Changing the Culture & Guest Experience in PT with Scott Marcaccio | CashPT Lunch Hour #104

Hello. Welcome back to the Cash PTO lunch hour podcast. Today I have another special guest, Scott Marchaccio from myodetox. He's another Canadian on the show and we're gonna talk about how they're taking over the United States with their brand of physiotherapy. So, Scott, welcome to the show and it's a pleasure, pleasure to have you here.

I appreciate the invite.

Yeah, man, it was great to meet you at Accelerate Live in Toronto earlier this year in the spring. I've been following you, you guys. And Vin, I think I first heard about you when I had Jen Esker on the show a few years ago and she mentioned she was knew you guys was doing some work with you guys. So you guys are killing it.

Thank you, man, I appreciate it.

Yeah, fun to work in every day

and see where it goes, right?

You do, huh? I mean, you ever take a day off?

I mean, we're getting there. I'm trying to. It's interesting, like the first three, four years you're just so head down and like going. And you realize like as the team grows, like to balance things out, you need to be balancing out that vacation time. Yeah.

Oh, totally. But it's almost. It's not really a balance really, is it? It's kind of like a work life mesh or marriage or something. You just, you put it in there and you get it right. But it's. There's no balance, is there? No.

I mean, I was talking. We just hired a pretty senior guy onto our corporate team and one things we talked about yesterday, which is how, you know, I don't think I've ever felt like this is a job. I basically get to like wake up every day and work with my best friends and try to figure out how we can shift the industry and, you know, it's pretty easy to put in there, you know, 14 hour days and feels like we can go for a while.

Yeah. So it's not really work. It's like passion.

Totally, totally passionate. It's just, you know, I think the fun comes from like trying to solve complex problems which say the healthcare system is a very complex problem right now.

Yeah. That's awesome. So what are the big problems you guys are trying to solve?

So a few things. I think there's two main issues we see in the industry right now. One is the physical therapy industry is extremely unfriendly to therapists. And if we look at the average turnover rates, most pts leave the profession within 10 or 11 years. You think of coming out of school with you know, 150, 200k of debt, expecting this is going to be kind of your profession. And most therapists get so burned out and so kind of turned off from the industry by year 10 that they opt out and raise their hand and say, I'm out of here. And that, to us, is a huge opportunity to fix. So we think a lot about career longevity and how do you. How do you coach a new grad into becoming a, you know, incredible therapist and then move into an incredible manager and then potentially into clinic ownership down the road and give them a very clear career path. So that's like, big problem number one, we wake up thinking about. And then number two is how few people understand the real benefits of pt and not from the reactive, blew my back out side of things, but, like, starting to come in for regular preventive care. And I think it's been very interesting coming down to the US and learning a lot about the direct access limitations and seeing in certain ways how progressive places like Canada and Australia are looking at PT as the first point of defense for pain. So it's a really interesting problem to wake up and think about. Like, how do you shift both the consumer behavior around their thinking around that, and also some of the medical lobbying roles?

Yeah. Wow, that's awesome. So is it kind of like, here's one thing that I've been thinking about lately is like, not everyone's cut out to be an entrepreneur, right? But a lot of people get their back against the wall and they're either gonna leave the profession or build a job for themselves. And some people don't succeed. And I'm like, well, why shouldn't we also think about creating great jobs for people where they don't feel pressured and they have this longevity and they can have a great career. Is that kind of the same sentiment that you guys are going on?

Yeah, 100%. I think, you know, you've been business under long enough. It's just there's a very particular personality type and person that likes the kind of the battle, the daily battles of entrepreneurship. And there's a whole host of people that aren't like that, but are ambitious and want to develop and want to have more from their careers. And I think one of the biggest challenges in this space is that it's extremely fragmented and it's a lot of single clinic owners that as therapists go through school, they don't get great business training, and yet all of a sudden they're opening a business and it's a very entrepreneurial small business. Type environment. So the incentive structure and the training framework along the way kind of sets everyone up to fail. And that's one thing that we're thinking a lot about is how do we empower the industry. And I think you've done a great job of just trying to give great business training and give pull together voices that have done this before. But that's. I totally agree with you. It's just not everyone's ready for that entrepreneurship journey. Especially when you're coming up with so much school debt and you get to a point in year six, year seven, year eight, you might start having kids, grabbing a mortgage. And there's a lot of factors stacked against people becoming entrepreneurs. So we see there's some solutions to that. But it takes time and effort to shift the system.

It totally does. So I want to go back and talk about how did you get into this? Because you're not a pt, but you're one of the most successful and like you guys have one of the fastest growing multi like clinic businesses coming in the US and you guys have a great, I mean a great presence on social media, et cetera, but you're not a pt. So like, what's the story? Like when you got out of university, you obviously did something else. How'd you get into working with Myo Detox?

Yeah, yeah. I think a lot of people always surprised that I'm not a pt, but in my early days I was personal training, managing gyms. I just really loved health and biology and anatomy and I did that all through university. And when I left university it felt like I kind of accomplished everything I'd wanted to in the fitness space. So I ended up really wanting to learn business and I ended up getting a very random job with a Hong Kong company and got to move over to Europe. And I was doing like economic reporting in Europe. And then from there I got a job with a European telecom company dealing with fiber optics and wireless infrastructure and stuff completely unrelated to healthcare. But my hobby at the time was Olympic weightlifting and I was really pushing myself. I was also flying back and forth from Europe to Canada a lot. I was just in bad position. Sleep deprivation, not great hydration. I ended up having a pretty bad injury within one of my training sessions, which led to about two years of chronic back pain. So my QL was constantly lit up and like sciatic nerve pain, everything. And thus began a I. Prior to that I was already seeing therapists fairly regularly because I really believed in the power of like preventive care. But at that time, then it Was like, damn, we gotta, we got to fix this. And I started really redoubling my efforts to find somebody that could get me out of pain. And I did everything from Cairo to massage to PT to yoga classes, to every kind of modality under the sun. And I just. Nothing clicked. And I was still kind of stuck in this pain. Sometimes it would go away for a bit, but it just kept coming back. And then a couple of years into that pain, I had a mutual friend of mine who saw Vin, my now business partner, and said, you've got to see this guy. He's the best therapist in Toronto. You know, let me, let me connect to him. Cool. So he text connects us at midnight and Vin responds at midnight, right away via text. And I'm like, oh, this is, this is not how I've communicated with my other therapist. And, you know, I go in the next day for a session with him and, you know, he shows up to the session wearing a backwards hat and Jordan flip flops and, you know, know, proceeded to give me the best session of my life. And I started coming back to him regularly, every single week, just paying cash because I really was such a fan of what he was doing. And within three or four sessions, I was completely out of pain, moving a lot better. And what just struck me is how he met me at my level. Every therapist that I'd been before, it was kind of like, they're the authority and I'm like the useless patient that showed up to just get the services. But there was just like this human element when he met me and like really understood, like, hey, like, what's, what's going on with this pain? What's it stopping you from so much a lot of your approach, we did it in just such a casual, empathetic way and him and I just hit it off immediately. And when you meet Vin, he's an incredible therapist and marketer, but on the organization side seems to lack a few points there. So I ended up coming on after a few months and said, hey, let me. At the time I was genuinely interested in business and I liked looking at other businesses. So I said, let me help you on some of the op stuff. I just, you know, give me free sessions. You know, I love this. I'm going to keep coming every single week. I'm paying, you know, every single week for it. So why don't we just trade? And that's how we started. And at the time it was him and one other therapist we had no intentions to scale. The first clinic was a two bedroom Condo above a barber shop in Toronto. And you actually had to walk up through the barbershop to get to the clinic. And it was like, I don't know, $2,000 a month in rent. And that was that. And Vin, you know, Vin, at the time, his mindset was he just wanted to educate the world and really try to change the conversation around PT and why you should be getting it on a regular basis and keeping your body in the best shape possible versus waiting for it to deteriorate. And that's. That's how it started. And he started putting out a lot of content on Instagram. When I met him, he had about 2,000 followers on Instagram, and today he's got about 600,000. So it's really been the impetus of how we were able to grow. It created a lot of brand awareness and demand early. And in the early days, we just had no real vision for where this could be. But it was just wake up every day and go and spread the message, and the snowball started rolling. And it really feels in the last 18 months, as we've. We've got some incredible senior leaders from the industry, like, other than myself, our entire executive team is therapists, physiotherapists. And that's. That's something that has been really important as we've grown, to just keep that sense of authenticity and, and making sure that we're. We're true to the values that got us here and which is that we want to heal the world. And, yeah, people go into the profession to be great healers and take care of people and not necessarily become business people. And along the way, we've had to kind of strike that balance between being a great business and really sticking to our values. But that's. That's how it started. And it's a little bit of a blur. That was about four and a half years ago.

Wow, that's amazing. So was it just, like, casual for a little bit, and then you guys said, okay, let's like, officially become business partners? Like, how did that conversation.

Yeah, it was about two. Two months after working together. It just felt like this thing all of a sudden was going to become a thing. And we sat down and over a couple conversations, kind of hammered out what that would look like. Him kind of handling all marketing and technical education and me just handling all the business side of things. And then we went. And something that has been the biggest blessing, I think, in this business partnership is we have completely opposite skill sets, strengths, weaknesses. He's this, like, incredible creative, very Visionary. Very. You know, anyone spending an hour with Ben will come away knowing where my hooks is going and super excited to help with that. And then for me, it's been more about, like, the tactical execution. Just making sure, like, there's a real strategy behind the vision and making sure, like, every day we're waking up and we're, you know, making tangible progress towards that goal. Mm, yeah.

Wow. So he's. He's the creative. Like, just blow everything up and you come around, you're like, hey, let's organize this. Is that general organized chaos?

Organized chaos.

That's how we work. That's awesome. And then. And then how long. So at the time, he had himself and was another therapist working with him or. And then you. And he already had myodox as a business. You came in and then what happened next? How'd you guys, like, what was the kind of path to scaling into the next location? Because I may not have mentioned this on the podcast, but you guys have what, four locations in Toronto, handful in Vancouver,

one in LA. So I think we're at 11ish right now. And then by the end of next year, we're targeting to be at like, 17 or 18. Yeah, but it was really, you know, when we started, it was actually our first clinic was called Movement Clinic, and then Vin had kind of created his own manual therapy and corrective exercise programming approach, and that was really his approach to healing. And at the time, the term myodox was blowing up on social media. So a few months after we started our partnership, I went to trademark Movement Clinic and also trademark my Detox. And I realized that one of our competitors had trademarked Movement Clinic, like two months before I had gone to do it.

Oh, wow.

This, like, wave of depression because I was like, oh, no, like, our clinic name is gone. And then after a couple days, then I were kind of looking at each other, how do we solve this? And we're like, you know what, let's just. Let's just call the whole company my Detox. Because it was catching on social media and it seemed like it was sticky. And there was like a sense of curiosity, like, oh, what is that? And that seems like actually drawing people in. So we're like, all right, cool, let's roll with that. And then going to the second location. As the brand started build in Toronto, we had a local gym reach out to us really wanting. It was an obstacle course racing gym back in 2015, and really wanted our therapist there to support their membership base. So we kind of played around with terms for six weeks and didn't feel right to me. So we're like, we walked away and then they came back and said, we'll pay for your entire build out. Let's like, do the thing. And we're like, cool, like two locations. Let's do it. But at the time, the first location was like three of us or four of us. And it was just, you know, it felt like the next logical step. And even if we knew, like, that location wasn't going to be like the most profitable one, in my mind, I thought about it like, this is going to be helpful to like, really force me to think at multiple locations. And that's important when you start thinking about business systems and how you're implementing that in the business. So very early, we were already thinking about, like, cool, this works at one location, does it work at two? Does it work at three? Our third location was a partnership with a guy that already had an existing clinic that we ended up coming in and acquiring because we wanted him to lead our education team, which in the long run it turned, you know, that didn't work out. And we wound that relationship down. But just a lot of learning. And it started with, what's the next logical step?

Right.

What's the next logical step to either, you know, build the team and get unique talent on the team or continue to build a brand and, you know, allow people to access the product. And then as things have accelerated, we've gotten a much better vision for, like, what our clinic size is, what the build out is, like, starting to really standardize on these. But in the early days, it's, you know, you're just flailing all over trying to figure out what sticks and what does this business become when it grows up, Right.

What was the number one thing that you guys, like, didn't do or didn't do right in going into, like, location two or three? Like, as you started to scale, what was the thing that you would go back and like, change or do?

Million things. But the first piece of advice for anyone is like, box within a box opportunities. Like, if you're putting a clinic within a gym or someone else's business, it feels very easy, but there's so many kind of cascading consequences of that one. You're never going to be able to maximize the box from like a unit economic standpoint because you're just lost within the four walls of someone else's business. To your customer, experience is always going to be subpar because you're kind of fighting how the other business runs their business. And three, like, we just didn't understand our unit economics. Right. Why are we opening a box this size? Why are we picking that location? Why are we using, you know, two tables versus six tables? And I think over time, what we've really gotten good at is understanding, you know, shift utilization and therapist coverage and, you know, what sort of volume we need to be driving the profitability in order to afford the real estate that we can afford. So it was more just. It was more mistakes out of, like, not understanding the business. And then number two, is just being a little too opportunistic and saying yes to everything because it's exciting. And we've really had to switch the dial of, like, saying no to most things, because as the business grows, you start having much more clear vision of, like, what fits within the core business and what's a distraction. And in the early days, you don't. You don't have any reference points to understand what is a distraction because you're still trying to figure it out. So all of, all of those were essential learning steps for us. But going back, knowing what we know now, like, I would. I would have done it much differently.

Yeah, it's, you know, and part of it is you almost have to go out and test it a little bit and see, like, is this going to work? I mean, I mean, otherwise we're playing it too safe. So, you know, how do you mix those things?

So, you know, I had a call with a physio from UK yesterday, and he was asking my advice. He's got one location and he's figuring out if he's going to the second or third. We decided in 2016 that, like, this was going to be a thing and we're going to try to scale it. And it was at that time when you. You can start taking more risks. I think there's like, this line that you cross, and you're either going to be one clinic and you're going to crush it and focus all your efforts on that, or you're going to try to push and be that four or five, six clinics. Because to me, like, the two to three clinic zone is like no man's land. A lot of clinic owners will make less money running two or three clinics, way more headaches, way more admin, way more people issues, et cetera. And I think, you know, it was really in 2016, we made the decision and, like, let's see if we can get this thing to 10 locations. And we had no idea how the heck we were going to do it. But it was just at the time the mental decision to say you're going to go there. I think it starts to really change your decision making process and like your framework for how you think about the business. And I think you can take more risk. Like if you know this is going to be a testing phase, you take a little bit of the pressure off getting it right every single location versus if you're on one location, like, you want to be very thoughtful around any changes because that's going to be your kind of loyal clientele forever. So it just, I think the biggest piece of advice I have for a lot of clinic owners out there is like really clearly decide what game you're playing, right? Are you playing the. There's kind of three phases to this. First phase is are you creating a great job for yourself? Which, you know, maybe it's your clinic. You are kind of the, the number one therapist there. You're doing a lot of the billing, you're building the doctor relationships, you're really, you know, almost create a great job for yourself. Second phase is like, are you acting like a real owner where you can take time away from the business and the business continues to run with no negative impact? And that's a great goal for a lot of people, like doing that at one location. And then this next phase is like you're going to go to multiple locations. And this is a, this third phase is a very different game. And I think a lot of people have to gut check themselves before they go there.

Right. Is the key from going to stage two to multiple locations, is that making the decision and just hiring the right people or is it figure and is it almost creating a business that runs without you first and systemizing it and then, you know, replicating it multiple places, or is it something else?

There's both, I think, I think having good tolerance to if you can mentally handle a lot of moving parts, the systems don't have to be perfect before you go to number two, because you're gonna, you're gonna learn a lot. Like, especially I think a lot of people, I'm not sure if you've ever been in a gym and you're like spotting someone and it's like it's all you, it's all you. But really like if your hands are on their elbows or whatever. And I think a lot of clinic owners don't understand how much of an impact they have on their business when they are in the four walls all the time. Right. They're able to keep their eyes on stuff their Staff is behaving differently. They're able to correct stuff in the moment. It's just such a different game when you have to rely on your clinic directors and your managers. So I think that that becomes the core skill is like just having a lot of self awareness of like, is the business ready to scale? And a good test of that is like, can you go away for a month vacation and come back and the business has either continued to grow or at minimum it has, like, you know, stable. If you can't go away for a month without your business falling apart, don't go to a second location because you're not ready.

Yeah, yeah, that's a great point. That's awesome. So as you're growing your business, clearly you guys are hiring. And you mentioned earlier about creating better jobs for people. So can you talk about how you guys are bringing on people? Are you bringing on. And I know you're bringing on younger millennials. And now we're even almost like, what's the next beyond millennial generation? Gen Z. Gen Z. How are you guys bringing them on? Are you doing things different? And I don't even know, Scott, are you millennial? Are you like in the middle?

No, I'm millennial. I'm 80, I'm 30 years old right now.

Yeah. So I'm Gen X, but I'm just on the tail end of it, right? Yeah, like, I don't know. I mean, is there something, is there something different you guys are doing? How are you bringing people on, developing them? You know, what is that? What's the secret? You know, like, you know, I mean,

look, it's interesting watching older clinic owners trying to manage millennials, if you want to call that. But like, the truth about millennials is like, we just don't have a high tolerance for bullshit. And this is like the single biggest area that I just see, like everyone failing at. That's 20 years older trying to manage a group of 25 to 35 year olds. Just be transparent and be straight up. Like, even for us, we, one of, one of the things we really push is like, our staff knows what's going on in the business, both like the good and the bad. And we've got just over 200 people right now on the team. And it's like we're pretty open with like, oh, we have to deal with this, or, you know, we're having to go raise money or this is what's coming down the construction pipeline, or here's, you know, the new clinic directors that are coming up. And I Think over. Communicating is what really works well to kind of glue millennials in. Are you a Daniel Pink fan? Have you read any of his books?

No, I haven't.

I've heard, like, my number one book I'd always recommend for every single clinic owner or entrepreneur is drive until about the balancing internal versus external motivation. So the three factors he pulls out of, like, how people feel, like, excited about their job is like, everyone needs autonomy, mastery, and purpose, right? So autonomy is like, are you setting the course for your own career? And for us, when we bring staff on, we make it very clear that they can go down an education pathway, they can go down a community pathway, they can go down a clinic director pathway and really learn business skills. So they can kind of raise their hands and have the autonomy to say, like, yeah, actually, I love clinical education and I want to help support the company with more of that. Or, hey, I love going out to do community events and activations and, you know, supporting community health. Like, then that's the path they're going to go down. So that's kind of autonomy. Mastery is do they feel like they're constantly leveling up?

Right?

And that's. That's the biggest thing, I think, where a lot of if you're hiring new grads or millennials, like, they need mentorship, and that's both on the technical skills, which I think is like, every clinic needs to be pushing that, but also, like, there's this big piece around soft skills, and how do you actually develop and retain a caseload? So that's kind of like the base level of, I'll call it mastery training. And then beyond that becomes like, can you manage? Can you provide feedback? Can you have hard conversations? Do you understand what the levers of the business are? Right? How do you create a profitable clinic? How do you open a new clinic? All these things that as someone grows in the organization with us, they start getting exposed to more and more and more. And to me, that checks a box of mastery, where they feel like they're developing on an ongoing basis. And then the third piece is purpose, right? So we've got economy mastery, purpose. Purpose is do they get excited for what they're waking up for? And I think this is one of the challenges a lot of single clinic owners have is a lot of therapists feel like they're just making the clinic owner rich, and there's no path for them to become more than a physical therapist. And that's. That's the ceiling. That's one of the ceilings that drives a lot of therapists out of the profession within 10 years because there's nowhere for them to go. So that it's an incredible book drive by Daniel Pink. But those are the three takeaways of like, when you think about managing Millennials, if you're not checking all those three boxes, they're not going to stick around forever.

Yeah. So what do you guys do at Myo Detox to give people that feeling that you're listening to them? You know, their ideas aren't going, aren't falling on like deaf ears, which is, you know, number one thing. People say, I have all these great ideas, but they don't want to listen to me. I'm just making them rich and I can probably do it better myself. So, like, are there, are there certain things that you guys are doing? Whether it's systems or meetings or conversations

you're having with people, take that on. So that has to happen at every level of the business and it has to happen constantly. So our, at the clinic level, our clinic directors and our front of house manager, which are our guest experience manager, they're constantly just having those one on ones and kind of small group meetings and team meetings and that gets relayed up to the regional director. So we have a really good upstream flow of information. But we also want to make sure that every person in the company feels confident to reach out to leadership. And even if the company gets to a thousand people, we still want to maintain that. So a few things that we've done to try to push that is on Monday nights, we run all hands town halls. So myself and my COO, we jump on a Google Hangout for two hours, totally open. Anyone can jump on if it's five minutes, 30 minutes, whatever, come on and talk to us.

Right?

So give them an outlet. So that's number one. Number two is we're trying to be very thoughtful as like a leadership team to be in the clinics and not to overmine the clinic director because we want like, it's the clinic director's job to run that, that clinic. But for us it's like, let's get out for coffees, let's take team members out for lunches and dinners and like, just have human conversations, like what's working and what's not working well. And also continue to reinforce the vision of like, hey, this is why we're doing all this to get here, right? So it just, it has to happen on every level. And I think, you know, soliciting feedback is hard because sometimes you hear stuff and you're like, Damn. That was, like, totally out of the blue, or. It's hard to hear certain things, but that's the most important thing, I think, especially the millennials, is like, they need to feel heard, that they have a voice.

Yeah. Yeah. What's the best way to work on it? Yeah, like, what's the best way to keep that? I mean, I think what you. I mean is, here's the interesting thing is, like, sometimes I feel like my wife walks in the business and she gets a different story than I do, which is the same with our kids. You know, maybe it's my ears are open to different things, but, you know, what's the best way to keep the communication system open so that people do feel like they have a voice? Is it just like having these opportunities, or is there a way that you communicate this to your staff and employees like that they do have this ability.

So I think having the leadership aligned on messaging is so important. There's two things from a. I'll call it like a headquarters lens that we do. So we start the week every Monday morning with a meeting that I call our Align and cascade meeting. So in that meeting, we talk about called the 5 to 10 most important issues in the business right now that we're as a team, working to solve. And we get really aligned on the messaging and the action plan on that. And then part two is Cascade. Right. We finished that Monday morning meeting, and everyone burst into action. And it, you know, from the regional directors to the clinic directors, everyone knows what the focus areas are. And then on the Friday, we have a kind of a debrief call where, you know, the five or six kind of main leadership team gets together on a Google hangout, and we just talk about what worked, what didn't work, what are we hearing? So, for example, when you. When your wife walks in the clinic and hears a different story, the most important thing is that to understand is that certain people will vibe with her better than they vibe with you, vice versa. So there's just a certain level of vulnerability certain individuals will have with her. What's most important is you and her then getting all the dimensions of the story. She's going to be able to add some of the picture, you're going to be able to add some of the picture, and then together, you guys can figure out, oh, this is probably what's actually happening. And let's address this. And that comes down like, the better you know your team and the better you know your staff. One thing we've had a lot of fun with the Last few weeks is we have everyone, uh, There's a website, 16 Personalities Calm. We had everyone do this personality test. And it was so fascinating how on point, like every. Everyone's personality just like, oh, I totally see why they're. They're acting that way. Right, right. So the better you can understand the humans working for you and not just, oh, they're a physical therapist, the better you're gonna be able to communicate and manage.

Yeah. That's awesome. You know, that's funny because you were asking me before we started recording, like, what? One of the things I got out of this last weekend in working with Bedros and my mastermind, and one of the things that reminded me is that they said is he was talking about how they like three different people, a couple of the guests and Bedros were like, in our businesses, we're using those personality tests. And he's like, you see where you just have people on the wrong seat on the bus? You know, it's like sometimes you got the right people. You just need to move them around to different roles and responsibilities based on their perspective, personality, other, and so that they thrive.

Totally.

Yeah. Do you guys see that? I mean, you see that with your business and all the time.

And I think, you know what? One thing I've been really happy with in the business is we've been able to keep people very flexible. Like when we need to shift roles or shift roles and responsibilities, our team, there's no friction around that. And you know, it took a few years to like drive that into the culture. But it's really important because as the business evolves, there's different demands on it and it requires different personalities and different roles. So we have to be really, really thoughtful of, you know, at every level. Who's in, in that seat on the bus. Right.

Awesome. So. So those are, those are some awesome, like, management tips. Those are really great. I think, Scott, I wanted to ask a couple other questions. Slightly different topics and before we run out of time. So talk to me. Like, I know you guys are from Canada and there's the US and in Canada, I know health insurance works a little bit differently than here. How are you guys like collecting payments and dealing with it? And I know there's two different pieces, but are you guys working with like contracted with insurance companies here in the US or in Canada? And how's that working for you guys?

So Canada. Let's start with Canada first. Canada is a very straightforward insurance market. Typically employer driven. Everyone gets a bucket of benefits. I would estimate 70 to 80% of our business in Canada is insurance driven. Our clinic management software has a really easy integration with the insurance providers there. So that, that's smooth. And as we came down to the U.S. we kind of all looked at each other and we're like what is going on down here? Because the system is quite different and clearly broken. So we had to make that decision of like where on the insurance continuum do we want to sit? And we took the approach that especially getting into the deep end of the spectrum of Medicare, Medicaid, really like doing in network insurance contracts, it felt like that was really going to compromise the quality of care that we set out for. One of the things that makes us different is we have no assistance, we have no machines. You're coming in for a full hour assessment, treatment and then follow up visits are 30 to 60 minutes with one on one with your therapist. And that was one of our core values when we started that we could drive another 15 to 20 percentage points on margin just by switching to an assistant model. But it's completely against the values that we have around delivering the highest quality care. So our thought process, especially because we're opening in cities with lots of disposable income around LA, San Francisco, NY was we're really a direct cash pay business. And it's interesting, you know, looking at some of the WebPT stats, for example, there is a lot of clinics that have one location and are cash pay and doing really well. There's not a lot of clinics that have more than a couple cash pay locations. So we had to really dig in and say why? And it came down to many factors. But the 2 or 3 was like can you build enough of a brand to be able to acquire enough customers to fill up therapists? It's one thing to try to keep one or two therapists busy, but our locations, like if our locations are at peak, we have 12 full time therapists on, right? Six in the morning, six in the afternoon, then we've got a couple on the weekends. So it's a lot of therapists to keep busy. And that's why over time we'll start to get into the Denver's of the world, the Seattles of the world. But, but to start and continue to build the brand, it felt right to us to start in the bigger cities with more access to disposable income. So at this point as we've gotten more comfortable with the insurance system in the US we're sitting on the continuum of if people request them, we'll provide super bills and they can deal with their insurance plan directly, but we don't interact with the insurers at all right now. It feels like that's kind of how we'll continue to grow the business.

Right. Right on. That's awesome. And so in Canada, are you only because I know one of the things up there that I encountered at, When I spoke in May was that the insurance pays a certain amount. And people are like, okay, well, we'll just take what the insurance pays. Are you guys charging more than the insurance will pay? And how are you. Is that what you guys are doing?

No, we're pretty much on market. I think this is balancing act. Like if you, if we were one location and we were kind of holding ourselves up, you know, out as like the Navy Seals of the therapy space, like, I think there's, there's a lot of merit to charging more. I think human psychology always pegs prices as value and quality as well. You know, buying a $30t shirt versus a $200t shirt, it feels intuitively, just based on how human psychology works, that that $201 is somehow more valuable. So I think it is. It is interesting to think about where pricing psychology sits at the individual location. But when you think about access to care and you think about volume, you know, for example, just, just in Canada, we've got 70 something therapists.

Yeah.

You know, you need to be really thoughtful around market. Right. What is market pricing? And for us, we've, you know, we're kind of on the middle, the high end of market. You know, we're definitely not super premium pricing. We try to deliver a premium experience and our buildups are premium or our therapist quality is high. But it's been a pretty informed decision of where we want to sit on the pricing. But it comes down to like, you know, in Canada last month I think we had close to 10,000 visits.

Yeah. But it sounds like it's not compromising your quality, mission, vision, values and treatment.

Yeah, exactly.

But here doing that sounded like it would because like, I know people in Denver only get $32 no matter what

they do or, you know. Right. And that's the thing. Insurance is just much more straightforward in Canada and it's a very reasonable and fair pricing. And it just feels like, you know, it feels like market is where the service should be, whereas in the US it's all over the place. And we've really struggled to find the right pricing here the first few months because it's hard where to compare to. And I think for us, it feels really interesting coming down to the US and just seeing like every clinic essentially committing insurance fraud and saying, hey, the insurance rate is this and cash rate is this. And like, like by the letter of the law in Canada, like that would be totally illegal up there. But that's how the system runs down here and it's so broken. So it's been interesting.

That's crazy. Are you guys getting any pushback from patients here at all?

Nope. No. I think we came in pricing where we're really happy with it feels kind of competitive to a high end sports massage. You know, that's kind of. We always think about what are the alternatives, like where else would somebody go to either get out of pain or think about kind of their longevity, body work sort of thing. And yeah, it feels like we're in good hands right now as we go into San Francisco, New York, we'll probably pump prices another 20 or $30 an hour, but it feels good. And it's back to that balancing act. If we were trying to build one clinic with like three to four full time therapists, like our pricing would be different.

Right.

But we're really trying to bring this to scale and support a lot of therapists in their career development. And we have to find that balancing act of keeping people busy. Right.

And it's got to be something that's profitable, that allows you to afford the real estate, pay a good salary, develop clinical staff and be able to do and provide the experience that you guys want to provide. So it's probably a lot of number crunching.

Like a lot of number crunching.

Yeah, we know therapists have to see this many people. We have to put, we have to utilize the room and space. Like you said you were staggering therapists, right?

Yep.

That sounds awesome. Are you doing, are you guys, when you're, are you calculating, like what kinds of things are you calculating? Are you calculating in your calculating. So you've got different in each different market, like la, San Francisco, New York, Vancouver, Toronto. They're all like not inexpensive places to live. But I'm sure that real estate is different in different neighborhoods. Is that something that affects you? Are you looking at the big picture overall to okay all these things? So I guess my question is, are you taking each individual location into account when developing your pricing strategies and compensation packages or is it the whole system,

so pricing and compensation set on a regional basis? Otherwise I think you start to have some market confusion of like, oh, why, why is the pricing here different than four miles away? And same with therapists. We want you Know, generally speaking, comp varies regionally, but it doesn't really vary within the city that much. So you know, Louisiana region will have a certain comp plan. San Francisco have a certain comp plan. Because you also have to look at what's the market rate for per pts there, what's the cost of living? Right. We always want to be just slightly above market plus have some additional upside for them. We have to do a lot of crunching. So we always think from the big picture of like, let's look at the real estate cost, like what does it cost for us to get retail commercial space? Right. For example, I just, we just signed some real estate in Studio City in Los Angeles and it's going into a development where no other clinic would ever go. Right. There's going to be an equinox right beside us and Erewhon Food Market, NextHealth, which is like a really high end kind of health bio optimization center. And you know, at first glance a lot of clinic owners would see the rent and be like there is no way we could ever afford that. But for us, big picture brand positioning is important. Like we want to be there. It's great co tendencies so we can really drive a lot of volume. So then we take that and say this is where we want to be. Here's where the therapist kind of market salaries are. Now let's work that back into a proper clinic financial model and start to understand like what percentage of utilization do therapists have to have? What does our client acquisition have to look like, how many visits per month we need to be doing? What does our cancellation rate need to be under? So we look at every single detail in like very granular levels. And we've, we've been fortunate. We've been able to have a lot of mentors and advisors that have built, you know, extremely successful businesses like SoulCycle and Equinox and Core Power Yoga before. And we've been able to learn a lot of great kind of business thinking from them. But we think about every detail starts from the big picture, but then it gets ripped down to like what does the daily revenue per hour need to look like per table? And does it make sense to get five tables in here, six tables, seven tables? So thinking through like even the architectural plans around, how do we optimize every square foot of a space?

Right.

And that's the level of detail you need to play in real estate that cost you 10, 15, 20, $25,000 a month.

Yeah, that's awesome. Yeah. Because I think a lot of times it's people like, well, how do I get. Oh no, that's too expensive. How do I get into a place that is like, yeah, I can put two or three therapists in there, but if we readjusted it, we could probably get three or four. Like you said, utilize the time from probably 6:00am to 7 or 8:00pm, you know, I think and then Saturdays, because I'm sure people, you know, people want to come.

And Sundays, you're still paying rent on Sunday. So even right now, like our, we just changed our West Hollywood hours from 6am to 10pm, Monday to Friday and then Saturday, Sunday 8 to 4 and like Saturdays and Sundays, especially for new therapists, that's this. Those two days are the single easiest time to get new initials in the door. If you can bring in initials on the weekend and then push them into the week as part of their ongoing follow ups. Like, that's how you really keep shifting demand and making sure customer acquisition is as easy as possible.

Wow, that's awesome. What kind of things are you guys doing in your clinics to create a customer experience for people? Is there something unique that's happening when they walk in the door or when they leave or the way you're communicating with your patients?

So first of all, I think a lot of clinics, they think about the front desk as receptionist and just like put a warm body in there, someone to do the billing and answer the phones. And that's just the complete wrong way to think about it. So we actually are our front of house, we call it our guest experience team. So we have guest experience managers and then guest experience coordinators and we have incredible director of operations that we brought on that she was at SoulCycle previously running a lot of the front of house operations for them. She opened the Toronto region and she joined us about a year ago. So she's been hyper focused on these hospitality elements and really treating the guests like a guest. So when they come in, are we offering them water and tea? Right when they leave, they get like a cold eucalyptus towel, like wipe off any wax or oils that might have been used. And every step along, if you're coming in for your initial session, you're greeted. We have standing desks with stools versus like sitting behind a desk with a big monitor. So there's a lot of hospitality training we put in place that we've been able to learn from the hotel industry, from the restaurant industry. And when somebody's coming for their first appointment, they're greeted warmly, they're giving a tour of the space, they're showing where to change or show in the lockers. It's such a choreographed thing. And you know, one of our mentors used to be the head of ops at Equinox. He has this quote which I love, which is great. Operations is choreographed. And for us, like, we think about every step of that customer journey and making sure like, what is our ideal feeling? And somebody walks in, how should they feel? And it should be a sense of like, like it feels like they should be coming into our house and we should be really taking care of them and making sure they have everything they need. So those are the elements. There's more tactical stuff that happens within the clinic of what they get. But that's the mindset we use when we think about that hospitality experience.

Wow, that's awesome. And that's deep. I don't think a lot of people go to that level to think about that, which is amazing. It's clearly like the attention to detail that you guys have is one of the big things.

Details are everything. I mean, Paul Wright is another kind of business coach, one of the staff, he always, always push them. I'm not sure how accurate is, but one of the things he always says is I think it's like 64% of clients self discharge because of perceived indifference. And that's something for us that's so important. Like even in the therapist notes section, are they writing down some of the factors that like not on the soap notes, but it's like, is this person interested in xyz? And if so, like, how are we giving them a surprise gift by session five? Maybe they're wanting to run a marathon and then we surprise them with a running magazine. It's all those like little opportunities to surprise and delight. But you can't do that unless you pay attention to the detail. Right?

Wow, that's so awesome. So Scott, is there a question or that I didn't ask you that I should have.

No, I mean, look, I just obviously genuinely love this space. Excited and you know, I'm so grateful to be able to wake up every day and you know, work with such passionate therapists that are, I think very excited to hold true to their values. And for us, I think the, like the main point is like we're just trying to change the industry and whether people come and work for us or if it's other business owners that want support, like we're just trying to help support everyone. And this is. It just feels like there is such a wave of passion in the space right now, which felt very stagnant for the last 10 or 15 years. So that's, that's the thing that excites us the most right now is, you know, whether people join our mission or just continue to develop their own. I just think, you know, people waking up every day and feeling like they have the tools and the knowledge to like run a great business is what we're, what we're really passionate about. So I'm happy to see like a lot of stuff you're putting out. And I just think, I think there's a lot of great sharing happening in the space right now. And you know, in an industry that is so fragmented, right. There's 17,000 clinics in just the US and the top 10 clinics combined own only 8% of the market share. So it is staggering how many individual clinic owners are out there that are just by themselves and they're not, you know, they look at other clinic owners as like competition. There is just like an endless amount of people that we have yet to experience proper physical contact therapy. Not the, not the old school insurance mill, but like people that have a true health coach and somebody that can like support them to think about their body over the long term. And I think that's the bigger goal is like, you know, we're just all about kind of cheerleading every business owner on right now and that's it. I just think like the resources are getting better and better out there.

Yeah, awesome. Yeah, I totally agree. So, excuse me, what's, what's your, what's your five year plan? What. What's up for myo detox in the next five years?

Yeah, it feels like we're kind of going four weeks at a time right now, but I think our vision is to change the conversation in the industry and just how do we make physical therapy accessible to the average person? Just change like totally the collective consciousness of like how people think about taking care of their bodies. And right now it's so backwards, it's so reactive. And you know, what we have seen is the only way people get inspired and start thinking differently is like through culture. Right? So if we're collaborating with like Drake and you know, professional athletes and all that sort of stuff, that starts to allow give us the platform to change the conversation, right. And also just access to care. Something that I'm really passionate about and I'm excited about is we have a kind of philanthropy arm which we do global community trips. So most recently we just sent a few of our therapists over to Lagos, Nigeria and we trained 100 physiotherapists for two weeks over there in some manual therapy and corrective exercise techniques. And that for the team was so fulfilling. We've got another trip coming up in Jamaica in a few months. We're sending three of our therapists down there. So I think collectively we can make corporations real incremental progress in North America. But the reality is like the average person, if they really want it, they can go find a great therapist. But our bigger mission is like, can we build the brand and the platform and eventually having hundreds of therapists on the team where we can actually start deploying them in third world countries and really supporting changing healthcare globally. And Africa is a great example for us where the amount of preventive opportunities for children being injured, that, that goes on because they can't walk to school, they can't help support the family farms and they're totally incapable of actually living a life and end up often dying early or being discarded by their family. That's ultimately what we can solve and we are taking a very capitalist, entrepreneurial route to get there. But we need to do that to build the infrastructure and resources to actually be able to solve that. That's kind of the five year goal. We're going to continue to just pump as much resources and people into the global community trips as we can and just keep making it so well known around. Like physical therapy should be the first point, you know, the first gateway for any pain.

Right.

People should not be going to their GP because they're having lower back pain. It's just such a burden on healthcare system which is clearly broken right now. So I think that's, that's kind of what we wake up and fight for every day is like, let's fix a system that's clearly broken, but on top of that let's start to support systems that haven't even developed yet and get in early. Right. It's something like Nigeria. If we can start to really educate people that physiotherapy is such a, such a viable alternative versus going to visit the hospital, it really is going to help support those economies to develop. So it's a fun, fun road to look down.

That's awesome. That's a really powerful and an awesome vision. And let me know how I can support you guys in doing that because that sounds great. Yeah. So Scott, if someone wants to get in touch with you online or learn more about my detox, maybe they even want to work for you guys, where do they find out about you and how do they get in touch?

For sure. So we kind of live on Instagram, our platform of choice. So check out the Ydetox Instagram handle. You can check me out at scottmark. So M A R K K on Instagram, you know, there's anything I can do to be helpful in any way, feel free to DM me or shoot me an email@scottowdetalks.com clearly my passion is just like supporting business owners. And I think there's a lot of people that are right there and just need that, like, you know, someone to talk to. And, you know, I think something, some of the things that we're really going to be focusing on over the next year, year and a half is actually doing meetups because we're traveling so much in these cities. We're going to start doing meetups like a San Francisco meetup, a New York meetup, just to start to get clinic owners together and start to have more interconnectedness around clinic owners and entrepreneurs. And I think a lot of clinic owners have a pretty lonely journey. And for us, we're trying to make that, make that less lonely one for leading the charge and showing that you can build something amazing in this space that has been so stuck in the mud for so many years. But beyond that, trying to share a lot of our learnings around business and how we run a clinic and how you should be thinking about real estate and how you should be thinking about hiring. And then for the last piece, if you're interested in work, working with us, we're constantly hiring right now and I would say check out our website and our careers page. There's a really good video on our careers page called Work with Us and it's actually the story. It's like Inside My Detox is a 3 minute video and shares some of my partners within and Nick, our coo and Drew, who's our head of education, just to get a real sense for the culture behind the brand.

Wow, that's awesome. So, Scott, thank you so much for being on the show today and making time and I know you're busy and it took us a few weeks to get this set up, but I really appreciate you being here and sharing everything with the audience.

Appreciate the invite and big fan of what you're doing. So keep it up.

Yeah, I appreciate that. So thank you. Well, this is the CashPT lunch hour. If you got anything from this show, just go ahead, screenshot this share with your friends on Instagram and tag us and I'll reshare you. And Scott will probably give you a shout out too because we'd like to share this message with the world. And we'll see you on the next show. Go big. Go all in. And don't listen to people that tell you it's not possible. See you next time,

Sam.