The Practice Owner Journey Of Success With Norene Christensen

[00:00:00] Welcome! You've entered the Physical Therapy Owners Club podcast where your host Nathan Shields

[00:00:08] and other successful PT owners and leaders share their experience and insights on how

[00:00:13] to build successful PT businesses. They'll share the stories of their paths to success

[00:00:18] and show you how you can also obtain greater freedom and more profits from your business.

[00:00:23] That's what the PT Owners Club is all about, greater freedom and more profits. There's

[00:00:28] plenty of room for you as well, so come on in and join the club.

[00:00:38] Hello! Welcome to the Physical Therapy Owners Club podcast. I'm your host Adam Robin and

[00:00:44] I am with a good friend, well not a good friend, a new friend, a new friend, Ms. Noreen Christensen.

[00:00:50] Hey Noreen, how are you?

[00:00:51] I'm good. How are you?

[00:00:53] I'm good. I'm fantastic. A little bit of background. So we have our Facebook group

[00:00:59] that's amazing. Anybody who's listening should join and Noreen is super active in the Facebook

[00:01:04] group. And like I'm walking that Facebook group like a hog. So I can kind of see the people

[00:01:09] who are in the game, who are in the trenches, who are playing, who are thinking about what

[00:01:12] they're doing. And Noreen, as I saw you commenting and engaging in the group, I noticed like,

[00:01:18] man, this lady, she's got some things figured out. So like we jumped on a phone call,

[00:01:21] right? We jumped on a quick call and I started learning your story and it became

[00:01:24] very apparent pretty quickly that you were a rock star owner.

[00:01:28] Thank you.

[00:01:29] And somebody who had a pretty cool story, a unique story that I thought would be super

[00:01:32] valuable to share and share with the listeners. So tell us about you, Noreen. Tell us where

[00:01:37] you're from and tell us a little bit about where you came from and how you started

[00:01:40] to practice.

[00:01:41] Do I have to admit where I'm from?

[00:01:43] You can lie. Nobody will know.

[00:01:45] No, I grew up in Northwest New Jersey. It's kind of the afterthought of the

[00:01:50] rest of the state, super rural. Grew up working on a fruit vegetable farm and

[00:01:54] went to school in Boston. Close my eyes, pointed on a map, took my first job in

[00:01:59] Baltimore, had never been there before, worked at a large teaching hospital,

[00:02:03] which was great to learn medicine and then moved over to a sports medicine clinic.

[00:02:09] I closed my eyes, pointed on the map. No, I didn't. That was to get the

[00:02:14] Baltimore. I went skiing in Utah for 10 days and I didn't even know where

[00:02:18] Utah was and went back and gave my boss a year's notice. I'm like,

[00:02:22] I'm not going to be here next key season. So I moved out to Utah without a job.

[00:02:27] Peace mealed some jobs together until I got a job up in Park City at a

[00:02:32] sports medicine clinic and part-time down in Salt Lake at the Orthopedic

[00:02:36] Specialty Hospital, which was fabulous. So that was, I got there in 90

[00:02:41] and managed care was really strong then and I was getting very frustrated

[00:02:46] having to grovel for all the visits I could get for somebody with a major

[00:02:50] injury. And I just thought to myself, I'm going to leave the profession or I'm

[00:02:54] going to go to Moab and open up my own clinic and do my own thing or I'm

[00:02:59] going to leave the state. And I'd ridden my bicycle around Alaska for three

[00:03:03] weeks and we used to get the weekly PT bulletin and I saw a job in Alaska

[00:03:09] and had five phone interviews about the job and said, great, where's

[00:03:13] Ketchikan? And they're like, well, you better look at a map. You can't

[00:03:15] drive here from there. So it's a two and a half day ferry to Ketchikan

[00:03:19] and that was a great job. I was there to help develop some orthopedic

[00:03:23] programs and the community was great. I was one of three climbers on the

[00:03:28] mountain on the island. So I became high-angle team leader for Search

[00:03:32] and Rescue. Got to know the Coast Guard guys really well through that. But

[00:03:37] my heart was in the mountain west. And so I committed a year, I stayed a

[00:03:42] year and a half and then I moved to Jackson, Wyoming and started

[00:03:47] talking to my way into a job at a hospital in Jackson. They weren't

[00:03:51] hiring and I was kind of cocky and told them that they needed me and

[00:03:55] it would be their busiest therapist. And then 95 and 98, 97, I left the

[00:04:02] hospital and just felt like I could do it better and opened up my own

[00:04:07] clinic in January 98. And I don't know through all the different clinics

[00:04:11] and facilities, I saw what I liked, I saw what I didn't like, I saw

[00:04:15] how patients were handled, I saw how employees were handled and my

[00:04:20] mission was just to do that completely differently.

[00:04:23] I love how skiing is the thing that got you to move. You're a pretty

[00:04:28] big fan of skiing, I'm assuming.

[00:04:29] Yeah, I would drive from Baltimore to Vermont just about every

[00:04:33] weekend and drive home at like four in the morning, five in the

[00:04:36] morning to be at work by eight.

[00:04:40] So we just got back from Keystone.

[00:04:43] Oh, nice.

[00:04:44] We went to Keystone for three, we skied for four days. It's man,

[00:04:48] there's nothing like it. There's nothing like it. Super fun time.

[00:04:51] So you've had a journey you've been all over, then you opened up a

[00:04:53] clinic in Wyoming, correct?

[00:04:58] In Jackson Hole. Yeah.

[00:05:00] Awesome. Tell us about that. How'd you get started?

[00:05:03] By my father telling me to stay in one place and maybe I'd

[00:05:06] get married. So I knew I didn't want to stay at the

[00:05:08] hospital. My five year plan coming out of school is I was

[00:05:12] going to have a clinic in Vermont, New Hampshire with a

[00:05:14] climbing wall work with the US ski team. And so it took me 10,

[00:05:19] 11 years to do that. I'm not a good corporate employee. And I

[00:05:24] just wanted the culture to be completely different than where

[00:05:28] I had worked. The patient was the center of the

[00:05:31] relationship and that education was key. Educating them on

[00:05:36] the call, the first call, educating them about their

[00:05:40] benefits and how it works and the billing team educating them,

[00:05:44] front desk educating them on scheduling and the importance of

[00:05:49] their plan of care. And then the PTs. You know, I've been

[00:05:53] really fortunate, I would say 96% of my PTs that I've hired are

[00:05:58] lifelong learners educate the patient. And it's a dynamic

[00:06:02] I like a very dynamic somewhat loud, fast paced environment.

[00:06:06] And the patients love it that we've been treating a lot of the

[00:06:10] same people for 26 years.

[00:06:17] Before we jump into the next episode, let's talk about

[00:06:20] something I think we'd all like a little more of and that is

[00:06:24] money. As a PT owner, I know how hard it is to increase your

[00:06:27] revenue without spending more on marketing or trying to

[00:06:31] attract a flood of new patients. And let's face it, you're

[00:06:33] already stretched thin trying to run your clinics. But what

[00:06:37] if there was a proven way to increase your revenue 10%

[00:06:39] in just 30 days with minimal effort? Better yet, how could you

[00:06:43] use the additional revenue in your business? Maybe you could

[00:06:46] hire another PT, you could start saving to open a new location

[00:06:50] or my personal favorite invest in yourself by hiring a business

[00:06:54] coach. Regardless of how you choose to spend at a 10% bump in

[00:06:57] revenue can have a huge impact on your business. And that's

[00:07:00] why I created how to increase your revenue 10% within 30 days. A

[00:07:05] free guide to help you boost your clinic's revenue and see

[00:07:08] big changes to your bottom line by tracking just one simple

[00:07:11] statistic in your business. And here's my big promise when you

[00:07:14] follow the three steps I lay out in the guide, you're going to

[00:07:18] see up to a 10% increase in revenue in 30 days. This revenue

[00:07:23] boosting strategy is the same one I teach inside my one on

[00:07:26] one coaching program for PT owners. But it's my gift to

[00:07:29] you just for being a listener to the show. So head over to

[00:07:33] ptoclub.com to download your free copy of how to increase your

[00:07:38] revenue 10% within 30 days. And again, that's ptoclub.com. After

[00:07:44] you download it and implement it, feel free to reach out to me

[00:07:48] schedule an appointment with me on the same website, schedule

[00:07:51] an appointment with Nathan, and let me know how it went. And we

[00:07:54] can talk about next steps. That's ptoclub.com.

[00:08:05] There's a few things that you said, two things actually

[00:08:08] that really stuck out to me. Number one, you said, when you were

[00:08:11] interviewing for that, that hospital position, you said, they

[00:08:15] I convinced them that they needed me. Yeah. Right. Then you

[00:08:19] said, I felt like I could do it better. So like, there is a

[00:08:23] savagery and like, like a piece of there's like some

[00:08:25] confidence inside of you. That's hard to explain. Where does

[00:08:29] that come from? Well, my mother died when I was super young.

[00:08:32] And despite my father remarrying, you know, I'm still kind

[00:08:36] of I had older brothers and sisters, but still I kind of had

[00:08:40] to survive. And when then when you have older brothers who

[00:08:45] humble you all the time, you learn to survive. I've always

[00:08:49] played sports. And I think I've always have been confident

[00:08:54] in what I do. And I remember one time I went to boarding

[00:08:58] school, and I just I didn't fit in with the cool kids. And

[00:09:02] I was sitting in my window looking out at everybody. And

[00:09:05] I remember a senior year going, you know, I don't care. This

[00:09:08] is who I am. And this is what I'm driving for. And so I think I

[00:09:12] still do that in my life.

[00:09:14] There's a lot of power in that too. You know, it that's when

[00:09:16] people become their most bold, authentic, powerful self when

[00:09:19] they realize who they are, and they actually step into that

[00:09:21] and it's like a lot of things happen. That's awesome. Okay,

[00:09:24] so you opened up the so I wrote down toughness, you're

[00:09:27] a tough cookie, I wrote down toughness, right?

[00:09:30] Don't meet me in a dark alley.

[00:09:32] Yeah, yeah, Noreen will take you out. So what I think would be

[00:09:36] fun is for those who are listening, Noreen's a rockstar. And

[00:09:39] what we're going to do is just kind of uncover her story. And

[00:09:42] what I want to do is just kind of write down, learn a little

[00:09:44] bit about your journey. And then we're going to write down

[00:09:46] your recipe for success through your story.

[00:09:49] Sure. So the first clinic you opened up, I'm assuming you

[00:09:53] opened up like most people with a lot of hard work, a lot

[00:09:56] of just late hours, long hours, hard work. So tell us

[00:09:59] about your startup phase and how that was.

[00:10:01] Yeah, startup phase, it was just me and a front desk tech. I was

[00:10:06] there a lot. I didn't mind. I was loving it. I still was

[00:10:10] opened up in January, but I still took the time to ski two

[00:10:13] days a week full days and two half days. I actually had a

[00:10:17] ski mountaineering trip scheduled that June. So I'd

[00:10:21] be gone for three and a half weeks. I knew I needed to

[00:10:23] hire. So I was able to get one of my coworkers from the

[00:10:27] hospital to come join me. And then my dad's like, you can't

[00:10:30] leave all month. I'm like, yes, I can do that.

[00:10:35] I think my work like balance was a little better early phase.

[00:10:40] But I also was doing all the wrong things. I was

[00:10:43] undercharging. I really didn't know my costs and we're

[00:10:46] giving great therapy. But I was getting it handed to

[00:10:51] me financially. In 2004, I met Paul Martin of Martin

[00:10:57] Healthcare Advisors at the PPS meeting in Vancouver. And so

[00:11:03] I signed up with him and his team came out, interviewed all

[00:11:07] of the therapists in the group went through our systems,

[00:11:10] went through our billing. At the time I had it just a

[00:11:13] local person do our billing. And that's when I got

[00:11:17] introduced to KPIs. And I was just like, what's that? And

[00:11:22] what does that mean? And so they helped me set up my

[00:11:25] budgets every year and what our goals were. But I still

[00:11:29] didn't have a real firm knowledge of what that meant.

[00:11:33] So I didn't have the ability to coach up my

[00:11:37] professionals in their coding and all that. And you

[00:11:41] know, when I'm working full time with them, I had a

[00:11:44] big heavy patient load actually didn't come step out of

[00:11:48] the clinic till like a year ago. And I do love the clinic. I

[00:11:52] wasn't working in the clinic 40 hours a week, I was like

[00:11:55] down to two days a week or three days. But it really

[00:11:58] just got to be too much and the old work on your

[00:12:01] business or work in the business, you're gonna be

[00:12:03] better if you're working on it. So when I got a new

[00:12:07] consultant with Martin Group, then I really started

[00:12:10] understanding per visit visits per hour, you know,

[00:12:14] referrals and visits per referral. So then I was, and

[00:12:19] he would help me coach with my help me coach my

[00:12:22] pts. And then we're constantly trying to improve

[00:12:26] front desk and collections. And we weren't great at

[00:12:29] that. We had our EMR at the time was doing our

[00:12:34] billing. This is our second EMR at the time. And

[00:12:37] they were great at first, but then they started

[00:12:39] cherry picking and I'm watching my 120 plus go

[00:12:42] to like 30%. And I'm like, this you can't do this.

[00:12:46] And so we thought and my front desk person was, I

[00:12:50] can do this better than them. I said, okay, so

[00:12:52] we changed the MRs. She took on billing my 90 day

[00:12:56] plus it doesn't break 3% anymore. And one of our

[00:13:01] patients we hired an alpine to be our front desk.

[00:13:06] And she is really great coaching and support and

[00:13:10] ideas. And so I worked with her a lot on developing

[00:13:14] systems and we did debills program. So any of my

[00:13:17] front desk that come on, they have to do debills

[00:13:20] program. And then we have very specific systems

[00:13:24] for the activities of the front desk and the

[00:13:28] information we get that they upload and how

[00:13:31] they collect. And we kind of give them goals

[00:13:34] every month or every quarter for collections. And

[00:13:36] it's almost like a little, a little game between

[00:13:39] all of them is like, how are you doing? How are

[00:13:40] you doing? Well, do you need help? Are you behind? Do

[00:13:42] you need help? I've done so they want to see each

[00:13:44] other be successful. So then I crawled out of

[00:13:48] what rock I lived under and I found the PT

[00:13:51] owners podcast like two and a half years ago.

[00:13:54] And my one clinic's an hour 10 minute drive and

[00:13:57] I would just binge. I had you guys on 1.5

[00:14:00] you really talk fast 1.5. And just listening

[00:14:03] everything I'm like, Oh my God, a coach. What a

[00:14:06] great idea listening about will Humphreys and

[00:14:10] recruitment in the richest county in the US

[00:14:13] and the highest cost per living is rough. And so

[00:14:17] I went through his recruiting. I got myself

[00:14:19] an executive coach. And the last year and

[00:14:23] a half just has been magical. I mean, we

[00:14:26] were growing significantly every year

[00:14:30] significantly sometimes 25% 18%. And so I'm

[00:14:35] like, Okay, I have to come out of the clinic. I

[00:14:37] have to drive this boat. And I've had my

[00:14:40] leadership. I think my first clinic director

[00:14:43] was in 2012. I put a clinic director in

[00:14:46] immediately when I opened up each other

[00:14:48] clinic. And then as we kept growing, I'm

[00:14:52] like, Okay, before I open up this other

[00:14:54] clinic, I need to bring in another biller

[00:14:56] because that's going to push that volume on

[00:15:00] them. So let's get this biller up and running

[00:15:02] and get going on this clinic. So I have

[00:15:06] three and a half billers now that manage

[00:15:09] everything. And they I just did this KPI

[00:15:13] review the consultant and they're like the

[00:15:15] unicorns, they're just taking names and

[00:15:18] they're the rock stars. And my manner that

[00:15:21] front desk person who I hired that started

[00:15:23] helping me with the systems. She's the

[00:15:25] manager of the billing front desk. And she

[00:15:28] just it really came down to consistent

[00:15:30] systems and consistent messaging for the

[00:15:34] therapists, they get weekly KPIs, we go over

[00:15:37] twice a month there coding diversity, we

[00:15:40] look at their payer mix. So if their units

[00:15:43] per visit are low, maybe they're high in

[00:15:45] Medicare. If their units per visit are

[00:15:47] really high, maybe they're high in

[00:15:48] commercial, but we look at how are they

[00:15:51] billing her insurance type. So they're not

[00:15:54] undercoding or over coding. And are they

[00:15:56] using the skilled timed units in a nice

[00:16:00] diversity? So I heard about it, a billing

[00:16:03] company likes the KPI of therapeutic

[00:16:07] activity and neuro and your mips of

[00:16:10] coding over a quarter should equal over

[00:16:12] 50%. And some of my therapists are and

[00:16:15] some aren't. And so now we have those

[00:16:17] graphs that we can really sit with them

[00:16:20] and show them where their coding

[00:16:23] diversity is rather than just a bunch of

[00:16:24] percentages. So you got into coaching.

[00:16:29] Amen. You got into coaching, you said

[00:16:31] the guy Martin, what was the first?

[00:16:33] No, well, he's my business advisor.

[00:16:36] Okay. Dave Pierce with Martin and

[00:16:39] healthcare advisors. And then I started

[00:16:42] with Steve Alred from Practice U.

[00:16:44] Got it. So you started getting into

[00:16:46] coaching. So and then your things

[00:16:49] just changed for you, right? You

[00:16:50] started changing up your perspective

[00:16:52] just trying to shift it up your

[00:16:53] understanding, shifting up the way that

[00:16:54] you think managing your priorities a

[00:16:56] little bit cleaner. Yeah, I'm still

[00:16:58] working on that. But last winter, I

[00:17:00] was, I was reaching out to everybody.

[00:17:03] I was desperate. I was talking and

[00:17:04] I'm like, okay, so you sold your

[00:17:06] practice and now you're a coach. What

[00:17:07] makes you a good coach? Where did

[00:17:09] you get your coaching training? But

[00:17:10] I'm like, oh my gosh, I have to do

[00:17:12] something. I am just losing it. I

[00:17:15] don't have a good grasp or control

[00:17:17] on a lot of things. There's too

[00:17:18] many moving parts. And yeah, getting

[00:17:21] that learning that clarity, doing

[00:17:23] the Eisenhower matrix, like what

[00:17:26] can I get rid of and whatnot? I did

[00:17:28] try to hire an operations manager

[00:17:30] and I'm like, this is what I'm going

[00:17:31] to teach you. This is what you're

[00:17:32] going to do so I can do these

[00:17:35] things and be more of a benefit for

[00:17:38] the practice. Unfortunately, I did

[00:17:41] not ask if he knew how to use

[00:17:43] Excel. I thought everybody kind of

[00:17:45] had to use that. Yeah, so we had

[00:17:48] to and I asked him, I'm like,

[00:17:49] do you feel successful in this

[00:17:51] position? He said, no, you've given

[00:17:53] me every opportunity to learn. And I

[00:17:55] said, well, is it fair to you? And he

[00:17:57] said, no. And I said, is it fair to

[00:17:58] me? And he's like, absolutely not.

[00:18:00] So we split paths and I told him

[00:18:03] I'd be happy. He was an awesome

[00:18:05] manager with people. But the

[00:18:07] operations, the spreadsheets and

[00:18:09] stuff, that's where I need

[00:18:11] somebody to present to me. So let's

[00:18:14] go back to how long did you have

[00:18:16] your first clinic before you

[00:18:18] decided to jump to number two? The

[00:18:19] second clinic?

[00:18:20] Number years. So pretty much nine,

[00:18:22] 10 years.

[00:18:23] What sparked that transition? How

[00:18:26] did that go?

[00:18:27] Oh, it's like so easy, except for

[00:18:29] buying a bunch of equipment. I just

[00:18:32] found a space. My other PT was

[00:18:35] totally on board. She was excited.

[00:18:37] My current front desk person had a

[00:18:39] daughter who had reception history

[00:18:42] so or experience. So we hired her.

[00:18:45] I did not do the most expensive

[00:18:47] build out because it was a small

[00:18:48] space and my goal was only to be in

[00:18:50] that space for five years and then

[00:18:52] move to a bigger space. We

[00:18:54] immediately started knocking

[00:18:56] on doors for the physicians. A lot

[00:18:59] of our patients currently lived in

[00:19:01] that valley and drove up 45

[00:19:04] minutes to see us. So we kind of

[00:19:07] got that crowd right away. I built

[00:19:10] all the equipment by myself, which

[00:19:12] I will never do again. I was

[00:19:14] crying on a Sunday afternoon

[00:19:16] looking at the free arm motion

[00:19:18] machine going, I don't know how I'm

[00:19:20] going to do this. I did call a friend

[00:19:22] of mine who's a construction worker.

[00:19:24] The treadmill had a few leftover

[00:19:26] bolts and screws and stuff. And

[00:19:29] it's like, well, hasn't broken yet.

[00:19:31] So it was a lot of sweat equity

[00:19:32] going into it, but word of mouth

[00:19:35] and our orthos love us. And so

[00:19:38] they were stoked that we were down

[00:19:40] there and we really only have one

[00:19:42] ortho team in Jackson. There's

[00:19:44] another ortho team in that valley,

[00:19:47] but they're tied in with the hospital.

[00:19:49] We immediately got the enemy

[00:19:51] number one from the hospital system,

[00:19:54] but a lot of their physicians told

[00:19:57] us flat outs like you guys actually

[00:19:59] provide therapy. So I don't care

[00:20:00] what the administrator is telling us.

[00:20:03] We're referring to you. So you know,

[00:20:06] we have quality quality and more

[00:20:09] than just establishing the

[00:20:10] relationship, we would get people

[00:20:13] that transferred to us that were

[00:20:15] in therapy for eight months.

[00:20:17] And they were only with us six,

[00:20:19] eight weeks because they got better.

[00:20:21] And they're like, well, I never had

[00:20:22] to do this kind of stuff.

[00:20:23] So we demonstrated our quality

[00:20:25] and our professionalism.

[00:20:27] So did you have a PT that you

[00:20:29] opened with or did you how did

[00:20:31] that work? Did you have a guy or

[00:20:32] a lady that you open that you had

[00:20:34] that was Kaya, who was my intern,

[00:20:36] who I hired. And I said, OK,

[00:20:39] I'm going to hire you.

[00:20:40] I'm going to open up a second clinic

[00:20:41] and you're going to help me

[00:20:43] open that up and get it running

[00:20:44] and be the clinic director.

[00:20:46] So how long of a time frame

[00:20:49] was it between that hire and the

[00:20:51] opening of the second clinic?

[00:20:52] Roughly two months.

[00:20:54] Wow, because I knew she still had

[00:20:56] another internship after us

[00:20:58] and we gave her a job offer.

[00:21:00] So immediately I started looking

[00:21:02] at space and there happened to

[00:21:04] be a space and one of my

[00:21:07] employees knew a guy that could

[00:21:09] build it out for us and got

[00:21:11] some plans written up from

[00:21:13] an architect and off we went.

[00:21:16] So this was a new grad therapist?

[00:21:18] She was a new grad, so she and I

[00:21:20] worked that clinic together for about

[00:21:22] two years and then we hired

[00:21:24] another therapist and I backed out

[00:21:26] and she continued as clinic director.

[00:21:29] Way to go. That's amazing.

[00:21:31] So I did hire a clinic director,

[00:21:33] but I fired him after four months.

[00:21:35] I've always found that that's harder.

[00:21:37] It's it's a lot harder to hire

[00:21:39] a director straight on like you have

[00:21:41] to spend some time with them.

[00:21:42] Yeah, you know, or her whatever.

[00:21:45] He was not a good cultural fit.

[00:21:47] Right, right.

[00:21:49] So the third thing I wrote down

[00:21:50] is strategic hires.

[00:21:51] So I love that you hired and this

[00:21:53] is big, Noreen.

[00:21:54] This is a big piece because

[00:21:57] maybe some people get this,

[00:21:57] maybe some people don't.

[00:21:58] But you had to have a vision,

[00:22:00] right? Like you had to have a

[00:22:01] vision that I'm going to hire

[00:22:03] this person and then that's going

[00:22:05] to give me the capacity

[00:22:06] to open up another clinic.

[00:22:08] Right. Yeah.

[00:22:09] Especially the infrastructure.

[00:22:11] Like I wanted to look at the

[00:22:13] infrastructure first.

[00:22:14] I mean, do I have the billing team

[00:22:17] and professional team to open a clinic?

[00:22:20] So yeah, these hires have been really good.

[00:22:22] And I'm just looking back

[00:22:24] the company from 2020

[00:22:28] where we dropped 16 percent

[00:22:30] from the previous year.

[00:22:31] After that, we grew 14 percent,

[00:22:33] 28 percent and 18 percent.

[00:22:35] So in my mind is like, OK,

[00:22:37] we have this volume.

[00:22:38] We need to get the professionals

[00:22:40] and we need to get the billing team in place.

[00:22:42] And one of our other interns,

[00:22:45] we hired, he was working part-time

[00:22:48] in that second clinic

[00:22:49] and up in the main clinic.

[00:22:51] And when we opened the third clinic,

[00:22:55] the goal was to get him out there

[00:22:57] because the cost of living is lower

[00:22:59] and he really loves that area.

[00:23:00] And so we moved him out there

[00:23:02] after a year and he moved out there.

[00:23:04] Then twice a week came to the main clinic

[00:23:06] but worked at the other clinic

[00:23:08] twice a week as well.

[00:23:09] And now we've had some staff,

[00:23:11] some shake up and now he's the clinic director

[00:23:14] for that clinic as of this year.

[00:23:16] And it's growing.

[00:23:17] It's a slow grower, but it's growing.

[00:23:19] So that's good.

[00:23:20] And this year just seemed to like pop

[00:23:22] in its third year, starting its third year.

[00:23:25] Yeah. So I love that you have

[00:23:28] going back to the vision,

[00:23:29] you're able to see that, wow,

[00:23:32] got this business that's working.

[00:23:34] All I need is another who give me another who

[00:23:36] and then I can start pouring into that person.

[00:23:38] And that's going to give me the capacity

[00:23:40] to like go and open up my second location.

[00:23:42] So there was a strategic hiring process

[00:23:45] that you that you had to go through

[00:23:47] in order to make that happen.

[00:23:48] So it wasn't just like, let me hire.

[00:23:50] Or I accidentally went through it.

[00:23:52] Well, you know what?

[00:23:53] Maybe just a natural gift.

[00:23:55] It's just a natural gift.

[00:23:56] I mean, you obviously have a lot of

[00:23:58] passion and a lot of toughness

[00:24:01] and you obviously have vision for you and your company.

[00:24:03] You're willing to invest in yourself, right?

[00:24:05] You're willing to invest in the company.

[00:24:07] And that's what it takes.

[00:24:09] That's what it takes.

[00:24:09] And you just keep rock dice on yourself

[00:24:11] and eventually you won hits.

[00:24:13] And the next thing you know, you got three clinics.

[00:24:14] You know what I mean?

[00:24:15] Yeah. In a way, I've always kind of hung it out there.

[00:24:18] I do not have a lot of risk adversity.

[00:24:21] And I think that helps if you're a little risk adverse,

[00:24:24] you're probably going to overthink things

[00:24:26] and kill your gut and either not follow through

[00:24:30] to what could have been a very successful thing.

[00:24:32] But I mean, there is a downside to it being,

[00:24:35] you know, highly risk tolerant.

[00:24:37] I can crash and burn with the rest of them.

[00:24:40] And it's not like I haven't looked at bankruptcy

[00:24:43] after the 2009 crash.

[00:24:45] I was down to one therapist

[00:24:47] and it was just he and I picking our noses

[00:24:49] waiting for people to come in.

[00:24:51] That put me in a huge amount of debt.

[00:24:53] Banks didn't want a loan.

[00:24:55] And but, you know, it's just grit.

[00:24:57] It's just putting your nose to the grindstone

[00:24:59] and getting it done and knowing,

[00:25:01] believing it's going to work.

[00:25:03] And maybe that's what I do.

[00:25:04] It's just I believe it's going to work.

[00:25:06] So I just do it.

[00:25:07] Yeah. Well, I think that there's only a few things

[00:25:10] that you can really control.

[00:25:12] And I think that the most important thing

[00:25:14] that you can control is the people

[00:25:16] you surround yourself with.

[00:25:17] Like if there's one single piece of advice

[00:25:20] that I like to give young people or young business owners

[00:25:23] or even my or even remind myself, it's like,

[00:25:25] just put yourself in front of getting around good people

[00:25:28] who are aligned with you

[00:25:29] and who want to help you go where you want to go.

[00:25:31] And you did that with your team

[00:25:32] and you also did that with your coaches.

[00:25:34] So like, if you have that, you can almost do anything.

[00:25:38] You can be more, you can afford to be more risky

[00:25:40] when you have that.

[00:25:41] Cause things typically will work out more often for you.

[00:25:45] Like we have like a, for our professionals

[00:25:48] like a four step interview process.

[00:25:52] I first sit and chat with them.

[00:25:54] I like everybody.

[00:25:55] So I'm not allowed to hire anybody anymore.

[00:25:57] Then my clinical manager and clinic director

[00:26:00] for that clinic will do a formal interview.

[00:26:04] I have a therapist on staff that's like,

[00:26:06] this is the best job ever.

[00:26:09] And I'm happy to talk to anybody

[00:26:12] who's interested in working here.

[00:26:13] So then they talk to her

[00:26:15] and those two groups will say yay or nay.

[00:26:18] And then if they say yay, I'll reach back out

[00:26:20] and go, well, if you're super interested,

[00:26:23] we'd love to fly you out

[00:26:25] and have you spend a day with us

[00:26:26] and take you to dinner.

[00:26:27] And then, for sure it's, are they excited by the environment?

[00:26:32] And what kind of person are they?

[00:26:34] And I share the vision and the culture of the clinic.

[00:26:37] They see it, they feel it.

[00:26:40] And then that's our little final,

[00:26:42] are you gonna be someone that's gonna work

[00:26:45] with the company and help them grow?

[00:26:47] And I feel fortunate in 26 years, we've had four wingnuts.

[00:26:51] So I think I'm doing pretty good.

[00:26:54] Yeah, heck yeah, you're doing good.

[00:26:56] You're killing it.

[00:26:58] So tell me about, you said people have a tendency

[00:27:02] to overthink things.

[00:27:04] Oh my husband's a perfect example.

[00:27:06] Yeah, help us with that.

[00:27:08] How do we stop doing that?

[00:27:11] How to get out of your own way.

[00:27:12] Yeah, how do you get out of your own way?

[00:27:14] Let's start the podcast over.

[00:27:16] How do you get out of your own way?

[00:27:18] If we could, yeah, like tell us the secret.

[00:27:20] How does that work?

[00:27:21] Gosh, it just popped into my head now.

[00:27:25] I never thought of it this way,

[00:27:26] but think of your chronic pain patients

[00:27:28] that had that fear avoidance of movement

[00:27:30] and how much better they feel and how much excited they get

[00:27:35] when they're like, oh my gosh, I can bend over

[00:27:38] and it doesn't hurt.

[00:27:39] I guess it's believing that you can make huge mistakes

[00:27:44] and no one's gonna die.

[00:27:46] You might get in trouble.

[00:27:47] You know, if Thyrus might come after you,

[00:27:49] the banker might be mad at you.

[00:27:50] But at the end of the day,

[00:27:52] you go home with your family,

[00:27:53] you sleep in your own bed

[00:27:54] and you wake up and you do it again.

[00:27:56] I've never actually been a very reflective person,

[00:28:00] so maybe that's why I can do that.

[00:28:03] But I think the more you have to think

[00:28:05] about what you're doing to it,

[00:28:07] and you have to put your spreadsheets together

[00:28:10] and it's like, is this going to work?

[00:28:12] And then you have to look at your environment

[00:28:14] and the community is like, is there room for you?

[00:28:17] And can you do it better?

[00:28:19] Can you provide something different

[00:28:21] than what's already provided?

[00:28:23] And if you can check out those box,

[00:28:25] then what's stopping you?

[00:28:26] Just get it done.

[00:28:28] Yeah, yeah.

[00:28:30] Even with all that data,

[00:28:32] there's still no way to be certain about anything.

[00:28:35] It's all a risk.

[00:28:36] It's all a gamble, right?

[00:28:37] And so you're using the data

[00:28:39] to help you objectify your odds, if you will, right?

[00:28:42] But at the end of the day,

[00:28:44] no matter how much data or how little data you have,

[00:28:46] it all comes back to,

[00:28:47] you're gonna have to take a gamble on yourself.

[00:28:49] You have to believe in your capacity.

[00:28:52] So ski mountaineering,

[00:28:53] I remember this one mountain we were going up.

[00:28:56] There were crevasses everywhere

[00:28:58] and we were on this really thin kind of ice.

[00:29:00] We had ski crampons on and it came to a point

[00:29:04] and we had to turn around the point,

[00:29:07] go a little bit further, get over a crevasse,

[00:29:10] put our skis on our back, get over the crevasse

[00:29:13] and then climb up a little bit of an ice

[00:29:15] and then put your skis back on and go.

[00:29:18] The guide was nowhere to be found.

[00:29:20] And I'm like, this is a total no-ball zone.

[00:29:23] So two things can happen.

[00:29:25] You can believe in your capabilities,

[00:29:29] focus and get it done

[00:29:31] or you can completely fall apart

[00:29:33] and you're gonna end up falling in a no-fall zone

[00:29:36] and that's not good for anybody.

[00:29:38] So I think you truly have to believe

[00:29:40] in your strength, your capacity, your intelligence.

[00:29:46] You have to believe in yourself.

[00:29:47] Yeah, and then I think at some point,

[00:29:49] correct me if I'm wrong, as you start to build a team,

[00:29:52] it starts to become less and less dependent on you

[00:29:55] and it's more in like, hey, I've gotta trust my team.

[00:29:57] Like I've gotta believe in my team.

[00:29:59] So your ability to-

[00:30:00] Yeah, I'm trying to wean my directors off of me.

[00:30:02] I'm gonna be going the next two, three weeks

[00:30:05] and I'll look, I'm not in cell service.

[00:30:07] You're going to have to make decisions

[00:30:10] but just remember the mission,

[00:30:13] the values and the culture

[00:30:14] and base your decisions on that.

[00:30:16] I totally trust you guys in making the appropriate decisions

[00:30:19] and we can talk about it when I come back.

[00:30:21] Maybe I like it, maybe I don't but decisions been made.

[00:30:25] That's fun and that gives you so much more freedom.

[00:30:28] It's getting me there, yeah, it is.

[00:30:31] It helps you let it go

[00:30:32] and then that way you can actually be happy again.

[00:30:35] Right?

[00:30:38] I am way happier than I was a year ago.

[00:30:41] Boy, you and me both.

[00:30:42] I was a hot boss.

[00:30:45] Yeah, I get it.

[00:30:46] I get it.

[00:30:47] So I've got four things down that you mentioned.

[00:30:51] Number one, gotta be tough.

[00:30:53] This is Noreen's recipe.

[00:30:56] Toughness, gotta be tough, gotta be gritty.

[00:30:59] Gotta get your hands dirty.

[00:31:01] Number two-

[00:31:02] And just mean I haven't cried.

[00:31:04] Yeah, I cried too.

[00:31:05] I'll cry, you know?

[00:31:06] Hey, I can't remember how many times I've had this light.

[00:31:08] I'm sitting down with a glass of wine

[00:31:10] talking to my wife, talking about

[00:31:11] I'm just gonna just sell all the clinics.

[00:31:12] I'm gonna get rid of this stuff.

[00:31:14] I've been there too.

[00:31:15] So you gotta be tough, gotta have coaching.

[00:31:17] Yes, I wish that was around 20 years ago.

[00:31:20] By the way, guys or girls,

[00:31:23] this is me and Noreen's second time we've ever spoke.

[00:31:25] She's not a client of mine.

[00:31:27] We don't work together.

[00:31:28] She works with other coaches.

[00:31:29] Get you a coach.

[00:31:30] If it's not me or Nathan or anybody,

[00:31:32] just get you a coach

[00:31:33] because if you wanna, if you,

[00:31:34] you've got to learn,

[00:31:36] you've got to have that person in your corner, right?

[00:31:38] So number one, toughness, number two,

[00:31:39] coaching, number three, strategic hiring, right?

[00:31:43] So not just building your culture

[00:31:46] but building your company

[00:31:48] through the hires that you're making, right?

[00:31:50] So like who's your next leader?

[00:31:51] Who's your next, I don't wanna say stepping stone

[00:31:53] but who's your next person

[00:31:55] where you can take this company

[00:31:57] and like go to the next level with?

[00:31:58] Like that's who you're looking for, right?

[00:32:00] Person that help you go from one clinic

[00:32:02] to two clinics, from two clinics to three clinics.

[00:32:04] And then number four is taking risks.

[00:32:06] Stop thinking, less thinking more doing.

[00:32:09] There's not a whole lot of things

[00:32:12] that I can think of that get better with more thinking.

[00:32:18] Oh, true.

[00:32:19] It's educating ourselves.

[00:32:20] Any consultant and they come with a price tag,

[00:32:23] they're priceless for your company.

[00:32:26] I remember back in 2004 when I started,

[00:32:29] I'm like, how am I going to afford this?

[00:32:32] But then I quickly grew to poor therapists.

[00:32:35] So I mean, we're just not taught the business

[00:32:38] in PT school

[00:32:39] and it's investing in your business and in yourself.

[00:32:43] That's amazing.

[00:32:44] So you've got three clinics now

[00:32:45] and you're going on vacation.

[00:32:47] Tell us about your vacation that you're going on.

[00:32:49] Oh, I'm doing a two week back country

[00:32:53] hut ski mountaineering trip up in the glacier

[00:32:55] in British Columbia.

[00:32:56] And then I'll be home a couple of days

[00:32:58] and then go a week to Hawaii.

[00:33:01] That's amazing.

[00:33:02] Look what you did.

[00:33:03] I know.

[00:33:04] You did it.

[00:33:04] Yeah.

[00:33:05] Congratulations.

[00:33:07] Congratulations.

[00:33:08] Well, Noreen, I really appreciate your time.

[00:33:10] I think your story is amazing.

[00:33:11] I think you have a unique story.

[00:33:12] I love your recipe.

[00:33:14] I think it really excites me.

[00:33:16] If people wanted to shoot you an email

[00:33:19] or maybe connect with you

[00:33:20] and seek out a little guidance

[00:33:22] or seek out some support,

[00:33:24] how would they get in touch with you?

[00:33:25] My email is noreen.

[00:33:29] E-n-e at fourpindspt.com

[00:33:33] which is F-O-U-R-P-I-N-E-S-P-T.

[00:33:36] Our website is fourpindspt

[00:33:39] or physical therapy.

[00:33:40] So you can always Google

[00:33:41] and then my email address is there.

[00:33:43] I'm active in the PTOwners Club group

[00:33:46] which found a lot of value in.

[00:33:48] And I mean, just the podcast,

[00:33:51] I was like, wow, where have I been

[00:33:53] and why haven't I listened to this?

[00:33:54] And I started from number one

[00:33:57] and I probably listened to 95% of the episodes.

[00:34:01] I did the same thing.

[00:34:02] Will Humphries, you mentioned Will earlier.

[00:34:05] He's a mentor of mine too.

[00:34:06] I love Will.

[00:34:07] But he told me one time,

[00:34:08] you are the product of the books that you read

[00:34:10] and the podcasts that you listen to.

[00:34:12] And I didn't really fully understand what that meant

[00:34:15] but you can't really control the outcome of too many things

[00:34:21] but you can control how much you educate yourself

[00:34:23] and how much you commit to listening.

[00:34:25] And I promise you,

[00:34:27] and Noreen and I are both examples of this,

[00:34:30] if you commit to listening to this podcast

[00:34:32] every single day for the next year,

[00:34:34] your business will grow.

[00:34:37] Your business will grow.

[00:34:38] And I don't know why that is

[00:34:39] but like your paradigm shifts, your perspective shifts,

[00:34:42] you start to see things a little bit differently

[00:34:44] and stuff starts happening.

[00:34:45] So commit to reading.

[00:34:47] And your library grows.

[00:34:48] There's not a lot of good books.

[00:34:50] That's right, that's right.

[00:34:51] Well, I really, really appreciate Noreen.

[00:34:52] I would, let's do this again.

[00:34:54] I'd love to catch up in maybe six months or so

[00:34:56] just to kind of see where you're at with things.

[00:34:58] Sure.

[00:34:58] Enjoy your vacation.

[00:34:59] Oh, I will.

[00:35:00] Thank you.

[00:35:01] Bye-bye.

[00:35:03] Thanks for joining us today

[00:35:07] in the Physical Therapy Owners Club,

[00:35:09] the resource for stability and freedom in your PT practice.

[00:35:12] Reach out and join the network today.

[00:35:14] Subscribe to our podcast, get links to social media

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