ve got to be really good at managing patients first and foremost.
[4:58] Darryl: Absolutely. Yeah. And that is the key to a lot of stuff, right? If you can deliver amazing outcomes, an amazing product. And that’s one of the conundrums of small business, right? You go into small business because you want to do it better than where you used to work. I can do it better. I want to have more time with my patients. So you get into it for that philosophy. But then you soon realize there’s a lot more to it than just treating patients. And in order to go beyond that solopreneur model, you have to learn the skills of business. But then how do you deliver the care, the outcomes that you want, on more of a scale? That’s different systems and processes for the clinical side of it. Even as you see some of these practice owners grow, having one or two clinicians and an admin, maybe one and a half FTE, that’s not too bad. That’s a solid unit. But then as that clinic grows and you start ingesting different personalities in there, your whole leadership focus will have to change too. And probably one of the biggest wins that I had recently is I was working with two practice owners, and I had one of their clinicians in our private practice boot camp. He never had anything bad to say about the practice owners, but I knew he always really struggled on challenging them to do things differently, being a little bit more assertive with how he managed patients from start to finish. He ended up moving to a different province. Next thing you know, he’s calling me to say, “Darryl, I need help, because now I’ve opened my own practice.” And the highlight for me was those practice owners that I had that were pushing me a little bit harder, man. They had it dialed in, because now, on the other side of the coin, he’s like, “Holy [expletive], this is harder than I thought.” And what they were asking wasn’t about business. It was about how to really create a better experience so people knew what this business was about versus the other five healthcare businesses within a stone’s throw away.
[7:04] Neil: Yeah, totally see that. I’ve been there. I remember when I had that moment in my practice with the guy I worked for before. I was like, “Oh, yeah. He actually had it. He was doing pretty good.”
[7:14] Darryl: Yeah. And it’s sort of like when you get the right person too, they’ll eat that humble pie. I told this guy, the only thing I need you to do after today, besides everything I told you to do, is call your previous practice owners. You guys still got along. You have to tell them they’re doing a great job. That’s all I need you to do. And he did. They texted me to be like, “What did you say to that guy?” I’m like, “Nothing. He just realized that it’s not that easy to run a practice.”
[7:41] Neil: I love it. And so, as you’ve coached hundreds of different physios and physical therapists, is there anything that frustrates you, like that one common mistake that keeps happening?
[7:56] Darryl: Yeah, like especially… sorry, you were kind of thinking more on the PT side of things? Yeah, I think the fact that we don’t really sell our expertise, and it’s consistent in Canada and the US. Especially up here in Canada, dealing with certain insurance carriers, a lot of our practice is really cash pay. So if you’re not demonstrating value early, they’re not going to return, right? The challenge I find with a lot of individuals, and this is where the business versus quality of care debate happens and becomes a real barrier and objection to working for a particular organization, is that I actually think we’re really good at managing people early. I don’t know necessarily if it’s lack of experience, lack of confidence, or lack of mentorship and coaching potentially. But whenever you and I have a conversation to say, “These types of patients with these types of conditions in outpatient MSK, we have so much data. These patients should come to our clinic 12 or 14 times, but yours are only coming four,” it becomes this “well, they ran out of funding,” or “well, they were better.” And it’s like, yeah, but we have a continuum that we should be putting patients through from a recovery journey perspective. They start with us, we calm things down, we put out that fire, whatever they’re coming in with. But where do we rebuild things? Calm stuff down, build it back up, and then how do we keep them there? Or, quite honestly, maybe even exceed expectations, to help people realize that based on my expertise and my skill set, I can actually help you do more. But let me tell you why we’re going to get there. And hey, guess what, Neil? Do you even want to do that? Sure. But what really frustrates me is that it becomes a business argument as opposed to “why did our patients not finish their plan of care?” Neil needed to go back to an activity with his grandkids, but all I have written in your chart is that the patient had less pain, 60% improvement. Where’s the objective eval? Where’s the functional test? Where’s the validation that this gentleman went through a full course of care with an expert, which we would call ourselves as PTs? That’s my biggest frustration, because it’s not just about how busy my practice is. It’s how will people respect what it is that we do in primary care.
[10:41] Neil: Yeah. And the beautiful thing with that is that if you approach it that way, it’s going to help you get amazing outcomes, and it makes it so much easier to grow your practice, because now you have incredible word of mouth. People are getting amazing outcomes. They stay with you a lot longer. So obviously that’s going to help you with patient visits and revenue, but it’s from the point of getting them to where they want to be eventually, right? The number one thing that people really shoot for is that they just want to be healthier. People aspire to be healthier. Our model tends to be: you have an injury, let’s get you in, we’ll get you to a certain level, and then you go figure it out on your own. And like you said, we need to be on that continuum. We’re at that pivot point now in our industry. I’ve always said that Canada has been ahead of the curve because of the need to be more cash-based than here in the US, but we’re at a point now in the US where more and more clinics are really bringing in cash models because they have to. The insurance just is not there anymore. So the clinics that will be successful are the ones that bring in that hybrid cash model and increase their ability to help patients go beyond the scope of basic care, if you will.
[12:05] Darryl: Yeah. And what I like about where you’re going on that is that the challenge will always be, with some of the clinicians we work with, we see them through a bit of their lifespan. They’ll come in as a younger clinician and really struggle. You told me I should see this patient eight times, but now that they’re clinic directors and they’ve been through that journey, they’ll tell us, “Yeah, but I didn’t actually know what to do in those eight visits.” So I was like, “So you under-dosed and under-treated because you didn’t have the confidence, but why wouldn’t you have reached out?” I know one kid in particular whose owner is one of the smartest guys I know in Canada. But it’s sort of interesting. As a practice owner, or if you’re coaching your team, or if you’ve got a clinic director, you’ve got to help them, and kind of expect that based on what the data is telling you. I think the other thing is a really good test that we should always think about as practice owners. When I’m in that clinic, if you just did a quick survey, or had your admin do it, and said, “Neil, before you leave the clinic, why are you coming back next week?” Guarantee you have no idea. Does the clinician know? Absolutely, most do. I know in my head where I want to take you, but if you have no idea, why would I go from what was covered under insurance to all of a sudden I now have to pay out of pocket? I don’t know what’s changing. What would I pay for? I’m already happy. I’m happy with my 60% improvement, but is 90 bucks to $200 a session worth paying out of pocket for? That’s the question we have to ask ourselves.
[13:40] Neil: Yeah. And that’s traditionally been the weakest area in physio, in PT: the ability to sell yourself. We really don’t get that kind of training in school. It comes more from “here’s your evaluation, here’s our plan of care,” but there’s more to it. What was interesting is that the business coach I was with sold us a course that was sales training for our PTs. They actually had a person come out to our clinic for a two-day thing and work our therapists through a training course on sales, but from the perspective of doing the right thing for your patient. It was really fascinating to see the improvement in people keeping their plans of care going beyond that, with some more cash pay. But you’re right, you have to train your therapists to be able to tell that story to your patients: here’s where you are, here’s where you want to go, and here are the steps it’s going to take for us to get there. I don’t know that your insurance is going to cover everything here, but in order for us to get there, this is what we need to do.
[14:52] Darryl: And I think as we start to evolve in practice, we can take lessons from other industries. One thing that’s really fascinating, and this is probably good for larger practices, is the plastic surgery model. When you go for plastic surgery consultations, you see the doctor, he does his thing, but then you don’t stay with the doctor for the financial component. You go to the adviser, or the care coordinator, and your care coordinator is really the salesperson. They’re sales trained. They say, “Hey, Dr. So-and-so recommends this, this, this, and this, and this is what it’s going to be. We’ll map it all out for you. Here are our plans. Let’s make it financially affordable.” So it takes the financial part of it off the clinician, and it’s held by a sales role. I think that’s a really positive thing for a larger clinic. At a smaller business, you’ve got to train your therapist to have more of that conversation. And it’s kind of similar in the car industry too. Once you choose, “This is the vehicle I want,” then you go up to finance, or whatever it is. But one of the things I find so interesting, especially being in the university system and now watching the gaps that exist, is that when we think about where private practice is going, the reality is that we weren’t trained to deal with, one, what the repercussions are if, Neil, you don’t do that. I’m not placing blame on you, but letting you know that if we do it this way, this could be an outcome, and if we do it that way, this could be an outcome. Sometimes that has to be a conversation around the negative too. On the flip side, we know we’re going to face barriers. Time is a barrier. Motivation is a barrier. Finances are a barrier. I don’t recall one program or course that ever taught me how to have a conversation with a patient to give them alternative options. So all of a sudden the only default I have is “just come less,” or “let’s just see how you do on your own.” Why would you do that, without any follow-up? So it’s really interesting. If I were to hone in on a practice owner right now who wanted to dial up their clinic and really focus on mentorship, and deal with those barriers and objections, I think a therapist is pretty good at saying “this is how I can help you,” but we were never given the resources to know what to do when someone says no. And trust me, the reason we’re all PTs is that we don’t like sales. If someone told me to do outbound sales calls, as soon as I get my first no, I’m done. It’s going to negatively affect me emotionally. I hate rejection, but teach me how to deal with rejection, because it’s normal.
[17:50] Neil: Yeah. You’ve got to sell those outcomes, right? And you’re totally right, we often don’t paint the other side of the outcome. If we don’t really handle this fully, I usually say, “Here’s the deal. We’re going to have this certain expectation, and you’re going to start to feel better, but you’re still going to have weakness and poor coordination in your joints, and that sets you up for future injury. I don’t want to see you back here in six months with the same problem again. Let’s get this fully handled and move forward.” Those are the kinds of conversations we need to train our team to have.
[18:29] Neil: Awesome. And so, Darryl, I’m curious, because this is something you teach in Clinic Accelerator, but you’ve opened and designed dozens of floor plans for clinics, as well as startups, to optimize the patient experience and get the most revenue per square foot. Can you tell me how that looks? What are some of the secrets to floor planning?
[18:49] Darryl: Yeah. For me, the most important part is how much of that space I can make revenue-generating, but also bearing in mind that if you take away all your storage and your staff rooms and all that stuff, your clinic will just be a huge mess. So for us it’s really about designing really good patient flow. Can I as a therapist see sight lines everywhere, and can patients see all the different components I have in my practice? Don’t tuck away your gym. Make sure it’s actually visible. I would say too, and I know from visiting a lot of practices in the US that it’s still a little bit aligned with the model we would recommend, it really needs to be a hybrid. I think the secret to being revenue-generating and having room for growth is that you can have your private rooms as needed, but you’ve got to have an open treatment space still, with beds. You choose whether you use curtains or keep it open. But I can make so much more happen. Even on the mentorship side, if I really want to get clinicians rocking and rolling, I want them to hear what I say when I’m treating side by side. I know there was a big movement, where we are out west, where everything went private room. I don’t know why. And then you look at a regular sports clinic and the whole thing is open. So for me, the secret is how you create a hybrid, so you can really create an interdisciplinary model. One of the other things we’ve used is trying to get people away from “this is my room, this is your room.” How do we make these rooms so I can turn over a room really quickly, and make sure a room is available if I do need a private space? If you do need some private space, like pelvic health or massage therapy, can you put them a little out to the side, so I’m not clanging a squat rack at the same time, but people can also know what’s going on back there? So I get that patient who says, “Hey, what’s going on in those back rooms?” Well, we also offer these particular services. And the other thing we’ve started to see, and a lot of people have had really good success with it, is that when you are designing that gym space, make it stand out a little bit more. We see a lot more people putting turf into their clinics, so people know that’s the gym on that side. We’re also seeing a lot more equipment, but I always say to people, design it like a small apartment. We don’t need huge equipment. Make sure things can fold. Your squat rack folds into the wall. You don’t need a huge pulley system anymore. You can buy a little anchor unit. The other big thing I would say, that I’ve messed up multiple times designing clinics, is that you try to keep everything to sections. This is my gym area, but then you’ve got four people in a gym because you’ve got five clinicians working, and no one can work. So it’s really about workflow. You’ve got a shoulder patient at the top, maybe in the gym, and you don’t have the second shoulder patient waiting for the pulley to become available. So really think about designing that space for when you have a full team, not just when you’re designing your new space and you only have one clinician.
[22:10] Neil: That’s great advice. And I’m curious, have you seen practice owners approach it from how they can do a minimalist build because of cost, or whatever it may be, and maybe the impact of that later on?
[22:27] Darryl: Yeah, we’ve seen that for sure. I know I have built a clinic that’s going to have eight treatment tables and I only had three to start. It actually looks like the clinic’s not designed properly. I really do like the middle-less approach so you can maximize space. And I think you can pretty much design a clinic a lot cheaper than it used to be, because I don’t need Biodex machines anymore like we did in the past. There are lots of other strategies. Another thing that needs to get built into a lot of clinics now is where we do our objective testing. How do we justify to patients that there’s more for us to work on? We used to talk about bells and whistles. We knew that if we had an IFC machine, and there was a study on it, you had good conduction, lights would go on, and patients would respond positively. That’s a bit of hocus-pocus stuff, versus now, what do our clinics look like? Do we have a TV that shows someone on a force plate doing objective testing, so the next patient says, “Can I do that? Can you show me where I need to go?” So I think there’s an opportunity to use a minimalist approach at times, still build out your practice so it looks like a complete practice, but maybe put things on a wish list. If I needed to save money, maybe I’m going to hold off before I buy my shockwave unit. It’s going to be 30 grand, and I need six months to build up some cash flow. But I wouldn’t waste time and resources when I’m trying to get a really good experience for people coming through the door.
[Mid-roll promotion for Neil Trickett’s Market2Grow book and the free copy offer at practicepromotions.net/book, about 24:01 to 24:43. Not transcribed.]
[24:43] Neil: And it makes sense, if you have that plan of what you would want to add. But I see it from a marketing perspective also. What I’ve seen is that the clinics that have the equipment, the lasers, or shockwave therapy, the perception in the patient’s mind is that this is something I can’t do at home. I’m going to pay for this service because this laser, this shockwave therapy, is helping me out. And if you have certain exercise equipment, things they may not have at home. So I think there is a certain investment you need to make ongoing in the practice to level up, especially as you want to start building more cash-pay programs. People will pay for something they see as technology or valuable to them, in addition to your knowledge. If it’s bare bones, like a plinth, there’s a certain value you can provide from your knowledge, but if you can have more of that experience of someone coming there… And I really love what you said, plan the openness of the gym too. That might be something you have to consider: “I have to put a little bit more into this build-out to make it the way I see it happening in two or three years’ time.” Because if you have all those small rooms, it’s also part of the patient experience. When we built a new location in our practice that was straight from concrete, it gave us a lot of flexibility to build it the way we wanted. Having a really large open gym was so awesome, because people saw each other having success and wins. It keeps them motivated to keep coming. They say, “Hey, I didn’t know you also treated necks. My husband has a neck problem.” “Come on in. Let me take a look at him.” There are all those opportunities you can create by thinking of it from a patient experience standpoint.
[26:54] Darryl: Yeah. And I’ve been challenged on that. I totally agree with you, Neil, and then someone will challenge me and say, “Well, we have lots of patients that maybe want to be a little more private. They don’t want to be in that environment.” But I think that’s the thing for a lot of us as practice owners: who’s your ideal client? I can’t be everything to everybody, but I have to think about what’s the best utility for my space. And quite honestly, we see lots of patients who need a private session. They just go into our private room. But I’ll be honest, 90% of the patients that walk through my door are talking to the patient beside them too. It is what it is. And there’s a lot of social proof for a lot of people. “I came in and I was really down and out with my knee, but I’m watching that guy literally run on the treadmill now,” and they have a conversation, right?
[27:47] Neil: Totally. Yeah. So I think that hybrid, having enough private rooms where you can give privacy to people you need to work with, but then creating the flow and the gym experience, is really key.
[28:01] Darryl: I think the last thing on that one, Neil, just as a little tip for everybody, is to be really structured with how you use those private rooms, especially if you’re using different disciplines. If you’ve got one provider who sees eight patients all day, but you and I are going to see 16 all day, you have to make sure you’ve got those rooms in shifts. Or you really structure it through your EMR, so certain patients are held for that room. Otherwise you’ve got a room that’s not really generating any revenue, and that becomes a huge problem, or you’ve got another provider that can’t access the room, and then they get really upset with us as practice owners. So really think about shifting out your rooms, an AM shift and a PM shift, so you can get full utility. And remember, Saturdays and Sundays we all pay for as well.
[28:50] Neil: And we can learn something from the retail industry. There are consultants for the retail industry who just plan traffic flow in a store to get maximum revenue from that store. There’s a whole science behind it. So before you open your first practice, or your next location, whatever it may be, that’s something you can think about: let me look at it from that perspective, and see what I can learn. I’m sure there’s a ChatGPT for it, right?
[29:22] Darryl: Yeah. And I think a lot of people, if you were to open another location, patients have followed you for years, Neil. Same with me. I would actually hire one or two patients to do a walkthrough, as long as it was safe. Walk through and tell me what I should change before I finalize this print. And the other thing, I know it sounds a bit silly, is that before you sign off with your architect or your designer, just put a bunch of tape around. One of my biggest screw-ups was that I put in a little half wall before I really saw the depth of getting all the equipment in. What I thought was a huge runway for higher-level functional training didn’t exist. So really think about it. What looks good on a blueprint may not work when you actually have the flow of patients, therapists, and assistants in there. Just be really mindful and take that extra time.
[30:12] Neil: Love that. So, Clinic Accelerator, I love what you’ve done here, but you’ve broken out the stages of growth into five key phases. Could you walk us through those and what that means at each phase?
[30:27] Darryl: Yeah, and hopefully I can get all the phases right, Neil. We look at it from a full lifespan perspective now. We’ll see a lot of clinicians right out of school, so they’ll even enter our programs through private practice clinician-based training. That group will usually come right from there, whether they grow into leadership positions within a practice that we work with, or they come to us right at the very beginning: “I want to be a solopreneur and I’m going to open my practice.” That becomes our first entry point into real entrepreneurship for a lot of these individuals. From there, we get to the point where growth inside the business, beyond me as that solopreneur, starts to become a little harder, because I’m managing people. I need to do marketing now, and I don’t know how to do marketing. That becomes a problem for many people. HR and marketing is where we tend to see them, even though we’ll pull them backwards to say, “Where’s your scoreboard? Where’s your P&L?” So it’s that owner who’s kind of stuck in the weeds a little bit that we’ve got to help get out. And then we’ll see people who are at a point we reference as “scale well.” They’re in pure growth mode. That could be “how do I get more juice out of the current orange that I have,” or “how do I grow into a bigger footprint,” or “I’ve got one location but I want three.” We have groups that say, “I want three, I want five.” But then we have the group that goes from scale well to thinking about exit already. So we’ll take them through that full lifespan, from a brand-new clinician, to solopreneur, wanting to scale, all the way to actually exiting from their practice.
[32:05] Neil: I love that. And from what I remember, it’s committed solopreneur, stressed operator, growing operator, millionaire CEO, and then strategic seller, right? So what are the key things you’ve seen about hitting those seven figures, about becoming that millionaire CEO? What are some of the key things there as far as developing clinic directors or lead therapists to play that role?
[32:37] Darryl: Yeah. I think one of the biggest challenges, and you and I would probably agree on this, is that sometimes we were our biggest stuck point. I was in the way far too often. Or I just fed off that need to solve everyone’s problems, as opposed to developing my leadership team. People management is so critical, but developing leaders who can do things better than you is not a weakness, it’s actually a strength and a talent. And what tends to happen is that to get to seven figures, you can’t skip meetings. You can’t forego a mentorship session or a coaching session. You can’t not invest in yourself a little bit further. So when they get to the point of that clinic director role, yeah, you can do some meetings, but it’s not me just telling you, “Neil, just go do my dirty work.” It’s, “I need to develop you as a leader of my clinicians. I need to develop an office manager as a leader of my admin team.” And I’m giving them the tools, resources, and support from my side to actually help them drive the business further. I think choosing the right people as well, people who have some skills potentially, but also some people skills, who can get more buy-in and push people a little further to grow the business, is the critical step. But everyone needs to understand scoreboards. People have to understand the finances. That’s also part of your role as that seven-figure practice leader, that CEO: to make sure people are aware of what their role is to move those needles. Because if I’m a glorified babysitter as a CD, you might as well not even have a CD. It doesn’t work. That CD has to be a driver of the business.
[34:29] Neil: Yeah, that makes sense. And do you see practices that will promote someone to a clinic director role, or that next office manager level, whatever it is, to help with management, but they promote them based on the fact that they were just a good clinician?
[34:52] Darryl: Yeah. I think that’s sometimes one of our biggest mistakes. And not always, because sometimes it does work. Usually your most talented clinician could really step into that role. But I think sometimes what we expect, and I’ve been there myself, both in that role and trying to pull myself out of that decision, is that the clinician doesn’t maybe understand all aspects of that role. Let’s be honest, I don’t know if I can swear in this one or not, Neil, but you shovel a lot of [expletive] as a clinic director. That’s literally what you do. If you can lead your team well, and not just be a manager, where they actually want to meet with you and want to learn from you, you’re also going to have to do some performance reviews and some difficult conversations. If you weren’t aware of that, you’re not going to want to do that role. So you take your best clinician, you put them in a role they don’t really want to do or may not excel at. But it doesn’t mean you overlook them. I’ve learned over the years that sometimes that becomes such a good peer-to-peer support. As a CD, my job’s just, “Hey, Neil, why don’t you and Steve go work together? Steve’s like a magician and he’s got so much confidence in managing neck pain patients, and I can tell by your data you can’t handle a neck pain patient at all.” Now, I’m not going to tell you that, but I’m going to give you some time with Steve, and I’m going to eat that as a CD, saying to the practice owner, “I know we’re going to lose some productivity this week, but I really think in three months we’re going to see Darryl gain a lot more confidence managing some of these spine cases.” So you don’t necessarily have to force your expert clinician into that role. But I think we do a really poor job, because I’ve done it so many times, of not highlighting the outcome of that role. What do I really need my CD to do? Work backwards. We create a job description that’s kind of fluffy, quite honestly. But what’s the outcome, and do I want to do that outcome? And for those that are listening and thinking about promoting somebody, test them first. Give them a project that involves a little more of the challenging interactions they may have before they have to overly commit, because it’s really hard too. You’ve got your rock star, and you’re like, “I kind of have to get you out of that role.” That’s an awkward conversation.
[37:12] Neil: And I think maybe 90% of the time it’ll work, if you have good communication about it. Like, “Hey, I’d love to promote you. This is what this role is going to entail. It’s going to entail you getting others to get the work done and get the outcomes. And there are going to be times for, like you said, evaluation and coaching. There are going to be some difficult conversations.” If the person knows it going in, their mental state shifts on it. They can handle that. It’s just when you say, “Oh, we’re going to promote you. You’ve done so fantastic with patients, and you’re just going to help all the other therapists do what you do with patients,” and they’re like, “Okay, cool. I’m going to be the best therapist in the practice.” And then they get into some of these situations, like, “Oh, such and such is giving me a hard time today.”
[38:04] Darryl: And they’re like, “I hate this part.” Yeah. Or the other one is, the CD role in my mind is the most difficult one. Same with the office manager. At one point you were colleagues, but also probably friends with most of the team. And now I have to come to you and say, “Hey, Neil, I know you and Darryl go for beers every Friday night, but you either have to turn Darryl around or he’s going to go, and guess what, you’re going to fire him. How are you going to do that?” That’s your role. You have to work through some of those scenarios, because at the end of the day, you have a new job to do. Are you willing to do it? Because it sucks when it’s, “Okay, team meeting, quarterly rocks. We’ve tried with Darryl as much as we can, but Neil, he’s got to go.”
[38:50] Neil: The tough choices. And so one thing I was curious about, as you coach practice owners, is this thought around what they should work on first. Say I need to get new patients in the clinic, or I’m losing patients, or people aren’t completing their plans of care. What should they look at first? Should they spend more on their marketing, or should they try to fix their systems first?
[39:15] Darryl: Yeah, it’s a great question, and it’s hard to say you’ve got to do one versus the other. I still think you need to be running them both simultaneously. Which hose you put on as the priority first may change. For me, if I’ve got a team where I’ve added a new staff member, I’m cranking my marketing right off the bat, because if I just move leads over to the new clinician, my other team is empty. And one of the differences for you, for Canada versus the US, is that a lot of your clinicians are salaried, so you’ve got individuals who aren’t really producing anything, but you’re paying them still. Up in Canada, that would be pushback, because a lot of them get paid if they see patients. If I’m coming to your clinic full-time and I’m not getting any money, that’s a problem. But I do think there are so many holes as you go through. As those patients come through the door through your marketing lead generation, you’ve got to follow it through. And this is stuff you can help me with, Neil, because this is your wheelhouse. What even happens when they call the clinic? I may not even have an opportunity to get them to complete a care plan, because my front desk isn’t really operating. That’s the engine of my clinic.
[40:35] Neil: I would say the most important part of your clinic is actually your front desk. Yeah, I think it’s your clinicians, but it’s not, because the front desk gets people to arrive and pay.
[40:45] Darryl: People always said to me, “How are you so good at managing a caseload?” And I’m like, “I don’t know. My admin was amazing.” I just had such a strong relationship with my admin. And I always say this too: a strong front desk can compensate for a weaker clinician. But if you’ve got a weak front desk, I could be the best clinician, and I can’t remember everything. From working with thousands of different clinics, the thing I’ve seen, and this is always a frustration of mine, is that clinics who struggle will say, “Hey, my marketing is not working. I don’t have enough patients. My revenue is not doing well.” You take a look at the numbers, you take a look at the data, and they’ve got a ton of leads coming in. Then you start looking through the call logs, the call tracking, and it’s missed call, missed call. They didn’t call this person back. Then you can show that to the practice owner, and they say, “Oh, I had no idea my front desk was missing a lot of calls or not calling people back.” And it may not be their fault. They may not be trained enough to have a good sales conversation. They may just be overwhelmed because they’re handling so many different things, and you need another person just to handle those inbound calls. And maybe that’s a virtual assistant or something like that.
[42:03] Neil: Yeah. And Dee Bills and I did a little chat not too long ago with some of our owners, and we looked at the flow through a clinic and what the staffing model should be at the front.
[42:12] Darryl: I just had one of the owners the other day give me some feedback. She said, “Darryl, I didn’t know if I could justify this additional expense, but thank God I did. What you didn’t see as potentially lost revenue, all of a sudden they started converting more of these leads, so then their staff got busier.” So to summarize where you start, I think everyone still has to pare back to what the data is telling you. If you’re looking at scoreboard data or some sort of performance data that people will track, you have to include leads in the same scoreboard as discharges. There are certain things I look at, I forget the name of that quadrant, but high effort versus low effort with a positive outcome. I’m looking for what I can change with the lowest amount of effort that has a positive impact on the clinic. That’s where I’m going to go first. The reason I’m a little hesitant on the clinical operations side first is that it takes longer to execute. When I think about trying to get clinicians to think differently, first I need them to buy into the strategy, then I have to get them to behave differently, and then I can start working on quality improvement, like using treatment planning properly to get someone to really focus on closing out a full plan of care, not just partway through. I can’t fix that quickly. But I can fix my leads a little bit faster. Now, as a practice owner thinking, “Oh my God, I’ve got all these people coming into the clinic,” is it going to affect my reputation a little bit? Probably not as much as if I push too hard. Especially, as we were chatting about earlier, HR is a nightmare right now. There’s such a labor shortage for what we all need to run our practices. If I push someone too hard and they quit, I’m really in trouble. Now, as a practice owner, I’m back treating again. We can’t be afraid to challenge people. But at the same time, we have to realize, like everything we said at the beginning of this, no one was taught this stuff well. So it’s going to take a little bit longer. Make your decisions with data, analyze that data, choose marketing versus systems, but realize your systems are probably going to take a little longer for you to see the true fruits of your labor. So think low effort, positive outcome.
[44:48] Neil: Love it. Go for the low-hanging fruit. And so you have a really good pulse on the industry in Canada and the US. Where do you see private practice heading in the next five years? What should owners be doing now to stay ahead of this curve?
[45:06] Darryl: Yeah, it’s a great question. I think everything has to consistently evolve around an even better experience every time a patient walks through that door, no matter what. It literally will come down to whether your outreach, from a lead generation perspective, presents a different experience than the clinic down the street. If you pick a dot for us right now, Neil, in an urban center, there are probably literally 10 clinics within a 3 km radius. So for me, it’s about thinking about the experience of that patient, especially if I have to drive value for someone to be willing to pay out of pocket. That’s the focus I always have. Then we’ve got to pare back. What am I going to do with AI that’s either going to improve efficiency, so I can spend more time driving value and outcome, or make me a little more efficient and effective in my ability to diagnose and map out a plan? Can I use it to coach? So again, the whole thing has to focus on even better care and outcomes. But I’m also going to challenge this, though I know there are lots of differences between provinces and states that we have to think about. I do believe that clinics that have a much better integration of disciplines, so an interdisciplinary model, not just “oh, we have a bunch of people under the same roof,” are the way people are going to go. People have less time. They want a one-stop shop. And I see so much, if we think about how negative outcomes come from bad narratives, in the communication piece, where people have access now to information anywhere. We have to be prepared for a patient to throw their MRI through AI to tell me what to do as a physio. We have to be prepared for how we’re going to manage those people who are more knowledgeable than they were with Google. So again, how we use this next tech era, in my mind, is what’s going to change the game, as long as it’s focused on even better experiences for the patient.
[47:16] Neil: 100% agree. We’ve seen this shift happen, and I think it’s just going to accelerate further, in terms of insurance companies not paying more, or even paying less, and obviously inflation keeps chugging along. I did a survey for myself of what I was making 25 years ago in practice versus today. I got paid 100 bucks for a patient 25 years ago. Today you get paid about $98, but the dollars of 25 years ago, in today’s money, that’s actually $190. And for a physio, it was like $50,000 US in salary back then. Now we’re at hundreds. So our per-patient-visit revenue needs to be higher. And in order to do that, we have to deliver more. We have to raise the patient experience. We have to raise the bar on what we’re delivering. If your model is to lower the bar because of what insurance is paying you, it’s a dwindling spiral. You’re just going to get lower and lower outcomes, people are going to come less and less, and it’s very hard to build a successful practice on “come in for 15 minutes and this is what your insurance just covers.” Now we have to go beyond that. “Your insurance covers this little part here, but we’re going to take you beyond that and have this amazing outcome for you, and we have all these types of programs to help you achieve that.” I will say, Darryl, that in Canada, because the health system is different, you’ve developed a more integrated approach than here in the US. I think you’ve been ahead of the curve on that. And because we work with a lot of Canadian clients, and a lot of mutual clients together with Clinic Accelerator, what’s really fascinating is that the clinics that have that hybrid model, with all these other disciplines and a holistic type of approach, find it so much easier to market and so much easier to grow the clinic. There are more and more clinics adopting that style here in the US. It still has a long way to go, but that really is the future.
[49:34] Darryl: Yeah. And I would say, to be honest, I’m set in my ways at times too. But if everyone can change the narrative in their mind, from “I can’t do it in this state.” There could be a few where it’s just not possible, let’s call a spade a spade. But the reality is to change that narrative: how could I do this? In the past, we never really had to think that way. Now we’re at a point where, if I were to look at fee guidelines, and to keep all my therapists and my admin teams on a proper cost-of-living increase every year, patients couldn’t afford to come to the clinic anymore. I couldn’t charge them that much per session two or three times a week. It’s just not sustainable. So the reality is balancing fee guidelines with accessibility, but I do have to pay my staff so they can all eat and survive, versus the days of me still saying, “Well, when I started in practice, this is what I got paid.” No one gives a [expletive] anymore. It doesn’t matter. This is what it’s going to cost me to go and buy bananas. It’s terrible when you think about it. But what it is, is change that narrative: how could I make this happen? And if that practice model doesn’t work, what’s another practice model that could work? For me, I’m watching you guys very closely blow up remote therapeutic monitoring. I wish I had that as a fee code. We don’t. But it doesn’t mean we shouldn’t do it. What else could I do to generate revenue based on quality outcomes? Why am I not doing that? There are just ways to think about strategy differently, as long as it goes back to what we started with: put the patient first, so it’s not selling something that’s not required, because then you won’t get buy-in from your team. But are there other ways we can increase the lifetime value of a patient, because we can’t make physio out of reach.
[51:28] Neil: 100% agree. So, Darryl, thank you so much for being on the podcast today. You’ve given us tremendous insight. What’s the best way for our audience to learn more about you and about Clinic Accelerator?
[51:39] Darryl: Yeah, thanks, Neil. I appreciate the invite. It’s been fun, and it’s great to see you all the time as well. The best way to get hold of me is clinicaccelerator.com. That’ll take you to our website. But probably the fastest way, because email these days isn’t as quick for me anymore, I must be getting older, is to go right to Instagram. That’s the fastest way to get hold of me.
[52:01] Neil: And we’ll put those connections for you there in our podcast links. Don’t forget to check out Darryl and his group, with Rick Lau and everybody else at Clinic Accelerator. A phenomenal group supporting both Canadian and US clinics and helping them grow. So thank you, audience, for being on with me and our Practice Marketing Podcast. Don’t forget to subscribe to the Practice Marketing Podcast for future episodes, as well as our YouTube channel, where we put a lot of this up too, and also at practicepromotions.net, where we have tons of marketing downloads, advice, and tips for you. You can get our Market2Grow free book also on practicepromotions.net. And this is Neil Trickett from the Practice Marketing Podcast, wishing you much success in your practice.
[Outro inviting listeners to leave a five-star rating and review on Apple Podcasts, about 52:48 to the end. Not transcribed.]
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