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Marathon or sprint

“Customers and employees come and go. Supporters are with you for the long haul.”

Blake Mycoskie, Founder of TOMS shoes

I recently took over as a manager in an outpatient physical therapy clinic. I would love to say that I came in and that business is booming, but it’s not so…yet. I’m busting my tail and those patients that have come into the clinic are no longer just patients. They are supporters. Heck, they might as well be a giant billboard walking around town. I’m getting new patients coming in and their doctors are telling them that they are hearing great things about me and the clinic! This is exciting. It takes a small event to create a ripple in the ocean. That one patient telling the prospective patient about me and the clinic is the rippling effect that I need.

Not everyone needs PT. It’s a shock to hear that coming from a PT! I’m telling you that you may not need my services, which in turn means that you won’t spend your hard earned money on my services. Financially, this statement hurts, but I learned from a wise business man that service to the people is the most important part in business. I had the opportunity to hear his story and ask questions about his journey. This man has a following, with me included in that line. He built a career on serving his customers and creating supporters.

This guy is one that I will attempt to emulate in the coming years. Doing good deeds can’t hurt anyone. When I go back and review these blog posts next year, I’ll give an update on my attempt to emulate the best businessman that I had the opportunity to chat with this year.

Thanks for reading.

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Story

“Having a story may be the most important part of your new venture…”

We all have a story. I actually have spent a good amount of my time recently learning about other people’s, group’s and mission’s story on my FB page People you should know. My story started a long time ago, but I won’t bore you with the details. The one part of the story that is most important is that I always look for the next opportunity to succeed. At Sam’s club, I was named employee of the year in 2013 and quit soon thereafter because I had reached my ceiling. There was no other Hill to climb or challenge to face. I know that it sounds like a small feat, but I worked hard to reach that status. Unfortunately, the journey was worth more than the victory, because my journey seemed complete.

My PT career has taken a similar trajectory. I started in a clinic, that I was excited to work at, in order to learn as much as I could. After 2 years, I lost that zest because I was more like a robot than a sponge. I wasn’t learning…growing…as much as I was simply going through the motions of treating patients. It sounds horrible, I know, but I was pretty good at using the McKenzie Method back in those days. If you’re familiar with Mariano Rivera, you know that he had one pitch. It was an unhittable pitch for a long period of time. He built a career on throwing his “cut fastball”. I spent more than two years honing my craft as a McKenzie based PT, but after 2 years I felt like the game wasn’t any fun anymore. I remember taking the trash out after 18 months on the job and thinking that I was “bored” with my job and could treat patients with back pain while dreaming.

Not soon after, I left that job and took a hefty pay cut in the process (you’ll start to see a pattern that I didn’t see until recently). I switched to a hospital-based outpatient department. Mind you, for two years I saw nothing but patients in pain with a generic diagnosis of: low back pain, neck pain, shoulder pain, knee pain, hip pain so on and so forth. I don’t mean to demean the patient’s pain, but c’mon “low back pain”?! Is t that what the patient told the doctor at the beginning of the session. The doctor then turns around and gives the patient a referral to PT stating back pain. (Venting a little).

At the hospital, I encountered something that I hadn’t encountered in the two previous years…a protocol! A protocol is similar to the old book “paint by number”. There is. O significant thought that goes into treating these patients post-surgically because we are bound to treat the patient by following the directions given. I had the hardest time treating patients post-surgically because I spent the previous 2-3 years with constant algorithms floating through my head. Think John Nash from “A Beautiful Mind”. I may be exaggerating, but that’s what it feels like at times. For those two years I was playing a chess match with the patient’s symptoms and pain. I was always playing 5 moves ahead with an answer for every patient move. (A patient move is considered his/her response to a previous exercise or intervention. For instance, a patient can only always respond one of three ways: better, worse, same). I had a response for each of these answers and just worked through this chess match with each patient. My biggest fear was “paint by number” because the patient would come in and…game was already over because I couldn’t make any moves.

I digress.

I matured while working at the hospital. I learned to be a team player instead of playing clean-up or closer. I learned that when horses pull in the same direction that they can pull harder than they could as individuals. Unfortunately, I also learned something else about me…I hate when the game is over. I continue to search for ways to grow and be better day-day. I reached the end of my limit at the hospital because the opportunities to play and grow were no longer available.

This is where my story starts again. This time, this time, the game is much bigger. The chess board has expanded. The moves I can make are multi-variable. I liken my current position in the profession like playing a continuous chess match in which the boards are suspended above each other like floating plates. When one piece gets taken it gets placed on the board above the previous board. The game ends when all of the pieces make it to the top board and only one piece remains. There is no tipping pieces. There is no quitting. Only moves and reactions. This is the equivalent to the biggest algorithm I have ever got to play inside. I can make on”wrong” moves, only temporary losses.

Life is pressure, but the game is fun.

Goodnight all.

Thanks for reading some of the late night ramblings.

Btw, the quote was from Blake Mycoski in “Start Something That Matters”.

Admit weaknesses

“You don’t always need to talk with experts;sometimes the consumer, who just might be a friend or an acquaintance, is your best consultant.”

Blake Mycoskie

This is more apparent now than it has ever been.  As a practicing clinician for over 10 years, the patient’s/consumer’s/acquaintance’s input mattered, but it played a small role in how I would change.  Not to belittle the advice, but I was getting great outcomes in patient care and was just making great strides clinically over the past decade.  My patients had little to offer in terms of things to change.

Fast forward to now and I am a clinic director taking on the same struggles that other new businesses face.  Not many new patients are walking through the door.  I will always be my biggest critic, but at this point, the words of wisdom given to me by patients and family members is worth gold.

“You have no visibility from the street.”

“No one knows that you are here.”

“You need to get out more to the older communities.”

“You should advertise in the local newspaper.”

“You should give more talks to churches.”

“You should go to neighborhood associations and speak”

All of these are great pieces of advice.  Some are more doable than others because advertising takes money.  Fortunately, since I have time on my hands, I am reaching out to different organizations for speaking opportunities.

Listen to your ideal client because they know how to reach more people like him/her.

 

Be the change

“Be the change you want to see in the world”

Mahatma Gandhi

This quote gets thrown around, but how often do we stop to analyze it?

What is the change that I want to see?

1. I want all PTs to have easier access to research.

2. I want the public to be more aware of the difference between good PT and bad PT services.

3. I want the public to know that a. PTs exist b. how PT is covered by insurance related to out of pocket costs c. and how PTs can help with physical issues.

4. I want PTs and students to be humbled and ask for help when needed and offer help when able.

Hello 2018, I got some lofty wants.

How have I started to accomplish these goals

1. Writing a blog and putting out videos describing the research that I am reading on a daily basis.

2. Giving community lectures educating the public regarding what to expect from a physical therapist. Educating the public on the core values and how some practices may demonstrate the practices. Unfortunately, I also highlight how some may not practice according to our profession’s core values.

I also started posting reviews of some of the neighboring clinics on social media when these clinics aren’t practicing in an ethical fashion.

3. Again, the blog and community lectures serve to educate the public of our existence and during these lectures I typically explain Medicare Part B regulations and coverages so that the potential patient can feel more comfortable about their responsibility financially.

4. To help others in areas of my strengths I do one-one conversations on FB, via telephone and in person. I readily ask for help when I am stuck and believe that I have a team of Avengers that I can reach out to at all times of the day.

How will you be the change in 2018?

 

Archilochus

“We do not rise to the level of our expectations. We fall to the level of our training”

This quote is taken from the Tim Ferriss book Tools of Titans.

In PT, we all believe that we will change the world. We have visions of grandeur in which we take patients from wheelchair to playing field. Preventing surgeries, curing world health problems and wearing a red cape with a big “S” on our chest…okay maybe not all of us have these dreams.

In the end though, our patients are doomed to fail if they see a PT that has not lived up to his/her professional duties of continuing education. In Illinois, we are required to obtain 40 hours of continuing education every 2 years.

Let’s think about this number. It’s been said that one needs about 10,000 hours to master a topic. That’s a lot of years if one takes the minimum amount of hours. At that pace, one can never become a master of anything other than a long commute.

When choosing a therapist, there has to be more thought put into it than your next vacation. You are spending your hard earned money…or the insurance company’s money…don’t you want to know that the person treating you is actually good at what they do?

Have they taught classes? Have they studied independently? Are they giving back to the community?

HELL, let’s start at the basics…do they pay attention to you when you’re in the clinic? Not in a three ring circus kind of way, in which they are just managing the acts that come in and send the patient from machine to machine, but are they paying attention to YOU?

I’d love to think that everyone in this profession of PT is operating up to his/her expectations, but deep down I know that we operate at or below our training. Not all PTs have the same knowledge.

https://movementthinker.org/2017/10/17/not-knowing-versus-not-learning/

Having spent time in the profession, I can state that I’ve seen the top 5% of the profession, and they are awesome. Unfortunately, it’s only the top 5%. The rest go nameless like worker bees to support a queen. There are very few queens in this industry and if you do a quick search, you can find those companies that make the most, are worth the most, are publicly traded etc.

We just want to help people. That’s the number one answer I hear from students entering the field, unfortunately not everyone continues to practice in this mentality once out of PT school.

We need to live up to our expectations more and improve our training to reach those expectations.

Salute!

Online presence

I think that this sums it up. If we aren’t posting online on our personal websites, on social media (SoMe) or on a work website then we are missing out on contact points with over a third of the population. Our role has to grow larger than treating the patient that walks in the door with a referral. We, as a profession, have to go out there and educate the public, medical doctors, podiatrists, dentists, laborers, plumbers, and at times other therapists.

We don’t get to sit in our offices anymore and wait for patients to come to us, but we have to go out and educate!

How are you establishing a presence in your community, your workplace and your profession?

Leave comments below.

A quick story

“Twenty years from now you will be more disappointed by the things you didn’t do than by the ones you did do…Explore. Dream. Discover” Mark Twain
Where do I start? I come from very humble beginnings. We were a family of 5 growing up on the East side of Joliet. I have 3 brothers and one sister. This changes over time so follow closely. Growing up on the East side wasn’t easy. Access to drugs was though. I smoked my first joint before some kids learned to read, although I learned to read before smoking the joint. My dad used to make me sit down with the Joliet Herald News and read the comics to him. This was from the age of 3 onward. Anytime I would ask him a question, one that readily comes to mind is “why is Australia called the land down under?” He would tell me to look it up. I WAS FIVE! This was before the days of Google. We actually had to go to someone’s house (Terri Graves) of someone that had the old set of encyclopedia Brittanica. I learned the answer from somewhere in that stack. My dad would always say that he was doing it to make me learn, but I don’t think he actually knew the answer and was taking the easy way out. If you knew my dad, he’s never at a loss for saying what’s on his mind.
I smoked my first joint at 5. Before I got hit by a car on Clay street, which is another good story that I will get to. Marijuana was so easy to come by on the East side. Hell, we were growing it in the backyard. (When I say we, I mostly mean my brothers). I am the youngest of the bunch…the runt of the litter you could say. Wasn’t planned, but i’ve come to accept that over time. Drugs were commonplace, and access to guns was even less restricted. At one point growing up there were guns in almost every room, but that because of a Hatfield-McCoy quarrel that my family had with one of the gangs on the East side in the 1990’s.
How does a kid from that environment go on to become a Doctor of Physical Therapy? How does one get out of that mindset of drugs, gangs, teenage pregnancy, and high school dropout to go on to study under some of the best minds regarding back pain and dizziness that our country has to offer? Why would that same kid go “straight edge” for over 20 years?
Finally, why would that kid ever want to come back to the streets and city that started it all?

Do your neighbors know what you do?

Do your neighbors know what you do?

 

“Many of our potential customers can’t tell the difference in therapists from one clinic to another”. This is an age old argument. Pepsi or Coke? Both colas and both had a strong following in the previous decades. I’d like to believe that the brands are losing strength in the days of paleo, crossfit and the resurgence of health and fitness. Not as much as I’d like to see, but it’s a start.

 

Let’s touch on this for a second. Why would Joe Shmoe believe that one therapist is any better than another? To start the argument, the APTA has stated that it would prefer that all PT’s place their licensed initials after the therapists name and then place all of the other qualifications after this. This means that my name is Vincent Gutierrez, PT, DPT, cert MDT, CFT. We get accused of alphabet soup, meaning that we have way too many letters after our names. We could easily cut that down by having the therapists establish themselves based on credentials and not on simply passing the licensure exam. For instance, if I wrote Vincent Gutierrez, DPT this would enable our customers to see that there must be a difference between BSPT, MPT and DPT. I’m not going into the turf war of whether or not one is better than the other, but we could allow clinicians to educate patients on why or why not the clinician chose to pursue one degree over the other. The public has a right to know what we do and how we are educated. This is a start. We make the assumption that a medical doctor went through 4 years of undergraduate schooling, 4 years of medical school and a few years to specialize prior to us going to the medical doctor. Us placing our initials after our names is the starting point to differentiation.

 

Past credentials, another way for Mr. Shmoe to understand the difference between therapists or companies is to soft market ourselves. When I say this, I don’t mean go for the sell, but instead educate the person in front of us while they are there so that the person that is in front of us can make a better choice of which provider to see for their problem when said problem arises. Otherwise, Dr. Superstar is no better than Dr. Squirrely in their eyes.   Every person that we encounter is a potential patient either for me or for one of my colleagues. I at least want to make sure that the potential patient has the information to arm themselves with confidence in making that decision.

 

Your “brand” is how people think of you or your company when the company’s name is mentioned.

 

Coke = Polar bears

Apple = easy enough for a toddler to use

Honda = 200K miles

Marianos = high end grocery shopping

TJ Max = bargain shopping

 

What words do you think of when I say your company’s name?

 

You can see that there are only two companies that my first though was positive for me. I want to exceed expectations for my patients so that when they think of my name they think of excellence and exceeding expectations.

 

Testimonials were previously against the law in our state. This changed recently and I recently learned of this. Testimonials seem to be the most powerful use of marketing for a service based profession. We are behind the times in healthcare. Let’s look at one brand and how testimonials are used. Crossfit has made significant gains in terms of business growth. How’d they do this? A simple Google search for “Crossfit testimonials” has yielded over 28,000 hits. This is how you brand a business. The same type of search for “physical therapy testimonials” yields about 4X that amount. Wow! That’s a lot of testimonials. What’s the problem with these numbers? PT has been around for almost 100 years and crossfit has been around for about 10. There are over 200,000 PT’s and only about 7,000 crossfit gyms. We need to do a better job of educating the public about the importance of PT using real people. Those that have experienced the joy of becoming pain-free, living life with improved function or simply receiving a consultation that assisted in a life-saving diagnosis. This is what we do! We need to make sure that our neighbors and their neighbors understand our value.

 

Theme from:

Barron B. Is Your Brand an Experience? The Importance of the “HOW” in branding for physical therapy private practice. IMPACT. January 2017:56-70.

Results based care

Results based care

 

I’m going to get away from typing out all of the quotes, which is what I have been doing for the previous year, for the sake of time. I have opinions that can be expressed without the need for the direct quotes. I’ll still link to the article so one can go back to read it if interested.

 

Health care is changing. We are moving from a fee-for-service type of setting to pay-for-performance setting. Some of us are thinking “about damn time!”

 

Fee for service indicates that a person gets paid for doing things to do. For instance, if I keep you for 90 minutes and do a bunch of stuff with you, then I would get paid much more than if I only spent 45 minutes with you. Now, if I see you for 90 minutes and see you 3 times per week for 4 weeks, then I would make a lot more money from the patient than if I saw for 45 minutes 1-2x per week. There is absolutely no incentive to get a patient better quickly. Do the patient’s realize this? I hope that this article goes viral so that the patient’s have a better opportunity to read this information. Some health care providers would hate for this to happen and other are thinking “HELL YEAH!”

 

Pay for performance: Some of the ways that this is being done is that a certain dollar amount is allocated for a specific diagnosis and this amount is paid regardless of how often or how many times I see the patient. I now have a huge incentive to get you better fast and to make you as independent as possible so that you no longer need to seek treatment for the same issue. If the patient can get better faster, then there is more money to be made in healthcare because we are not treating out of fear, but instead out of ambition. Some companies are afraid to discharge a patient because there may not be another patient taking that spot anytime soon. I’ve worked in these situations multiple times before, so I am not talking out of my A$$. Treating out of ambition allows the therapist to apply the evidence as best fits for the patient in front of us in order to get that patient better faster. No offense, but I want my patients to get better and leave. Hopefully, to never come back for the same thing again. I was listening to an episode of Mechanical Care Forum in which the therapist (Mark Miller) was describing an embarrassing moment in which Mark had a patient returning to therapy for the same complaint that the patient was there previously. He was proud because he thought the patient was coming back because he did such a good job the first time and the patient was satisfied with the treatment, but Robin Mckenzie, one of the most influential PT’s of the last century, noted that if the patient was actually better and if Mark did his job then the patient would know how to address the situation without seeking help again. I want to treat with the hope that the patient will only come back because they have a separate issue that needs a consultation for treatment. This is the ambition that I am talking about.

 

The article speaks of staying up to date on the literature, regularly attending continuing education classes, learning new approaches, tracking outcomes and adjusting treatment according to the patient. I would love to say that 100% of PT’s are performing all of the above in the list, but I can’t. There are countless articles speaking to the reasons that PT’s give for not staying up to date with the research, which indicates that there are some aren’t doing their professional or social duty. I take this stuff seriously. It’s Easter and I am typing about the stuff I just read. It sucks to take time away from work in order to find the articles, read them and then try to put the information out on the World Wide Web for patients and other therapists to read and criticize. I’d love to relax with my beverage of choice and just not think about it, but my patients and society, as a whole deserves better from my profession and me.

 

Anyway, Medicare is moving more towards a pay for performance method of healthcare and their goals are pretty aggressive. Medicare will have up to 50% of patients on this type of fee schedule by 2018 and for those that are still fee-for service, medicate will tie the payment to outcome measures in 90% of the cases by 2018.

 

I’m doing my part to educate, educate and overeducate the patient in order to get the patient on board with treatment. If I can get the patient to play an active role in the treatment, then I know that I have a better chance of getting that patient better.

Themes taken from:

Jannenga H. Tracking for success: Why outcome measures are essential to your practice. IMPACT. Jan 2017:53.

Build you and your brand

Build you and your brand.

 

“…your brand not only communicates who you are and what you value, but also elicits a response from those you are trying to reach.”

 

How many brands can we think of off the top of our head. I think Coke and think of polar bears and Christmas. I think Apple and think of technology so easy a 3 year old can use it, which lessens my fear of breaking it. I think Google and think the greatest search engine in the world. Our lives are surrounded by brands. Some we notice, but the great ones are just a part of our day.

 

“…branding process is about painting a positive picture that will stir an emotional response from your target market.”

 

I don’t know if I necessarily agree with this. Some brands are based on loyalty to the initial need that they made easier. For instance, I didn’t really use the internet before the age of 20, but now closer to 40 I am on it frequently because it is so portable and convenient thanks to the Iphone. Thanks to Amazon, I don’t have to drive to the baby store at night in order to purchase more bottles. Thanks to Facebook, I now have thousands of friends that I never have to see. I don’t know if the brand has to elicit an emotion as much as it has to fill a need.

 

“…a brand is a promise that is conveyed through a ‘combination of logo, words, type font, design, colors, personality, price, service, etc’”.

 

I am looking at the top 500 brands across the world and looking at the logos. There is a consistent pattern that I see with red, yellow and blue. I don’t think of colors when I think of logos, but obviously those much smarter at marketing have figured out that these colors give a response. After seeing this pattern, I decided to look up color schemes for logos and this cool infographic was the first link. I hadn’t thought this much about color, mostly because my wife says that I live in a black and whit world. Oh well.

 

“As a way to broaden your perspective, take a moment to objectively evaluate the other physical therapy clinics in your area and see if you can identify what they are promising”

 

Your brand gives the patient promise. Some clinics have the name of the owner on the front. This tells me that I am guaranteed to see the owner when I come in, but if I don’t see the owner I may not be as satisfied with my experience. Others name themselves after the feelings that they are trying to convey to the patients. The name carries weight when seen from an outside perspective.

 

“Once you are clear about your practice values and what you are offering your community, you can start to develop the visual look and feel of your brand…logo should be unique but also relevant…convey both who you are and what you have to offer.”

 

After reading this article, I scrolled through about 500 logos on Google images (again the only search engine that I use) and this logo was the best that I saw. It clearly states what the company does. It takes a person from a continuum of care from a non-walker to a runner.

 

“As you begin to express your brand, I can’t stress enough the importance of being invested in your community.”

 

This one is the most important for me. I believe that if I get in front of enough people that I will be able to sell my services. This goes back to some of the views from the Gary Vee show. He notes that giving away services can come across as a hack move, but it still gets people to buy. I can remember working for Sam’s club and on the wall would be a huge cardboard check of all of the money that the store has donated to the local charities. It makes the employees proud to know that they had a hand in providing support to the local charities. I am not sure if anyone ever shopped at the store because of it, but it made me feel good that I was able to give to those causes. I’ve volunteered at local races, though I haven’t gotten a single patient from those races. I rarely volunteer at those races anymore. I spend most of my time in the community doing patient education regarding back pain, blood pressure checks and the importance of staying active. These lectures bring in patients. This is how I stay invested in my community nowadays.

 

 

 

EXCERPTS FROM:

Stamp K. Painting a Positive Picture: How to craft an effective brand for your private practice. IMPACT. January 2017: 37-38.