The Shockwave Sprint: Fast Tracking Pain Relief with Dr. Tony DiCesaro

Hey there and welcome back. I'm Dr. Vince Leone, executive producer and co-host of the Practice Builders Podcast. With my partner in crime, Dr. Kyle Pankinen, we deliver proven strategies to help you grow fast, specialize with confidence, and build profitable staff-run practices. Let's go ahead and dive into today's episode now. Hello and welcome everybody to the Practice Builders Podcast. My name is Dr. Vince Leone.

And my name is Dr. Kyle Pankinen, and, uh, we are super excited. We have a special guest on today that I think you're going to enjoy listening to, and that's going to bring a wealth of knowledge. So, Dr. Leone, introduce our guest for us.

Yeah, Dr. Tony DeCesaro from Pittsburgh. How are you, sir?

I am well, gentlemen. How are you today?

Doing great. And so our title of this podcast is The Shockwave Sprint: Fast-Tracking Pain Relief with Dr. Tony DeCesaro. And you know, Doc— well, I call him Dr. T, but Dr. DeCesaro has, uh, I would consider him an OG in the shockwave space. So let's just start there. Like, um, just give us a little bit of background. How did you get— I know you've been, you know, you've been practicing for a long time. You have 2 clinics, 2 successful clinics. Um, but tell us a little bit about how you How you got into shockwave? You know, what was the first inkling that you found? Oh, this is something I really want to specialize in. Just give us a little deep dive there, Doc.

Well, you know, it's it's pretty interesting. I've been practicing for thirty years, and we were thinking of doing, and I have a for a short period of time, I had a medical doctor and a nurse practitioner in my practice who's still on my board. I still consult with them, and we still have a great time. working together, although on a much, uh, not as much of a basis as we used to in the past. And it's mainly because of Shockwave, to be honest. I— we were looking at getting into the regen medicine space as far as stem cell injectables and those types of things.

Yeah.

And, um, the more I looked into it, I was really excited about it all in the beginning, you know, and, and this was 5 or 6, maybe a little bit more, longer, longer ago, uh, years ago. But, uh, I found shockwave at that point, and when I looked into it, the and I have buddies who do all the injectables, and you know they say it's great. But you know I I was just not ready to do to do that in my practice because when I looked at the pros and cons of it, and a lot of people get great results with stem cell. I think it's a great modality, or not a modality, but a great treatment. But um, I just wasn't sold totally on the costs of it and all the things that went into having. And being able to have that type of practice. Yeah. So I found shockwave in the midst of doing all this, and I really kind of turned my head toward the shockwave because it seemed like a much better option in the regenerative space. So I did. I went that way, and I can say that it was by far, for me, the best thing that I've ever done in my practice. Incredible results. We've never not had a positive result with a shockwave patient.

Really?

It sounds—I know it sounds crazy, but it's true. We may not have gotten as far as I would like to have gotten, and as I got better with my efficacy ratings and understanding what we can, what can, what can come of this, how far can we take this patient based upon where they're starting and and the technologies that are used? We've never not had anyone. There's never been a person that hasn't gotten better, and I don't know of anything else in. Any space that can I can say that with. So that's kind of how I got into it.

Just kind of went from there. Dr. T, would you quantify that in the sense when you say you've never had anybody get better?

Are you talking in the sense that not get better? Anybody not get better?

Anybody? In other words, they all what you're saying is they all got better. Some degree of improvement.

Correct, correct, correct.

Not necessarily 100% is what you're saying, but at least they showed some progress or improvement there. Correct. And it's significant progress.

I mean, it's. It's worth the time, energy, and expense that they, that they, they, the currency that they bring to the office and spend in my office, my offices. So, so let's put it, I got a lot better at getting what I can, what I call, and this is the stuff that we teach, right, is the efficacy rating. So if you're giving an efficacy rating for someone who comes in, it's their age, how bad are they as far as, say, say a knee. I love knees. Knees are phenomenal. They respond incredibly quickly. And have lasting effects. So say you have an 80-year-old with a knee who's relatively— they're bone on bone, 8, 9, 10 in pain. You're never getting them to a 0. They're more than likely a surgical— they're ready for surgery, right? But they don't want surgery. Now, we have bone-on-bone knees that have not gotten surgery, and they are at a 1, 2 daily. You're more than likely not going to get them to a 0 in pain. And no 80-year-old's jumping a high jump anyway. So, right? It just depends on where we are. And what they want and how, what do you think you can provide? But in the beginning, I think practitioners do themselves a disservice when they say, you know, well, we can fix that knee. They're 85 and the knee's shot, right? Can we help? Yes, significantly, usually more than 50%, but we're never getting them to 100%. And most people with a joint that's deranged and damaged, you're not getting them to 100%. Now, someone in their 40s who's a 2 to 5, 6 in pain every day, more than likely you can get them back in the game. And that's really what they want, right? So the efficacy rating, excuse me, is built upon all those factors, age, condition, right? What people expect, their expectations. And then when you get that, then you can, when you figure that out and the patient can agree to it, So if you have a patient says, you know, if I— and it happens all the time. If I say, you know, I think we can get you 75% better, then I'll hang my hat on that one or 80% or 90%, you know. But there's a lot of people I tell there's 50%. I can get you 50%. And when you're 80 and don't want a knee replacement or a shoulder replacement, that 50 is— that's enough. You know, that's enough. And usually if I say 50, I'm looking at 60. And if I think 70, I'm looking at 80, right? So Yeah, that's what I mean by that. And it's dead on the money most times.

Yeah, I love that. I mean, having a, you know, it's kind of like our protocols, you know, at SP, right? Having a really clear outcome target and having a structured approach to pre-frame the patient of what success looks like. Because if you don't, if you don't do that and you say that you can help them, they typically think, well, I'm going to be pain-free. And I know in, you know, treating neuropathy, um, I a lot of times use the 50% because if they're 75 years old and their pain is an 8, it's like, hey, can I get— if I can get you to a 4, is, is that a successful outcome in your mind? Because otherwise they're going to think, you know, well, I'm, I'm going to be pain-free. Well, maybe not, but going from an 8 to a 4 Is potentially life-changing, right? So, um, what— so what unit— well, give us a brief, very brief history, shockwave. I know it's been around for a long time, right? Lithotripsy back, uh, to treat kidney stones, right? Isn't that where it kind of originated from?

It's 30, 40 years. Yeah, it's 30, 40 years back. And these, these, these machines we use today are measured in millijoules, where the lithotripsy machines are measured in joules. So, for the everyone out there that's afraid to take the jump because these machines are dangerous, they're really not dangerous. I mean, there's clearly contraindications and things you shouldn't be doing with them, but the power levels are so low, it's unlikely that you're gonna hurt someone with the device if you're using it to, you know, the way that the way it's intended and the manufacturer specifications and those things. Yeah. Yeah.

So, what, so let's talk about the different units out there. There's, there's a ton, right? And, and a full Full range of them too. I mean, yeah, you know, you obviously have the high-end ones that are, you know, $60,000, $70,000, and then there's some that you're seeing for like $3,000, $5,000. I mean, that makes me a little nervous. Um, but like, talk to us a little bit about the units that you started out with, the units that you like, um, and just kind of going a little bit.

Sure, happy to do so. Uh, yeah, you know, there, there's different types of machines. So there's the rate— there's radial machines, there's hydroacoustic machines, hydroelectronic And there's electronic acoustic machines. So being they're all sound waves and no shockwave machines, you're going to get the acoustic moniker in there for each one of them, right? The radial devices are the ones you're seeing for between $2,000 and sometimes $20,000. Those machines are much less effective. They're not really true shockwave machines. They're more of a pulse wave machine. 90% of the energy you're trying to get to the target tissue to cause biological effect. Is lost at the surface. So if you're trying to treat, well, anything, right? Because it, it, it just doesn't, it's not a true shockwave, so it doesn't pass through tissue the way a true shockwave would. A true shockwave is, would be the, in the machines that I like the best, and we can get results with all of them. I wouldn't use a radial device cuz I don't think I, you just can't get the results you're looking for with that. But the machines that I like the best are the, and the first one I had was a Softwave machine. The Softwave machine's a great machine and all 3 of these machines I'm about to speak about are, are excellent machines. The Softwave machine was the first one I had. The Stemwave machine is the second ones I had, and I've used the Omniwave machines as well now. And those three are probably the best—not probably—I think, in my opinion, are the best ones out there for for getting the best results, the best. Like I said, the best outcomes, ease of use—they are consistent, but they're expensive. So that that's that's the you know the downfall of that. It's not a downfall; it's just it is what it is. You pay for the best stuff, in my opinion. The other ones are the electromagnetic machines. And they're not true shockwave machines either, although they would argue to the death that they are. Those machines use pulses of energy so that when— it's tough to explain. If you have a pulse that meets here, so you have a pulse and a pulse and they meet together, they increase. It's kind of like sine waves, right? Sine waves in phase will double the height. If they're out of phase, they're like noise-canceling headphones. They'll cancel it out. So when they take these pulses and they meet at a focal point, they increase the power at that focal zone. So the focal zone is where we want to be treating with those machines, which is why things like the PiezoWave, again, nice machines, we can get good results with them. You have to have the different blocks and the differences between the length of that block that the power tends to go through has to meet. You have to pair that up. With what you're trying to treat, whereas the other machines, it's not as important. Okay. And now there's a bunch of new ones jumping into the game. Now there's pulse wave and hydro wave and this wave and that wave, and everybody's wave is is out there now, and some of them are are much less money. The the ones in those in that kind of area from the beginning were the um the stores dualith. The Chattanooga machine is a white label dualith, so that was a really a great you know stores. Wonderful company, great company. They've been in shockwave for decades, but they also have some radial devices, and those are the lower level ones. And I, I know guys who get really good results with it, but as far as getting, you know, trying to get to a hip, something deeper, time is a factor with those. It takes a lot more time and many more pulses to be able to get any type of result whatsoever. So, you know, I know guys that are good with all of them. I just Prefer the, the true shockwave machines.

So with that being said, and so there's doctors listening to us, to this, that don't have a unit yet, they're thinking about getting one. Um, what are some of the best practices, you know, in terms of, okay, we're gonna, we're gonna install this into the practice? Um, what have you seen with your clients, um, that the best doctors are doing to get You know, the best results and ramping up revenue.

One of the reasons that I, that I started this, um, the consulting portion of what I'm doing now, uh, within, with my trainers is that they're not training. They're, they're treating this like an ultrasound machine. They're treating it like an e-stim machine. They're taking the, the girl who got the front desk and saying, you know, go hit them with X amount of waves in this area. And just, you know, they're treat— they're not treating it as a lane of service and there's no expertise to it. So if you really want to be great at this and make this a lane of service that can challenge some of the other lanes of services in your practices, if not blow right past them, you need training. They need training. And being able to train with the gentleman that sells you or a woman that sells you the device is not enough. It's just, it's not. They don't, you know, maybe even, maybe they do understand. I shouldn't assume that they don't understand the physics of, of The device they're using, but it's just you know I think people are are kind of turning a deaf deaf ear to what needs to happen to really get good with these machines because when you're good with these machines extraordinary healing happens and if you don't train you don't know if you don't know you don't get a result it's really very simple it's everything that you guys are doing on your weekly calls and you know I mean a specialized practice I think you guys doing a amazing job. I mean, full disclosure, I'm a client, and there was a reason I did that. Um, I enjoy what you do and say and how you do it, and, and it works. So it's about training.

Yeah, I— and I couldn't agree more. Um, I've always said there's, you know, if you're going to, you know, specialize in one of these services and, and have great success with it, you need to make 2 investments. The first one is in the equipment. The second one is in yourself, right? I mean, you have to elevate your skill sets And typically the person that sold you the unit is not a practitioner. They're not in the trenches every day, and they don't know how to grow these services, you know, consistently and predictably. So you need to find an expert that's already figured it out and, and follow a proven model. I mean, you can have, you know, when you go into a new endeavor, you can use guesswork, you can use hard work, Or can you— you can use a proven framework. Um, you know, it's— the choice is up to you. Dr. Pinkett, did you have a question there? I thought that I saw you.

Yeah, so a lot of our listeners, of course, are, you know, they're looking to get into niches, or maybe they are niches. Of course, at Specialized Practice, we do chronic neck and back, chronic knee, peripheral neuropathy, and plantar fasciitis are the ones that we really focus on, just I know you, you, you talked about great results, but just specifically for those 4, 3 or 4 conditions there, what are you seeing? And, and some, a little bit about the protocols you use and, and if you're using other modalities besides the shockwave to treat some of those things.

Yeah, the, the first thing I wanna say about any of those things when we talk about this is when we look at, when we look at a shockwave device, a true shockwave device, People need to stop thinking of it as a, as a, as a pain reducer. These machines don't, don't kill pain. They cause healing. And when the body heals in turn, what do we get? We get a decrease in pain. And it's significant. And, and it's, it's, I mean, it's, you know, in 5 minutes you can cause pain to diminish by 50 to, 50 to, I mean, 100%. You could, you could, but it's, it's short-lived because it's not, you know, there's a protocol that goes along with it. So when we talk about these machines, you want to be able to talk about them to the patient as it being a healing machine because patients want healing, right? They don't just want pain reduction or they wouldn't be doing the things that we're all doing in our practices, which makes us so successful. To the question, anytime we need healing to occur on any of these tissues, it's going to take more time. You guys know better than anyone that it takes— healing takes time. So what it does is it takes the healing and cuts that down. It cuts it almost in half. I would say 25 to 30%. I want— I don't want to go as far as saying half, but that's what we see in our practice usually. So, the protocols that, that I'm using for decompression, for neuropathy, for all those, I mean, they're significantly— it takes significantly less time. Like I said, we probably about to say 25% less to get the same results that we're getting just because we're getting this, this advance in healing and healing, you know, it happens faster. So, I don't use my lasers really much anymore. I know, Doc, you and I are going to roll around about this a little bit, and I think that's fun. And I have to— I was a huge fan. I designed a lipo laser device. I have a US patent on some phototherapy stuff, so I get it. I just, you know, I'm just— this shockwave stuff has kind of taken over in my practice where we had the lasers. Now, the way that you do it, if I— and I know I'm not wrong when you have the robotic lasers, I love that. I had one of them. I don't have it anymore, but I have had one of those. I think it was great, and I think it adds another level of healing. But I still think that shockwave tends to be a little bit more advanced when it comes to getting healing to happen more quickly. Now, with that said, I use my lasers for things like TMJ. We don't really use them as much for the low back stuff anymore, but if it's a large, broad You know, area. I put them under my lipolaser stuff, and I'm getting I'm getting significant results with inflammation reduction and pain reduction with those as well. So my decompression stuff, we we use shockwave sometimes. We never do it before. If it's the first couple of visits, we don't use shockwave initially because it causes the the musculature to relax too much. And if you get them into a decompression protocol where we're pulling Right? And we're not taking into account the fact that that's going to change some things back there. I don't want to use that beforehand. We get them on the table first. So we'll use— we'll get them on the table, warm them up a little bit, get them on the table, and then do shockwave after. But after visit 2 or 3, we're shockwaving before, and it's working incredibly well. Typically, typically the way you'd use laser, we're using shockwave. Right? So I mean, it's you know for neck pain we're doing the traps, we're paraspinal, we're depending upon what they're what they're seeing and feeling, what muscles are quote unquote working. I don't know if we still use those terms anymore or not, but we used to use those.

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Yeah, so that's what we're doing—the knee stuff. The knee stuff protocols are you know you're in once or twice a week for a couple of months. All my protocols are typically between eight and twelve sessions, and we're usually you know some significant results. If there's specifics, Kyle, you want you know ask me the question. I'm happy to happy to answer for you. No.

I think you did a good job of answering that. Dr. Leone, go ahead.

Well, I was kind of curious, because it's attended, I know doctors are thinking, well, I don't, you know, that seems like a lot of time for me to be on the unit. So obviously we're using staff to do it, right, to deliver it. What is that, you know, what does the training process look like to get a staff member so that they are up to speed, proficient at Use competence, competence that they can use the device, get results, and it can be a true kind of almost like a, you know, well, it's a lane of service, but it's, it's not reliant on the doctor. Maybe he does, maybe he or she does, right, the consult, the exam, but not, you know, delivering any subsequent care.

Yeah, I mean, typically the way it happens in the office is I'll do the day ones. We actually call them day zero here because it's like the test drive discovery day. Visit, whatever you guys want to call it. Uh, so we'll do that. It takes me about 30 minutes to get the patient to come in, qualify them, and then get them to commit to care between 30 and 40 minutes. Now that's, that's the first day. So I'm close. We're closing 70, I think it was 73 or 74% of our clients on day 1. So for sure.

And you're— and so day 0, day 1, so you're going to do your consult exam and then the diagnostic portion, which is like the diagnostic and treatment.

Yeah, it's diagnostic and treatment. So it's either we— I, I labeled it a mapping. It's you doing a mapping because, because these devices, other than the OmniWave, which doesn't do such a good job with that, but there are some, some, some real positives to that machine where the patient isn't feeling as much. The patient, you know, these machines uncover areas of inflamed tissue, damaged tissue, tissue and diseased tissue like arthritis, right? So when you're doing that, it's really easy to get the patient, unlike laser, which was always been my issue with laser. It's like, trust me, right? It's the doctor stuff is always trust me. With these devices, you don't, they don't need to trust you. If you teach them what's about to happen, they will say, oh, that's a bad spot. Yeah, that's the bad spot, right? So you get instant diagnostic or the mapping. That's the diagnostic portion. You get instant buy-in from the patient understanding what's happening here. So that, that takes it and elevates it, or it's different. I shouldn't say elevate it. It's different than laser, right? So because with laser, the problem that we have with laser sometimes is, well, it feels warm, right? And then you get a little bit of pain reduction. Sometimes you get a lot. Most times you don't. So then that's, that's what happens. So when you get the shockwave to be able to, to work appropriately and know what you're doing, then you get that to happen. You get that happening at day 1. To answer your— but to go back to what you said earlier, as far as time, it's 5 minutes. It's a 5-minute— 5 minutes you spend with shockwave on a patient if you're using the, the better— I said better, I shouldn't say better, but the, the higher-level devices with true shockwave devices, it's 5 minutes. Anything other than that, you know, you're at 500, 700 pulses. The other devices, it's 2,500, 3,000. As you go down in cost, your time goes up that you spend with the patient. So that's a huge thing. So when we talk about, you know, when you talk about what does it cost and why does it cost so much and what's happening, you know, it's 5 minutes in. Our practices, Every 15 minutes, we have somebody booked in Shockwave.

Okay.

So, you know, it's for an hour or more. And they're in and they're out and they're doing other things. So when we talk about, you know, how much time does it take? The other machines, it took me 18 minutes to do 2 knees. This, my, the machines that I like and I use takes me 5.

Wow.

So there's significant differences in time. Right. And efficacy, I might add.

Yeah. So with your best clients, are they— are the doctors typically doing the treatment or is the staff member doing the treatment?

Staff's doing the treatment. So I put together a whole— I put together a whole program and training program. There's an online and then the shadow in my office. That's part of what Acuity Consulting does. Yeah. I want to give you guys and everybody that's out there, I want to give you just a ninja in that room. Yeah. Shannon's my tech. Shannon, I put her up against the best doctors in the country. She's spectacular. She didn't have any medical background when I, when I, when I, she was a patient, to be honest. And we just worked together. And now we have, you know, a large number of people that have gone through the training program. And now, you know, when you consider your average case to be between $1,500 and $5,000 for Shockwave, you know, you're doing, if you're doing $20,000 to $50,000 a month in Shockwave, Correctly and appropriately, you can afford to put someone in that room for that kind of money.

Oh, you know, so, so, so back to that question then. What does that process look like to get a staff member trained up? Is that, you know, do they—

Through me and through Acuity? Correct. Through Acuity. Well, what's going to happen is that they call, we'd have a conversation with the doctor as to what they're trying to do and why and what and who. And then they would say, I want to get him or her trained, and I'm going to accept them or not accept them. And you'd be surprised how many times doctors are calling me and saying, this is my person. And I ask them questions, and I'm like, that's not— that's not your person. Not that anyone can't do it. It's just important that we pick the right person. And everybody who's been in practice ever understands, you know, picking the right people. So once we find the right person, Um, there's a couple of week online course that they're going to take and then they're going to shadow us in Pittsburgh for 2, 2 days, 2 or 3 days. Oh, really? Yeah. With me, with me and Shannon. Oh, that's awesome. The other docs. Yeah. So that's, that's what happens there.

Got it. Got it. So what's, so what's the potential you think? Um, not, not like, you know, the, the best clients, not the worst clients, but like what's, what's an average amount of revenue? Um, you know, without a ton of paid marketing. So I'm assuming, um, you know, Jay Abraham, he's, he's like one of the, the biggest marketers of all time, always said, hey, the one of the easiest ways to add revenue to a business or practice is to just add another service and offer it to your existing clientele.

Right.

Which, if most doctors are just doing chiropractic, or maybe they do decompression as well, They could very easily open up a lane of service for, you know, joint pain, right? So obviously through shockwave. And so what do you think? What could they—

I think last week I spent—

what could they generate in additional revenue with—

Well, I'll say this, with one device doing it the way that we do it, and I hate— I don't hate throwing numbers around. I love throwing numbers around because we do really well with this. But, you know, last week I was On the West Coast, closer to you. And this person, this doctor has a— they're seeing, I think they said 150, 150 a week. It's nice practice. You know, it's not killing themselves, but not lazy either, right? They're doing pretty good. We did $46,750 in 2 days.

Well, in 2 days.

2 days. Whoa. So what did that— I want to picture your face right now, Vince.

Yeah. Okay. Now I'm excited. So—

Yeah, I know. Everybody should be. And this is— I have been banging the drum on this for the last 3 or 4 years, right? And this before it, but it's the reason I put Acuity together is because it's not because I need a side hustle. Let's put it that way. It's because the people that have these machines aren't doing what they could be doing because they're not treating it as significant lanes of service. What they're doing again is saying, okay, I'm going to train you for 5, 10 minutes how to turn the machine on, squirt the gel on, move it around and do right. That's what we're doing. And that's a mess.

That doesn't qualify as an expert?

Not for me.

I want to go deeper into this case study with this client. Sure. Okay. So this is not the first time we've done this. Fair enough. So she, okay, she has a nice practice or, you know, kind of You know, whatever healthy practice. She buys a device, she flies you out there. Tell us what did the process look like?

Well, we have a— before that even happens, right, we're going to do some consulting as to what we're— as to the smart ones will call me and say, what should I buy? What's going on? How do I know? And then we figure that out because based upon what the doctor wants, I can say, okay, this sounds like it's a better fit for you and this machine and this device and this is why, right? So, um, each machine has a little bit of a learning curve to it as to how we're going to do what we're going to do. Um, so with that said, and then we go about 4 weeks out, 3 or 4 weeks. You don't want to go longer than that. But 3 or 4 weeks out, we're going to grab the entire, the entire, uh, patient list and we're going to do some email. We're going to do some text. We're going to, you know, and it's all written out for us and to garner some excitement, get this wave swelling, right? And get this thing happening. Yeah. And then we're going to book people every 15 minutes. I'm sorry, every 30 minutes to come in. And while they watch me treat, close, give efficacy ratings, tell people it's not for them. Like, we had a couple of people that were in that I said, you know, I don't, I don't think this is right for you based upon what you, what your, their expectations are based upon their, how they present or they can't define their pain. They're not sure. I don't think this is right for you, right? So it's just like any, any other patient that comes in that we're not sure how we can treat them. If it's not right for them, we're not going to offer the service to them. So, but with that said, if you don't get the result on day 1, you don't have a patient. So here's what everybody does. Here's what they— this is incredibly important. Listen up. Everybody goes, buys the machine, says, or buys a machine or whatever machine and says, I'm gonna, I'm gonna try and do this for 2 months and see how I do. And if I don't do so well, then I'm gonna reach out to you.

Yeah.

Well, let me explain something to you. All the love you, know you, love you, trust you patients that when you say, hey, John, go get in room 1, I want to show you the shockwave thing, they just turn and they start walking, right? That's those patients. They're all quote unquote warm leads. They're patients. They're your beloved and cared for patients. But they know you have their best interests in mind. But if you go and you screw up 10% of these people that walk in, your confidence is gone. Like, I always talk about 2 things. I talk about confidence and intent. If your intent is not correct, if you're not— the patient picks up on it, number one. If you're trying to put a lane of service that's worth a bunch of cash in your office and your intent is just for the money, you're not going to do very well. The patient picks up on it and your practice stinks. And it just is what it is. So, With that, you have to give them the confidence to do well with the machine. They have zero confidence because they don't know what to expect. And here's how it works. I'm going to charge $500, whatever. I'm going to charge $800 for 10 sessions. Okay. Then they get more confident. All of a sudden it's $1,200. Then they're more confident and it's $1,400. And then they get more confident, $1,750. And they go, Not the way to do this. The way to do this is not screw up with all these patients because let's say in my office, I charge $2,100 for one joint for 10, 8 to 12 sessions. It's a protocol, right? So a knee is 30. I charge $3,750. Could I charge $5,000? I could. Could I get it? I could. I think it's fair in my area at my, you know, my neighborhood, the people that I treat. I think it's fair to be around $3,750 by $4,000. So So, let's back that up. If you missed 3 of those, you blew $12,000 because you didn't want to get trained, because you didn't want to have someone in the room, because you felt that you could do it because all the doctors are experts at everything. Listen, it's not worth it. It's not worth it.

So, okay, I totally agree. Well, just walk me through a little bit how it works. So, you go out, so you actually are on-site. And then, and you, you know, obviously do the all the internal marketing, generate buzz, sign up appointments. Is it on a workday, regular workday? And is the doctor, the client shadowing you then? And the tech?

Absolutely.

Got it. Got it. Okay, cool. And so in 2 days, I mean, how many patients was that?

36.

36. Dang. What was your close rate?

82%.

Really? That's, that's impressive, my friend. And what did— what was the client— I mean, what was she saying? Was she just thrilled, or—

Do you think she was saying—

Or is she like, get out of here, you suck?

Let's put it this way. She's a yearly consultant client. Yeah. There's no— she's, where do I sign? Right? So, yeah.

So, that's amazing. That's amazing. Congratulations on that.

And anybody can do it. I mean, yes, I'm, I'm pretty good at it. Yeah, I'll give you that. And, you know, I get calls all day, every day from other doctors that I'm working with and some that want to have questions just like you do. And Dr. Kyle does. But, you know, this isn't as hard as people are making it. It's really not. I know it's easy when you know what you're doing, right? That's the old saying. But it's If you can, when we talked about like when you can get the efficacy ratings down, if you can be honest with your patient, if you can get the right machine and understand the physics, the physical, how it works inside the joint into the musculature of the patient, this is what needs to be taught because we're just guessing, right? That's what 95% of the docs out there are doing. They're guessing. And when the patient says, oh, I feel better, they go, really? Right? I love that one. I mean, literally, I'm in the room doing the treatments with the— with these patients and the doctor. I'll say, how do you feel? And they say, you know, I expect a 50% increased range of motion, 50% decreased pain every time I do a mapping. Every time. And if I don't get it, it's a technique issue or there's some— there's something going on with the machine. There's something. I don't always hit the mark, but, you know, apparently 82% of the time I do. So, you know, that's— and the funniest part, right? The funniest part of this is, you know, they'll say they came in, they'd lift their arm like this. That's all I can do. And I treat them and they go like this. And the patient goes, wow. And I said, how are you feeling? Like, you know, it's about 60% better, maybe 50%. I'm like, that's where I want to be. That's good. And the doctor says, Really? Right, right. They're like, it's mind-blowing how this works. So, yeah, I mean, there's a lot to it. It doesn't take a lot of money to be able to learn this. It just takes time and, you know, intention. And that's what we're teaching all over the country now.

Yeah. And the beauty of that is, you know, you build the skill set and it's going to serve you the rest of your career.

Absolutely.

Dr. Kyle, you had a question.

A doctor that's listening to this and saying, well, I just wanna start on the lower end and start with a less expensive machine. Basically, from what I'm hearing you saying is basically bite the bullet, buy the higher-end technology, the higher-end machine, because your reward, even though you're paying more upfront, With the results that you're going to see and the potential revenue upside with that, it's well worth the investment versus just the doctor says, well, I'll buy a cheaper unit and just kind of get started and build my way up with that and maybe down the road get a more higher-end unit. How would you kind of address that?

I would say that it's the best analogy here. If you No matter what you're selling, I don't care if it's cars or tomatoes or like whatever. And Vince is going, where is he going with this? I could see that. I could see it.

I am. I'm very curious about the tomatoes.

Right. So, you say you're selling, I don't know, I hate to use the analogy of a used car guy, but if you're selling cars and you sell shitty cars and you get shitty results with these cars, you do not have a high-end service. So when you go—

This is a family-friendly show, Dr. Tony, by the way.

What'd you say?

This is a family-friendly show.

Oh, sorry. How many, how many Doogie Howser's do we have as doctors now? I'm sorry. I apologize. Now I'm going to have to bleep you out.

Jeez.

I'm going to let her rip if we're going to do the bleeping thing. Now, so my point is, if you build it, if you're going to build this lane of service and you're going to have a poorly, you know, you don't know what you're doing, you get, it's all about results, period. If I had to choose one word, it's results. If you don't get the results, those patients talk. You take the ads that like you just don't. If you don't get off to a flying start with this, you're you're you're kneecapping yourself. That's exactly what's happening. You're just not gonna. You know, I got it. I got this machine. Okay. Well, it doesn't really and and doctor won't use it anymore, so it goes away. So the next time you're going to go, hey, I got a new machine this time, I bought the right one. Like, what are we doing? I don't— you know, if you can pay for— ideally, I want my clients to pay for their machines within 3 months. That's what I want. And that's what usually happens.

Yeah.

6 months at the outside, right?

6 months. 6 months is a no-brainer. Yeah.

The other question I had as you were talking to me, I know you originally you had that interest in injectables and stem cell, but you eventually Went to shockwave. Do you think in some instances, I mean, you know, stem cells is kind of the shiny object in the sense that's been out there a lot and people see so much promise in that. But do you think the technology behind shockwave in many ways can circumvent or take the place of the need or the, the drive towards stem cell injections and things of that nature? I think you have things like that.

Yeah, yeah, yeah. Um, I think so. I think so. I mean, the the problem that we have with some people is you know the when you're when you're using shockwave, it's it's it's it's creating an endogenous stem cell reaction is what they talk about. So you have endogenous stem cell activity that happens within the joint or or whatever we're using it. So I mean with that said, the problem that we have sometimes is someone comes in that what happens? So so what happens if you have someone that can't heal? You got someone with an A1C that's a 9, 9.5, 10, right? They heal poorly. So you have to not pick and choose, but you have to— when you're giving an efficacy rating, you have to think about how well they're able to heal. Because if they're not able to heal well, your results will be not as great. Now, that doesn't mean that with stem cell you would get a better result, because you probably wouldn't. Because you still— when you inject stem cell, it's still a fat, you know, there's still Stem cell factors that occur when you're trying to get that that joint to heal or those tissues to heal. So that's one thing that people don't take into account when they talk about things, and I don't think most people give efficacy ratings anyways. I think that's a huge problem because there's no covenant between the patient and the doctor at that point, because the doctors again don't know. They mostly don't know what they're doing. So I think stem cell is. I think I love the tech. I'm a tech guy. I love what's going on there, but it's prohibitively expensive for a lot of people. It is expensive for doctors, I might add.

Yeah, you got to restructure your whole practice.

Yeah. And you need, you need, depending upon the state you're in, you may not be allowed to do it anyways. So, you know, you need a medical doctor for our chiropractic friends on the call. You need a nurse practitioner if the medical doctor doesn't want to do it. And then you need to like, you know, you're right away, you're chasing this thing. And I always said, my friends who are honest about stem cell are saying it's 70 to 80% of the time it works. But for $15,000, $10,000 to $15,000, I don't want to have a conversation that I have to start with, thank you for your donation. I'm sorry it didn't work. That, you know, and it stems— it just seems like magic too, right? A little bit of it. So, and I just, I don't want to have that conversation. You know, I, I don't, and that's why I said at the beginning of, of this call was that, you know, I never had a patient come in and go, I don't feel any better, and we had no measurable response or reaction. So that's pretty cool. That's super cool.

Yeah. Here's what I really like what you said, Dr. Tony, is, is the, is the confidence being such a factor for the doctor because that's something that we work on with our clients is creating confidence in the protocols, in decompression, in, um, the, you know, how we present plans to patients, because it's, it's a subconscious communication from you to the patient. In other words, they sense, whether it's consciously or subconsciously, whether you know what the heck you're doing, right? And in the beginning—

100%.

They gotta, they gotta borrow your belief in the treatment protocol. And so if that's not conveyed, confidently, they typically won't buy. A lot of doctors want some silver bullet for the ROF. It doesn't exist. Now, there is a way to structure your ROF so that you create, um, a patient who understands exactly what you're doing and how it's going to work, but there's no substitute for confidence in being able to deliver a result.

Absolutely. And that's why— and it all goes back to the training. Right? Everything goes back to the training. When we work with, you know, when anybody works with specialized practice and you guys, it's like, listen, you got to go over this stuff. You got to know it. You got to know what your patient's thinking. You have to be, and it's not about the sale. Everybody wants to talk about it. You know, how do I sell them? How do I do this? How do I do that? It has nothing to do with that. I mean, don't get me wrong. There's ways of presenting, which makes it more likely that someone will be able to, to, to commit to care. I always say, listen, I don't make the decisions. I propose and you guys decide. And if my proposal isn't appropriate for what they want, need, and are— and I can expect, then now we have a problem. There's a disconnect there. And too few doctors ask the right questions. They just wait till the patient has something to say and make a decision based upon a lack of information. I say it all the time, the confused mind says no. If your patient looks at you like this, They're not ready. You do not propose the care plan at that point. What you do is keep asking them questions. Do you have any questions? And they'll say no. And then you fill in the gaps, you know, as to what they didn't ask, because you know what questions they have. You've worked with thousands of patients in our careers, and even for the new guys.

By the way, what— for those listening versus watching the video, Dr. Tony kind of Tilted his head and squinted his eyes.

It's like, what is— what do you mean? Um, well, look, that, that—

I love that. It's all great information. Um, Dr. Kyle, do you have any, uh, last questions or thoughts?

No, I think it was very comprehensive what we went over in the sense I think this gives a listener, uh, if they're thinking about adding shockwave Or they already have it but want to take it to that next level. Here we have, uh, an expert that's going to deliver the training that's going to help you take it to the next level. So I think we should let the guy just tell us a little bit more about Acuity and how people can get a hold of that if they want to look up more. And also mention that Dr. DeCesaro is going to be at the Decompression Summit certification coming up here at the end of September. So Just tell us a little bit more about that, Dr. T.

Sure. Super excited to be at the summit. I was there last year as well. And we— I was there as a practitioner and listening to you guys do your thing and incredibly impressed. I recommend anyone who's doing any of these niches to come out and spend the weekend with us. It's a beautiful place. And I think you should go, number one. Number two, it's consultwithacuity.com. Is the website, uh, consultwithacuity.com is the website, like I said. And to get, to get a hold of me for right now, you know, I give people my phone number. They want to talk to me, talk to me. It's 412-759-0753. 412-759-0753. That is my personal cell number. I'm not ducking anybody. If you want to talk to me, give me a ring, send me a text. Um, and I'm gonna—

I'm gonna turn that phone number into some of these marketing guys that call me all the time.

I'm gonna boomerang it right back to you, Vince, because I got your personal cell. Start a war. Here we go.

Okay, so, uh, we'll put that in the show notes, consultwithacuity.com. I don't remember your phone number, but we'll put all that in the show notes, um, so people can reach out to you. But, uh, I appreciate your time today and sharing your, your knowledge and your, your wisdom on the, on this topic. Uh, any last thoughts on your side, Dr. T?

I just like to help our guys and girls get, you know, get all the docs on the same page with this. I think we're doing our patients a disservice when we have the machine and aren't using it appropriately. You know, I think we have a moral imperative to help our patients and to— and we're in the business of healthcare. And if, you know, that means we should take every opportunity to help the patient and to enrich ourselves and our families and our practices and the people in our communities. So if you're not doing that, I I question why you're doing what you're doing. So if there I can help in any way with training, consultation, words of encouragement, I don't know. However we can help, you know, we're we're helping a lot and willing to help some more. So give us a call when you can.

Love it. Well, again, thank you for joining us on the show, Dr. Kyle. Thank you for your time today. And so that's going to wrap it up this episode of the Practice Builders Podcast. Thank you so much for listening, and we'll see you on the next show. Hey, it's Dr. Vince again, and hope you enjoyed that episode. And if you're ready to grow your practice fast with high-value decompression patients, then the Decompression Accelerator could be a phenomenal option for you. This is our 90-day sprint to help you scale with proven systems, staff-driven protocols, and full marketing support. And it's all guaranteed. Spots are limited. Head to www.decompressionaccelerator.com to learn more.