The Practice of Therapy

Gordon: Well, hello everyone and welcome again to the podcast, and I'm so glad for you get to know today TaVona Denise. Welcome, TaVona. I'm glad you're here.
TaVona: I'm excited to be here, Gordon.
Gordon: Yes. And TaVona is, uh, has done some incredible work with a report that she's gonna talk about private practice and vitality and that sort of thing.
But TaVona, as a start with everybody, tell folks a little bit more about yourself and w- how you've landed where you've landed.
TaVona: Oh, yeah. So I'm a therapist too, but one of a different variety. I'm a physical therapist by training, and I went up the ranks to clinic director, and then there was an incident, and I decided that I wanted to work for myself so that nobody would ever tell me when I could take off.
And I became a contractor. I started a contracting company, which I ran for 13 years before I went into consulting. And so that's what I do today. Because of my background as a clinic director and running that large facility, I really help practice owners with the performance and efficiency of their business.
Gordon: And I think you've, uh... A- and I'm, I'm really curious, uh, with the report you developed, how did that come about and how did you get started on that?
TaVona: Oh, my goodness. So I, like many of you, have gone to private practice conferences, and this time I was at one for the American Physical Therapy Association.
And they were complaining and commiserating over some issues that they were struggling with, and what struck me was that these were the same things they were complaining about six years ago, the last time I had attended this particular conference that was for private practice owners. And so because I do so much work across disciplines, I work with h- mental health therapists, I work with physical therapists, chiropractors, functional medicine, et cetera, I realized that the p- part of the problem was that we were in a silo, and we were talking to other physical therapists about the problems that we were having as practice owners.
And while that's helpful, I think, when we're talking about patient care, it's not always as helpful when we're talking about running a practice, because there are certain things that you all do in mental health that we could learn over in the physical therapy realm, and that maybe dentists do that chiropractors could benefit from, and thus and so forth.
And so as I kept hearing these same complaints, I thought, "What if I asked all these different disciplines about their practices, ask them the same questions, listen to their answers, listen for patterns, and see what we can learn from each other?" And sometimes what we can learn is just we're all going through the same thing, so you can calm down.
Gordon: Yeah. It's, uh... Yeah, and as long as I've been consulting, it's a lot of the same... yeah, a lot of the same issues that we all deal with, and just, uh, even though we're providing maybe different services, but they're d- they're not that dissimilar as far as the, you know, the type of things that we're doing.
So yeah, so big question: What did you find out? What did you learn?
TaVona: Well, I'll, we'll, we'll cut to the chase and give you all- Yeah ... the big finding- Yeah. Yeah ... uh, save you reading 28 pages.
Gordon: All right. Right. I
TaVona: worked very hard on, by the way. Um- Right ... but the biggest thing that I learned was that 79% of the practice owners that I surveyed in the study experienced some level of disruption to their practice when the owner stepped away.
And the even more surprising than that was that 68%, over two-thirds of them, already had staff in place. And I think that one surprised me, but I think it's important to note because so often we think, "Okay, if I'm burned out, or if I'm ov- overwhelmed, or if I'm stressed out as a solo operator, then I just need to hire more staff."
And what we found, even up to owners that had practices over 2 million in rev- annual revenue, is that more staff didn't necessarily solve the problem, as well as more time in practice because there were certain, um, practice owners that had been in business over a decade and also more revenue.
Because like I just mentioned, over 2 million in revenue and they sometimes were still, um, experiencing some level of disruption when the owner stepped away.
Gordon: Right. And what, what did you find that were, were the, kind of the contributing factors to the disruptions? And I, I guess too maybe curious about what ty- when you say disruptions, what are those that you found?
TaVona: Yeah. Well, really what we found, um, in the answers is we looked at it in two angles. Either we're talking about a disruption to financial, so revenue goes down significantly, or we're talking to a disruption in the operation, so maybe patient care goes down, the quality of care goes down. I saw many of the, especially the higher ups, higher revenue with team members, they're like, "It...
The, the team doesn't drive as hard when I'm not there." They're just like, "Oh, I'll just wait till he gets back or till she gets back, till the owner gets back." Mm-hmm. And so what I found was a couple of things under there is there's a cultural, um, difference that drives things so that the, even if you have SOPs, standard operating procedures, in place, you may have those in place, but your staff without the culture may not carry those out if you're not there- Mm-hmm
to reinforce. Uh- Mm-hmm ... structure was a big thing. If they didn't have the structure in place, you might have high revenue, but that would significantly fluctuate, fluctuate or there would be a disruption to it when the owner wasn't there to drive said revenue. Mm-hmm. And so I think one way I wanna talk about is for the practice owners that did not experience disruption, they had three things in common.
Gordon: Okay.
TaVona: One was their operational independence. Things could move without them. Decisions were able to be made without, "Let me just call the boss," or, "Let me just ask the boss how they want it to be done." The, they had the structural advantage. They, what made the business work was not tied directly to the owner being in the treatment room or working with the patients, right?
None of the nine practices that were classified as smoothly running depended on the owner's skill or the owner's specialty as their primary competitive advantage. And then the third thing that these specific practices had in common was payer diversification, and I know you've talked about that some in your- Mm-hmm
in your podcast, that when you start out in your practice, you have to decide, are you going to be private pay? Are you going to take insurance? Are you gonna be a mix or a hybrid? And so one of the- Mm-hmm ... things that we noticed, even if they weren't mixing or diversifying their payment sources that way, they had more than one stream of revenue or they had more- Mm-hmm
than one payer.
Gordon: Yeah. And so, yeah, and there's, uh, the, it sounds like that was mainly with what, physical therapy practices? Or would, did you find it in, you know, health practitioner- That was across the
TaVona: board. I,
Gordon: I- Yeah, yeah ...
TaVona: I looked at seven disciplines. Okay. So we're talking about mental health professionals, physical therapists, chiropractors- Mm
functional medicine.
Oh, physicians. Ooh, I'm missing a couple. Nurses. There's one that I'm missing. They're gonna kill
Gordon: me. Dentists.
TaVona: Natural medicine, I think. Dentists. Mm. Thank you.
Gordon: I was like, "Oh my
TaVona: gosh." Yeah, yeah. The dentist.
Gordon: Yeah, yeah. Yeah. And there's so mu- there, there is so much similarity with, with the way practices are run in that way, and that's, that's interesting what you found is that the owner being able to step away and things continuing to run.
I'm reminded of, um, there's a book by Mike Michalowicz called, uh, Clockwork.
TaVona: Clockwork.
Gordon: And that's exactly what he talks about in that book is how do you set up your practice or your business so that it is not owner-dependent. And it sounds like maybe, I'm guessing here, is that, that the owner's ability to empower people in their practice is, sounds like that might be key.
So what did you find as far as that get, you know, to get those factors going? What, what needed to happen?
TaVona: Well, we didn't study... What we were trying to figure out is what is happening in the practices. Mm-hmm. So I didn't study h- the how out of that per se, other than to note what the practices that were running smoothly without the owner and operator, and which I listed just a moment ago.
Mm-hmm. But I did, I distinctly remember asking one of the practice owners who had a smoothly running practice how did they get that, because I think a lot of us who love being a clinician, love working with patients, we get stuck in what I identified in the, the report as the identity trap. And part of that is where our skill as the clinician is the primary competitive advantage And the problem with that is among the 12 practices that listed the owner's clinical skill as a primary advantage, those were the ones that were trapped.
They couldn't- Hmm ... get out. And it makes sense, right? Because if we've built a practice on our clinical skill, our clinical excellence, and the patients get well, and they tell all their friends and family about us, and that's what's driving referrals, then we think that it's our magical, in our case, magical hands, in your case- Mm-hmm
the magical ability to talk to the patient. But we think that's the magic in the practice, and that traps us. And so what this particular person did, and he did it kicking and screaming, actually, uh, got ill and- Mm-hmm ... found himself in the hospital. Wow. And then he was in a crossroads, "What do I do?"
Because for a long time, he had trouble getting his patients that would come in the door to see somebody else in his practice- Mm-hmm ... who were just as qualified, just as capable, otherwise he wouldn't have hired them, right?
Gordon: Mm-hmm.
TaVona: But there was this perception in the patients' minds that, "I have to see you because you have the magic."
And so what he did, and this is... I haven't studied this further, but I thought it was brilliant so I'd share it with the audience- Mm-hmm ... is that what he had to do is really think about his own framework, his own process for treating patients, and how he was able to get the results that he was getting so that he could teach that to his other therapists, so that everyone- Mm-hmm
of course, could put their own little flair on it, but they had the general framework that helped- Right ... them get results. So then he was able to transfer that trust to his other therapists, and then also articulate it and sell the patients on the fact that it's the framework. I'm not this special snowflake.
Mm-hmm. That these other people are highly qualified, and they can give you just as much care, and they can help you get the same result, and here's how we do that.
Gordon: Yeah. And that's a... I would think, too I don't know if this is true for other disciplines, uh, but I know in the mental health field, having something that's very niche specific helps a lot, and having a diversity of people that, that work with different niches.
So I think about, I've got a small practice. Um, I've got five clinicians that work for me, but each one of them is kind of specialized in different populations that they work with. You know, whether it's children or got one person that specializes in EMDR, another person that specializes in working with young adults, and yeah, and then another person that specializes in working with older adults.
And so it's, it's... I think that is what attracts people because- I think about the people that are, they're contacting us, they're asking for those specific therapists rather than me as the owner, which is-
TaVona: 100%. Yeah. And I think that's a, a great way to diversify, right? So you think about two ways. We do this in physical therapy as, as well.
I worked in a general clinic- Mm-hmm ... so we could have someone that has a stroke, so that's neuro coming through, and we could have someone that had a sports injury, so that's orthopedics coming through. And then we could have somebody with a hand injury. So we have specialists as well. Um, in the, the instance that I shared with you, he had a specialty clinic where they saw tennis players.
Mm-hmm. And so that's another way. So either you're niching down where your clinic specializes in something, or like you said, you diversify so there are other people taking diagnoses or populations off of your plate. 100%.
Gordon: Right. Yeah. So it, with, uh, with what you've learned so far, what kind of, uh- What are some of the main factors that help owners pull themselves out of the picture so that they can let their staff do their job?
And you'd mentioned earlier, and I think this is an important topic to to hit on, is culture and the culture within the practice. You wanna say more about that?
TaVona: Yeah. I mean, I think it's one thing. So let me go back and give everyone a place to start. So if you find yourself nodding your head to some of the things that we're talking about and you're like, "Yeah, this thing really does depend on me.
It runs through me. Everything's about me. It's my name on the door, so why not?" Right? Mm-hmm. How do I start to walk myself back from this? And the very simple question that I like to ask anybody who is in that situation is the 30-day question. So if you had to step away from your practice for 30 days tomorrow with no notice, you have no Wi-Fi, no cell- cellphone, no way to contact the office, what would keep running smoothly in your business and what might fall apart?
And literally write down everything on- as the answers to those question. What would keep running smoothly as the list, and what might fall apart? And that will help you see in black and white some things that need to be addressed in your practice, okay? So that's the first thing. You have to, you have to really think about this.
I was talking to a group the other day, and one of the therapists has a partner, and she said, "Well, I didn't even think about it." There are many things. She runs, she does the books. The partner doesn't do the books. So there are many things that she does that her partner is not even aware of- ... that she does on a daily basis.
So I think it's really important for us to get out of our head and onto paper or the computer what we're responsible for. And then that way we can also kind of look at do I need to be doing this, or is there somebody- Right ... better suited, or can I cross-train somebody to do this so that, one, they're aware of what's happening behind the scenes, and two, somebody else knows how to do it should something need to be picked up," right?
Mm-hmm. So awareness, then really looking at what, what can be delegated. Also, that list tells you what might need to be eliminated. I love that too. Sometimes we're delegating- Mm-hmm ... stuff that doesn't even need to be done. Right. Okay? So taking that off. Um, and then back to your question about culture. Once you've done that exercise and you've created some standards around it, some standard operating procedures and how you want it to be done, 'cause I think that's another reason when we talk about culture, why people are not...
They hire, but they're not able to let things go, or they hire and they feel like now they're doing even more work babysitting adults, is because we have a standard of how we want things done. And it's in our head, but nobody else knows what that standard is.
And so when we take the time to figure out, okay, these are the things that need to be done in the practice, this is the standard for doing it, then you can also give people the creative freedom.
I don't care how you get to this standard, as long as you get there. Mm-hmm. And so I think that's another piece of it, is sometimes we want people to do it the way that we do it, as opposed to saying, "This is our standard of care," or, "This is our standard of of practice." Mm-hmm. And y- you get to do it how you, how you see fit, as long as you hit that standard.
And I think when we empower our staff, our team to Be creative. I think they step up on, step up to the plate, and they'll surprise us.
Gordon: Mm-hmm, mm-hmm.
TaVona: And I think sometimes we think accountability sometimes turns into this micromanagement, and I would flip that and say, let's set the bar and let them rise to it.
Gordon: Yeah. Yeah. I would agree with all of that because I think, um, what happens is that i- i- and I think practice owners in general are really have, have a hard time letting go of things th- that they've done. Maybe they started as a solo practice, and so they did it all. And then as they grow and have more of the different pieces, particularly having employees or contractors or whatever working for them it's really hard, I think, a lot of times to learn the, the skill of outsourcing and letting go of things.
Because one, one example that comes to mind is, and this is a big one that in doing consulting with people, is, um, moving away from answering the phone. I think a lot of times the, the owner feels like, "Oh, well, nobody can do it as well as I can." And I like to reframe that and say nobody will do it like you do it, but it doesn't necessarily mean better."
And ma- as a matter of fact, probably if you let somebody else take that over, they might even do it better than what you think you're doing it. And I know I learned that in my practice, um, a fe- several years ago with my intake coordinator. I just let her handle it, and I t- told her, "You just, like you said, here's the standard, here's the goal.
I don't care how you get there, but this is what we want in the end." Yeah.
TaVona: And I 100% agree. And when we think about really creating a culture where people feel valued, they feel like they have something that they can own. I think a lot of times, uh, practice owners come to me and they say everybody doesn't drive it as hard.
They don't care much, as much about it as I do." And, and I mean, if we're just being honest, it's true, because you have more at stake. They don't have the entrepreneurial spirit and things like that. However, comma, I think that people can take ownership over their job if we allow them to. Mm-hmm. And so when we think about culture and what you said in terms of sometimes they can do it better than you, I think part of culture and is it starts in the hiring process and understanding your strengths- Understanding your opportunities or weaknesses, however you wanna look at them- and hiring to fill them. Sometimes when we started doing everything by ourselves, we f- we feel like we have to learn everything, learn how to do everything, and I think that is a recipe for resentment in business and burnout. Mm-hmm. And so if and when you have the opportunity to bring on a teammate, really look at, not just look at the lists that we just talked about, but also look at your strengths.
Look at the things that really light you up in your business, and see can you hire someone with a, a different personality. Mm-hmm. Because that might be the person that's the best to answer the telephone, so.
Gordon: Yeah. T- yeah, totally agree with that, because it's, um, we get in our heads that, that there's a, a certain way to do it and a certain standard that we wanna keep, and I think that's important to keep.
But I was trying to remember, and I don't- I'll have to go back and research it, but there was some research done about, you know, what makes for a good culture within any business, and what you just said is really the key to it. People don't work for a paycheck. They work for knowing that they're making a difference or that they're contributing in some way to what is happening.
And so if you can create a culture to where they feel like, "Okay, this business or this practice can't operate without me," then you're getting into the, getting into the right ballpark with creating a good culture.
TaVona: Yeah. I love that. I mean, 'cause I think I haven't gone to staff meetings in many, many years, but I remember some of my colleagues when I was working at the hospital, they would come after the staff meeting, and one of the biggest complaints when I was doing burnout coaching was, "The manager doesn't listen to my ideas."
I mean, it was, like, the number one complaint, and it speaks to what you just said. People, of course, want to feel seen, want to feel heard, and the people in, in your organization want to feel like the work that they're doing matters. It w- that, like, they're making a difference, like their ideas matter.
And so- Mm-hmm ... I think if we can keep that in mind, we will create a culture and we will create a organization that people don't ever wanna leave. They want- Mm-hmm ... they want you to succeed. They will come to you with ideas that you couldn't even think of that may make your, your business so much better because of their lived experience, their perspective, the things that they encounter and do every day.
Gordon: Well, Tavona, I know we've gotta be mindful of our time, but I know you've created some tools for people, and you've also got the report available that you created. Do you want to tell folks about that?
TaVona: Yeah. Well, the main thing in terms of tools which are within the report, the Private Practice Vitality report- is the vitality matrix.
And so that's where you'll be able to go in with a simple two questions and score yourself and figure out where you are in the matrix in the quadrants that arise arose from the research. So you'll be able to figure out are you in what we categorize as the hidden practice? Are you in the clinical trap?
Are you in, oh, the golden cage? And I'll explain that one a bit- Mm-hmm ... um, because that's- Mm-hmm ... a really popular one. Mm. And then the vital practice, which we're all trying to get to. So we, I already talked to you about the vital practice, but the golden cage- Mm-hmm ... is, is a quadrant that practice owners find themselves in where the, they have financial stability, they have demand for their practice, and it's all on them.
And so- Mm-hmm ... the money's good, the money's stable, but it still requires them to be there. And so if you download the report and you do the, the matrix, you'll figure out which of the four quadrants you're in, what that means for your practice, and then I- Mm ... I do help you with how do you start to move up amongst the quadrants.
Gordon: Yeah. And I believe you've got a special link for people that are listening to the podcast. Um-
TaVona: Yeah ... yeah. Made a special one so that we knew who came from- yeah, yeah ... from your crew. Yeah. Yeah. Yeah. So it's beyondpatientcare.com/practiceoftherapy.
Gordon: Yeah. And we'll have those links in the show notes in the show summary for people to find that easily.
So, TaVona, this has been great. I m- I appreciate your work and what you've done to help practice owners across all the different disciplines and, and that sort of thing. And if they wanna get in touch with you other than through that link, how else can they get in touch with you?
TaVona: Oh LinkedIn is a great place- Okay ... to find me.
Gordon: Okay.
TaVona: Yeah.
Gordon: Okay. And it's just- And we'll
TaVona: have- ... TaVona Denise on LinkedIn.
Gordon: Oh, okay. All right. Well, TaVona thanks again for being on the podcast, and well, uh, hopefully we'll have another conversation here soon.