Understanding Clinic Revenue and Personal Income in Physical Therapy

Dr. Zach Long // #FitnessAthleteFriday // www.ptonice.com

In today's episode of the PT on ICE Daily Show, Fitness Athlete lead faculty Zach Long discusses how to earn more as a PT working with fitness athletes, including learning to understand how much you're currently generating & earning, as well as ways to increase your take-home pay.

Take a listen to the episode or check out the full show notes on our blog at www.ptonice.com/blog

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EPISODE TRANSCRIPTION

INTRODUCTIONHey everybody, Alan here. Currently I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PTI Nice Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app.switch. And if you decide to make the switch, don't forget to use the code ICEPT1MO at signup to receive a one-month free grace period on your new Jane account.

ZACH LONG Good morning, everybody. Welcome to the PT on Ice Daily Show, the May 10th episode, Fitness Athlete Friday, always the best day of the week here on the podcast. Excited to chat to you all today about a couple of different strategies for us to earn more money as physical therapists. We all know how much money that the average student is coming out with in terms of Debt when they graduate and that's we're constantly as a profession complaining about these declining reimbursement rates while it's becoming more Expensive to become a physical therapist But I think we're missing the boat on a lot of different things that could actually help us generate more money Whether we are a business owner or an employee. So I want to hit a couple strategies for that For you all today Before we jump into that topic, I do have to mention one thing that we have coming up inside the Fitness Athlete Division. That is June 22nd and 23rd in Fenton, Michigan. We are hosting our first Fitness Athlete Summit. So we're going to have the entire team there. All of our instructors are going to be together for one course. That one is going to be an absolute blast. Check that one out at PTOnIce.com. Alright, so we're going to talk about a couple things specific to the fitness athlete in terms of earning more income. But before we get to those specific things, I want to talk a little bit more big picture on some things that I think are incredibly valuable for us to research and know and think about if our goal is to earn a little bit more income here.

UNDERSTANDING WHAT YOU'RE GENERATING And so the first, whether you're an owner or an employee, and this is going to be more particular to employees, most owners hopefully already know this, is we need to be educated on how much money that we are generating for our clinic. Or if you're an owner, you need to know how much money is each one of your employees generating for you. But I really so frequently don't see employees understanding this. And so one thing that I did throughout my career when I was working for different people, now I own my own businesses. But even when I was an employee, I was always diving in these numbers because I wanted to understand what I was doing for the company that I worked for. So, you know, depending on what software your clinic uses for billing and things like that, that might just be a couple of clicks to be able to see how much money you've generated over this entire year. Or you might have to do a little bit of math yourself. I've been in situations where that number was readily available. I've been in situations where that number was really hard to find. But in general, if it's hard to find, then you just have to figure out what your average reimbursement if you're in network is per visit and multiply that by how many visits you see per year. And you're going to get a decent idea of how much overall money that you're generating for the clinic. And then what you wanna do is you wanna take that number and compare it to your income. How much of that money that you're bringing in are you taking home? And I don't, you're gonna find a lot of variation in that number in terms of what you're taking home versus what you're generating. I will say that the number that I've heard thrown out repeatedly is the 30 to 40% number. At Onward, we're at a network, Onward Physical Therapy. So we believe that that number should be 50%. or maybe even a little bit more than that, depending on a number of different factors. But 30 to 40% is the number that I've seen thrown around the most. I'm always really shocked at how often when I'm traveling and teaching and talking to different physical therapists, at how often some of them are in a model where they're seeing four patients at once. And if we do four times $75 times, you know, however many patients per week, that is times, however many weeks per year you work, I've run into a number of physical therapists that are out there generating 500, $600,000 a year for their clinic. while making about $80,000. We'll make it like 20% of that number, which is just insane. And you have to be educated on this so that when you go in for your next contract negotiation, you kind of have an understanding of where you sit here. Now, again, that number is going to slide back and forth quite a bit. And I think one of the things that that would slide back and forth considerably on is if you were taking a salary, a set in stone salary versus you having a deal in place where you take some sort of percentage of revenue or you're paid per visit or something along those lines. And that tends to scare a lot of physical therapists that tend to want that set in stone salary. But I'll say like, if you really want to have the ability to make more money, then I think a lot of times we need to do a better job of just betting on ourselves and being willing to say, yeah, I'm happy to take a percent of my revenue. I know that up front that might be a little bit harder as I'm building my caseload. But on the back end, I could potentially make more money as long as I'm doing a great job providing clinical outcomes to people so that more and more people want to come see me. That is a great way to make more money as a physical therapist. The first time I went from a set salary to that, it obviously took me a little bit of a while to build my caseload up. but it resulted in me making $30,000 more per year. Once I got past that first year of rebuilding my schedule, that helped me pay off my student loans dramatically faster because I was willing to bet on myself and take a percent of my collections rather than a fixed set in stone salary. And I'll also say, if you're an employee, there are a lot of owners that love that idea as well, because they're not going to have a fixed expense. They're going to have somebody that's in this eat what you kill model. And they know that that's going to keep you hungry. That's going to keep you working a little bit harder, things like that. So it can oftentimes be a very big win-win for all parties there. And, you know, if you're an owner, one of my favorite parts about being a business owner is being able to pay my employees really, really well. And so I love to see when they're really dialing in on their clinical skills or doing a great job marketing and selling, and then they're getting rewarded for their hard work. And I wanna pay them so much money as a reward for that hard work that they never want to leave my clinic because of the finances of it. I want them to stay with me forever because they know that I'm gonna do the best job I possibly can of taking care of them financially. So think about betting on yourself and taking a percent revenue instead of a flat salary. With that one other tactic that you should consider is are there things in your contract? It that you don't need So let me give you an example of this a few years ago I was working for a clinic and I was making 40 of my collections from that company That resulted in me again making a big jump from my previous salary, but they also offered a couple other things They had a health insurance plan that they offered and they also gave me 15 sick days Valued at 150 dollars per day. So I don't remember the exact math on that. But when I ran the numbers here I recognize that number one I could use like a religious medical sharings insurance option instead of their insurance option And that would cost me less money and get rid of the fixed expense for the business And I also recognize that this was earlier in my career before I was married I wasn't taking that much vacation time and I wasn't taking any sick days. So I'd get to the end of the year and I'd have all these sick days at $150 per day. And I recognized that, goodness gracious, I could take those five sick days, but I generate more money when I'm in the clinic than $150. So I'd rather work. This was when I was trying to really aggressively pay off my student loans. And so I actually did the math on this in terms of the insurance versus the sick days. And if my My percent collections went from 40 percent to 41.5 percent That was like my break-even point there So I went to my boss and I said look you've got these fixed expenses of sick days And my insurance and I don't need either one of those So what if instead of that we just change my percent collections to 43 percent? My boss was thrilled. He was happy to get rid of a fixed expense And so just by doing those numbers and thinking through what I valued and didn't value as much I was able to come up with a strategy that made me several more thousand dollars per year probably resulted in about Probably results in about two and a half to three thousand extra dollars per year, which is wonderful So negotiate those things away that you don't need And then another thing that I think is really important for us to do when we just talk big picture numbers here is to set your goal income, then backtrack to the amount of money you need per hour. And this is one that's really important for both employees and owners. But like if you're an owner of a business and you're trying to decide how much to charge for different services, especially the ones that we're going to talk about here in a minute, what I like to think of is what's my goal salary for that year? Divide that by 2,000 hours and that needs to be the net income that I make per hour. So let's say just for simple math, you want to make $100,000 per year divided by 2,000, that's $50 per hour that you need to be taking home. And so that means that you then have to factor in your admin time, marketing time, your expenses, et cetera, et cetera. But that gives you a really good idea of where to start from your pricing standpoint. And you got to have that in mind if you really want to grow financially a little bit. Final big generic thing before we get into a few fitness athlete specific tactics is that I think overall, we need to worry dramatically less about the alphabet soup behind our name. Our patients don't really care that you have the ABC and the XYZ certification, et cetera, et cetera. What people are looking for now more than ever, especially as people are more and more educated, there's more information available online. They are looking for specialists in the areas that they are having issues with. If they're having hip pain, they want to see the best hip physical therapist in the area. If they're struggling with running, they want to see the best running physical therapist out there. If their shoulders hurt with snatch, they want to see a physical therapist that understands the needs of the fitness athlete. So worry less about the alphabet soup and more about building an undeniable skill set with your target demographic that you can then market to and have basically a guaranteed nonstop, um, influx of patients into your door. That's why ICE is really working on revamping our course logistics here. We're really pushing people towards our certification, such as our fitness athlete certification or older adult certification. We just want you to start to become known as the go-to person in your region for X or Y. That way you can really market that and leverage that in growing your business.

CHARGING FOR ADDITIONAL SERVICES That then brings us to our fitness athlete division. And some of the specific things that I think that we teach in our courses, that we think that a lot more physical therapists should be marketing and selling to add additional revenue into their clinics money, or maybe some of these things become a side hustle that you do. So I'm gonna throw just a couple of different ideas out at you. Number one, mobility programming. Especially in the fitness athlete space where we're doing some really complex movements that take our muscles and joints through more range of motion than we see in almost any other sport. So take somebody that's working out trying to improve their strength at a global jump. Maybe they're doing lat pulldowns. Well, that pulldown usually take your shoulder to about 160, maybe 170 degrees of flexion. If you join CrossFit and you're doing kipping pull-ups, bar muscle-ups, etc, your shoulder is being taken to absolute enrage. If you don't have 180 degrees of shoulder flexion, you're going to be in really poor positions. You're not going to perform as well. It's going to often lead to some little aches and tweaks. So writing mobility programming is something that so many CrossFit athletes are looking for. And if you have that skillset, you should be marketing that to them. It doesn't take a ton of time. You could do really quick, you know, once a month, 30 minute follow-up sessions and you write them, you know, three or four days a week. Here's your 10 minutes of mobility work that you should be doing before or after or on your off days in relationship to your workout. So think about mobility programming. Alongside of that is accessory programming. Like say somebody comes and sees you for, for back pain. You analyze their squat and they've got a good morning squat pattern. You recognize that they need a little bit more quad emphasis, a little bit more quad strength and hypertrophy to help improve that movement pattern a little bit and reduce those aches long term. write them some accessory program. So that could be like two or three days a week. You're writing them, you know, 10 to 15 minutes of work to do after class. It could be that maybe they're dropping one day a week across it and they're doing really specific work on the areas that they are held back in a little bit. Because I think a lot of times we forget, you know, CrossFit's broad general fitness. So if somebody comes into CrossFit from an endurance athlete background, they're going to have a big hole in their game, like their strength is going to be behind their aerobic capacity. So maybe they need more strength bias in their programming and maybe one day a week you program that for them. Maybe somebody comes from a powerlifting background, they need the opposite. And so you start programming them some accessory Zone to work to really build that aerobic base There's a lot of stuff that we could do in the accessory programming standpoint, too And I honestly I don't see a whole lot of CrossFit gyms doing this right now So most of the time you won't be stepping on your local CrossFit gyms toes by doing this because they just simply usually don't have the time to handle extra programming. I also have a friend that does full programming. So like when he discharges his patients, he offers them fitness programming on the back end of that. So he works for a standard clinic and he's adding, last time I checked in with him, $20,000 extra per year that's straight to him. His company doesn't mind him doing this at all. Straight to him an extra $20,000 a year, just programming for people that he's already discharged. So a lot of these things don't even require that much more work, that much more marketing, and simply just offering this to your existing customer base as a little bit of add-on. In terms of like the specific like fitness athlete, you know, crossfit or powerlifter, limit weightlifters, I think one other thing that we should really look at is regular maintenance work. And physical therapists always get really up in arms when we talk about maintenance work, but I think we need to recognize something about this. So many individuals out there are actively seeking out regular maintenance work. They see a chiropractor once a month to get adjusted. They see a massage therapist once a month. They talk to a personal trainer and they're paying for accessory programming online, something like that. Why not offer doing all of that in one spot? Like why would you not say, okay, Jimmy, I know we took care of your low back pain, that upper back still stiff, your pain's gone, but we need to get that upper back unlocked a little bit. So why don't we follow up once a month for the next few months, I'm gonna write you some accessory mobility work to do. But once a month, we're going to crack your upper back. We're going to spend some time doing some mobilizations there. We'll do some soft tissue work, et cetera, et cetera, et cetera. We can put all of that together in one package for them rather than them having to go out to multiple different places. And it's a win-win there. We're still providing valuable services that's helping out their performance, that's potentially preventing future injuries and issues from happening while simultaneously growing our business. So I think we dropped the ball quite a bit on maintenance work and we Need to be a little bit more open to that in certain situations when we're providing value to people still. And then finally, I want to mention a couple of things from the more endurance side of the fitness athlete division here, and that's things like bike fits. So we have a bike fit course at ICE. We also have a running evaluation course, but both of those are things that people are more than willing to pay cash for because they understand how much it's going to help them perform to their absolute best and reduce, you know, a little bit of those aches and pains that they get with those sports that do have a decent injury rate there. And then with that population too, we should also be thinking about programming for both. We all know that runners aren't doing enough from a strength training perspective. And so often they have a running coach that they're hiring that's programming their running. And usually when I look at the strength work that the running coaches program for them, it's air squats, unloaded lunges, glute bridges, things like that, that we all know are not heavy and intense enough to drive adaptive changes in that population that needs the heavier loading. So why do we not offer that? Can we not really quickly write twice a week, a 30 to 45 minute program to get those individuals a little bit stronger and help stay ahead of issues that they have going on? So I hope that gives you a lot of different ideas that you can do and market to your business. The question that I always get asked when we talk about different ideas like that is then how do I know what to charge for that? And that goes back to setting your goal income. So you set your goal income, how much money that means you need to generate per hour. And then you look at all of these different extra services and you say, how long would it take for me to do this? So let's say bike fit, for example, let's say a bike fit takes you 90 minutes. It also takes you on average, about 30 minutes of marketing to get every new person in the door. So we're saying it's two hours for every bike fit. Two times the amount of money you need to generate per hour plus your expenses results in you understanding exactly what you need to charge for these services. So I hope that really helps y'all understand a few different things. And as always, we look forward to seeing you on the road at Fitness Athlete Courses in your area. Have a great one, everybody.

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