Tag: Business

Lean Management Theory

Lean Management Theory

 

  1. “The concept of 5S is just one of several key elements of the lean principle, which is designed to improve efficiency in the workplace while promoting organization and cleanliness.”

 

I can remember my teenage years. I started working at the age of 12 as a ranch hand and continued to work through this day. During those years, I worked as much as I was needed, because $20 was more attractive than anything else that I was doing with my time. My room was a disaster. I had trails in order to go from the door to the bed and another trail to get to the dresser. Fast forward 7 years, I was working at Sam’s Club 8298 during the overnight shift. I was nicknamed “The Tornado”. I could stock off a pallet faster than anyone else in the club. At times, they had to have someone come behind me to clean up after me, because it was faster to let me do all of the heavy work and pay someone else to do the “easy” stuff”. Continue to fast forward to one year ago, I was the most productive therapist in the clinic, priding myself in how many patients I could treat in a day, and still get good results of course. Fast forward to today, I realize that none of that matters. If I can teach people to do what I do, then I can help to create systems, which is now more interesting to me than simply stocking shelves, feeding horses, or treating patients. Don’t get me wrong, I enjoy treating patients, but I can only effect one person at a time. That is not as productive as creating systems to treat 10’s of patients at once, with the same treatment philosophy and outcomes. I now realize the importance of cleaning up my room, 36 years later.

 

  1. “The 5 “S’s” in Japanese are Seiri (tininess), Seiton (orderliness), Seiso (cleanliness), Seiketsu (standardization), and Shitsuke (discipline)”

 

Am I the only one imagining Myagi-son saying these words with emphasis? It sounds do formal and warrior-like.

 

  1. “In its simplest form it is designed to keep the workplace safe and organized without regard to size or pace”

 

When I worked at Sam’s, I could do aisles per night without ever tiring. Now, I left all of the cleaning until the end of the night (unless of course they had someone come over and clean up after me). What was the problem with waiting until the end of the shift to clean? I made everyone else’s jobs harder by taking up so much space that it was hard to get a forklift down my aisle during the shift. It was very productive for me, but I slowed down the entire team. It took years to figure this out, but my zealousness of productivity may be a detriment to the team.

 

  1. “The goal of the 5S is to remove waste, both actual and conceptual, by eliminating excess inventory and out-of-stock supplies, and reducing wasted time searching for, getting to , and waiting for supplies”

 

This is but one example. Think of the 20,000 foot view of eliminating waste (both in terms of stuff not used, and time spent on stuff not needed). I try to listen to multiple podcasts per day, and this concept is spoken of in many shows such as EntreLeadership, Barbell business, Tim Ferriss, and The School of Greatness.

 

  1. “Keep only what is necessary”

 

This is hard to do, especially when thinking of “what if”. I have like 8 pairs of jeans, but will only wear the jeans that don’t restrict my squat, namely 2 pairs. This means that at the end of my closet, I have 6 pairs of jeans that haven’t been worn in a long time, just in case I need to wear a third pair of jeans. The clutter in the closet would be removed if I just donated or sold the other pairs of jeans. Parting with any thing that we “own” is hard because we can always create scenarios in which those “things” are needed. Unfortunately, that same scenario never plays out in real life.

 

  1. “…identify, organize, and arrange everything in the work area, so that items can be efficiently and effectively retrieved…Everything should have a place and a purpose”

 

I suck at this step. Good story. I am on a team that is very close in terms of trust and partnership at work. There is a long running joke that I am Oscar and my supervisor is Felix. Hang out with us enough and it becomes obvious to those that understand the metaphor. I am learning that I need to become more like Felix in order to improve professionally. (For those that don’t understand the metaphor, go look up the Odd Couple…and nothing that was produced after 1990).

 

  1. “Once you have everything sorted and set, it is important to keep it that way…requires regular cleaning”

 

Because I suck at the previous step, this is also not a strong point for me. I know where I want to keep things, but for some unknown reason my way is not always the best way for everyone else. I struggle with the regular cleaning step. When I worked at PT and Spine, Bill was a stickler for standard operating procedures (SOPs). It wasn’t written, but he had a way that he like the clinic cleaned every night before locking the door. There was a proper way to open and close the clinic. Because I don’t have that type of standard at the place I work now, it makes it difficult to put everything in its place. I know that it sounds corny to think that there should be a standard operating procedure for the little things, but go back and listen to barbell business’ SOPs episode and it will all make sense.

 

  1. “Develop written structures and standards that will support the new practices and turn them into habits”

 

I am hard headed at some things. When it comes to organization, I have the ability to learn it, but I am a slow learner. I can spout off statistics on back pain, I can assess/treat darn near anything coming into the door, but performing organizations skills and all of a sudden…DUH? In Bill’s clinic, I was there for 2 years and by the time I left, I was able to leave the clinic in the exact way that I found it.

 

Funny story though: My dad is a Vietnam Vet (101st Airborne medic) and he could tell if something in his room moved while he was at work. Needless to say, if I wanted to be discreet, I could be. Unfortunately, this same discreetness doesn’t carry over to other situations.

 

  1. “Standardize is one of the harder steps in 5s as it calls for changing habits”

 

If I were a clinic owner, I would only hire new graduates that performed a clinical with me. It just seems much easier to teach what I find works best than to unteach stuff that I don’t like or research doesn’t support and then teach what I do prefer. This being said, being in a clinic with people who have much “experience” makes creating new standards difficult. Clinicians can be set in their ways and change can be scary. It is less scary for those that don’t know any better.

 

Excerpts taken from:

Spradling SC. Practice Management Systems: Add value to your practice by “5S’ing”. Impact. June 2016:31-32.

Is therapy worth it?

“Value is defined as cost divided by benefits”

 

This is very elementary in definition, but many of us in healthcare don’t do enough to sway this equation to make the benefits match the costs. When patients come to see me they receive multiple benefits during the session: educate, educate and over educate, personal care as much as possible staying within the realm of the evidence, and entertainment during the whole process. When I teach students, I make them tell me if they believe that they are worth $100/hour. Although we don’t get paid this much, that is the average payment to the clinic. We may have an excellent front desk staff and only have to provide the same amount of value as the cost of our salary, but I believe that we should be conveying the cost of the session, which may be up to 3 x the amount we actually receive in payment.

 

“What are the costs associated with the care we deliver? Co-pays, coinsurance, and deductibles question? ”

 

These are the basics to consider when treating patients. Patients sacrifice their times to come see us. Patients sacrifice time away from family to come see us. Are we providing the value, beyond the monetary value, to the patient? Human connection has value. I provide value to my patients not just through treatment, but also through that human connection.

 

“Now look at the benefits: what are the benefits we offer our clients through physical therapy?”

 

It’s easy for me to say functional outcomes. Patients at this point in time, do not know what that means. My job is to take the patient’s wants and needs and turn those into results. I have my own functional needs, but it would be wrong of me to impose my functional needs onto the patient. Some patients are quite content to sit in a wheelchair all day long instead of putting the work in to stand up. The best I can do is to educate the patient. If after education, I can’t motivate, then I can’t help that patient. We make the assumption that patients coming to therapy are ready to get better. This is not always the case. I see patients frequently that are only coming to therapy because their doctor told them to go to therapy. There was no indication as to what therapy would actually do to help the patient. If they are not ready to change, then it is very difficult to help that patient.

 

“patient’s assume they will get better when they see us”

 

Malarkey! At no point in time am I providing divine intervention. No one gets better simply by breathing the air I breathe (although this is one of the jokes in my repertoire). I am sure that my patient understands they will only get better when they take ownership over their problems.

 

If you are that patient, and you are ready to change, then there is help. When patients understand the problem and takes ownership of the problem and then performed the treatments in order to treat the problem, there very few patients that will not improve. Some physical therapist, such as myself, believe that we hold the answers to fix our patients. Robin McKenzie many, many years ago stated that the patient has the answer, our job is to bring that answer out. I would be arrogant of me to think that I am that answer.

 

Again, I went off on a tangent, but I did not believe that the rest of this article held any additional information that would be benefit to you.

 

Excerpts taken from

Quatre T. WHY THEY BUY: Because They Can Calculate Your Value. Impact. July 2016: 11.

Does taping in addition to PT provide increased benefits?

 

This is a look at a popular form of taping using in the PT profession. This was popularized in the Summer Olympics years ago and has increased in usage in the PT profession, regardless of what the evidence states.

 

  1. “Low back pain is a significant public health problem that affects approximately 39% of individuals worldwide at some point in their lifetime”

 

This is like beating a drum. If you follow the blog, I have written many times over the year regarding how expensive back pain is in the developed countries. One aspect that surprises me is how low this number actually is. In other articles, it talks about the lifetime prevalence rate between 70-80%. I would have to surmise that “worldwide” changes this number. I don’t have the reason why, but I have my guesses. I would guess that those “undeveloped” countries are spending less time on their kiester and more time either in a deep squat or standing position.

 

  1. “Several interventions commonly used by physical therapists, such as manual therapy techniques and exercises, are endorsed in most guidelines as effective treatments for patients with low back pain…”

 

Moving is better than not moving (in most cases). It’s funny because when I was a personal trainer (many, many years ago) I used to think of Physical Therapists as overpaid personal trainers. I completely disagree…sometimes. Don’t get me wrong, there are some PT’s that only prescribe 3 sets of 10 repetitions because it is traditional and for those PT’s I would agree that they are overpaid personal trainers. When prescribing exercise, we always have to think; “what’s the goal”. If the goal is pain reduction, than 3 sets of 10 may not be appropriate. If the goal is absolute strength or power or endurance, then 3 sets of 10 may not be appropriate. If the goal is hypertrophy…you got me…it may be appropriate for some patients for some muscle groups. In the end, 3 sets of 10 for everyone is no better than 3 sets of 5.

 

This isn’t meant to blast the PT profession, but if you are being treated in PT…Look around! If you are doing the same exercises as everyone else, then you have to question whether you are exactly like everyone else?

 

  1. “Kinesio Taping method was introduced at the Olympic Games in Athens and has since gained in popularity”

 

We have seen these tapes for the most part. The colorful tape worn on shoulders or backs of athletes. In the summer games, especially for women’s volleyball (I’m sure other sports have them, I just seem to watch more of this than anything else except for weightlifting), these colorful tapes are apparent. I use the tape, not for the reason indicated, but it makes for a great thumb wrap when using the hook grip in weightlifting.

 

  1. “The evidence of the benefits that Kinesio Taping can provide for patients with chronic low back pain is still scarce”

 

I could sell a cup of water to a drowning person in the ocean. I could easily sell Kinesio taping to my patients and others in the athletic arena, but I have yet to read a well-performed study that shows it is better than not using Kinesio tape. It’s the modern day ultrasound…It works until it doesn’t.

 

  1. “There is no current evidence to support the use of this method.”

 

This is not to say that it doesn’t work…yet, but of the studies performed thus far…it doesn’t work. One of two things will happen over time: 1. The company(ies) that sell the tape will continue to publish their own case studies to show the efficacy and/or 2. The peer reviewed journals will stop publishing all of the negative studies because academia will stop performing studies that consistently give the same results.

 

  1. “…the objective of this randomized controlled trial was to compare the effectiveness of adding Kinesio Taping to a physical therapy program in patients with chronic nonspecific low back pain.”

 

This is a well-performed study. Randomized doesn’t mean that the study is done randomly or half-assed, but the people in the study (guinea pigs) are separated in a scientific manner.

 

6a. Misc: There is a bunch of instructions for how the study was actually performed in the Methods. This is boring to the non-medical reader, and sometimes boring for those of us that read research. I will spare you the details. Just know that the study is well-performed.

 

  1. “The group that received physical therapy plus Kinesio Taping had the elastic tape applied to the lower back at the end of the sessions”

 

Essentially, if the tape is to provide greater benefit than exercise alone, this group should outperform the exercise-alone group in the data measured.

 

  1. “The corresponding author is certified by the Kinesio Taping Association International and provided training to the therapists on how to apply the Kinesio Tape”

 

This is important. If there is a method to perform on a patient, but the participating therapists are not certified in the method, then it could be that the practitioner doesn’t know the method well enough to perform the method. Since at least one of the authors is certified, it would make this a moot point.

 

  1. “After 5 weeks of treatment, the between-group comparisons showed no advantage of using Kinesio Taping in these patients for all primary outcomes…the addition of Kinesio Taping to physical therapy did not enhance treatment outcomes at any point in time.”

 

Crickets chirping………….Enough said.

  1. “Our data corroborate the results of 3 previous randomized controlled trials that do not support the application of Kinesio Taping in patients with chronic nonspecific low back pain.”

 

This means that if you want to tape your thumbs in order to lift weights, then go ahead, but using this type of tape (there are many different manufacturers of this type of tape) for back pain may not be ideal.

 

QUOTES TAKEN FROM: (Also, the initials of the first author is actually MAN, that’s awesome)

 

Added MAN, Costa LOP, De Freitas DG, et al. Kinesio Taping Does Not Provide Additional Benefits in Patients With Chronic Low Back Pain Who Receive Exercise and Manual Therapy: A Randomized Controlled Trial. J Orthop Sports Phys Ther. 2016;46(7):506-513.

Unleashed upon the world

I work in a small community hospital. At this hospital, I have been blessed to work with people that are really good at what they do. We all expect excellence with our specific niches, and it’s great to call them colleagues.

In this location, I also get many students (physical therapy students) and volunteers (hopeful to get into PT school). There are some students that I wonder how they got into the program and they force me to worry about the direction that our profession is going. This has nothing to do with knowledge, but with passion, excitement, initiative, confidence, and people skills.

Every once in a while I come across students that make me sit back and enjoy. It’s like watching a Picasso at work. They have people skills mixed with passion, integrity, knowledge and time spent in the books.

It’s disheartening to hear of some student’s clinical internships. For instance, a recent student’s experience was nothing more than that of a PT mill. The student reports doing the same intervention to all patients with a similar diagnoses. There was no classification, there was no critical thinking and the student then passed the patient off to an aide once the manual therapy portion of the session was over.

This is why I am an CI. Students deserve to learn the craft of Physical Therapy. There are many short-cuts. There are ways to maximize profit, but the ways to maximize profit, by performing said short-cuts, doesn’t typically translate into proper patient care.

We all have what’s called the sniff test. If it smells bad…it probably is. I take mine a couple of steps further and call it the “I’m disappointed in you” test. I’m 36 years old and can remember the one and only time that I heard these words from my Dad. It hurt enough that I don’t want to hear those words again. When I am practicing and treating patients, I think to myself; “Does this pass the sniff test? Would my Dad be disappointed with how I treated a patient?” It doesn’t take much people.

We recently were required to take 3 hours of ethics courses per renewal period (every 2 years). I know…it doesn’t sound like much, and it isn’t, but these 3 hours that I spend “learning” ethics are 3 hours that could be spent learning the latest/greatest interventions to treat problems. You know why we have to take ethics courses? Because there are some in our profession that are not practicing in an ethical manner. Mr. Pelligrini from Providence (my high school), on day one, wrote a big dollar sign on the chalkboard (do they even use these anymore?) and he proceeded to walk up to the $ and bow to it. This was day one. In high school, he was probably the hardest teacher that I had, but having grown a little older and more mature, that guy was so full of knowledge that is coming true during these times. I won’t go into it, because I am trying to avoid political blogging, but just know that he was wise beyond his years.

Unfortunately, many in our profession are bowing down to the almighty $. Why? When I poll students, they are graduating with over $150,000 of cumulative student loan debt. These students have a house payment…without the house. Therefore, these students will be forced to make decisions that take salary and bonuses into account. I have listened to over years of Dave Ramsey on the Podcast and unfortunately most students don’t live by his principles. Hard at first, but allows for ethical decision making professionally. When students don’t have to worry about how they are going to pay back their student loans, they can make more altruistic and personally satisfying decisions in his/her career, instead of chasing the $.

If you are applying to PT school, do your research! How much is that school going to cost you in total? Are there scholarships? How much is that school going to cost you per month when you graduate? Can you graduate without taking on any debt? How much will your starting salary be? What type of lifestyle do you want to lead and will this profession allow for that type of lifestyle?

Having lectured to many students prior to getting into the profession, many students have never even considered these questions. It’s sad, but it becomes easier for companies to play the puppetmaster because it is known that the students have to pay that loan monthly and they can’t do it without a high paying job.

Schools need to hear this and start offering financial planning courses. It’s sad that we take a student and have them rack up $150,000 in debt, but never prepare them for how to start paying that money back, saving for retirement, choosing an ethical job position, etc.

I went on a rant, but it’s on my mind this morning.

Good Ole Days…Gone!

  1. “When I graduated from physical therapy school, therapists expected to work for someone and had abundant choices in location and specialties. The expectation was for a good paying job with ample opportunity to learn from mentors and a patient load that would allow for generous one-to-one patient time. It was also expected that the salary would afford an improved lifestyle and cover the payment of their low-interest student loans”

 

Wow! This was a mouth full! Let me start by saying…those were the days (in the Edith Bunker voice). If you don’t know Edith, go get some culture!

 

Prior to the balance budget of 1997, jobs were a plenty and the salary was good. Unfortunately this is also one of the situations responsible for the need of a balanced budget. People were seeing patients for such a long time and Medicare, and other insurance companies, continued to pay for any and all treatment issued. This was regardless of need. Can you imagine that in today’s day and age? We shot our own foot by over treating and creating the spa-type environment in which everyone got ultrasound, hot packs, electrical stimulation, and massage. That’s not very physical for being physical therapy. Those days are long gone and welcome to modern times. Students are taking out between 100-200K in order to earn the right to make 65K to start. Doesn’t sound like living the dream to me.

 

  1. “The emphasis on cost containment and required documentation has created an atmosphere that does not support the very reason that most of us went into this field in the first place: ‘patient care’….Student loan debts compared to starting salary make a potential physical therapy student consider other options that have better financial outcomes.”

 

I have this discussion with prospective students often. If you think that being a Doctor of Therapy sounds lucrative, think again. Depending on school choice and loan terms, the school could cost in excess of 500K (when interest over time is accumulated). We make good money, but retirement will have to be sacrificed in order to pay off student loans. Once ours are paid off, then we have to worry about providing an education for our children. Good luck in this profession! It has treated me well, but I don’t live an extravagant life either.

 

Quotes taken from:

 

Brown TC. From the President: Come Together Right now. IMPACT. July 2016:5.

Soft sell to patients

Soft sell to patients

 

  1. “Your clients do not know what you know”

 

Man…this statement says a lot! We are highly educated (some more than others of course) and our patients come into the session with varying levels of education regarding either their health or the specific ailment. The part that irks me though is when the patient DOES know more than my students. We dedicate so much time to teaching our patients that I am frustrated if my patient now knows more than the student working with the patient.

 

Don’t be offended, but I am going to talk to you like an 8 year old, until you’ve earned the right for me to talk to you like a teenager. I will talk to you like a teenager until you’ve earned the right to be spoken to like a college student and so on and so forth. I have to ensure that you know what I am trying to teach you. If that means that I have to dumb it down a little at first…so be it. Senor Sosnowski once said that a smart person can always climb down the ladder of intelligence, but an ignorant person can’t just climb up the ladder. They have to put the work in order to get to a level of intelligence on this topic. I will be the first to say that I suck at a lot of things…physical therapy just isn’t one of them.

 

  1. “simply calls for a direct and simple correlation that is made between your intervention and the positive outcome achieved by your patient.”

 

I expect people to improve. With patients that I don’t expect to improve, I am over educating that patient on day one. This is few and far between though. I expect patients to improve and in the end, I will never act the hero, but more like the facilitator. When you understand that you are “in charge” of your symptoms, then I become your cheerleader. (I’ve worn heels, but won’t go so far as to wear the skirt…one day I’ll tell the story of the heels).

 

QUOTES TAKEN FROM:

 

Quatre T. Why they buy: Because You Have connected the Dots. IMPACT June 2016:11.

 

Have you sold your services?

Hot Dog!…Get your hot dog!

 

This article highlights how we, as healthcare professionals, are salespeople. Some points I don’t agree with and others I would take a step further. Enjoy!

 

  1. “Be patient: ‘the purpose of a pitch…is to offer something so compelling that it begins a conversation, brings the other person in as a participant, and eventually arrives at an outcome that appeals to both of you’.”

 

I reminisce about my few marketing experiences that have produced major referrals. In one instance, I (there were three of us, but I did a majority of the talking) was sitting in front of a medical group (around 12 physicians) and just gave my pitch. It was great! Those that know me, know that I can be verbose and a salesperson…especially when it comes to back pain. It just so happens that it was my opportunity to tout our clinics greatness when it comes to treating back pain. I was writing checks that my a$$ couldn’t cash at the time, but in the end it worked out so well that we have more patients than we can handle.

 

  1. “Be present: Be in the moment in your encounter”

 

This holds true for every encounter throughout the day. This doesn’t apply just to “the sell”. My patients can tell when I was up late writing…like tonight. I just don’t have the same sharpness that I normally do. I try to be in the moment as much as possible and do my best to clear my head during the workday by taking a nature walk in the short time I have for swallowing my meal. Do what you have to do to make the person in front of you feel like the only person alive.

 

  1. “Be prepared: Physicians are just like everyone else, and they typically love to discuss things like football, golf, and pop culture.”

 

Look…I disagree with this to my very heart. If I have to learn about how Taylor Swift broke up with her latest boyfriend…(this statement seems to be timeless throughout the years)…in order to have a conversation, then I consider myself a failure. If I can’t make my topic of interest so compelling that I can keep the physician’s interest, then I need to work on my knowledge or performance of my knowledge. I go a little different direction with be prepared. Know so much about your topic that the other person actually learns something that can be helpful to your audience. If I provide a physician with information that can help his patients…I have physicians now call my personal cell phone for a quick phone consult…then I will have done a good enough job to have that physician’s trust to send me patients.

 

  1. “Ask questions” Referring to personal questions.

 

I don’t look to this as selling, instead this is simply “not being a douche”. I know as much about my referrals as they want me to know. I don’t pry, but I don’t shy away from a “normal” conversation either. Be real…be you…and if you are a douche…act like someone else.

 

  1. “Be cool: …this is a way to show off your bedside manner”

Again see number 4. I thought that this point was redundant.

 

  1. “Be punctual: Which really means, be early.”

 

Again, this goes back to not being a douche. If someone takes the time out of his/her day to meet with you, in order to further your agenda, at least be respectful of his/her time. I’ve heard that in the military if you are 10 minutes early, then you are late…but if you are 15 minutes early, you are on time. Take this to heart.

 

  1. “Be human: Give them a chance to highlight their accomplishments or current work they are doing.”

 

I don’t know how much I agree with this, especially for the first encounter. I would be just as happy to say hello…My name is movementthinker and here’s my card. If there is anything that I can do to assist you with a problem or if you have a patient that has tried everything else…give me 3-5 visits to prove myself. Wow them!

 

  1. “Be awesome: …always point out the things that you have that no one else has”

 

I think that this is a very superficial definition of awesome. Writ a check that you will difficulty cashing! Make statements that you will have trouble backing up. Push yourself to be better by putting pressure on yourself to get better.   You had better live up to the hype though. If you can’t cash the check…don’t bother even having the discussion. As a matter of fact, if you can’t cash the check…go listen to the following:

Entreleadership, Spartan up, PT insiders, the Tim Ferriss podcast.

 

  1. “ Do your homework: Find out where they went to school, where they did their residency, and most importantly what their Starbucks preference is”

 

This is infuriating! Drug reps sell drugs to physicians, but really they are just the closer. The commercials pitched the entire game and the lunches, “business trips” and other perks are acting as the Mariano Rivera of drug sales. I would rather find a good starter and have them pitch the entire game. When I need a closer, I will look into it. Give me a Nolan Ryan over Kid K. I will be advertising…no…selling to the patients. They are the ones that make the health care decisions, because as time moves on…they will be the ones paying out of pocket. I will give value.

 

  1. “The most important ingredient we put into any relationship is not what we say or what we do, but what we are.” Taken from Stephen Covey.

 

I have had many conversations with private practice owners and this seems to be the overarching message. Provide good care, be a good person and allow the patients to see that. The attitude of “if you build it, they will come” no longer applies in healthcare. I take pride in the fact that patient’s refer me friends and families, I will take my attitude towards providing service to whatever avenue life brings.

 

Quotes taken from:

 

Lee A. Top Ten Tips: Selling strategies for the nonsalesperson physical therapist. IMPACT. April 2016: 63-64.

Patients through the door

The age old question

 

How do we get patients in the door? Many therapists, especially the mom and pop clinics, struggle with this question. Some physicians are spoken for by specific companies, which makes getting a referral from the physician difficult. Some insurance companies are making it difficult to see a physical therapist of choice, at least without you paying $$$$ out of pocket. So how do we get patients?

 

  1. “…marketing to physicians-would not provide the expected revenue stream. Instead, a direct-to-consumer marketing strategy was needed and needed fast!”

 

Why does it take so long for PT’s to catch on to this concept? I have heard it all my career; “patient’s need a referral in order to come to therapy, so we should market to physicians.” There’s a great documentary done by a fellow meathead called “Prescription Thugs”. Drug companies realize that if they can sell their drugs to the patients, that the patients will go to their respective physician and ask for the prescription. The question is where do we want to spend our marketing dollars or time? I have seen over and over again, the physical therapists takes coffee to the physician and tries to grab the physicians ear for a couple of minutes. THIS WILL NOT WORK! Think about it. When you go to the physician, how much time do you actually see the doctor? What…5 minutes…maybe 10 max? How much time do you think that the doctor has to offer you…for free? Not much. With that said, there are some companies that have doctors ears. I will let you make the conclusion about how they are able to get into the doctors ears for 5 minutes.

I think that a good t.v. commercial would look like this…dream with me.  A father picking up his child and having a big red throbbing circle radiating from his back.  Black screen. A mother breast-feeding her daughter and a big red throbbing circle radiating from her neck. Black screen. A weekend warrior doing pull-ups with a red circle radiating from the shoulder.  A different weekend warrior playing basketball with the circle from the knee.  Black screen.  DO YOU HAVE ANY OF THESE SYMPTOMS?  Go talk to your doctor and then see movementthinker.org.

My biggest referral source is previous patients. I have so many patients requesting me at this point that I am unable to satisfy the need in a 40-hour work week. There are many private practices that would kill to have this problem. I see this as a major problem though because I stand for very personalized care to each patient and if I can’t get the patient in the door…it’s not very personalized.

 

  1. “1. Clearly define the customer”

 

Who is my customer? Anyone that I come in contact with knows about my blog. Everyone is my customer. This is where you define your elevator pitch. What do you do? I can tell you what I do. I offer specialized care in which I take the puzzle that is your problem and break it down into smaller pieces that you can understand and teach you how to aide in not only fixing yourself, but preventing your problem from returning. I am a teacher, disguised as a physical therapist. My customer is anyone that has a problem…puzzle…that revolves around movement based pain or limitations.

 

  1. “2. answer the question, ‘Why should the consumer come to our clinic specifically and pay cash at our practice”’

 

I will give you value. Within a short number of visits I will teach you about your problem. I will guide you and teach you how to fix your problem. I will educate you on why this may have started and how to keep it from coming back again. I will ensure that you understand the basics of human movement. I will guide you to resources that you can read if you want to learn more than you can in a short number of sessions. I will tell you if therapy will help you. I will tell you if you are more likely to respond to surgery than to therapy.

 

Not only that, but I will do this in a short number of sessions in order to save you money in the process. It would be cheaper for you to pay out of pocket to see me than to go through your insurance company. I will give you value.

 

  1. “3. Determine how to effectively reach that target market”

 

You’re reading the first way that I am answering this question. I just realized that I have reached over 900 “visits” over the previous 4 months. Officially, this blog now reaches more people than I can care for in the clinic. This is my start of marketing myself and my knowledge to others. Whether you choose to come see me or not, you will be better after having read the blog.

 

Quotes from:

 

Clinton SC. OVERCOMING MARKETING OBSTACLES: A cash-based practice perspective. IMPACT. April 2016: 52-56.

 

 

Not all are altruistic

Not all are altruistic

 

I want to congratulate this student for getting published before graduation. This is a great feat and kudos to you. Now the student makes great points, but I doubt that this student is at the bottom of his class. Not all can be amazing students. Someone has to be the student that brings the average down. Nothing wrong with that, but unfortunately, anyone lower than the highest-grade earner will be that student. Someone wrote this article on the “awesome-side” of the bell curve. I retort using the “not so awesome side” of the bell curve examples.

 

  1. “There is a way to meet these goals (increased productivity demands), a simple and safe way that bypasses the “high-risk, high-reward” decisions that practice owners face when on the brink of future growth of their company: Add a student into your clinic”

 

This is coming from a student!? Look, I love taking students. I am a credentialed clinical instructor (this means that I have taken a course to learn how to work with students). I completely disagree with the above statement. From a business perspective, we should not be using students as free labor in order to pad our profits. These students are paying for the right to be in the clinic. Our primary objective as clinical instructors is to produce the best therapists that our ability allows. If I treat a student as a therapist, then I am doing the student a disservice by asking them to do the work that I usually do, and then going off to do more work in order to increase the companies bottom dollar. There has to be a line drawn in the sand regarding business ethics.

 

  1. “I have experienced good clinics, bad clinics, and great clinics; and I have noticed certain characteristics that tend to separate one from another”

 

I’m sorry, but as a student, the sample size is very small. To say that one has seen great clinics is a far reach since, in my opinion, they are few and far between. It is rare to be in a clinic in which the bottom dollar is secondary to patient outcomes. This will be changing in the future, but not anytime soon. For additional information, please see: http://www.mechanicalcareforum.com/podcast/97)

 

  1. “…students can be your safe haven for boosting morale”

 

I haven’t seen this as much in my career. There are those “go getters”, but this is just as rare as finding a “great clinic”. When looking at the bell curve of PT classes, there are only so few on the awesome side of the bell curve. Mostly, students coming out of PT school are average in my experience. Every once in a while, we get the student that has the potential to change the profession, but again…few and far between.

 

  1. “…having a student in their second or third year of physical therapy school who can take half or one-fourth of your caseload can save you time to work on documentation while maintaining clinic productivity standards”

 

This is where the shit hits the fan. Most students coming out of school have not mastered biomechanics. If a student can’t step in and do my job, including my clinical rationale, then I should not be using this student to bolster “my productivity” because the student will not be giving “my quality”. Some therapists come out of school and after 3 years are no more than overpaid personal trainers. Again, this doesn’t apply to all, but to believe that a PT student can come out of school and do my job with my experience leads me to believe that I am overpaid. In 8 years of practice and having well over 50 students, I have only had two that could possibly take my job. Again, these two were rock stars. They have the potential to change the profession. All other students needed to be built into clinicians. This does the opposite of improving my productivity because I am now spending time that would have been spent on paperwork in order to teach the future of our profession. I have had very few failures, but also very few rock stars. The rest start as average and become clinicians as the weeks progress.

 

  1. “Another benefit of having a student is that they can keep you up to date with the latest evidence”

 

Again, this is another fallacy. There are clinicians out there that don’t know how to research. I believe that Jensen (many will cite this article about PT’s that don’t research) states it clearly that the longer you are out of school, the less likely you are to perform research. That doesn’t mean that the newer grads coming out of school are much better at interpreting research beyond an abstract. I have encountered many abstract readers, but few students that can break down the article to actually tell me if it will affect my clinical outcomes. As you can see though, I also am spending time making myself better by reading the “latest evidence”.

 

  1. “What better way to create a legacy than to help students practice with the same methods that helped you prosper?”

 

It took the author many pages of writing to get to the heart of why many of us take students. I am looking to create amazing clinicians that feel confident in their abilities. My goal is that for any student that goes through me to become a Doctor…Doctor…Doctor of Physical Therapy, will earn that title. If a student has me as a CI, it will be a rough clinical, but I guarantee that the student will be much better off for it. This is why I do what I do!

 

Quotes taken from:

 

Sinacore A. SIMPLIFY! How adding a student can amplify growth. IMPACT. April 2016:40-46.

HEALTH CARE BUSINESS

HEALTH CARE BUSINESS

 

  1. “As an industry, we have a tremendous responsibility to offer our consumers information, tools and, of course, quality treatment”

 

Having sat and conversed with PT’s with other companies recently, I think that this sentence is a bunch of fluff. Don’t get me wrong, it sounds great, but it doesn’t happen too frequently. As a profession, we are hounded with productivity requirements and profit and loss statements. We got into this profession to help people, not to make mega corporations a mega-profit. Unfortunately, to the company, you are just a number. The bigger the number (see $$$) the better your number. If you have a therapist that treats you one-on-one, then you are among the few. This profession is being taken over by the “wallymarts” of physical therapy. Focused more on price than quality. For instance, if your sessions followed this game plan: warm up, stretch, manual therapy, and rehab tech or aide (see high school graduate) takes you through some exercises and then applies a hot pack with some electrodes or an ultrasound, then you are among the majority. It is harder and harder for a private (one owner, not publicly traded, not 100’s of clinics) practice owner to make it because everyone sees “wallymarts” and prefers convenience over individualized care. I am blessed because I still work for a company that allows me to treat one patient at a time. I don’t have to worry about productivity, as long as I am seeing one patient per hour that I am in the clinic. This is easy…but two every hour…this is very stressful. You should look up the term burnout. If you want to be a therapist, at least understand the world that you are entering.

 

  1. “Payers are pushing for new payment mechanisms: pay for performance (evidence-based medicine), higher deductibles and coinsurances, and assistance in managing spending. Relying only on insurance payments is a thing of the past”

 

Customers…patients…need to understand the nature of healthcare. For instance, if I could help you in 3-5 visits and you have to pay 70 dollars per visit out of pocket, your total would be 350 dollars. Now if you have to pay a 40-50 dollar copay and I decide to keep you in the clinic because the insurance is reimbursing more than I am getting from you, then I would keep you for 12 visits (average for back pain). In the end, I would make 480 dollars from you. You would have paid an extra $130 to be seen for more visits that you would have needed from someone that runs a cash based business and doesn’t take your insurance. Seek out good, quality care. Take care of your wallet, because there are some of us that will pick your pocket, shake your hand, and give you a t-shirt to advertise our clinics.

 

Quotes taken from:

 

Ziccarelli C. A Shifting Landscae: Growing your business in changing times. IMPACT. April 2016: 29-30.