Most private practice owners know they should track their numbers.
The problem is they either don't know which numbers matter, don't know what good performance looks like, or don't know what to do when the numbers are off.
In this solo episode, Nathan Shields shares a concern he's seeing across the physical therapy industry: declining reimbursements, rising expenses, shrinking profit margins, and clinic owners making critical business decisions without the data they need.
After conducting operational and financial audits for clinics around the country, Nathan has found a consistent pattern—many practices are unknowingly leaking tens of thousands of dollars each year simply because they aren't measuring and managing the right metrics.
This episode breaks down the three common categories of owners, why understanding your numbers is now a survival skill rather than a luxury, and how better visibility into your business can dramatically improve profitability without increasing patient volume.
In this episode, you'll learn:
✅ The biggest financial blind spots affecting private practice owners
✅ Why many clinics are unknowingly losing $30,000–$100,000+ annually
✅ The three categories of practice owners when it comes to metrics
✅ Why declining reimbursement rates are creating urgency for operational excellence
✅ How executive dashboards help owners make objective decisions faster
✅ The key difference between being busy and being profitable
✅ How identifying operational leaks can improve margins without seeing more patients
✅ Why data-driven leadership is becoming essential for long-term survival
If you've ever wondered whether your practice is performing as well as it could—or if you're concerned about the future of your clinic in an increasingly challenging reimbursement environment—this episode is a must-listen.
Want to build a stronger, more profitable practice?
Join us at the upcoming PPO Club Workshop:
👉 https://ppoclubevents.com/04-17-26-workshop
Learn proven strategies to improve profitability, optimize operations, and create a practice that delivers more purpose, profit, and freedom.
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Want to talk about how we can help you with your PT business, or have a question you want to ask? Book a call with Nathan - https://calendly.com/ptoclub/discoverycall
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[00:00:02] Welcome to the Private Practice Owners Club. Your hosts and coaches, Nathan Shields scaled his practice and exited for millions, while Adam Robin went from working 60 hours a week in one clinic to scaling to multiple clinics while working less than four hours per week remotely.
[00:00:18] This podcast is meant to share with you exactly how they did it and how you can build a business that supports the lifestyle that you truly desire. And don't forget to join the Private Practice Owners Club community on Facebook, where we are obsessed with providing even more resources that help owners just like you win the game of private practice.
[00:00:43] Hey, it's Nathan. Quick heads up for all the Private Practice Owners who are listening. If you've been listening to the podcast for a while, you know that it took me at least 10 years of grinding in my own clinics before I finally figured out how to scale and sell my four practices for seven figures and about three times the national average.
[00:01:01] The biggest shift wasn't some secret marketing hack. It was how I thought about profit systems and actually my role as the owner. That's exactly what we're going to be working on together with you at the High Performance Practice Conference this fall in San Antonio, Texas.
[00:01:20] From October 15th through 17th, Adam Robin and I are hosting a three-day hands-on event for PT, OT, speech, mental health, peds, pelvic floor, and medical practice owners who want to build clinics that are profitable, scalable, and best of all, don't depend on them 24-7. We'll dig into simple profit and KPI frameworks, real leadership and culture work, and practical systems you can take home and plug in with your team.
[00:01:48] So if you're doing roughly six to seven low figures a year and you want your clinic to feel more like a real business and less like a job slash cage, I'd love to see you there. Frankly, I'd love to see you bring your leadership teams as well because we will have breakout sessions for them too. You can get all the details and grab your seat at the link in the show notes. All right, let's get into today's episode. Hello and welcome to the Private Practice Owners Club.
[00:02:15] I'm your host, Nathan Shields, and this episode is a rare solo episode where I actually don't have a guest. I'm not interviewing anybody. I haven't done one of these in a long time. So I hope you bear with me and you're okay with me talking to you a little bit because I want to talk about something that I'm concerned about in the physical therapy ownership world. I've been concerned about it for a while, and I'm sure you're experiencing it yourself if you are in the physical therapy space regarding the viability of the individual private practice owner.
[00:02:41] I've been doing audits of operational and financial audits on private practices over the past year or so. And consistently, I'm seeing opportunities within clinical organizations where they are losing tens if not hundreds of thousands of dollars a year because they're not clear on their metrics and what really moves the needle. I've seen owners who know some of them have multiple clinics.
[00:03:08] Some of them are actually doing pretty well if you consider the number of patients that they're seeing and the financials that they're seeing. Yet, I can promise you if I were to review your operations and financials, I would be able to find probably at least $30,000 to $50,000 a year that you could be generating. And I call that a leak in revenue. And here's the problem with that. Not just that we're losing money, but like I said, the viability of our organizations are at stake because reimbursements are declining. Newsflash.
[00:03:36] Our expenses are increasing, right? And that margin, that profit margin is continually squeezing to the point where if you don't know your numbers, if you're not tightening up your operations, and if you're not maximizing production on a regular basis by reviewing your systems and doing the training and following the metrics, your ability to survive what is oncoming in the next five to 10 years is at stake.
[00:04:00] So knowing your numbers and knowing these things and how to improve your operations is really a survival skill and not just the convenience. It's not like, oh, I can do this and add another $10,000 to $20,000 to my revenue. And that would be nice if I could take an extra vacation or buy an extra toy. No, these are things that make the difference between profitability and closing your doors.
[00:04:21] At this point, I'm seeing a lot of owners that are single digit profit margin owners that are questioning whether or not they'll be able to survive if they have any hiccup in reimbursements whatsoever. And I never want anyone to be in that space. That's when we make poor decisions based on those emotions. So here's some of the problems that I'm seeing amongst owners. And tell me if you fall into one of these categories, because I think a majority of the owners in the physical therapy space fall into one of these three.
[00:04:47] Number one, you don't know your metrics much at all outside of knowing your total visits and looking at your bank account balance. If our schedule is full and my money's flowing, then I know things are pretty good. And if they're not, then I need to just see more patients or let someone go or something like that. Or number two, you know some of your numbers, but not the ones that really matter or you're not sure if they matter that much. And even if you do know some of the numbers, you don't know if they're good or bad.
[00:05:15] Is 85% arrival rate good? Is it bad? How does that measure against standard? Is 11 or 12 visits per initial evaluation a good statistic? You don't know the benchmarks. You don't know what's good or bad or how to judge them. Or maybe you're number three, where you know your numbers are off and you know where they should be, but you're not totally clear as to what to do about it. And that level of knowingness and what to do about it paralyzes you into doing maybe things are okay.
[00:05:42] And I'll talk to my front desk again about doing better at over-the-counter collections, but I don't know what else to do. I think a majority of owners in the therapy space fall into one of those three categories. And even if you don't, I know you have to go and dig into your management reports, pull them out, put them on an Excel spreadsheet, and then analyze them. And then even track them over the past four to six weeks. Whether you're in one of those three or four categories, you're in trouble.
[00:06:07] You're doing a little bit more work than is necessary because in a lot of other spaces, they have what's called an executive dashboard. And that is what I'm promoting today is an executive dashboard specific for the physical therapy space. And I call it Pulse Board. Pulse board is the ability to see all your key metrics and statistics on one page by day, by week, and by month. The idea is to put them all in front of you, color-coded, red, yellow, green, against acceptable benchmarks and what you expect,
[00:06:37] so that you can make good objective decisions and know exactly what metrics to focus on within your organization. You can see the objective data and make the objective decision to actually increase your profit margins without significantly increasing the amount of work that you're doing in terms of patient visits. There are plenty of clinics out there that could simply generate 10, if not $100,000 more in their clinic
[00:07:00] with the same number of visits if they just tightened up operations and focused on key metrics and improved them to an acceptable benchmark range. And so that's the key behind pulse board. Give you the data so you can make decisions. Don't make you go into the EMRs and find the data, dig it out, make your own educated decisions, but put it in front of you to save you time and energy. I'll even take it a step further.
[00:07:25] I have plenty of resources through the Private Practice Owners Club to tell you what you can do and try to improve those objective measures. Thus, pulse board will also include an educational component with forms and resources, podcast episodes that focus on those metrics and how to improve them so you're not left wondering what to do and in a paralyzed state. And this is what I've seen with owners that have done audits with me is as I've given them the metrics,
[00:07:53] as I've shown them where they are leaking money in their organizations, they are able to then make objective decisions and improve their profit margins an extra 10, 20, 30 plus thousand dollars a year because they now know where money is leaking. So here is the goal with pulse board and why I'm presenting it to you today. If you want to check it out, go to my Pulse Board dot com.
[00:08:19] I'm looking for 20 founding members who will put down 197 deposit, which will lock in that monthly rate for life. And it's fully refundable. There's no risk to you. If it doesn't work for you, you get that $197 back per clinic per month. The people who helped me build this will be able to help me also introduce this to the rest of the industry because I recognize that as I became a better business owner, I made better decisions.
[00:08:46] I made more money and I was able to pay people better and give them bonuses, etc. So again, I invite you to consider being a founding member for pulse board, which is at my pulse board dot com. And if you feel like it's a fit for you, definitely make a deposit $197 per clinic per month. Thank you for your time. I love that all of you are listening to the private practice owners club. It's truly a joy for me over the past eight years that I've been doing this to provide this kind of value to those who listened. And I truly wish you the best.
[00:09:16] And I want to say that everything I'm doing in the private practice owners club and with pulse board, frankly, is to help you become better owners. I'm rooting for you. So again, go to my pulse board dot com and see if it's a fit for you so you can become a better owner yourself. Thanks for listening to the private practice owners club. If you enjoyed this episode, would you mind doing us a huge favor and leaving a review?
[00:09:40] This helps us get the podcast out to more clinic owners to help them create greater freedom and profits so they can own their future. And visit our website, ppoclub.com to find more resources and connect with us.