Out-Value, Not Out-Volume: Ethical Sales in Modern Rehab

Hey everyone. Welcome back to the show. Today's episode is gonna hit home for a lot of you, especially if you've felt stuck between doing right by your patients and trying to keep a healthy, thriving schedule. I got a message from a listener recently that got me thinking. I. They said something I'd love to hear your input on is the patient retention slash sales side of things that fits the modern approach. I'm surrounded by clinicians who fearmonger and push care plans with more visits than I do, so I'm struggling to keep my schedule as busy. I just can't seem to find the wording that I feel good about and feel like those who present themselves as the fix seem to be more consistently busy. So if you've ever felt the same way and had that same tension doing good work, but feeling like you're getting outpaced by those selling the fix, you're not alone. Today we're gonna tackle this head on. We're gonna reframe sales in a way that actually feels good. We're gonna talk about why simply treating pain is no longer enough. And most importantly, we're gonna break down how you can separate yourself from the marketplace by offering something that's not just different. It's better because the future isn't about selling the next appointment. It's about building lasting relationships and real wellness. Let's dive in.

This is the Modern Pain Podcast with Mark Kargela

so I will say personally in my own background, I used to think sales was the most dirty, yucky word\'cause I always thought of it as like the door-to-door salesman, snake o salesman. And I actually have respect for the door-to-door salesman. I remember the Kirby vacuum salesman got my grandmother to buy a Kirby vacuum. The thing weighs like 400 pounds and pushed it around and he brought it in. He did the demos and stuff. So there's a skill to sales and I've really grown to appreciate that over time, especially. As a clinician and somewhat as a business trying to sell value for what we teach clinicians that we feel like we can truly help and improve people's practices. I've had to look at how do I,'cause it's hard in, in education, especially when you can pack a dry needle in course in a manipulation.'cause let's face it, it is the more sexy things as far as especially young clinicians value. Yet I would say probably empty things that I also chased early in my career. But anyway. Sales is something that I've come around to thinking that we really, whether we like it or not, we're selling ourselves every day in the clinic. Every interaction is a sale. We're asking for buy-in compliance, continued participation. We're asking'em to do an exercise. We're asking patients to see if they're on board with maybe our approach That might be a little bit different than our clinician colleagues. And it's really truly just an exchange of value, right? You have knowledge, and especially if you're a new grad, you spend a lot of money, time, blood, sweat, and tears. To get this degree, you should value what you're bringing to the table and use that value, and you should not be guilty charging somebody for all that work you put in to receive the value of all that education, and we know we benefit patients. That's not a stretch. That's a, there's a huge amount of research to show the approaches that rehab movement, manual therapy and all the kind of rehab based practitioners can really show some significant benefits to patient with. If we truly believe our services will positively impact somebody's life. It should be an obligation for us to sell'em confidently. Doesn't mean we have to come across like late night tv, snake oil salesman type folks. Ethical sales really shouldn't be manipulation. It's alignment. It's alignment of the patient. I. If they have a problem that you identify with your consultation with them, you know you have a solution that can help them with that problem, that's an alignment. You should be able to tell the patient, yes, I understand your problem. Here's what I can do to help it. Here's what it's gonna take for us to move that. Be it. Commitment of time, commitment of finances, whatever it may be for that patient, But again, that shouldn't be something that we feel dirty doing and really studying. Sales is self-development for ba better patient outcome. I think being better at sales. Again, in a very ethical way and looking at ethical sales and looking at buyers and consumer psychology, to me has been a huge help as I've done it mainly initially for my continued education business. But now I've looked at it, it's really helped me a ton in the clinic of really understanding. I. You know how to position my care as a solution and really try and identify what the problems the patients really have, and not superficial ones that we define as clinicians. But what are the things that if you can dive into a encounter with somebody, really understand what is at the root, what's the things that really matter in their life? What are the things that are really missing? That we can help them get back to as a solution with, of, with our services, then that usually can get somebody pretty interested in what you're doing. Now, of course, I understand there's financial situations where some folks can't pay in different things and we need to be able to develop systems and situations where we. Hardships, scholarships, pro bono services, things like that, that meet the needs of our society. But we're also, whether we like it or not, often in a business, if I could offer my services for free to the whole world, I would definitely do it. But I'd also probably not be able to live in my home and pay my bills and do all those things. I think we have to understand that the value exchange is what it is, and it's something that we can improve society by selling our services and helping society really become more healthy and more active. So the short term fix model is reactive. It's not proactive. It's something that we've been pedaling and it's been pedaled over millennia, that there's something structurally faulty that humans are cars and we're gonna fix these people. I used to pedal it, so I'm not by any means dog, anybody who may still have that narrative, but I think it's time and long since time to understand that there is no such thing as the fix. The fix is with inside our patients and whether of a ritual and thing we need to provide to make us feel important as clinicians. Maybe that's not the thing. Maybe it's just that we're tapping into a person's ability to self-regulate and get back on track that their nervous system and their homeostatic systems of their body, given the right environment and the right context and support really can right the ship and get these folks back into some good situations. High visit care plans often promote dependency instead of empowerment, granted, we can save fixes. And I've been in that situation with patients where I call it manual therapy jail, where I was in for 20 visits doing the same things. And I remember patients saying, oh, mark feels so good when you, yeah I'm looser. Yeah. Oh yeah. Look at my next turn. A little bit more limber or whatever. My back's bending more. Look, I can raise my shoulder more. But it was all under this fix doing most of my work where people were laying on tables doing this stuff and I was really lacking that ability to get people active and engaging and having strategies outside the four walls of my clinic. The fix is always gonna be attractive, right? It's an easy story. We're often taught it in school. You're broken, I'll fix you. It doesn't take too much. And when we still have a lot of that narrative of the body is a machine that permeates biomedical looks at pain, we still see it a lot in our surgical colleagues and our sometimes physical medicine pain, interventional pain folks really look at it as there's a broken part or a faulty part. I can inject it, burn it, do all these things. And again, it's not to say sometimes can't be very appropriate for the right patient. I don't think it's a stretch to say that we're really over utilizing these invasive, highly expensive risk laden interventions. but again, that comes down to the finances of things as we know, the fixed cycle though is unsustainable and it doesn't serve long-term health. So our patients, and we know this, we see it, we see patients who spin the wheels of 2030 visits and then they finally either get bored or sick of coming to see you or. Maybe you as a clinician, and I've been this clinician, say, you know what? I think we've been doing this for a while. I don't think we're finally, we're helping. And you find a way to get to discharge. you feel guilty, the patient feels unfulfilled and you're both in a situation where you don't feel like things have went the way that you'd like it to. So patients are gonna eventually seek clinicians who can offer more than crisis care. And I think that's where I've seen it, and as I really didn't know much more to do besides, Hey, I got you feeling better. Good. You're done. We can do so much more with that, especially with all the research and things we know about lifestyle medicine and all the things that, beyond just musculoskeletal interventions and examination things that we have so much more that we can examine, evaluate, help, guide people with beyond just musculoskeletal dysfunctions. And this isn't something you should look at. Ooh, I'm trying to really squeeze money outta patients. You're trying to offer them opportunities to continue to do well, to get, to stay healthy, to stay active, to maybe improve their diet, to improve their sleep, to understand stress management, how it impacts pain in other parts of their health. I think these are all things that we as rehab practitioners should be able to confidently engage patients with. So we have to broaden what we sell. We gotta expand beyond just selling pain relief. We need to sell a pathway to better health and life performance. So what can and should we sell? Exercise is a lifelong tool. Again, I mentioned stress management skills. We can do sleep optimization strategies. I just read an act book, the sleep book that really are some amazing sleep strategies that easily a physical therapist, chiropractor, or somebody who's working with somebody with pain.'cause guess what? If you're working with somebody in pain, there's ample evidence to support that. You should probably be looking at these things, at least educating people to help understand that these are probably important things as part of their. Unique situation that might be impacting the whole big complex picture versus this unilateral, let's look at your tissues and fix your tissues and you're gonna be better. We could do nutrition collaboration with dieticians or other nutritional professionals. We could collaborate with physicians for metabolic and pharmaceutical needs, so we want them to run blood tests or lab values. Although we, I know a lot of physical therapists are moving into helping patients get their own lab values and lab testing. Understanding their unique metabolic health challenges and different things, or unique cardiovascular cardiopulmonary challenges, and really leverage some of our expertise to help folks in that. Obviously we're not gonna be able to prescribe pharmaceuticals, and we obviously, most patients ideally aren't really looking for just a passive pharmaceuticals fix. But there's definitely a role of course for that to manage diabetes and to manage blood pressure, to manage other things that our patients might be having on board. I. And then we can work with physicians to help maybe. I know physicians I talked to would love to help get patients into exercise routines and, but our primary care colleagues are buried in a mountain of activity of all the things they need to do. I think it's our duty to help them out to, to help to. Them with patients who have significant metabolic health challenges and significant pain challenges to really get them on a wellness path that when we send them back for the P to the physician, after a year of working with us, that the physician sees those lab values significantly better. They see a patient who's mood and who's sleeping better, who's in better moods and their mental health better'cause we've connected the dots and helped them understand the role of exercise and activity. And of course, when pain's better, our mental health often is better as a result. So let's become a guide to wellness, not just a technician for symptoms. So we have to be willing to broaden our sales approach if you're just selling the fix. And we know that can be a short term thing and eventually the patient's interests or patients with that can wear thin. We've all had those patients, as I mentioned, that get. Spin their wheels time after time again where they're 20, 30 visits in and the same oh feels good in clinic, doesn't feel better long term. And my life sure ain't changing outside these four walls. We need to do better. Let's not just sell pain relief, let's sell a pathway to better health and life performance. This is, again, if as you look at coaching and strategies and other things that clinicians are getting into, especially if you understand acceptance and commitment therapy, motivational interviewing, I think you can really take and add services to your practice that once they're out of that rehab, pain, rehabilitation component and now we just wanna get them in wellness. Man, there's such opportunities I think, for us to sell exercise as a lifelong tool. We as physical therapists, as chiropractors and others, there's plenty of good opportunities for us to really prescribe evidence-based exercise routines. There's ways we can stand out in this crowded marketplace.'cause let's face it, fixers are everywhere. You can look anywhere online, Facebook ads, all the things that you see people proposing the fix. And one of my pet peeves the fix because there, I think that is so shortsighted and I think we can do so much more for people. But I understand for some folks that might be a way to market themselves, to get people in for what they want and give them truly what they need. I think we can probably do better, but that maybe that's for a different episode. True wellness guides are rare and valuable, and I'm talking wellness beyond some of the, let's just sell you supplements, let's just sell you diet and things. But we're truly coaching, guiding, and taking them from a movement health. And again, from that pain, rehabilitation, pain guided rehab to where now we're moving them into. Different services we provide from exercise, sleep coaching, pain coaching, lifestyle coaching, things like that they can help patients really reclaim their life and really maintain wellness beyond just, I felt better after pt and they have no strategies or things they're doing to help maintain their wellness long term. So differentiate yourself by offering broader solutions and teach patients. I don't think it's too hard for patients, especially when they have that story behind them that how many people have you seen? How did it feel short term? Did that last? Was that getting you to the long-term goals you wanted? A lot of patients will tell you if you guide them into that conversation that yeah, a lot of these things feel good short-term, but they're not really getting me back to life. Now. There's plenty of good short term. I do some manual therapy that I know is short term. I've done other, soft tissue and other things that are. Short term, but I don't weigh on them as some sort of fix that is like a supporting cast member to maybe moving people down that value ladder that I can offer them in my clinic to get them to more of a wellness, other services that move beyond just when you're in pain, let's get you out of pain. So let's focus on building health, resilience, and autonomy for patients. Use storytelling, share patient journeys of transformation beyond pain that you might've had. Some patients that you saw that you were able to work with them beyond just when it was pain and you saw them really establish some impressive routines. Maybe they changed their sleep and it changed their life and grab testimonials from your patients. These patients are often happy to tell others. The help that you've provided them. I don't think that's anything that we shouldn't be doing or feel guilty about. Say, Hey, would you mind sharing your story so we can share that with other patients who might be having the same problem with you? I'd love if we could just record a quick clip of you doing that, or if you wouldn't mind writing that out on in a quick thing and emailing it to us. That'd be a huge help because I think we can help a lot more folks who are dealing with some of the same situations you were. And again, I think when patients have that social proof or they say, this person had the exact same problem I had and man they were working with John here and they did amazing. And that they're sleeping better their pain's much better. They have a plan and things that John and them are executing with them to stay active and to stay engaged in the life that's important to them. That can be huge. So coming back to sales, there's practical tips for ethical sales conversation. We can start with discovery and by discovery. I think finding out what the patient truly values. Sometimes they just wanna talk about pain and we anchor on the pain and of course that's important to them. But what is the pain stopping them? What is it getting in the way of that truly matters in our life? I think. We stop at just the pain, we interrogate it, we get all the factors and all the data around the pain. And again, that can be important, especially when we understand how we want to examine and treat somebody. But where is it aiming us, we need to connect their goals to our services. As far as I. Once we can find out what are the true things that make this patient tick, then we can connect our services to those things. Especially when you can say, I can get you outta pain, but it a patient's probably gonna respond better to the, I'll get you outta pain versus, I think I can get you back to playing with your grandkids. That's what you told me is really important to you and I have no doubt if we work the path that we would work that we should be able to help you get back to doing that. Invite participation from patients. You don't need to push, example, would you be open to working on not just getting you out of pain, but building a system that keeps you strong and thriving Long term doesn't sound too, pushy or salesy. To me it's something that just, would you be open to, is this something you'd be interested in? Based on what you've told me today, it sounds like you want to get back to being able to, take walks with your husband. You want to be able to be active with your grandchildren while based on that, I think, would you be okay if we work on getting the pain, but then building a system that keeps you strong and engaged with them so it's not just short term feeling good and again, you can reflect maybe past in inter actions they've had with other healthcare folks. Well-meaning people of course who maybe gave them short-term games but never really gave them a plan to get back to and maintain their ability to engage in the life that they wanna live. So shift from a retention to reten shift from retention to relationship building. And that can be a huge gain for you. In the end, you don't have to out volume, the fixtures, you have to out value them. So we need to provide value that shows that beyond just getting'em outta pain for the right patient. Cause of course we know there are patients that we aren't gonna pay, maybe get out pain and that's even part of the things we can sell. Like maybe we can't get you outta pain, but we can get you to doing the things in life that you want to do. Would that be okay with you? Would it be all right if you still had pain, but you were back to playing with your grandkids or, engaging with your husband on dates again and getting out in the community and maybe going to a concert? I just had a patient who went to a concert with her husband after not doing that for over 10 years and was a massive win for her and for her husband, which was awesome to see. So that's the stuff that if you, that is highly more valuable than just getting somebody outta pain, getting them back into life and then teaching folks. We have an obligation to to teach people how their lifestyle engages with their health and that how it can impact their pain and it can, how it connect to them losing the ability to be engaged with their husband, losing their ability to be engaged with their grandkids if their metabolic health goes downhill, if their stress management goes, poorly to where their body's, starting to have significant negative impacts from that. Really look beyond just our traditional way we provide value and there are so many opportunities to provide more value than what we've done in the past. So I'd love if you could d you know, DM me or email me with your thoughts to share your experiences. I'd love to see what are you doing to create value beyond just our traditional get you outta pain value? I'd love to hear it in the comments. And for those of you are listening, I'd love if you could subscribe to where you're listening, whoever you're watching on YouTube, please subscribe. Maybe and share this episode with somebody who could benefit. We're gonna leave it there this week. We'll talk to y'all next week.

This has been another episode of The Modern Pain Podcast with Dr. Mark Kargela. Join us next time as we continue our journey to help change the story around pain. For more information on the show, visit modern pain care.com. This podcast is for educational and informational purposes only. It is not a substitute for medical advice or treatment. Please consult a licensed professional for your specific medical needs, changing the story around pain. This is the Modern Pain Podcast.