E554 | Small Town Hybrid Practice Success With Justin Dimitt

Today, I had the chance to chat with Justin Dimitt, owner of South River Rehabilitation and Performance in Waynesboro, VA. We're seeing more and more hybrid practices within our Mastermind group and Justin's practice has to be one of them. We get into this, how he got into the profession, and more! Enjoy! 

• Making the transition from home health to full-time business owner
• The differentiator between Justin's clinic and other clinics in his area
• Justin's favorite part of owning his own business

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Podcast Transcript

Danny: [00:00:00] Hey, I've got a question for you. Do you know if you're tracking the right data, the right metrics, the right key performance indicators in your practice? This is something that's huge for us and really helps us make solid decisions within our business, but the prior software that we're using to run our practice made it really challenging.

To actually get that data out and use it in reports. Since we've switched to PGA everywhere, this has actually become way, way easier for us to be able to have the right data. We have a dashboard of all the things that we actually want to see, the metrics that we want to pull, and it makes our life a lot easier to pull the information that we need to make the right decisions within our business.

So if you're running blind and you're not tracking the right things, or you're having a. Hard time actually pulling everything together. I highly recommend you check out our friends at PT Everywhere and see what they've got going on with their software platform. It's what we use for our practice. It's been a game changer for us.

You can check 'em [email protected]. I think you really like it. So here's the question. How do physical therapists like us who [00:01:00] don't wanna see 30 patients a day, who don't want to work home health and have real student loans create a career and life for ourselves that we've always dreamed about?

This is the question, and this podcast is the answer. My name's Danny Mate, and welcome to the PT Entrepreneur Podcast.

What's going on guys? Dr. Eddie here with the PT Entrepreneur Podcast, going live in the PT Entrepreneur's Facebook group. Again, if you're not in that group and you're listening to this on the podcast and you want to get involved in the conversation, ask questions, meet other entrepreneurs like yourself, head over to Facebook, PT entrepreneurs, go ahead and join.

We make sure, clinician, everybody in, there's a clinician and then we'll accept you to the group. So today, I'm fortunate to talk to Justin Demit. Justin is the owner of South River Rehabilitation and Performance in Waynesborough, Virginia. He's running a hybrid practice, which is pretty cool. We're seeing more and more hybrid practices develop people that are taking cash that [00:02:00] are deciding to take some insurances and make a hybrid model out of it.

And more often than not, it's. An insurance practice that is like deviating towards starting to get some cash pay involved to help out with some of the decreased reimbursement that we see over and over again in the insurance world. So we'll get into what happened with Justin in a second. But first of all, I just wanna say thanks for your time, man.

Thanks for being here today. I know you got a lot to do, so we appreciate it. Yeah, anytime, man. Awesome. So tell me this. So I'm always interested in how people got in the profession to begin with, because I feel like it's such a profession of like service to others and it's, it's there's, if we're probably smart enough to do a lot of other things, but this is what we chose to do.

And in most cases it meant like making less money than some of these other career paths. But there's something very personally rewarding by the profession. So how did you end up becoming a pt?

Justin: I was one of the unfortunate ones who got injured playing football, dislocated my shoulder, and it was reduced on the sidelines and we just kept managing it throughout the season.

I dislocated over 30 times and oh, they were treating it as like a tendonitis type thing. And [00:03:00] then I, self rehab, went through weightlifting, decided to go into wrestling, and went into a district meet, undefeated and dislocated on the mat again pretty badly. And ultimately had surgery, went through this thing called physical therapy and I was told I was never gonna be able to play again and my PT got me going and I was able to play at the college level for a little bit and yeah, and just fell in love with the profession, what it could do for people, and gave me new hope on athletics and everything

Danny: else.

So it was pretty cool. I think that is the most. Just the most common, story that I hear. It's very, I got involved in PT cuz I had a football injury when I was in high school as well, and I just felt like the environment, it's such a cool environment. I had a really cool PT that, that sort of was functioning in what I would consider like a sports performance, like hybrid setting without knowing it, what was your pt? The one that you worked with? What do you remember from your time working then?

Justin: When I remember his name's David, he Basically we were the only in this area that was available was in a hospital. Yeah. Basically you went to it, I think there was maybe one [00:04:00] other practice in the area at the time, and he just treated me like an athlete.

And we did a lot of performance-based stuff. Doing heavier rows, heavier presses and things like that versus what I was seeing everyone else doing. And it was cool to be treated in that sports medicine mindset. And after I had, after I would leave pt, I'd go and doo like day at my high school for football conditioning and stuff.

And it was kinda like working, banging, backing off of that.

Danny: So he didn't just give you a theban and give you some low level stuff to do and then throw a i ice pack on it. He actually was like, Oh yeah. Back up. That's

Justin: cool. He moved, he put me through it. Let's put it that way.

That's cool.

Danny: Okay. So te tell me this, so you decide all I'm gonna become a pt, you graduate. What's your what's your first job out of OUTTA school?

Justin: I went to a private practice down in the Christiansburg area named Total Motion pt. And the owner there really took the time to teach me how to do manual therapy.

Teach me the sports medicine mindset and how to dose and, that just give people three [00:05:00] sets of 10 for everything. It was basically, here's the condition you have in front of you. You gotta do sets and reps or. Things like that to based on the condition itself, which was a lot more work, but I saw results that were better at the clinic I was at versus the area, and it just exploded through there.

And I carried it through the rest of it, even after I left that practice and really prepared me for my O c s, which I thought was really valuable to my career

Danny: too. So how much time did you spend, working in other clinical studies, like how many years before you decided to do your own thing?

Justin: Oh, Lord, that's a store in itself. When I moved back, I worked for a practice where I just, I, there was no work-life balance. I was a staff PT and worked through lunch, came early, stayed late, and, it was just not very healthy setting for me. Decided to leave and I was, knew I wanted to run my own practice.

I didn't have the desire to own a practice. And then after. That next adventure that just didn't work out for us. I ended [00:06:00] up leaving outpatient PT for about a year, did home health, and all of a sudden, I had a performance, I had a performance company that did strength conditioning and a facility, and there was more and more people asking me to treat them.

And I told 'em I didn't. I just didn't wanna do outpatient. And then finally it was almost like God smacked me in the back of the head and said, what are you doing? And. Started the practice. We've only been in for three and a half years now, and it's been a wild drive, let's put it that way.

Danny: So the, that's interesting. You basically, y I lump. You into this category of a reluctant entrepreneur because you did it, you did start you. So it sounds like you started this performance company where you were working with like youth athletes. Like what were you doing with that company where people started asking you to treat their, injuries?

It started

Justin: off with actually It was in this area there wasn't a whole lot of posts. Rehab, a c l Yeah. Continuation stuff. And my first two clients were post-op acls that would needed to return the basketball. [00:07:00] And I had those two that started on Tuesday and Thursday night, went in there at seven 30 at night and.

Then I started Stone, I started snowballing a little bit and I worked with a baseball company that was in the same building and started working with baseball players. And I did a lot of baseball stuff for a few years before this. And I was like let's try it. And it just kept picking up steam and we started.

I started the company the least from the company I was working in, and eventually we actually took over the whole building. Wow. So basically it was baseball, softball the female athletes. And it grew to basically this huge strength conditioning thing that we did with youth sports. We had some weekend warriors and some of the parents that dropped their kids off that I was like, Hey, why don't you work out if you're sitting there for an hour?

Yeah. And they jumped in and. And this was all pre Covid obviously, but and that's a whole other thing in itself. So basically, I was doing that while doing home health and [00:08:00] yeah, it was pretty funny. I worked for a home health agency that was like, you have your O c s, why are you here?

Yeah. I wanted to keep being doing a physical therapy and it just, it just didn't seem fit until that day and.

Danny: Here we are. It's interesting, for you with what you're interested in, that home health was the route that you went for a while, was it, was there a non-compete involved in that, or was it that you just wanted to be in a completely different setting?

It was burnout.

Justin: I, it was, I was only. What, five years into my career and I was just done. Cause the way, it was, the way I was experiencing everything outside of where I was in Christiansburg, where I, when I left there, like everything just it just didn't make sense. And I was like, this is not why I went to school.

This is not why I'm a pt. So I didn't wanna leave the profession and. I am probably the worst acute care physical therapist you could ever meet, so home health kind of lended me to, stay in some ortho realm, but like I got to meet some really cool people and yeah[00:09:00] I was good at the job. I wasn't great, which, if you're meant to do something, you're gonna be great at it.

And I just, home health was just, this made sense and it was a break from it.

Danny: Yeah, I feel like there's some benefit to it. I met I. I met another pt, we were on vacation in San Diego and she was telling me, what she's doing now and she was doing home health and previously she'd been working with hockey teams minor league hockey teams.

And I go that's a weird, you jump, and, but she had. She had kids and she wanted flexibility and she didn't have that with the team she was with. And what she told me that was interesting was, sh she goes, I take the same sports, mentality to my home health clients. And it's it's just an at-home athlete.

I go, that's awesome that you could do that. But for her, honestly, it's a trade out for flexibility for her lifestyle. That's why she'd do it. Not that she would probably pick that over, maybe in a more ideal environment, but for the time of the life that she's in, like for her stage in life, it's a perfect fit for her.

For you you spent, it sounds about a year doing home health [00:10:00] and then you started doing some of this, training on the side. How how long did it take before you were, you took over the entire building, like it, cause now you guys use the whole space.

Yes, sir.

Justin: I mean it's, what was it, four years ago? We took over the whole building, almost five. And there was a big jump and I'm obviously rents and Sure. I had a pretty awesome landlord and I did the typical story of, I talked to The guy who runs Total Motion Run, he did Home health as he was building his practice.

That's what I did. I did home health during the day, did everything in the evening, and then I started chipping away for earlier and earlier in the day to the point where I was like, okay, we're in. Let's

Danny: go. Yeah. Okay. Just describe what the practice looks like today. What services do you offer?

What sort of like business profit centers are there that you guys have describe what the actual, like business looks like in a nutshell.

Justin: In a nutshell, it's your, we, I. Are your private practice, outpatient orthopedic clinic? We have about 3000 square feet on one side that we do patient care with.

I [00:11:00] actually cat my therapist during the day so that they're not seeing too many in any given day. And on the other side of the building, we have more, we still have the performance setting. It's a little different now. Posts, pandemic type stuff. Yeah. That's not nearly as big and we're trying to regrow that at the same time.

But if we do dry kneeling, it's mostly manual therapy and sports medicine. Yeah. In a nutshell, everyone's, like I said, from my residency type stuff, it's everyone gets individualized stuff. Everyone looks like they're doing something different. You have one person crawling on the ground, you have another person back squatting.

You have another person jumping on force decks and all at the same time. What would

Danny: you say your, like bigger influences are clinically that, you've really gravitated towards? You feel like, you just love the methodology that, that you learned.

Justin: They was big with Ola Grimsby during my initial parts of my residency and things like that.

And basically it's. It's anything that was interesting in J O S P T that evolved sports, [00:12:00] and I applied that to my total knees and it works great. And now we're doing T P I stuff. So it's yeah, it's just basically the whole treating everyone in a sports medicine mindset. If there's something that's posted about.

New things on how to treat a c l reconstructions. I'm reading it that night before I go to sleep just because of if it's something new, I wanted to learn about

Danny: it. Yeah. Yeah. I think it's one of the coolest parts of the profession is this idea of lifelong learning. If you're okay with that.

Some people, I think it's, it just wears 'em down. But yeah, I think that's awesome. How was it running a performance center, during the pandemic? What was that like?

Justin: Interesting. We were very fortunate in that we came out better than from the physical therapy standpoint.

We came out better than we went into it. Sure. From performance standpoint, we actually shut that down for about six months, just being the good stewards and listening to things and then started ramping it back up which sucked because we had. Hundreds of people in there at every night and Wow.

Trying to [00:13:00] rebuild it, rebrand it, trying to, but it also gave us a aspect of let's do things better. Let's differentiate ourselves. And that gave us the breath to do that on that end, on the physical therapy standpoint, we took a hit for two weeks and just. Exploded from then. So it was, I feel like we did the things, the right things the right way at the right times and tried to be a little bit more proactive with it.

Danny: So if talk about doing things the right way, rebuilding, in a more efficient way. Like what are the differences on the performance side that you're going, and that you are actively like working on versus how you ran it previously. What are the differences that you're trying to build into it?

Justin: Basically we have more racks there that are more updated more updated equipment, and we're a lot more scientific when it comes to putting in filler exercises like wall slides in between sets, as opposed to like, all right, here's your sheet. You're gonna be doing this for the next. Two to three weeks.

Now it's, we're tweaking things [00:14:00] every single day based on how we see them move. And we actually can make those adaptations quicker than what we used to do, where it was just like, okay, how did they do on A, B, C, and D retrospectively. Now we can actually do everything prospectively and say, Hey, you did really good.

R p was at a seven, want you at an eight, so let's bump it up a little bit and do it this way, and doing things more efficiently between sessions, in between workouts with those people. And then we added more of the performance sites to any kind of the cage stuff. If we're working with baseball pitchers, yeah.

They're, they just throw a 90 pitch adding and they're 18 years old and they're tight. Hey, we're gonna work on some mobility stuff, a little bit of manual therapy before you go into your lifts, as opposed to, we didn't have that communication before and. That was a mess up on my end. When it comes from a system standpoint.

Danny: Yeah. Yeah. I feel like managing and coordinating all of that, like at a. At a high level, it requires massive amount of communication, and structure. So what does it look [00:15:00] like if an athlete comes to that side to work with you guys? What is the, the initial, assessment look like?

And it sounds like you guys are doing individual programs and people are, working through those. What does it look like if I came to you today and I was like, Hey man I'm 37 years old, I wanna throw 90 miles an hour. Just bear with me and be like, yo, it's not realistic, but we're gonna try.

But what, what does that look like, for somebody coming in

Justin: I always ask people what are your why's? Like, why do you want to throw a 90 mile an hour fastball at the age of 37?

Danny: I'm trying to impress my wife. I just want my wife think I'm like

Justin: super cool. Then we have the conversation of, will your wife be more impressed when you need to have a labrum

Danny: repair and complain to take me to surgery throwing

Justin: 90 and just look impressive on your neighborhood baseball

Danny: bat?

Yep. That's it.

Justin: Yeah. But basically people walk in they get a one-on-one assessment with our strength coach his nickname's tank. Ly and if you have an injury history of any point, even if you're not in pain, one of the physical therapists comes over and checks out. Whether we have any [00:16:00] issues, whether we have any concerns, whether you're compensating for stuff.

And our strength coach has spent a lot of time with me in regards to screening movements, assessments and things like that. And we put you through a workout on your first day. Nothing strenuous like. If you're not doing a metabolic and you're not getting taken out by wheelbarrow or anything, but it gives you a taste as to what you're gonna be going through, and then, it's always like I asked you like, why do you wanna do it?

I have all my athletes write down or vocalize three why's of why they want to put up with us, because it's more money than your commercial gym. And it's a little bit more challenging that you don't just go in and max out on bench press every day. Yeah, and it's, it's just one of those things that you establish it and you look back on it, and then before you leave, we tell you have to do a food journal just so that we can see what your intake's like in case there's, you're moody one day or you're not sleeping well, or you're just not recovering the way you're supposed to.

And we just keep track of all that stuff and that just helps us deliver a better product.

Danny: Yeah, dude, that's awesome. I [00:17:00] wish something like that existed whenever I was playing, sports like it for, it was not like that at all, into that. It was bigger, faster, stronger. Plus whe protein like that.

Exactly. That's all I did. Maybe some creatine

Justin: in there every once in a while. Oh,

Danny: definitely. We had our science teacher was our Weightlifting coach as well, and he would bulk order creatine while we'd be sitting there in like the chemistry lab and he'd be like, Matt, mate, you're too skinny getting creatine, and that was it. Yeah, no, we definitely didn't have quite as much systems around that. That's awesome. So tell me about the flow in between and the communication between the strength coach and the clinicians. Like, how does that work? Do you guys just like informally do that?

Are there check-in points? What have you found that works best that way?

Justin: This is something that's changed over the past seven months since joining the Mastermind, where basically that communication gets started off even halfway through the plan care. If I have an ACL that, Aetna's gonna booter at 12 weeks, and I'm like 12 weeks, you're not even close.

And so I'm like, all right, tank comes over, starts [00:18:00] talking. Just develops a relationship at that point. And then as we're getting to that last month of rehab, it's listen you're not gonna be close. I think you really need to go into the performance aspect. You already know tank, you already see other girls doing it, let's see how we can progress you to that point.

Yeah. And during physical therapy, we progress into the squash, the single leg and everything else. And if they're pain free, they have a quiet knee and they're at that performance aspect, they are getting ready for discharge tanks involved in that. And that way it's okay, you go from point A to point B and it's almost seamless.

Where Yeah, before. It was basically like an informal thing. Okay. Done with pt. You should go over there

Danny: and Yeah. And it's too late at that point, right? Yeah. What have you found with that? Rolling Start, it's we like to call it, we're like, hey, we're gonna, we're gonna get this rolling, start with what we want the next step to be.

And what have you found from like a ascension or transition standpoint from as far as the metrics go? Like how has that affected the likelihood that somebody actually moves over?

Justin: It's darn near a hundred percent. Like where [00:19:00] before it was like maybe 50 50 shot, where they either heard of us because of the performance aspect, then they would, they already had that in their mind.

Yeah. But now it's, I think only one person didn't immediately transition over, but they're still saying they're coming back once their season's done and do all their off-season stuff with us. So it's basically. And I think it was more monetary issues because of that, but it's, it's darn near a hundred percent.

Like the conversion's

Danny: much better. So this is actually a great point. Anybody's listening to this and they're struggling with continuity programs. So if you're struggling with getting people to, move on to something that's gonna be a recurring service, first of all they need to be appropriate for it, right?

But let's just say that checks the box after that, The mistake that most people make is they wait until the very end and then they bring it up and in that person's mind, they're already like, They think they're being discharged and they're on to the next thing, and they don't even know they're something that's potentially like really great for them to move [00:20:00] into.

And I love how you guys set that up as well as, I feel like, especially with like younger female athletes in particular with a guy named Tank, getting them associated with somebody like that who's not quite as intimidating, and and then being able to see other athletes like themself.

Like it's just, it's almost like you could set it up to where. It's you gotta do the work here and then you earn the right to do the fun shit over there. And I feel like that's such a great way to position it. And honestly, if we're really looking at a, let's just say this is acls.

The worst thing that can happen is a retail, right? And I would always tell parents that. I'm like, listen, the only thing worse than your kids turning their ACL is them retailing their acl. You don't wanna be back here with me. Again. So I feel like that's like really just compelling reasons for why would people would wanna move over.

So on, on the. On the rehab side, let's talk about the clinical side for a second. So what does that look like? What's your mix now between like insurance, cash services, and like how do you coordinate, all of that on the the clinical side.

Justin: So on the clinical side, we, we're a network with several insurance companies.

We actually just terminated the first one. We [00:21:00] actually got it because it just didn't make sense and we're trying to transition out of the insurance model. Now will we ever get rid of Medicare? I don't think so. Just because that makes up about 20 to 30% of our caseload and helps fill the middle of the day type stuff.

Definitely. But basically we look at their benefits. There's actually more insurance. Policies here now than before where you get a catastrophic policy. And they don't even have ancillary services on there. They don't have pt, OT speech or anything. So they're not even covered. So we, we started off with having one or two self pays here and there.

But now we're at, I think we're at about almost 10% with a self-pay model or a cash pay model. And then we also, those that have insurance limitations, like if they run out of visits, then we're like, Hey, you probably need to continue. Let's put you on like a once a week or once every two weeks.

Self-paid visit model. And we actually get more from that point. So it's. It's gotten better in that kind of [00:22:00] payer mix when it comes to that. We're also starting to do more like package selling and things like that, which has taken off pretty good. This is our I had to take a break from that because of other medical issues, but we're starting to gain momentum with that again as well.

Danny: Yeah. So tell me, how have you seen insurance in terms of the, The reimbursement, the contracts that, that you have over the last few years what's been the trend that you've noticed? So

Justin: the experiences I've had is we've only been doing the insurance model from a, this practice standpoint for a little over three years now, and comparing it to what I've gained knowledge of.

From a franchise PT clinic and a private practice from over the past 10, 11 years, our reimbursement's dropped. And I hate calling it reimbursement by the way, but it's yeah, about 15 to 20% drop. Wow. And all our costs are going up and it's just, it's a spiral that can't continue and survive at the same standpoint.

Which is part of the reason why we started. We joined the Mastermind and everything else to [00:23:00] pivot early. And our goals our goal is to get rid of 50% of our contracts over the next

Danny: year. Yeah, I think it's, at least from what we've seen with the hybrid the indirect practices that have moved to hybrid model the benchmark of being around like 50 50.

Is a really healthy place to be. Cuz you're right, if Medicare accounts for, let's call it a quarter of the people coming in and another, quarter of those folks have insurance contracts you feel are reasonable for what you guys are doing. Especially if you're seeing a lot of post-op volume.

Because then we're talking to a lot of visits. It's one thing that we'll see with people who do a lot of post-op volume. Hybrid makes a lot of sense. And if they, you're right, if you're in a h a higher Medicare population, That can make a lot of sense too. I feel like it's just, and you've been on the receiving end of just like high volume and a lot of documentation and being sensitive to that with your own clinicians.

While still running the business in a way where you can be profitable and stay in business, that's tricky. For you, what is it, what does a day-to-day look like with your clinicians? What's, what is their max volume? Is that over [00:24:00] a week? Like, how do you justify that?

Or track that, what's your process for actually making sure you're not burning your own people out?

Justin: I basically track every pay period, which we do it twice a month. They average the, at most 12 per day. Yeah. So 60 visits per week is what I cap them at. And if they do more than that, I always have the conversation like, Hey, you're starting to inch closer to it.

We need to back you off. Do you feel comfortable with your current complexity and load? So on and so forth. And if they say, yeah, then we have a bonus structure that happens after that. 12 visits. Yeah. But we, I look at that stuff. Almost, yeah, probably more than I should, but it's probably twice a week I look at it, and then again, at the end of the pay period and just tracking those numbers and trying to have those meetings, or at least the touchpoints every week with each therapist to try to make sure Hey, are you struggling with anything?

Do you have any crazy patients? Yeah, things like that you know I need to either help you with or, hey, We need to give you some extra time with that patient and do it that way. And [00:25:00] it's a fine balance between the pt, the patients, and of course we gotta make sure we get paid to keep the business running.

Danny: Totally. Yeah. I think you bring a good point, right? Cause it also, it's the patients make a big difference. And sometimes you get. I remember having patients come in and I'm like, oh my God, I can't see this person today. Like they just, I can't see this person and another person at the same time.

It's just certain people you have, it is just, they're just harder to work with, so for you guys, 12, 12 seems to be the max mark, right? Like, how does your staff feel about that? That volume overall. Cause there's plenty of people listening to this that are seeing double that, every day.

My,

Justin: I've, I only had, I only, I've only hired one new grad outta school. And she's by the way, freaking awesome. The other PTs that I've hired have come from higher volume where they're seeing 16, 18, 20. Yeah. I just hired a new person who starts here soon too, and she's used to seeing over 20.

A day. And it's basically, it's an easy sell. Yeah. From that standpoint for them. So when it comes to their [00:26:00] standpoint, it's a lot easier for them to manage. And, they have families and, I encourage them to not live the life I did the first few years outta school. And, they, I.

They appreciate it from what they've told me. And we get, make, if they need p t o I'm like, go ahead, take it, do it. And it's just, we, with us being a private practice and managing costs as well as I've, hopefully we've been doing it's, 12 a day. Works out really well and especially being supplemented with more and more cash patients that come in or training and things like that.

And a lot of those continuity things supplements that pretty good.

Danny: Yeah. Yeah, I mean I think that's a smart way to go about it. And in particular, if you look at, somebody coming in that's used to seeing like 20 people a day and now all of a sudden they've got somebody that's yo, We want you going on over 12 and we're making sure you're good to go.

That's probably a foreign, environment for them. They're probably like, wait a second. You're concerned that I am seeing too many people? You wanna make sure I have [00:27:00] good, a good work life balance. You want me to take vacation? These are it's such a It's such an ass backwards profession because it, it just requires you to be there and that, and then that dictates that the whoever's running it is wants more volume, more time, which takes you away from, other things.

And it's such a challenging problem to deal with because on the one hand, the profession is so personally rewarding. It's it has great people involved then, and people that want to, do that as a career long-term. And like building the environment to where you're not burning them out and they're starting to resent their own profession is that's what I think a lot of people are trying to figure out.

And it's interesting to see your clinic with the performance. Training center connected to it and how they kind of work hand in hand to together. I think we're actually gonna see more and more of that going forward for the right person, so for you, as you look at it, what area do you feel like has the most potential from the business side?

Is it, do you feel like you have more. Potential opportunity to really grow and [00:28:00] have more profit on the performance side, or is the clinic just getting more dialed in with cutting some of these bad contracts and having more cash pay services? Which one do you, are you more bullish on?

Justin: I'm actually bullish on both of 'em, especially tomorrow. We're ch changing a lot of the way we're scheduling and we're entering the peak season for our performance side where, you know, a lot football's ending. Baseball is usually we usually get a lot of kids for that. Volleyball is about right to end too, and, a lot of those things I, it's.

From the condition, strength conditioning standpoint, it should do well with minimal interaction. But it'll I'm really bullish on that cuz that used to feed the PT side. Yeah. And had to reverse during Covid where now the PT side feeds the performance side more or less. And then we're doing a lot of the things I've been trying to build up for the past four or five months.

Is gonna start coming to fruition this month of November coming up. And I'm really excited to see how things change and see what kind of ways we can make[00:29:00] out here when it comes to care and what people have the perspective of good care. And I think it's a mixed bag in the area right now.

Danny: A lot of times people don't know what good is until they've experienced bad. Yep. And I noticed that firsthand. When we would have people, they would talk to us or yeah. I think I'm gonna go in network and use my insurance and we'd always follow up and be like, great, here's some stuff to work on.

In the meantime, we'd send 'em a couple little exercises we thought might be effective, for what they were telling us was wrong with them. And then we usually check in on them like a month later. And the funny thing is, I. A good chunk of those people would end up coming and seeing us because they would have a watered down clinical environment, that they would go to, it'd be high volume.

They'd be getting templated exercises. They'd be off in the corner by themselves doing a shuttle, or whatever. And and then they'd come back to us. They'd be like, whoa. This is totally different. And they don't know until they go somewhere else, so what would you say for you guys, like the big differentiator is, besides like less volume, but like what would you say the differentiator is between yourself and like other clinics in your area that that are close to [00:30:00] where you guys are at?

Justin: We get to know you and we get to know what your goals are. We get to, we build you up to it. And, people say movement is movement. I see that on Twitter all the freaking time. And frankly, it's bull crap. Like proper movement in the way you're supposed to move. And, return to sport movement is what makes you better.

Yeah. And it's, I tell people, you should walk out and finish with us better than even before you got hurt. And like we have people who said, I, I haven't gotten off the floor in three years. Crap. Okay, let's go. You're, before you're discharged, you have to show me how you can kneel and get up off the floor, cuz just in case you have to chase a child's toy underneath the couch or something like that, you can't sit there and wait.

And people, we have people who sign the wall and put their, sometimes they put their stories up on our wall and people will read that and see that there was a personal connection. You're not just a patient number, you're not patient. 10,123. Like it's just, we get to know [00:31:00] you and we tell people you're part of the clubhouse now.

Like we have people that come by and say hi to us even after they're done with physical therapy six months to a year later. Yeah. Just cause hey, I'm in the neighborhood figure, I'd come by and say hi. Yeah. And that's very rare. And in this area where you're not doing the same thing as like your total knee shouldn't be doing the same thing as your low back patient.

So it's just one of those things, it's like we have one of our therapists, Jane will sit there and work with somebody and I'll try to touch base with each person that everyone works with, and they're like, Jane was the first person to actually listen to me. Yeah. I just run through questions to figure out what's wrong with me, but actually get to know me and it was pretty cool.

It's pretty cool to hear that type of stuff and oh yeah. It's just those personal connections, especially

Danny: in a small town. People can tell, man. When I was in the Army, some of the training we got was, hey, type up your note while you're while you're, going through your evaluation or reevaluation.

Cause it's not like we didn't do like treatment sessions, so it didn't work that [00:32:00] way. It was either evaluation, reevaluation, we'd build these programs out for our PTAs to actually run everybody through. Occasionally we'd see them in the gym and, but it just depended on your day. Because if you had a lot of people, you just, you couldn't, especially if you had like sick call hours and stuff.

And I just think back and it's like, how. What kind of meaningful connection are you making with somebody while you're asking them questions, while you're literally not even looking at them and you're just typing up, their mechanism of injury. It just doesn't, that's just not a good way of connecting with somebody.

What if I was like typing something up while you're talking to me? Like it just would ruin it all. And you can't do that. And I feel like that's such an awesome differentiator that we have that is just it's viral in a lot of ways, right? I'm sure you see this with your own.

With your own clients, like what percent of your business would you say is. Referrals from people you're working with or have worked with, versus people that are just like finding you randomly on the internet. Oh, at least three quarters.

Justin: Word of mouth has been the biggest referral source for us.

Like we, I used to take prescription pads and all this stuff to all these [00:33:00] practices and stuff like that. And, it, it's, we completely stop doing that. And sometimes like we'll sit there and say, Hey. I'm I'm new. I'm working at South River. Here's a bag of chocolates. Have a good one.

And we don't even like the whole prescription pad thing and everything else doesn't work. It's more social media or. Like I said, a lot of it's from people that we've worked with and told their brother's best friend's roommate from college 20 years ago and they come in and see us and it's just, it's such a cool thing where like you're treating people who know people that you've worked with and that's validation.

You did a good job. Like you did a hundred percent what you're

Danny: supposed to. No, totally. And when we talk to practices about marketing, Every, everybody just loves the idea of, oh, teach me this special marketing funnel. Or you know what, whatever, like quick turnaround thing that somebody's gonna see.

And one of the first things I wanna look, I always wanted to look at is what percent of your business is coming from. Past or [00:34:00] current clients, because that's gonna tell me your customer experience. And if your customer experience sucks, you could fill your practice up with a ton of people and it's not gonna make any difference because it's not it doesn't compound the same way that, that internal, referrals do.

And you have to be, Remarkable in order for people to remark to other people how you are right and say oh, they're gonna go out of their way to talk to somebody about you. And that comes from a lot of effort and intentional. Implementation of making sure you're communicating at a high level and you're treating your people really great.

And for whatever reason, everybody just wants to skip that. And they wanna say oh no I wanna do this marketing thing and this marketing thing. And it's man, you're missing the, you're completely missing the mark. Like the number of people that are coming in your doors because of the efforts that you're putting in is.

The number one metric you need to look at, and anything you layer on top of that is gonna be even better if that already exists.

Justin: Yeah. Like the saying goes, you can smell cow poop from a mile away if you don't put heart into it. People reckon, [00:35:00] recognize crap when they hear it and see it and smell it.

Danny: I've never heard that.

That's a good one. Oh, they're good. Tell me like say again. I already heard no, that, that must be like a Waynesboro one man. I haven't heard that

Justin: one before. Twice a year you smell Turkey poop or cow poop.

Danny: It's just the way it's. I think, but I think it's, I think it's great because what's the population, size where you're at.

Justin: This town of Stewart Str, I think just breached 6,000 or a little bit above that. Yeah. It's a very factory based one. It's one of the places that has a Hershey factory, little Debbie out here, NCO and all that stuff. It's, I think the whole county, and I mean I could be very wrong about this the whole county as a whole, I think is 50,000, not including the city of Waynesboro and the city of Stanton is.

Yeah. Augusta County's the third largest county in the entire state. So it's a pretty rural area out here with pockets of people

Danny: and stuff. Yeah. So let's say, let's just call it, sub 50,000 that you have, that are, they're gonna work with you. Let's, and maybe you know, far less than that, and this is actually [00:36:00] something that I feel like I.

Is really important to touch on because it's not like you're in a, I have 7 million people surrounding me right now in Atlanta, right? It's just a huge city. So there's lots of people that are hurt everywhere. I, I can't throw a rock and not hit somebody that has. Back pain or a shoulder problem.

In your case, being in a smaller market, I think for a lot of folks they look at that as well. This type of business just won't work in a super small town. And we've actually seen the opposite. We've seen. If you can take the level of care that you guys obviously do to a small town, it's actually Unheard of for people to work with, folks at that level of customer care, and you can just be light years ahead of everybody else because you're so intentional and you're just doing things in a more updated manner, versus clinics that maybe have been around for a long time and they're just running off of their relationships they have or.

Whatever the way that they've done things, but it doesn't mean that they've evolved. You're talking about reading articles before you go to bed, dude. That's not that common, for clinicians to keep doing that, especially if they, maybe don't have as much steady [00:37:00] competition. How has it been running a practice like this in a small town?

Like what's been your experience with that directly versus some of these other areas that you've been, that sounds like maybe a little bigger.

Justin: It's just, I grew up in the town of Jewish draft and it's just, It's awesome to be treating people I went to high school with. Yeah. And also just random people that moved into the area that are like, ah, I just heard about you guys from my neighbor.

And it's just the small, there's nothing that beats a small town in my opinion. Like I was born outside of Philadelphia and we moved around to Missouri and just. In city and cities and growing up here and now practicing in the area I grew up in. I just, I wouldn't trade it for the world.

And, some of the other things I've, I've worked out and everything else, they weren't huge in, it wasn't, it wasn't big city or anything like that, is just. It was just an atmosphere and I've been fortunate enough to have the experience. I had to do the opposite of what I've had,

Danny: that's awesome. What's the biggest, [00:38:00] what's the biggest challenge with running a business the way that, that you are between this, because really it's two businesses. So what's the biggest challenge with running, south River? The performance center and the practice together?

Justin: The hardest part for the performance center is because of covid. People feel like, they just exercise and work out however they want to and they'll get better at their sport. And everyone's got a home gym and things like that. And you gotta Sure. Show them the value. We have the reputation of having a hundred percent of our athletes that train with us go on to the college level.

Wow. And actually one that's, Doing really well in college right now, might actually get drafted before he graduates college. So that's a pretty cool, that's a pretty cool thing too. And from the PT standpoint, I have literally done just about everything wrong in placing my practices. Yeah.

Like you can throw a stone from my front door and hit the next practice that Has been there for years. Yeah. And you go to my satellite office, and again, it's like you can draw a circle, five square miles around it, [00:39:00] and you run into three or four other clinics owned by big corporations and Right. It's just showing people the value of, people who care.

There's something to say when you have a practice that gives a shit and the people who work there. They care. Like it's not just a paycheck to them. And they know that. And I only hire people that do care. They care about the people in the area as opposed to, oh, I just worked here because they paid me the most and it's stable and all that stuff.

And Hi, I'm I'm gonna be working with you today. Yeah. And it's just, you bring the small town feeling to everything and it works out. It's just the challenge is everyone

Danny: else. Yeah. It's, we talk about that as being like mission driven, right? And that talk that comes from you, honestly, it comes from the way that you interact with people.

You set the tone of the culture of that environment. I think it's really cool to, to hear that and also to see the success you're having, even with, obviously like other businesses around you and in a small town and all the things that people tell you it won't work, right? Like it's, you're checking a lot of boxes for why people wouldn't, [00:40:00] they're like, no, I wouldn't work.

In this town and we, it's interesting cuz I didn't think like a small town would work quite as well, especially with a hybrid model and a cash model until we started working with. Like a lot more clinicians in small towns, we've seen five, 10,000, person towns where it just depends on the demographics and the clinician and where, what their goal is because the top line revenue's not gonna be quite the same as some of these bigger cities, but, The thing is the cost of living is so much lower.

The the net can be a lot better and the people that you can hire, it's not gonna be as expensive as like a Manhattan or San Francisco or LA or something like that. I think there's, it's just, it's trade-offs and it's pros and cons and in different locations. But you're doing a great job with it, man.

What would you say. Your favorite part of owning your own businesses when there's

Justin: a problem or a decision to be made? I talk to my team, which I mean, I feel like I have the best team of PTs and front office staff that you can ask for. I just sit there if there's a problem, I go and I'm like, self.

What should you do [00:41:00] when you do that decision as opposed to running an email to somebody in another state that's sitting behind a desk that doesn't, hasn't been in the field. Like it's just, there's something to be said, and I learned this when I worked in a restaurant business through college. It's something to be said from somebody who's filled the position to make decisions versus somebody who went to school to make the decisions and has no experience in the field.

Yeah. I think that's been the better part of owning my own practice is, making decisions that I need to right on the spot. And yeah. And that way I'm also not driven by, Hey, you have to see 18 people a day. I can set that cap as I want to, and, if the cap's wrong, then it's on me.

I, the whole onus is right, staring right in front of me in the mirror. So

Danny: you like the fact that. For better or worse, it's on you.

Justin: Yeah. If I'm gonna fail I wanna fail on my terms. Yeah. Not cause of somebody else.

Danny: Yeah. Oh I completely agree, man. I feel the same way. And it's but that's hard for [00:42:00] people to do, I think, for a lot of people, having enough self-awareness and humility to, to also know certain things that they don't know, and be able to seek those things out.

And obviously, you've gotten to a point where, we're able to work with you on the business and for me, it took me. A lot of pain before I gotta, the point before I started working with people to help me on the business side, I just assumed I would just figure it out. Even though I, looking back, it's so silly though.

Cause it's like I didn't teach myself how to treat patients. I had I had professors and I had mentors and I went to tons of Con Ed courses and I remember like when it clicked for me, I go. What an idiot. Why weren't I doing, it's like, it was just, I just wanted this feeling that it was self-made all.

So I was like, I didn't want anybody to tell me like the right way to do this. I'm gonna figure it out on my own and then I'm gonna have all this, I'm gonna tell myself how hard it was and that I accomplished it and it's so dumb. And to just, to, just to be able to like work with other clinicians that have businesses like this, like it's so helpful.

So I'm interested for you, small town hybrid practice. The, with the mastermind, with the, couple hundred people we work with now you get to meet quite a few 'em in Atlanta. What has been the most helpful part of [00:43:00] that, for you with your business? I would say

Justin: like the hardest part of being at private practice where I'm at is that you don't have very many friends.

Sure. Like you don't have any people to collaborate with. And being a part of the Mastermind, even though it's through Zoom or through phone calls or messaging and everything else, like you're part of a team and you're pulling through to each other and it's Hey, this works at a similar practice.

Hey, let's implement it here and see. I didn't think about that. Let's try that. Yeah. That you miss when it comes to being a part of a bigger company and stuff where you can, you have 20 other clinic directors to work with. It's hey, you're by yourself in your area and reaching out and being a part of the mastermind to let you know you're not alone.

You have, people have similar struggles and ideas and if something worked for them, heck, you didn't think about it. Let's try it. And I feel like that's been a bigger part of the whole thing. And knowing that, you ca there is light at the end of the tunnel when it comes to struggles and stuff like that.

And yeah, having other people like Danny and everyone else is just works

Danny: out [00:44:00] really well. Yeah. Dude, entrepreneurship is lonely. Nobody tells you that shit. I got, because I remember the first year that we actually were doing we were starting to do really well and. I'd probably doubled my income from whenever I was in the Army, like my annual income.

And I remember I remember thinking, I was like, who the hell am I gonna tell this to? Like I this is a big deal. Like it's the business is working and I remember I was having a conversation with my brother who is not, he's in the healthcare, in landscape, like he is in emergency medicine, but he doesn't run a business.

He works for a big hospital. And I remember one year telling him like what our business's revenue was. And now every time we go anywhere I have to buy, I have to buy the meal. He's Hey, it's on you. And and it's I just wanted to celebrate all the hard work we've put in.

And the byproduct of that is impact and its value create to other people. And that comes back to you as well. So it can be hard, man, because it's hard to, you can't tell your employees if shit, it's going bad because, They're gonna think they need to go find another job and you can't tell 'em when things are going awesome either [00:45:00] necessarily.

And you can't tell your friends and your family. You can really only express some of this stuff with other entrepreneurs, and especially in the clinical world, it's, it's a little harder because we also gotta get people better, right? So it's what I always appreciate when we go to, when we have our mastermind events is you, I walk around and I'm hearing like conversations where somebody's talking about, some service they're adding or whatever.

And I walk 10 steps further and somebody's talking about like how they're progressing a c l patients back to like lacrosse or something like that. And, it's just all in the same room. It's all the same stuff. It's just so similar. So it's always fun, man. And it's cool to, to be able to dig into your story a little bit more.

Where can people reach out if they're interested in learning more, dude, if somebody's listening to this and they're like, man, it sounds like an awesome guy to work for. I wanna be the next tank. I wanna work on the performance side. Like where do they go to learn more?

Justin: Facebook and Instagram.

Man, that's the easiest thing. Websites under reconstruction right now, so Yeah. It's getting revamped and everything else, but Facebook and Instagram are the obvious two things or just. Walk into the clinic, you'll be greeted with a hello and what the crap do you want to do with us?

Danny: Justin man, I appreciate it dude.

[00:46:00] Thanks for being so honest about the practice sharing your story. This was great. It's great getting a chance to connect and learn a little bit more about you in particular. But dude, thank you so much for your time. And as always, guys, thanks for listening to the podcast. Thanks for watching if you're in the Facebook group and we'll catch you next time.

Yes, sir. Thank you.

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