Growing Your Practice and Legal Considerations for Adding Practitioners

Alan Fredendall // #LeadershipThursday // www.ptonice.com 

In today's episode of the PT on ICE Daily Show, ICE COO Alan Fredendall discusses the different avenues to find out if a potential hire is right for your clinic: screening the resume, conducting a series of interviews, and getting to know the person outside of work. In addition, he reinforces to listeners the importance of utilizing employment contracts.

Take a listen to the podcast episode or read the full transcription below.

If you're looking to learn more about courses designed to start your own practice, check out our Brick by Brick practice management course or our online physical therapy courses, check out our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.

EPISODE TRANSCRIPTION

00:00 ALAN FREDENDALL

Team, good morning. Welcome to the PT on ICE Daily Show. Happy Thursday morning. Hope your morning is off to a great start. My name is Alan. I'm happy to be your host today here on Leadership Thursday. We talk all things practice, management, and ownership. Leadership Thursday also means it is Gut Check Thursday. Gut Check Thursday this week is a workout called Gut Check. Kind of going back to our roots of a really kind of low skill, high work workout. We have four time, 180 calories on the fan bike, a one mile run, and then 100 bar facing burpees. So nothing complex here, just some good old fashioned grunt work. Each of those elements you're thinking is going to take you maybe 8 to 12 minutes and that you're going to get done maybe depending on your run speed, on your biking ability, on your ability to ignore the pain during the burpees. You might get done somewhere between 20 to 25 minutes. So that's a great workout to do in the garage, in the basement. Great workout in the clinic to scale and modify for patients. Very easy to modify the volume there, modify the movement, so on and so forth. So try Gut Check Thursday this week called Gut Check. Course is coming your way. I want to highlight our online courses. We have a bunch beginning related specifically to Leadership Thursday and Practice Management Brick by Brick. Our next cohort starts September 12th. That's next Tuesday with yours truly. All things related to getting your practice off the ground, all of the legal things you need to do to establish and incorporate your business, and then finishing talking a little bit of strategy depending on if you want to open a brick and mortar clinic, a mobile clinic, a dock in the box style clinic, whether you want to deal with insurance, be 100% cash, or maybe meet in the middle with a hybrid practice. Whatever your goals are for starting your practice, that is the course for you. Eight weeks online. That starts September 12th. Other online courses starting next week, Clinical Management Fitness Athlete Essential Foundations begins Monday, September 11th. Myself, Mitch Babcock, Guillermo Contreras, and Kelly Benfey. All things related to helping the recreational fitness athlete, the crossfitter, the boot camper, the orange theorist, the powerlifter, Olympic weightlifter, you name it. That class is for you. Clinical Management Fitness Athlete Advanced Concepts, the level two course of Clinical Management Fitness Athlete. That cohort begins September 17th. You need to have taken Essential Foundations first. That course is taught only twice a year, spring and fall, and it has two seats left. So if you've been thinking about rounding out your Clinical Management Fitness Athlete certification, you'll want to jump in that class this fall. Otherwise, you'll need to wait until the spring. Other online courses, Rehab of the Injured Runner online. That also begins September 12th. Modern Management Older Adult Essential Foundations kicks back off October 11th, and then Persistent Pain Management begins again October 31st. So today we're kind of building on last week's topic. If you were here last week, you know that we talked about really being intelligent and diligent and intentional about growing and scaling your practice, about how to add new practitioners to your practice, about how to do it the right way in a way that facilitates long-term growth, but also quality of the product that you're offering. So go back and listen to last week's episode if you have not yet. We used the example of McDonald's, of how they've grown and scaled to be one of the largest, most successful businesses in the world in all of history, and how they've done that. They've done that by having that shared foundation of training and a common belief system in all of their leadership and ownership to help maintain that company culture as they grow. Today we're going to build on that. As I said, we're going to talk about how to find that person. We talked about how McDonald's has Hamburg University, but how can you, maybe is the individual practitioner right now, solo practitioner, how can you find practitioner number two? How can you find maybe practitioner number one for location number two, so on and so forth.

04:15 FILTERING CANDIDATES

So we're going to talk about the different ways that you can really get to know somebody, and then we're going to talk about something that's really undervalued and not really discussed in physical therapy at all. The legalese of bringing somebody on board, of getting everything that you are promising them, everything that maybe if you're on the other side of the table, everything you're looking for in a position that you get that stuff in writing. You get it written down, everything that you are offering, everything that you are wanting to see out of the position, get that stuff in writing. So let's start first about talking, what are the three avenues where we can get to know somebody better? They are the resume, very familiar with resumes, they are the interview, most of us are very familiar with at least participating interviews, maybe not conducting interviews, and some other maybe non-traditional ways to get to know somebody else. So the thing to understand about finding that next practitioner, about maintaining that clinical culture, that standard of quality and excellence that you want to maintain, is that you can teach some of the stuff, but some of the stuff that's really important to be a physical therapist unfortunately cannot be taught. If I can teach anybody a clinical reasoning algorithm to rule in or rule out the lumbar spine if somebody comes in with low back pain, or comes in with maybe what we're suspecting to be, radicular type pain. I can teach the clinical reasoning to help that person find out if it's actually that patient's low back or if it's something else. I can teach somebody manual therapy skills, I can teach somebody spinal manipulation, I can teach somebody dry needling, I can teach somebody exercises, go-to exercises for different conditions, I can teach them about dosing for tendinopathy, I can teach them a lot of different things related to clinical practice, but what I cannot teach anybody is how to be a nice person, an interesting person, or a hard-working person. So we talk about these three different avenues of filtering people in and out of kind of sitting in what we might think of as a potential pool of candidates for a position. How do we find that stuff out? Because that's ultimately some of the most important stuff and it's stuff that you cannot teach somebody to do and you cannot make somebody good at. They have to kind of come on board with it naturally or at least show a passion at getting better in those areas.

08:30 THE RESUME

So the first way we're probably familiar with is the resume. If you have not gotten to this point yet in your clinic ownership or business ownership career, you will eventually, where you receive pretty much an endless stream of usually unsolicited resumes, of they come via fax, they come via email, sometimes they come via email and there's no message, it's just an attached resume. Sometimes people give you a long story about why they think they're the perfect fit and why you should hire them and they are a little bit forceful and they say things like, let me know when I can start. Sometimes they come in person and they drop a resume off. So we talk about a resume, you as the person evaluating a resume, what should you be really looking for? And when I look at a resume, I really just think it is a box check to get to the next step, which would be the interview of when someone gives me a resume, if I have an open position and I want to look at it, what am I looking for? I'm really looking to see is this person a licensed physical therapist because sometimes they're not and that's really important to be a physical therapist that you have successfully finished school and passed the board exam and you have a license. And then the only other thing I really care about on the resume is previous work experience besides school. My question in my brain is has this person done anything remarkable other than go to school for 25 to 30 years? Because when you look at a lot of resumes, when you evaluate new graduates who are coming out of school, what you'll find is that not everyone has experience besides going to school. And yes, I don't want to poo poo getting a doctor of physical therapy degree. Yes, work went into that. Yes, it is an advanced education. It is a remarkable achievement for that individual, but across our profession, it is not. Most of us are DPTs or we're working on our DPT or a transitional DPT. It is now the entry level of education for our profession. So just having that doesn't make somebody stand out. I'm saying, okay, this person has their DPT and their license, but what else? When I think about other things in life, hey, if you can run 10 miles in 90 minutes, that's kind of fast. You're faster than people who can't run that far, run that fast, but it's not that impressive to people who can run faster and or further, right? It's a remarkable achievement for you in the moment, but overall not remarkable. And that's how I look at the long list of education that you might see on someone's resume. Of the question in my mind is, does this person have experience outside of just going to school that would translate into being a good physical therapist? And again, those are the elements we're looking for. Is this person a nice person? Is this person interesting and are they hardworking? So when I see resume experience that maybe somebody worked in the restaurant industry or they worked in a retail position, I know, well, this person probably knows how to wake up to an alarm clock and be to work on time. I know they probably have some experience working with human beings, which is a very important part of being a physical therapist. And they're probably used to working relatively hard. So I learned a lot by looking at somebody's job experience on the resume. So that's my first filter of what else has this person done besides go to school to be a physical therapist. And in some cases, the answer is nothing. They have gone to high school, to undergraduate and to graduate school. And that's it. And that's okay. But that's not the person that I want to bring into my business. Again, the idea of having that shared foundation of training, having that common belief system of having things that I can't teach on board already. That's really going to facilitate that person getting into a good position in the business that I'm operating.

10:14 THE INTERVIEW

So that resume is just a filter for the next step, which is the interview. In the interview, I'm really trying to figure out where does this person lie with their passions and do those passions and interests line up with a position I currently have or that maybe I'm looking to provide, right? Is this person really passionate about vestibular physical therapy? That's fantastic because we don't have a vestibular physical therapist. That is an entirely new demographic of patients that we could attract and treat here at the clinic. If somebody had experience in it, maybe clinical experience in school, but also had a passion for that area. A lot of people in an interview, interviews tend to be very redundant and basically just a, a live action version of a resume of explaining what has been done. We often hear things like, I'm really passionate about physical therapy, just like a resume. Cool. You've gone to physical therapy school. What else you're passionate about physical therapy. Okay. Tell me more, right? I think many, many years ago, when I came to Jeff Moore, the CEO here at ice, when it was just the Jeff Moore road show, ice was just Jeff Moore and had taken a couple of his courses. I had not received my certificates, which I needed for school to prove I had taken the credits. And I said, Hey, I need those certificates. And he told me how long it takes. And I said, Hey, tell me your process. And his process was, as you can imagine, terrible. If you know, Jeff, not very logistically minded. And what I came to him with was a better process about a passion for logistics, about a passion of creating a system that streamlines things like issuing CU certificates. So that's kind of the same passion we're looking for in that interview. Does this person already have an idea in their mind of what they want to do? Do they want to run older adult, small group fitness classes? Do they want to treat vestibular or concussion type style presentations with their patients? That is something that in your mind, you're thinking, Ooh, that's something we don't offer, but I would love to offer. And finding more about that person's passions kind of again, checks another box of resume. Yes. Got them to an interview, interview, interesting person. It's obviously hard to learn everything you can about a person in a 30 minute or 60 minute job interview, even across maybe multiple interviews. But you're looking to uncover where does that person's passions lie? And is that something that can be put to use here at my clinic? And something that's almost never discussed in an interview is what is that person's longterm plans? I don't need to know where you see yourself in 20 years or 50 years, but I do need to know if you're planning to move out of state in a year, right? Because that's probably going to affect my decision to hire you. I'm looking to bring longterm people on board. I'm looking to train them, help them become a better clinician, but also give them a really stable, a well-paying job that really offers a lot of benefits as far as schedule flexibility and treatment, kind of freedom and how they want to almost run their own practice within a practice. So if somebody says, well, I'm thinking about moving to Colorado in six months, then again, that's in my check, check box in my head as I'm going through it thinking, well, that's probably not going to work out just as we kind of train you and bring you on board, you're going to be leaving. So that doesn't really work out. So don't forget to really kind of dig deeper of what are your longterm plans of if you see yourself settling down and having a bunch of kids and maybe leaving the workforce altogether, that's okay. But when is that again? Is that three months from now? If so, that's probably going to affect my hiring decision versus somebody who says, I do want to have a family, but I'm 24 or I'm 25 and that's maybe five to 10 years away. Okay. We can cross that bridge when we get to it. Again, that's a box check in my head.

14:52 EVALUATING SWEAT EQUITY

So the resume builds, get somebody to interview, interview, get some more boxes checked, maybe, or maybe it doesn't. But what else? How do you really start to learn those things about a person? We've talked here before on the podcast of watching that person practice in your clinic. That's great to do. If you're hiring somebody that's maybe currently or previously was a student, you can certainly go watch somebody practice. It's really kind of hard and awkward to have somebody come to your clinic and treat your patients while you watch them to get an idea. But there are other ways we can look at those characteristics of a person and get a good idea of is this person a nice person? Is this person an interesting person? And is this person a hard working person? And that's to get outside of the clinic entirely of, hey, come to my gym. Let's work out a couple of times. I can learn a lot about a person outside of the clinic. I can learn, are they punctual? If I say, hey, come to CrossFit class at 8 a.m. or meet me at 6 a.m. for a run, are they punctual? Are they reliable? Are they showing up late? Are they showing up not at all? Are they snoozing that alarm? How do they handle stress? If CrossFit is brand new to them or running is brand new to them or whatever you're doing is brand new to them, how do they handle that stress? Is that the person that trips on a couple of dumbbells and throws their jump rope out into the parking lot? Or is that a person who goes, hey, they're not in the cards today and just scales to single unders and keeps working out? How does that person handle pressure and stress? And ultimately what we're learning when we kind of use sweat equity as an interview is how is that person with being coachable and open-minded of are they open to feedback on improving their performance in the gym, running, rock climbing, whatever you all decide to go and do together, are they open or do they believe they've already learned everything and they have mastered it and they can't be taught anything? Because that is a red flag for somebody, right? Of somebody who shows up late to the whiteboard because they think they already know how to do CrossFit really well and they think they have nothing to learn from the coach. They don't listen to any sort of coaching. Those are all kind of red flags for you of if this is how this person behaves outside of the clinic, how is this person going to behave at my clinic? Are they going to be late to treat patients? Are they going to be somebody that calls in a lot? Are they somebody who believes they can't get better as far as the clinical practice goes? If their clinical reasoning is already at an expert level and they have nothing to learn? Those are all red flags for you of maybe this is not the right person for my job. This person does not seem to have our shared foundation of training and our common belief system.

18:36 GET IT IN WRITING

So moving through those three avenues, resume, interview, sweat equity call it. What if then you fall upon somebody you think this is the person that I want to hire for this position? What should you do? You should always, always, always get everything in writing of you can be the best friends with somebody. You can have known them since you were kids. It can be your brother-in-law or your sister-in-law. It doesn't matter of when we're talking about dealing with professional employment, we should have employment agreements on board. We have these here at ICE with all of the faculty who teach for us. They don't have to be this complex 50 page document. It just needs to lay out what we're offering and what we are expecting for essentially work in return. And all that stuff, no matter how small, should be listed out. Obviously pay should be described of how a person is going to be paid. Things like time off should be described. Things like payment for continued education benefits or health benefits. Anything you can possibly think of that you are giving in exchange for work should be written down. Anything that person is wanting to receive in place for their work should also be written down in that agreement. And these things do not have to be set in stone. You can set a three month, a six month, a one year, a three year expiration agreement on these agreements. You're not forcing somebody into chains, but you should have that stuff in writing. I will tell you as Jeff and I sit at the head of ICE over the years, what we see not daily, but definitely weekly are really unfortunate emails from you all who follow us at ICE, who take our courses of, Hey, I was promised this, but then this happened. I was promised X, but because Y happened, now I'm stuck with Z. And it all comes down to the question we always ask of is that in writing somewhere? And universally the answer is no, it was promised verbally. It was promised in passing. It was promised maybe at a meeting or maybe at my first job interview five years ago, eight years ago, 10 years ago. And I kind of just expected that that person would keep their word. And certainly things change with the economy or whatever excuse we want to use on the employer side, but at the end of the day, it's not in writing, which means it doesn't really count. Right. And so getting stuff in writing, it doesn't matter how you're going to be paid. If you're going to be a W-2 employee, a 1099 contractor, it doesn't matter. Get all that stuff in writing, get time off in writing, get benefits in writing, get scheduled pay increases. If you agree upon those in writing, this is just another friendly reminder that if you don't get a pay raise that matches or beats inflation every year, you have taken a pay cut. And if you don't have that in writing, you probably didn't get it. Right. So having all that stuff in writing, when you're accepting a new position, putting it in writing, when you're bringing somebody on board is later on going to save a lot of time, money, hardship, bad feelings by having that stuff in writing. And if everything related to what's expected at the job, productivity, you clean your own room, somebody cleans your room for you when you're done, whatever, no thing too small can go in that employment agreement. And once you've both read it, reviewed it and agree, sign it. And that's how you bring that person on board. We have all been in that position where maybe we were told, Hey, it's one-on-one for an hour. And maybe it became, Hey, could you see a double book this hour? And one patient per hour became two, two became four. And all of a sudden you find yourself, how am I seeing 20 or 30 patients a day? And you go back and none of that was in writing, right? It was all verbally promised in your initial interview or your onboarding training. And none of it was in writing. And ultimately at the end of the day, there's not much that can be done. So whether you're hiring, whether you're being hired, get all of that in writing. And that should be a red flag to you on either side of the table. If one party to the other does not want to put anything hard and fast into writing, that should be a big red flag in your mind that you push the chair back and you step away from that table. That should already be enough of a red flag that you shouldn't even consider bringing that person on board or being brought on board if you're the person being hired. So get it in writing, find those people, figure out that we have a shared foundation of training, a common belief system, use a filtering system of resume into interview, into maybe sweat equity interview to filter those people out, really ensure that they are the fit of the person that you see working for you at your clinic. And then get as much of that stuff in writing as you can get done. So I hope this little mini-series was helpful. Again, if you have not listened to last week's episode, listen to that one, get some context, and then maybe revisit this one. If you're going to be on a live course this weekend, I hope you have a fantastic time. We hope to see you in our online courses starting next week. Other than that, have a great Thursday, have a great weekend. Bye everybody.

20:35 OUTRO

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