After Brian Gallagher, PT, won “National Practice of the Year” in the early 2000’s, he became a judge for the award in future years. While evaluating nominees for that award, he saw common themes among the most successful practices. Now, as the founder of MEG (Management Expansion Group), Brian shares those lessons (and his wealth of other experiences) to help PT Practice Owners improve their marketing, operations, compliance, billing, hiring, and culture. In this episode, we talk about:
- The biggest challenges facing PT practice owners
- Brian’s 4 Keys to Building a Successful Business
- The 10-minute meeting that can supercharge your team and culture
- Why it’s so important to stand out in your local market (and how technology like the Neubie can help)
- The optimal balance of cash and insurance revenue
- How to balance the agility of a startup with the consistent procedures of a larger and more established practice
- …And more!
It’s full of actionable insights, so if you are a practice owner (or would like to be one someday), be sure to listen to the whole conversation. And if you want to learn more about Brian’s services and sign up for a free practice assessment, check out https://resources.megbusiness.com/resource-guide-for-pt-owners. (Plus he has a special offer for the practice owners who are a part of NeuFit Nation!)
Garrett Salpeter: Welcome to a very exciting episode of the “NeuFit Undercurrent” podcast. I am joined today by Brian Gallagher, physical therapist extraordinaire. And Brian has a really interesting story that we’ll dive in to a little bit here today. He is a physical therapist and a former private practice owner. He built a hugely successful practice, he won National Practice of the Year awards. He sold his clinic for multi seven figures who had a lot of success. Before that he actually worked in staffing. So he has a really unique perspective on health care, hiring and recruiting. And today, we’re talking to him, in large part because of not only that experience, but the recent work he’s been doing as the founder and CEO of MEG business. MEG is an acronym (Management Expansion Group). And they are actively training hundreds of physical therapy clinics, private practice clinics, on leadership, marketing, operations, hiring, compliance and other aspects of running a PT business. Plus, he also has compliance and billing services that we use at our own physical therapy clinic here in Austin, Texas. So I can tell you from experience that we’ve loved working with Brian. He also hosts the secrets of the top 10% podcast, and we just recently did an episode on there, I loved our conversation. And this podcast describes exactly what Brian does, he helps practices get into the top 10% of physical therapy practices. And Brian, thank you for being here.
Brian Gallagher: Thank you, Garrett. Thank you for that introduction. I’m been looking forward to getting on this podcast. This is great stuff.
Garrett Salpeter: Awesome. So you work with physical therapy practices across a really wide area, because you have some really depth and breathe really expansive knowledge in a lot of areas. What are some of the biggest things that you work with practices on some of the biggest challenges and the biggest areas where with your current coaching and consulting offerings, you’re able to help move the needle the most?
Brian Gallagher: I’d have to say personnel, I think anybody who’s in any business at all. I don’t know, if you’re Coca Cola, or lemonade stand or physical therapy, the number one challenge that we all face from time to time is managing personnel. We believe that there’s a sequential approach to success in any businesses, as long as you have three or more people assembled for a common purpose, common goal, you have an organization, you have a company. And so many of us, as physical therapists go into practice as PT’s who happen to own a business, and I’m constantly trying to reverse that flow and be like, no, no, no, you’re a CEO practice owner, who happens to be a PT. So I would say the number one challenge whether it’s big or small, and I’ve worked with clients ahead over 400 offices, I’ve worked with clients that are just starting up and just getting their funds and everything in between. It’s how do I create a company culture whereby the people who assemble around me are contributing to the best of their ability to the overall goals, products, successful actions of why we created this company to begin with? That’s the challenge really.
Garrett Salpeter: Awesome. I love that. And I think, speaks to the very fundamental question of being able to scale. If you’re a physical therapist, if you can treat one person at a time, how do you then expand that impact and reach more people? Obviously, you need to partner up and hire people and work together to reach more people and that’s great. So what are some of the strategies or tactics in that realm that have really helped people build a team effectively, hire recruit lead and maintain positive working relationships with their staff and other people they hire?
Brian Gallagher: It’s a great question. And that can go in two directions. I mean, we can get into the logistics and the mechanics of what does it take to run a successful private practice with the history and experience we’ve had? Or, we can talk about the beingness of it. Like, where do you have to mentally be as a person to be both an entrepreneur and an executive and a manager? So the entrepreneur executive, I kind of put that together, that’s leadership. Making the footprints in the sand where nobody else has been yet. You’ve lived that life, Garrett, you’ve been extremely successful with what you’ve done with a Neubie, you saw an opportunity to provide a better service and a better product and you put everything into it over a decade of your life. And as a result now, people are benefiting from that. But nobody did that before you. Nobody, you had to do that that’s a beingness. The mechanics, I’ll let you answer. I’m sure you learned a lot of things along the way that you wish you had known before you dove in, but we just don’t have that luxury when you’re an entrepreneur. You’re doing it for the first time. How was not your experience running into things like, didn’t know I needed to know that?
Garrett Salpeter: Absolutely. I can totally relate to that. You talk about having to create that mindset shift for PT’s to start to identify as CEOs and business leaders. And that was a big identity shift for me. I was an engineer and neuroscientists got into clinical work with various clinicians, I was working with here in Austin. And I was so identified with that I’ve had to learn business by necessity in order to do that to be able to scale and reach more people. And it really is like a fundamental identity shift, that it takes some work.
Brian Gallagher: It does take some work. And so a lot of PTs, if we go back to that, we graduate high school. Maybe we’ve been in sports, maybe we’ve been really intrigued in medicine, but we don’t want to be a doctor who’s just going to do three things, cut you up and give you drugs or send you for a test. Many people look at that and say, I don’t want to do that. So they want to work with people and change their life and have them live optimal health, and they throw themselves into physical therapy. They spent $150,000 and get a $75,000, $80,000 a year job and that’s all fine and good. Because you’re just hands on working with people changing their lives, you’re really physically engaged. It’s such an engaging profession. I really, really love to professional physical therapy. And then someday you hang your shingle and you say, I’m gonna run my own practice. I’m gonna have my own business. And what you failed to realize as being the best PT, being the best player in the field doesn’t mean you’re going to be the best team coach, doesn’t mean you’re going to cultivate the best commodity, the best abilities of those around you and that needs to be taught. That’s not inherent to people. You need to learn how to instill in people, how to flourish and prosper as a person and a being as a professional. I would say my number one most successful action of disseminated advice is to get my owners or people looking to be owners to comprehend the idea that you’re embarking on a new profession, you’re embarking on a new chapter of your life as a CEO and owner. You’re now invested in seeing that those closest to you are flourishing and prospering both personally and professionally. And that’s what will build you a culture, because transparency breeds trust. And if you can role model, and you can be transparent with those around you, they’re going to follow you anywhere, and they’re going to want to be a part of your game because you’re protecting their interest as well as your own.
Garrett Salpeter: I love that. I think that because there’s a lot there in terms of how to do that. And a few things come to mind for me, I’d be curious to kind of compare notes here. So I totally agree with you, we want that transparency, we want people to buy in. One of my friends and mentors has a quote that says, “People working on your team, people will do what you asked them to do, but they will passionately put their heart into what they help co create”. So for us, I’ve founds that doing team wide strategic planning is very helpful because people have a say in the direction of the business, obviously, we as leaders ultimately have the final say. But if we can create that environment where we’re getting input from people, especially the people who are closest to various problems and situations and, and have greater insights and how to handle them. If they can help create that plan and then for us doing some profit sharing and sharing numbers with some high degree of transparency there. I feel like those two things have probably been the most impactful for us in terms of creating that sense of transparency, camaraderie buy in. There’s probably others upon reflection, but what would you say other things that you in your practice, or that you’re coaching other practice owners to do? Things like that other different activities that they’re doing that really helped to create that that culture that you’re looking for?
Brian Gallagher: Absolutely, you hit the nail on the head. We’ve been going off site now for about 16 years annually to do our annual business strategic planning for our companies. And we’ve been doing that for like I said, 16 years, if not longer. And when you include everybody in your team, your upper team to be a participant in the authorship of where we’re going to be next year? What do we look like 12 months from now? Well, they take a little ownership of that. They’re wearing that, they’re folding those clothes alongside you. They’re not just waiting for the laundry to come out and for you to tell them what to wear today. They’re actually participating in the whole ensemble of the wardrobe. And that’s kind of how I see building businesses. Because what do we have to really challenge ourselves with, we have to challenge ourselves with the ability to scale and then expand and then scale and then expand. And so you have to scale within your 1800 square foot office. And then you want to expand in that second location, or you want to branch out and maybe you want to have a completely different practice, like a cash based practice, completely separate from your insurance based practice. There’s so many different things you can do or like in my case, I started as a staffing company built that up to about 160 employees, and had 55, 65 contracts where I sent people all over the state of Maryland. But I also had five, six clinics where people were coming to work each and every day. So I think back like, why did I do that? Like, why did I go? Because that’s what my people want it. People wanted just to go to a fixed place to work. And other people wanted the freedom to work six, or seven or eight visits a day and go all over town and stop and eat lunch wherever they wanted. So I afforded them the opportunity to have that flexibility. And I think that’s our job. That is our job is to identify who’s our public, who’s our market, it’s not enough just to have a great patient care experience, if you can’t have a great company culture. If you can’t have one where people are fully-fully vested in the participation of the success of your practice. And like you said, you talked about profit sharing. Monetarily rewarding people for their products, their ability to produce product. I always tell people, Look, I don’t care if my front desk staff member runs a crystal on her head all day. As long as she’s getting the product of all patients arriving as scheduled on time throughout their entire duration of care and all monies do over the counter collected. Those are the two products. Now there’s a whole bunch of doing this is that you need to do to achieve that. But I can break that down for every single solitary position in a PT practice. And so should you, so should every practice owner know that they can tap that employee on the shoulder and say, “What is your product?” Because your product and your ability to get your product is actually what your pay is for. I am not interested in paying people time for money. If somebody in my employment says oh my gosh, I gotta get the work, I gotta get my hours, I gotta get my hours. I’m like, I don’t want you working for me to get your hours. That is not what you’re here for.
Garrett Salpeter: I like that. It’s about the results and what you do with that time? Some really good insights, they’re really good insights. So you mentioned far and away, or number one issue is personnel. Are there any in terms of physical therapy clinics, most challenging aspects of being a practice owner? Are there any other close seconds or other issues that really tend to pop up anywhere near as frequently?
Brian Gallagher: I think it’s the stuff that we bury down inside of ourselves and we don’t really want to admit. And some of that comes up in my world what I see most often is financial. A lot of us went into physical therapy, because we’re very social characters, we’re very dynamic. But we don’t know a spreadsheet, a balance sheet from a P&L in the beginning. Income expense reports, cash flow reports, performers, Gantt chart, I use the word Gantt chart, and every physical therapist doesn’t even know what I’m talking about. And so we have to face the fact that we went through high school, went to PT school, and there’s this whole other arena of knowledge that we need to have to be successful in being an entrepreneur in PT owner, and we have to go buy it, we have to invest in it. I didn’t get it. Man, if I could rewind the hands of time back to 2000. Well, let’s see, I started my business in 1997. I opened my first clinic in 1999. So I’m dating myself. But boy, what I had to learn along the way, just like you. If I could have invested in that education first, and then gone into, it’s just like PT school, you go to PT school first, be a student and apprentice it first. And then you go and get your first job and then you treat your caseload. But so often we get into ownership, and we’re just bumping our own learning as we go. It’s what we don’t know that’s holding us back. So I would say the second biggest challenge second to managing staff is really introspectively admitting to yourself, that there is a good percentage of this endeavor that you’re embarking on as a PT owner that you’re not equipped with. You had no background and you have no mentorship and you’re just going to try to read books and watch some YouTube videos, it’s not going to work. You really need to spend some time and money on refining yourself as a CEO of finance director, recruiting officer, a PR director, a personnel manager, a marketing director, and the list goes on.
Garrett Salpeter: Absolutely. I can totally relate to that. I think that hits the nail on the head or hits the bull’s-eye there in terms of dealing with people effectively leading and managing the team. And then upgrading our skills, finding out what we don’t know. And then either learning it or hiring for it.
Brian Gallagher: Well, both of those are equally equipped answers. There’s certain things that I’m just not really great at. So I bring people closest to me who are really good at it and they complement. I’d rather spend if I only had three hours to spend on myself, I would rather spend two of the three hours on my strengths and one of the three hours on my weaknesses. I’m gonna get much greater return on my investment by enhancing and building my strengths and I ever will by refining my weaknesses.
Garrett Salpeter: Absolutely. I think that’s very wise advice there. So you work with both. I mean, you mentioned startup practices and practices that have dozens or hundreds of locations. What are some of the biggest differences? I mean, that sounds like in some respects people may have grown businesses but still need to step back and, and learn and almost adopt a startup, beginner’s mindset, which I think is helpful in a lot of areas of life. But what are some of the biggest, I guess we’ll say, differences in terms of your work with startups versus existing practices?
Brian Gallagher: That’s a great question. Do you do any boating, Garrett? Do you like going doing any watersports at all?
Garrett Salpeter: I have a couple of friends who have boats and I enjoy going on their boats.
Brian Gallagher: Here’s my analogy. I have a Mastercraft X30. It’s a 23 foot boat. It’s an inline boat. It’s a beast. I mean, I can wake surf. I can regular surf, wakeboard, kneeboard, anything you want to do behind this boat, it is just such a model boat of everything. And it’s so nimble, and it’s so quick and we can do all the stuff. But it’s so strong, I can pull tubers, multiple tubers, it’s just such a fun, it can adjust at any climate and then you see you get a mental picture of that. It’s like you loaded up for whatever activity, you’re gonna run into that day. And that thing’s just gonna pick that and do it. And then picture yourself on an aircraft carrier. It’s going to go straight really well, but it’s not going to be dodging and ducking. And it’s not going to be adjusting and compensating. That’s my franchise big corporate type owners. Not the franchise necessarily. Because they can be one off, and then they just participate to get that background support, but these corporate models, an owner came with 86 offices, and I helped him go to 114 within two years. But it was difficult, because it was like trying to change course of an aircraft carriers. Because people get into what I call fixed ideas, and they repeat back, well, that’s the way we’ve always done it. Brian, well, that’s the way it’s always been done. Well, that’s the way business is done outside. And they get so stuck on these things. And I tried to say to them, your biggest challenge when you’re a big provider 50 offices 30, 40, 80, 100, 400 the one, your biggest challenge is culture. Your biggest challenge is trying to have standard operating procedures that are efficient and productive, while at the same time not creating a sterile white clinic that every single clinic operates like a McDonald’s. And there is no variation, there’s no culture, there is no character, there is just no uniqueness between them because this is how we all do it. We all do it the same way. Meanwhile, they’re in all different towns. Spokane is different than Chicago, Chicago is different than Jacksonville, Florida. Jacksonville is different than Austin, Texas. So I’m often telling my large clients, I will help you create what’s called a cruise ship model. You should have a bunch of different islands with ports and let them run their island in a very unique characteristic way. If they want to wear jersey, football jersey Fridays, their jersey Fridays, if another office wants to have Jean Fridays, let them have Jean Fridays. If one wants to do more social media marketing, another one’s more direct marketing, because it’s better in that environment than embrace that, encourage that instill that uniqueness that character for them. You will be able to have a huge network of clinics that are thriving because everyone’s invested in their own individualism in it, they have their own self determinism that you’re allowing them to express. But when you get big that seems to get confined and you get pushed down into this one. Versus the smaller clinics, it’s completely opposite. I have everything under my control, I can create every unique thing. That’s their little bit of the problem there. They go into things that aren’t time tested or not proven. They’re just bright ideas, and they just go into, I had somebody say, Brian, I think I got this really great marketing idea. I’m like, really, Jason? What do you think? Well, I think what we should do is we should put our advertisement inside fortune cookies at the local Chinese restaurant, and people were going to come in, they’re going to be all over the community. And I sat back, I said, you’re joking, right? And they’re like, “No, we’ve been thinking about this a long time”. I’m like, “No, we’re not doing that”. That’s not happening. I was just like, what made you think of that? That is not a solution to a problem. But see, it’s what you don’t know when you’re small startup. Because 73% of all, I think there’s about 36,000 private practices out there. 73% of them are onesie, twosie. They have one location to location so they can get really kind of out in the fray and what they think they should do. Well, in the last 18 months, I’ve helped 28 people do start up clinics. So I’m doing that quite frequently and I’m trying to keep them on the secrets of the top 10%. There’s a reason why it’s the top 10% because they’ve already figured that stuff out. Now you got to make the best of it on your world.
Garrett Salpeter: That’s awesome. Some really good insights there. I especially like when you’re talking about the larger operations that can feel like aircraft carriers that are just so stuck going in that direction. And it just reminds me of a theme that ultimately, no matter what business you’re in, no matter whether you’re talking to a customer or a potential customer, like at the end of the day, it’s people who operate within live within businesses, and we’re dealing with people. And so kind of leading being human first, I think. And doing things that just feel good and speak to the humanity of each person there. And if you get into one of those environments where it’s just dehumanizing because it’s so much about being a robotic policy and procedure follower that can feel a little stifling there. I think that’s a great insight. I really like how you draw that distinction there. That makes a lot of sense.
Brian Gallagher: And I like on podcasts, if you don’t mind, and you’ve been hinting to this in the way you’ve asked your questions. Let’s give your audience some, let me back up. I think a lot of times I see podcasts done, and people talk about the ideas, like we’ve been covering, we’ve been talking concepts and ideas. I’d like to dig down even deeper and let’s give some tools. Let’s give some successful action. So to your point, which your questions have been fabulous. If I’m a small private practice owner, and I’m watching this right now and say, Brian, well give me something, what do I do? Give me a doing this, what would I do to achieve what you’re asking me to do? Here’s something you could do. It’s called the 10 minute meeting. What you do is you meet with every single one of your employees for 10 minutes once a month. And it’s their time, it’s for them to talk to you about what’s on their mind, what’s going on in their head, what they’re feeling at the moment. I don’t care if they come in, and they talk about their puppies, I got two Labradoodles, and they’re really cool. And I’m having to juggle going back from the clinic backup, and you just sit and listen, and you just be present. Be there for your employee, let them talk about. Maybe they’re going to talk about documentation, maybe they’re going to talk about innovation or technology or something they read or something they saw, grant them their beingness, grant them their time, their altitude with you as the owner, for you to be the listener. It’s not a time for you to end service them or anything like that. It’s just and I’ll tell you what, your company morale will just inch up almost immediately, because they’re feeling heard and they’re feeling valued. So the 10 minute meeting, I think that’s just such a super important thing. And then here’s another mechanical thing you can do, it’s called a two way street. We have something called a “Status Sheet”. If I were to hire you, Garrett, and I said, Garrett, welcome aboard. You’re three years out of school, you’re our new staff therapists, and you just accepted an $80,000 a year position. On your status, I can’t give you an appointment letter, because that can be construed as a contract. I would never recommend that. I give you this status sheets and excel kind of broken out status sheet. And it says, Garrett, you’re working at this office, these are your start and stop times. These are the benefits you selected. Here’s your pay. Here’s the compensation for the benefit package you did select. So your pay is 80,000 but your benefits add up to 9000. So really, you accept an $89,000 your position. And then on the other side I say, so on one hand, this is what we’re bringing to your home every two weeks for you working here. On the other hand, here’s what our expectations of you. 85% clinically efficient, 3.75 units of care, because we want to give you and see that you’re giving an abundance of care with each patient. Quality care as measured by Net Promoter Score, success stories, testimonials, outcome measures from their EMR system, you see what I’m saying? My point is when people start off working for you, and they get the two way street, I accepted this position to get this pay, this benefits, this number of time off, blah, blah, blah. In exchange, I’m held accountable to deliver this, this and this. And if those don’t match up, there’s going to be total justification for meeting, for a sit down. I think people respond really, really well to that degree of transparency. So there’s two mechanical things you can do as an employer, that’s really going to set the stage for a great company culture.
Garrett Salpeter: And I think that speaks to what you talked earlier. Even the receptionist answering the phones, everyone has a product or everyone has a metric or everyone has some standard to which they’re held accountable and the more clear, we’re gonna be about that. I think it not only protects the practice owner but also protects the individual employee because they know what they’re supposed to be doing. There’s less ambiguity they know the standard due to which they’re being held accountable. So it’s not just some arbitrary like, my boss gonna get mad at me. Because I haven’t done what I’m supposed to do today. You know the standards are the more objective, the better. So I think that’s great.
Brian Gallagher: Absolutely.
Garrett Salpeter: So let’s shift gears a little bit, I’m going to ask you to bring out your crystal ball. So as someone who’s very plugged in to the physical therapy industry works with all these practices speaks at State and National Physical Therapy conventions on a regular basis. What do you see as being the biggest challenges or opportunities coming down the pipeline in the next five years?
Brian Gallagher: Okay, that’s a great question. We can go in many different directions with that, I’ll take it from this angle. I think there’s three major challenges that we’re all confronting, and we see it just about every single day. I think we have geopolitical challenges. And I think we’re all pretty aware of what’s going on in Ukraine and Taiwan, and our national government and our deficit and stuff like that. Now, I not want to get myself all wrapped up into stuff that I can’t change. If it’s something I can’t do anything about, I don’t get all emotionally entrenched in it. I need to be educationally aware of the impacts of those things. And so I think that’s a challenge. And I think we all have to be somewhat mindful of what’s going on that level. The second major challenge, I think, is societal. I think it’s very evident that our society is shifting. There is never been a time where we’ve had so many people sitting on the sidelines of our labor market. The unemployment or the lack, that the eligible employed, number of people who are electing not to work has never been higher and we have to confront that. We have to, like what’s going on with our society that that’s the case, what is happening about the way people are coming out of school and dealing with that. So we have the general societal kind of shift. And then we have our actual workforce or actual labor. Give us specific on that. For years and years and years, what was really attractive to people upon being interviewed, because I had a staffing company. So I average seven interviews a week, every single week. And for the 90s and 2000s for the most part, people want to know what their pay was going to be? What the benefits were going to be? Did you have a short term long term disability plan? Did you have a 401K or retirement option for me? What was my longevity? Did you have a ladder of promotion? Did you have opportunities for me to grow within this business, so I can stay here longer and make more? Today, the average graduate from 24 to 34 years old will change jobs four times, those things are not important to them. They don’t care about the 401K. I mean, I’m being overgeneralize here, but a short term disability, long term disability. They don’t care. They want to know, what can you do to enhance my quality of life today? What are you going to do to impact me today? And if you can’t do it, I’ll leave and work down the street for $1 difference. We have to change that. We have to get people to understand that life is about giving more in value, giving more value, giving more than you expect in return. And I feel like when you run an organization, and you don’t look for an even exchange, you don’t look for a win-win. I hate win-win. I hate that concept. If you’re winning, then I expect I should be winning. I want what do you need? What can I do to enhance your quality of life while working? Because you have to spend 1/3 of your life sleeping, 1/3 life doing recreation, friend things and 1/3 life at work. And I believe that 1/3 at work, if done properly fuels the other two, so that you have a happy life. That’s my job. That’s where my mental tension goes. So barriers are the challenges of the new labor force, the challenges of quickly shifting society and these geopolitical things that I just never thought I’d hear people’s shouting about nuclear wars or whatever. I don’t get wrapped up in it, but I do have to keep a little attention. So what can you do as a small time private practice owner? Create a safe space, create a solid to, create an opportunities for people to want to never be anywhere else but with you because you have a long term plan, you have something for them to want to participate in stay with you and not keep jumping job to job and place the place. Believe me, it doesn’t forward them spiritually or physically or emotionally because it’s constant start change, stop, start change, stop.
Garrett Salpeter: I think those are great insights. One thing that you mentioned that some people might be listening, especially if they haven’t read “The Go Giver” book, which I know is one book I loved and learned about from you. But for you to say that you don’t like the concept of win-win. That on the face of it some people might think, well, what do you mean? That seems like everybody wins. Can you just share a little more why you say that that concept is not for you?
Brian Gallagher: I believe that concept forwards the mental attitude that I’m going to take my initial step forward in helping you win because I’m expecting something in return. I’m starting with my own self-preservation is my first forethought. I’m going to either artificially or I’m gonna manufacture some sort of a win scenario for you with the anticipation that I don’t think like that. I think how can I build the best team here? How can I create? The four keys, the business success is create the ideal work environment. Put in the optimal structure with standard operating procedures. Bring the best personnel and then invest in that personnel continuously, every single month through a learning management system, continuing education, anything you can so that they’re flourishing and prospering personally and professionally. And then last but not least, put in the ideal systems of operation. That’s why I got all these journals here. I’ve got two books there that I’m in the middle of, and I’ve got two audio books that I’m listening to at 1.5 to 2.0 speed, because I talk to that speed. So I think with that speed and why do we do that? Because I’m constantly looking. When you look at that systems operation, where’s the differentiator? Where’s the market disrupter? Where’s the thing that I’m going to put into my practice? It’s going to make us look like a zebra and not like all the other brown horses. And that’s when I found the Neubie four or five years back when I met you. And I was like, this thing is fabulous. Like, I’ve never, and people are always introducing stuff to me. And I’m like, I even went into it, like I’m sure there’s nothing new under the sun, whatever. And then when I saw people working out while getting high intense stimulation, I’m like, “Whoa, what is that?” And Jason was my good friend, I’m like, can you hook me up? I want to see what that’s like. I mean, I could barely break the range of motion. The muscles were pulling me back so hard, but I had to work against it. I was blown away. Because again, being a therapist for at that time, I was a therapist for 26 years, I found something new under the sun. I was so reinvigorated. Because after 26 years of doing some, you don’t see a whole lot of innovative new stuff that really got me excited. And now the rest is history. But that fell in my category of success, not under physical environment, not under structure, not under personnel that fell in that systems of operation. All owners listening here, you have to have some mental tension units continuously expressed and expanding in innovative systems of operation. And it could be administrative, it could be a new EMR system too. I mean, that’s just like virtual front desk, which is what we’re trying to promote. That’s new to you. But if you don’t put some mental attention units on that, that’s why I mentioned the books and magazines and audio, then you’re stagnant. You’re literally just working. You’re just working, you’re just changing time for money.
Garrett Salpeter: And ultimately, I think it’s all about growth. So I’m so glad you bring that up in our businesses. Our family life can be a vehicle for growth can be a catalyst for that growth. But ultimately, I think that’s the thing that is more important than the P&L statement. So that’s the really cool to hear you say that.
Brian Gallagher: And when you say growth, Garrett, you mean growth in one’s sphere of influence, that’s growth. You’re influencing more people, you’re expanding and helping more people, you have greater ability to help more people that’s growth, Personal growth, intellectual growth, physical growth. I think all of that when you say that.
Garrett Salpeter: Absolutely. I’m so glad you said that. Because there’s aspects to it. It’s not just growth, there’s growth mentally, physically, financially, spiritually influentially if that’s a word.
Brian Gallagher: Absolutely. It’s not just the P&L growing or the balance sheet growing or the bank account growing, that’s one element.
Garrett Salpeter: And that mindset, I think that’s a really, really cool. If anyone listening has not heard that concept before, where Brian talked about how win-win is actually, may not necessarily be the winning strategy. I think that’s an interesting mindset shift that just to try on the thinking leading, how can I give what can I provide what value can I provide an excess of what I’m being paid, and then trusting that the rest is going to take care of itself because it usually does.
Brian Gallagher: Well, if you have the right systems and you brought in the right person, it literally is such a natural transition to success. I know when I won practice of the year, I didn’t know at the time, but after I won practice that year, I was able to judge 10 some medals, some medals top 10 some medals for the next few years because you become a judge. And that’s when I laid them all out on the table, and I started highlighting the common denominators and that’s what I saw. I saw this selflessness of the top tier of our profession of practice owners who were just killing it and just doing so well. And the common denominator I saw was selflessness, not selfishness. It wasn’t, what can you do for me? It was what can I possibly provide to you? And if I have the right person, we’re going to do wonderful things together. It’s that sharing, it’s that inclusion.
Garrett Salpeter: Well, that’s so good. I think we literally could stop the recording right there. But I do want to keep going well, we have a wonderful resource of wealth of knowledge here. I mean, really, I just hope that sinks in for everybody listening some really good wisdom there. Let’s transition here to people who are thinking that’s great, I believe you. And I also want some more mechanics of the business. And let’s shift over into the revenue side. So can you share your thoughts on overall on the topic of cash versus insurance? And if you’re helping a practice owner drawn up a strategy, what’s your framework for deciding? Are there any target ratios of percentage cash versus insurance? What are the framework, the questions you ask? How do you approach that topic?
Brian Gallagher: Excellent. So let’s get into some more mechanics. Let’s give some tokens of success here. I always call my podcast “Tips for professional success”. So tip number one for professional success. Let’s say you’re 28 years old, you graduated PT School, when you’re 24. You’ve been working in outpatient, and you kind of know some stuff now. You’ve been out for years. I’ve seen a lot of patients. You’ve seen what you like, you see what you didn’t like, and now you’re thinking I want to embark upon opening up my own practice. And I’ve been watching these videos or podcasts about going all cash, the insurance industry is terrible, I’m going to do this. I can charge my own rates. Well, here’s the thing. With everything, there’s a heads and a tails of every coin. So the head side of that coin is, you get paid at the time of service, you don’t necessarily need a billing department. You can practice more liberally, you don’t have to be confined to the rules and regulations of some of the insurance carriers and so on and so forth. The tails to that is typically 6 out of 10 people who call or find your office will be willing to come in and pay cash because they have insurance. And they’re looking at it like I’m paying for that insurance. And now I’m not going to be using it I’m going to be spending it with you instead of using it. And so that’s a little bit of a bugaboo for a lot of people. And then the second negative to an all cash practice is most, not all because I’ve met some. I’ve stood corrected, but most all cash practices are successful a cash because people are willing to come see you. They’re willing to come to you because you’re the person that’s worth spending $150 a session, or $100 a session you’re the one that’s worth me for going my insurance. So it’s really hard for you to assemble a team of juniors underneath of you that are going to be carrying a schedule and carrying a caseload. So you can go off to Italy, or you can go to Ireland, or even go out to the Grand Canyon, and there’s going to be a check there. When you get back most of the time you there’s not. So an all cash clinic has its challenges. That’s all it’s not the end of the world. If you want to go that way. And you want to stay small and create a very nice paying job for yourself. I think all cash is really wonderful. What I would say, though, to give you the greatest position with the greatest advantage, given what the purpose is of becoming a physical therapist. When I asked people like what are the two most popular reasons why we became a clinician? Well, number one, because I wanted to find a professional where I can help as many people in my community as possible. The more people I’m able to help, the more satisfying my position is. In number two, I want to be as skilled as possible to achieve as much optimal health in every patient I can. So I can literally leave it all on the field when I work with them. I don’t want to shake and bake my patients and get them in and out in 30 minutes. I want to spend 55 to 65 minutes with each and every patient. I want to give them an abundance of care with each and every opportunity. I’m very blessed that they chose to see me when they have many, many other providers to choose from, but they’re here with me. And that’s how I think when you really ask a therapist, what are the tools not to help someone because everybody that’s part of being human? I think we should all hope you think there’s a reason why we’re human, but to actually try to make a difference in your community and to actually try to have the skills and the knowledge to have an impact with each and every engagement. Those are the two main reasons why you become therapists. So if that in fact is the case, then doing a hybrid office, to me is the golden. 20% of your total annual revenue should come from cash base services, 80% from insurance based services. Now you have the ability to provide both within one setting and one community, one demographic. To me, that’s the best. Some people can grow in your practice on the insurance model side. And when their skills get hot to the higher standard, and you give them a certificate of approval, they can now start taking cash patients at a higher clip, per visit. Because they have that skill set that’s going to demand that. To me, I think we need to look at our practice in that way. Find certain pieces of equipment, certain delivery systems, whether it be dry needling, or laser, or Neubie, PMF. I mean, there’s just so much new technology coming, you know better than I. I’m not one to, you’re the innovator of that. But I think as therapists and as owners, we should be thinking with that, how can we still serve as our traditional insurance community because they need our help? And how can we make ourselves available to this really optimal health idea of cash based services, I think that’s the best way to play it.
Garrett Salpeter: I think that’s a really good way to look at it. So I appreciate that. And, one thing that I’ll add for us, so our practice in Austin, we were all cash for several years. And we were doing seven figures in top line revenue so having good success. But we did start to accept on a limited basis some insurance, and one of the big reasons for doing that was post op care, because people have already and that’s one very specific circumstance where people have already spent a lot of money. And so to come out of pocket more for 20 post op visits or something like that could be cost prohibitive. So wanting to help people in that regard, was one of the motivating factors for us to start accepting some insurance. But I think I mean, what you said there makes a ton of sense. I think that really captures the best way to look at it.
Brian Gallagher: I think you’re right. I’m so glad you said it like that. Garrett, I’m a big fan of seeing Medicare patients. I think that’s the part of our community that we’re all going to end up in someday. If we live long enough. And for someone to be caring enough to stay in that system to help me, I think is a very enriching thing. I think there’s certain insurance carriers that are willing to pay fairly for our services. Like you said, you picked a handful of them. I think there’s some that are just abusive. I think there’s some insurance carriers that I mean, there was an insurance carrier that was paying $17 a session. I’m just on the face of it. That’s an insult like that is just a slap in the face to the profession. Nobody should accept $17 a visit that is just absurd. So I’ve seen everything in between. I was just talking to a person in the Pacific Northwest who says her insurance company is paying on average $149 a visit. I’m like, that’s not the national average right now. National average is 81 to 83, that’s almost double. She’s like, I got one carrier that pays us over $200 a visit. I said how much she goes, I can’t tell you. I don’t want to say she goes it’s embarrassing. I’m like, you’re so ashamed that you’re making $200 a visit. You can’t even tell me. What’s wrong with our healthcare system, Garrett? How could that be when you’re in upstate New York making $58 a visit, but you’re in the Pacific Northwest, and you’ve got an insurance carrier that pays over $200 visit? Those are the things that made me want to stab myself with a butter knife. It’s like, what are we doing? And your question is a good one. How do you combat that when you’re in upstate New York? You need cash based services. You need a fair amount of cash. And one of my owners up there, I think he has seven Neubies or something like that. And he just created a whole wellness, fitness, just huge compliment up there. And he did really well with that. At $58 visit you can’t just be traditional. You have to go a traditional.
Garrett Salpeter: Good shout out to Jeremy at Maple city. Got run in a great business up there. I think a lot of people listening may just be pulling up Zillow to look at houses in Seattle. So just one quick follow up question. You mentioned that your ideal ratio is going to be 20% cash, 80% insurance. Does that change based on the demographic of the area if you have more people with out of network plans or wealthier areas versus areas that may be more rural or less affluent or, any of those sorts of things?
Brian Gallagher: I think there’s about 12 markets that I would pinpoint where this wouldn’t apply. Cook County, Fairfax County, Orange County California, Cook County Illinois, Fairfax County Maryland. There’s certain pockets like that. Anna Rundle County, Maryland, Anna Rundle County, Maryland, the average household income is about $130,000 a year. I mean, that’s just way above the national average rate of $73. So you’re in these different markets. You’re up in the Pacific, US and Seattle and that’s exactly right. You’re up near Seattle market, the home of Google the home of Microsoft. I mean, I have a lot of cash owners up there that $200 on a vow, and $150 a revisit. It’s the market. So that’s really good that you pointed out because my statistics are more nationally average base. But there just are some of these pockets, but it’s really about a dozen after that it kind of filters into this normal level for everybody.
Garrett Salpeter: Okay, that makes sense. So let’s talk about coaching. So can you describe, I think in the intro, I talked about the breadth, you’re kind of coaching people throughout the customer journey from marketing and lead generation through operations, fulfillment, hiring and recruiting. Can you talk about what it’s like to work with big business and the breadth and scope of services that you’re providing?
Brian Gallagher: Absolutely. I don’t want this to be like a solicitation or anything, it’s just more of an informative educational answer that I’d like to give. Back in the day, when I had opened my second office, and it was far too big, and I just was far too green. And I hit the fan, I was $85,000 in debt, and I was burning $5000 a month. I was negative $5000 a month. It was my wife who put her hands on my shoulders. And she said, taking another Con Ed course isn’t going to make this a better practice. And I was like, blown away by that concept. She says, when are you going to realize this what you don’t know that’s holding you back from success? Because on my podcast, I often say the two reasons why I do podcasts and YouTube and I created MEG is, I want as many PT owners to live the ideal scene that they’ve always envisioned for themselves. And I want to help the profession of physical therapy as much as I can. Well, the only two reasons why I get up and out of bed and keep working. I’ve sold my practice twice. It’s not a necessity for me to do that. But I’m so entrenched in it, because I still want to pursue those two things. Back in 2003, when I needed help, and I started looking for help, I was just taken aback by this idea that I needed to go to this consultant group to teach me branding and marketing, I need to go to this consultant to teach me charging and coding, I needed to go to this consultant to teach me, business spreadsheets, and everybody was in their own little pocket. And when you did that, once you started making changes in this area, it trickled down had a negative effect or positive effect, or some sort of effect on other areas of the practice, which I now created more problems for myself. And I realized that I said to myself, I said, someday I’m going to bring this all together, from janitor to CEO, from administrative division, to quality control, division, to personnel division, to production division, to finance division, to recruiting division, I’m going to take all five of these divisions, I’m gonna sew them together so that the proper command channels are in, the proper communication lines are in. And that took me a long time, like my whole career flying all over the country being in and out of 500 offices. But I finally successfully did it in 2018. And I made it virtual, and I made it web based, and it had to be live and engaging. And it had to have a File Vault of all these templates. You can’t go rewriting a policy and procedure manual from scratch, it’s 300 pages, or a pay for performance model. We created the spreadsheets, we created the template. So I finally achieved that. When you ask the question, though, what about coaching? I think that was the biggest epiphany that I had, was back in the day when my practice one practice of the year. We shot up. Groups hired me to be their consultant. And they would fly me into these different cities, and they book a Marriott, and they’d have 30, 40, 50 people in the room. And I talked for the three days and they paid me $5,000 a day, just for my plane to land and $5000 hours a day deliver and I gave everybody everything I could and I left and I was on to the next city. Well, the funny thing about that is, when I got to the next city, my attention was now in that group. I had no connection to the group I just left, whether they succeeded or failed. After a year of doing that, I asked my assistant to go back through the database and track all the people we’ve touched and what percentage were living the dream, what percentage took that information at 3d training, and actually achieved their ideals? It was 37%. That means 1/3. Well, where’s the other 2/3? They just spent a lot of money and they didn’t get very far. That’s when coaching hit me. It’s coaching. When I played competitive soccer and I went to Europe, they gave me my own personal coach. And here’s the thing with coaching and I know you work with a lot of athletes, coaching by definition is someone who enables another to perform at a level that they otherwise would never achieve on their own. That’s the definition of a coach. If I am a good coach is because I’m able to get you to perform at a level that you never otherwise would have reached without my engaging it, without my coaching you. So teaching is dead, consulting is dead. I am not a fan of any of that. Giving people bright ideas and hoping the best for them is just a waste of time and money. You need to align yourself. I always tell people, if not us, find another group, find someone who’s going to be with you through the process of your evolution, through the process of your journey to coach you over each hurdle, each obstacle, each barrier, each curveball that comes your way. Give you the knowledge give you the data give you the application, like we have role plays, we have assignments, we have quizzes, all of that is very, very important, because it’s all two way engagement. But you also have to be available as a coach to take that call, to take that email, to take that tax and help role play live with them if needed on how to terminate that person who’s making some wild accusation? Or how to close that candidate who’s trying to decide between your clinic and somebody else’s clinic? What do you do and say, and how should you do and say? Sometimes how you do and how you go about doing insane things is far more important than what you’re doing, and that’s coaching. You got to hear it from another person. Anyways, it’s kind of a long answer. But I hope that answers that question.
Garrett Salpeter: Absolutely. I think that’s a really big distinction that coaching versus consulting, the guidance and accountability versus just giving the knowledge, or done with you compared to done for you or done maybe something like that.
Brian Gallagher: Done with you. We want to do it with you.
Garrett Salpeter: That’s really, really good insights there. And I know we’re coming up on the end of our time together here. So one more just Rapid Fire question here. So the only book recommendation I’ve gotten from you, I loved it was “The Go Giver”. Are there any other books that you recommend to practice owners or in general?
Brian Gallagher: “The Successful Millionaire” by Dean Graziosi, is one of my favorites. I’ve just recently completed that. I’m on an audible book right now, front with author Chet Holmes. Let me just pull up my Audible account.
Garrett Salpeter: Is it the Ultimate Sales Machine?
Brian Gallagher: It is the ultimate sales machine. I just love every page of that. Every minute I listened to is just a super, super great book. There’s another book called “Cashflow” another good book. So those are three that I’m very immersed in right now. I think they’re very relevant to our current society and the future of what’s coming. I will say this, though, with everything that you see, block out all the bad and just stay up tone and stay upbeat about it. Because people want to be around people like that. They want to be in environments, where the future is what you’re making of it. My strongest advice to anyone listening is your future is always what you make of it. Be more at cause and be less the effect. That’s why I often say to people, ask yourself. You can do it now hear it. I do it all the time, I say to myself, if I take a snapshot of myself today, and I take a snapshot of myself five years from now, how should those pictures be different? Or am I on a trajectory where a snapshot today and a snapshot five years now is going to be the complete same? And so many staff therapists or Clinical Directors are like, if I don’t change things, if I don’t really open my own practice and get that SBA learn or do so, five years from now, it’s gonna look no different. I might be making $5,000 more, but that’s not going to change my life. There is a certain sector of the population that is gonna be very motivated by that saying, I’m capable of more in my life. And if you are and you’re that person, then you owe it to yourself to live to your fullest.
Garrett Salpeter: Awesome. I think that is excellent advice as well. One final question. How would you say, so you mentioned little bit about your personal experience with the Neubie. Most people on here, have a device listen to this. Some just have learned about us may not have a device yet, but how would you say the Neubie has impacted the practices that you have coached that implemented it?
Brian Gallagher: Well, it’s impacted them two ways. And I’m glad that it’s these two ways. And it’s impacted their outcomes and their quality and brand. So I believe the outcomes the quality builds the brand. So their brand recognition in the mental perception of who they are has changed because of the institution of the Neubie into their practice. Because of the implementation of that advanced technology as seen through the outcomes and then in giving the higher quality and building their brand around it. And then the second is revenue. They become financially more stable, financially more secure. I had a PT practice owner come up to me at PPS a year ago. And she brought her P&L. And she showed me in 10 months on a cash basis side, she had collected over 100,000, I think it was $101,000 in revenue, cash services only using the Neubie in 10 months. Now, I don’t know about you, but there’s not many cash based services you’re gonna put into your clinic and within the first 10 months, you’re gonna clock $100,000 off of that machine. So I was blown away, that doesn’t even count what she was making on the insurance side of it. So when you find something that financially viable, and at the same time, it’s the real deal. I mean, as we’re doing this podcast right now, my wife, it’s right here. It’s in the next room right next to me here, the Neubie is right there, it’s all set up, she tore her meniscus, and she is having surgery on the eighth. But the only thing that has been helping her over the last couple of months, and I’ve tried to rehab her to 100%. But the MRI just shows us nice old big pair. But the only thing that gives her pain relief and enables her to function throughout the day and walk around because we’re moving and stuff. And she’s got to be at the house and all that stuff is the Neubie. She’ll tell you, she’ll just say, and she’s not. She’s a PT, of course. But she’ll say that’s the only thing I can. I can’t get my knee all the way straight. But I can put the Neubie on and do a 20, 25 minute session. And I can be pain free for the rest of the day until the evening when it’s bothersome again. And then she treats herself the next day, every single day she’s on that Neubie. And that’s what’s allowing her to hobble around until surgery. So I can just speak from experience. Now, of course, I used it in my back before I had my back replacement, my disc replacement. And that’s what gave me great results too. So she and I both have this personal experience with it. And then of course, I’ve got hundreds of clients that are using it.
Garrett Salpeter: Awesome. Well, thank you so much. I appreciate that you have been an advocate for the Neubie and really helped us get the word out in the physical therapy community. And even more than that, just the knowledge that you share on your podcast, and even just for free for people who haven’t hired you as a coach or are formally working with MEG. But I can tell you having gotten a peek behind the curtain and working with MEG at our practice that I can tell everyone listening that the value there is tremendous. We’ve loved working with you, we’ve gotten a ton of value out of it. And I know, many other practice owners, they work with you as has either helped them get over a hurdle or has transformed their clinic. I mean, it’s always been some variation of something incredibly positive. And you graciously have offered to not just for our listeners, but this is something that you do generally but graciously offered to provide a practice assessment. Can you talk a little bit about what if people are interested in learning more about you and MEG, kind of what that looks like?
Brian Gallagher: Definitely. So here’s what we can offer. When people reach in the MEG and they’re like, I’m not so sure if your services are right for me or not right for me, I have this kind of going on in my practice. I just need to bounce it off somebody and we need to talk it through. So that’s what we call practice assessment. You go to my website, www.megbusiness.com. Or you just email [email protected], you can schedule yourself or she’ll schedule you. You’ll have a one hour session or one and a half hour session with me. We’ll talk about all the divisions of your company, your personnel, your operations, and we’ll talk about where you are at, where do you really think you need to be. If you need some references will give you some references. And then if you decide to move forward with MEG Academy, you can check it out on the website. We have a platinum package, a gold package and [inaudible 00:59:02] package. We’re going to fit fine, which is the right fit for you. Then you get started. And you’re training at your own pace. I often tell people, you only have to invest two hours a week and you’re gonna be really successful. We have the same thing for billing, we have a billing assessment. We’ll read through all of your billing and I’ll tell you probably about 1/3 of the time we do a billing assessment. We say, “No, you don’t have to switch your billing over to us”, you’re doing fine. There’s just a few things on the edges you should correct and improve and do differently. And you’re not in bad shape. You’re not in bad hands. But then there’s other things we look at and we’re like what is going on, who’s doing this billing, this is a nightmare. And then we’ll flip them over we’ll take them on and we do about 4, 5, 6 new clients every single month. We roll them into Bill and they can be on any software any EMR that they want. From those assessments people become clients and I’m going to say this to your listeners as a special to your listeners, I will offer in there. Let’s say they do a practice assessment and let’s say they decide to move forward with our help, our coach services, I’ll throw in one hour of free coaching of my time coaching them specifically, it’s usually a $500 service to have my undivided attention one hour work. Whether you need me to design a clinic or workout your pay for performance model with you, or whatever the challenge may be, we’ll just add that to your account. $500 value to your listeners, it’ll be a one hour coaching session with me for anyone who goes through the practice assessment and then ultimately decides to move forward and make a change in their life. I’ll coach you myself, I’ll put an hour in on that as well. Of course, after that you have unlimited access to myself and all of our other team, and our whole community through our Slack channels. And that doesn’t cost you anything at all. And those are just 15 minute little coaching calls and sessions along the way, or emails along the way. But this is an undivided one hour block time just for you.
Garrett Salpeter: Fabulous, thank you so much. That’s very generous. I really appreciate that on behalf of all of our listeners. And one other thing I’ll mention that if you’re interested in learning more about Brian’s work and the type of content that they’re covering, check out his podcast “Secrets of the Top 10%”. It’s on Apple podcast, Spotify, YouTube, all the usual channels.
Brian Gallagher: Yeah, it is. And I really would love to help as many people as possible. That’s what gets me out of bed. Garrett, thank you for having me on. I’m very fortunate and blessed that you thought of me to come and participate with you here. For all the listeners both on my podcast and yours, I just love the idea that we’re just so grooved into the same purpose of just trying to see people live a better life. Anyway, we can help you guys get there. Call on either one of us. We’re happy to help. Amen.
Garrett Salpeter: Thank you so much for joining us, Brian. Thanks, everyone for tuning in to this episode of the “NeuFit Undercurrent” podcast, and we will see you next time.
Brian Gallagher: Thank you. Bye now.