Building A Successful Foundation with Brooke Kalisiak

Hi, welcome to the Pelby Biz Podcast. Are you a pelvic health PT or ot struggling to start your own practice? This podcast helps pelvic health PTs and OTs get out of debt, gain the income they desire, be able to treat patients without insurance restraints, and learn how to create time freedom for yourself and your family. I'm your host, Dr. Kelly Alhui, founder of Ortho Pelvic Physical Therapy, Pelvic health Business grower and Pelvi Biz. Over the last two years, I went from a solo entrepreneur to a seven person team in counting. I'm here to help provide a clear path to grow your pelvic health business as fast as possible so that you can gain the time freedom, decrease debt, increase income and live the life that you desire. Before we get started today, make sure you click the link in our bio to grab your ticket for Pelvi Biz. Now let's get into today's episode.

Welcome guys to Pelby Biz Podcast. I'm your host, Dr. Kelly Alhui. I am here with Brooke from Legacy physical therapy in St. Louis. Go ahead Brooke, introduce yourself.

Hi, Dr. Brooke Kolisiak. I have been a practicing physical therapist for 22 years. That sounds really weird to say, but I opened up Legacy physical therapy about 13 years ago to specialize in pelvic physical therapy. And it was just myself when we started, but have since grown it to myself and four other pelvic physical therapists where we specialize in all things pelvic health. So predominantly female focused, but we do see male clients. Sorry about that, didn't realize I didn't turn off my phone and that. So we see male clients, kids, a lot of pregnancy and postpartum issues. So even have a fitness side to our facility as well now. So really have enjoyed kind of growing it over the years to grow beyond myself, which was always the original goal. I did not want to be a solo practitioner forever.

That's awesome. And that's amazing point to bring up. So what really, what really made you dive into starting your own practice, especially, you know, some years ago.

So when I came out of school, I worked for an outpatient orthopedic company, but was always drawn to the women's health aspect. And in the St. Louis area at the time there were very few therapists who did that type of work and if they existed, they were hidden in hospital systems. So the general public had no idea that they were even an option. So I had the choice. I could stay with my orthopedic company and do all the same amount of work and open up a program for them, or I could do it on my own. And ultimately, I knew that I wanted to do it on my own because at my orthopedic company that I was working for, it was just crazy busy. Like, patient after patient after patient, like every 15 minutes. I was like, I know there's no way I can do women's health physical therapy or pelvic physical therapy that way. And so I wanted to set it up the way I wanted to do it. And so that's why I went out on my own. Honestly, for those of you who are worried about starting on your own, I started my own practice after taking pelvic floor level one. That was it. That was my only introduction. Me too. Like, nope, I'm doing it. This is what I'm going to do. And I was like, well, I'm in now.

Literally. Honestly, that's what I tell even anyone that's coming on board, you know, and I'm sure you, too, Brooke, that anyone that comes on board, it's like, okay, just at least take level one. Get your hands, you know, in there, and then. And then we can teach you the rest, you know. So, yeah, I think that's. That's. I believe that we don't need all these crazy certifications. Just really just start to get your hands dirty and then have a great mentor. And I think huge. Having a great mentor can be really, really helpful. So that brings us to, like, hiring. So when you hired your first, did you hire a PT first or did you hire an admin first?

Definitely admin, yeah.

That's what I did, too.

I needed to get a lot of that admin stuff off my plate. Knew I needed to get people answering the phones and calling out to people and, you know, helping with that side of it. So for a long time, I just had, you know, what you would consider your basic receptionist there. And it wasn't until probably several years in that I actually hired an office manager, which that's been, you know, super helpful, and that they're amazing. Just, you know, put all of that over their plate. So we actually have. It's my. Like I said, there's five therapists there. I have two front office people plus my office manager and that. And they all have kind of their own roles there. But, yeah, I think it's so important to be able to have someone there answering the phones and being able to talk to people, because otherwise you're just trying to shove that in between patient care time and you're playing phone tag with people forever.

Yep. And you can miss opportunities. Yeah. Of like someone calling and. Yeah, I think it's. I think it's a really good point to bring up is that, you know, even though people, I think, look at an admin as a liability more so than like an asset, I look at it as an asset because really they are the first person that people are talking to and they are the people that are actually bringing people into the clinic. People think so off. I've. I've worked with a lot of PTs that are just like, look, I'll hire a PT first because they can make me money and make me, you know, make me profit. But not necessarily because you have to manage that pt. Well, for you to manage that pt, you actually have to pull away from patient care and to then manage that PT to make sure that PT is doing what they're doing right. So, yeah, I did the same thing. I hired an admin first and then pt so that the admin can help manage the PT and also take the phone calls and all that.

Yeah, they are so important. I can't tell you how many people we have gotten at our facility who, once they schedule with us have said, you know, one of the main reasons why I scheduled is cause, you know, Mellie and Nicole were so nice to me on the phone and you guys just sounded like such a different clinic. And, you know, they're just so sweet. You guys just seem to really care. And you know, that one, that's not an act. That's how I want to be, is right.

Right here.

And, you know, we really do want to help them out and spend time with them. And it's like, you know, I'm constantly going over that with our front desk, like, you guys matter the most. You are the. The first opinion. So if they, you know, pardon my French, if a patient has a crappy experience with you guys on the phone or the check in process, it's going to be so much harder on the PT's end to convince them to come in and do what they need to do and keep coming back. So, like, everyone plays such an important role in it.

Yeah. And that's so huge is just having such a comprehensive approach from the website to then the same messaging that the front desk gives to then the pts, what message they give. And having that collaborative approach on what the mission is, what the goal is, I think is also huge. And it comes from us, you know, kind of leading the ship of, hey, we got to make sure everyone's saying, the. The same exact thing. So we're all on the same page. The patient, it's very clear when they come in of, hey, this is what kind of service that they will be getting.

Yep, definitely.

Yeah. So when you, when you brought on your first pt, I mean, I don't know if you remember this, but were you really, like, nervous to bring them on where you're like, oh my gosh, how am I going to pay this salary that I now had to pay them? Or did you. Would you bring them on salary? Did you bring them part time?

I had an interesting. I've hired many different ways over the years, so I got to start out. So Washington University program in physical therapy here has a women's health residency program. And at the time that it started, they didn't have enough clinical care time available at their facility. So we actually partnered together. And that resident would be at my facility a couple days a week doing pelvic physical therapy and then was at Washington University's clinic a couple days a week. So it was great because I had someone who was like, super motivated, like really, you know, into learning and was there and, you know, so. And, and it was part time, so I didn't have to be like, okay, I have to cover this person's full time Right. Schedule and all that. Right. The downside was it was a different person every year. So I did that for about three years running. And every year I'd have to re. Not reintroduce. I'd have to introduce a new person to my referral sources and to go through the process every year. And so after about three years with that, I chose not to partner with them anymore. Just because it was.

Just because you were tired. It's tiring.

Someone every August is like, okay, so. But it took the work out of the hiring process for me because while she was the one interviewing, which also a downside, I didn't have a say who that employee was contract. And it's like, here's so and so. So, you know, it's like, okay, but no, it was a great way to dip my foot into it. Then I got super lucky and had a former colleague of mine want to transition into women's health. And, you know, I had a frank conversation with her that at the time I didn't need. But, you know, she's welcome to shadow me and learn. So she did that. And she did that for several months. That's awesome. And came on, I was like, I will have a job for you in August when this person leaves and you know, you can come on. And so that was, you know, I know that's not the normal situation. I know I got really, really lucky there.

That's amazing.

But since then, most of my hiring has come from, you know, ad placements on. Indeed. And, you know, locally, as well as reaching out in different Facebook groups and that. And honestly, I've gotten a lot of people from out of state who have moved to St. Louis. And so my last. So don't think that you have to look just locally. Like, my last couple hires have been from Arizona, and I'm in St. Louis, so they just had spouses or significant others that had a job transfer here, and so they were looking for a new location.

That's so interesting that you say this, because my last two hires of pts were from out of state. Yeah. So. And, yeah. And it was just because of our pelvic health network. Is that just how they came upon the job posting? And they were like, yes. Okay. And I'm going to move here because my husband's doing whatever too, so why not?

Yeah, yeah, yeah, That's.

That's. That's awesome. Yeah. Okay. So you had not the traditional route to really of hiring. At first you're kind of like, hey, here, I'll give you these people. Okay. Yeah, it was. It's. It's kind of hard because when you first. I remember I picked my first pelvic health PT ever, and I was like, super excited about it, but also terrified. And I picked her and I gave all my effort, all my energy into her. At two months, it took me to like, onboard her, and within two months, she left and she became a neuro, like, therapist in a hospital because she didn't know what she wanted to do. She was a nurse and then was a pt. And anyway, she was very confused, right. And I was, like, devastated because I did not have. I didn't have a backup. And at that time, I was seeing 50 patients a week by myself. And if I could give any tips out there for anyone, I would always say, always be hiring. Like, always. Brooke, I don't know if you know if you agree with this, but I always say always be hiring because I think it's. You don't want to be in a situation where you're like, crap. I now had to put myself back into the clinic and see 50 patients because we just can't do that. Like, we have to leave the ship, you know?

Yeah, no, I always have on our website, I always have that we're hiring up there because you never Know when someone's going to come by who may be a great fit for you. And I'm blatantly honest with people, like, hey, I actually don't have a position right now.

Right.

But this is when I think I might.

Yes.

This is what needs to happen for that to be the place. And I want to keep in touch with you. And if they're, you know, if they're amenable to that, then I'll keep that conversation going. And I've had people who, it's like, you know, if you want to come shadow me some and see, you know, if you really like this place, that. But, like, you know, I won't have room for you until, you know, two, three months down the road. Right. So, you know, I'm kind of in that same boat right now. I've been talking with. With some people, and it's like, okay, you know, like, right now, I really, I don't. I don't have a need for you right now. But we're building, you know, we're. We're filling up our second location and, you know, we're building out stuff at our main clinic. So it's like, you know, down the road, I know I'm going to need someone later on this year, so I'm not going to pass up the chance to interview people now and get them into my world.

Yeah, I think that's so huge, is I have just a running list and just saying, okay. And being honest. I've also learned my lesson in that because sometimes I used to just keep people on hold and not, like, tell them, hey, you know, I don't really have a spot. And I, you know, but now I've learned be honest with them. Be honest with them. Say, hey, I don't have a spot for you now, but if you would like to be kind of on my wait list of, hey, when I'm ready to pull the trigger, you know, if you want to come on, great. And I think that's the best way to have a running practice with multiple providers to be ready to go so that you don't have kind of a hiccup in the business, you know? Yeah. So tell us about. For those that don't know, Brooke just got a second location, which is super exciting. So can you tell us about, like, the thought process behind that? Like, how did you decide going from one location to potentially looking into the second location? What was your thought process behind that and, like, what made you take the leap?

I laugh because this conversation would have been so different. Even Just a year ago, like my husband, honestly, when I was opening up this location, like you have always said, you would never open up a second location. I was like, I know, I know. But it was one of those situations where the opportunity just presented itself. And I'm sure, like, in. I'm sure this is the case in lots of different Cities. Here in St. Louis, we have St. Louis county, and then across the river is St. Charles County. And there's something about having to cross the bridge that people don't want to do. And we get people who drive 25, 30 minutes, sometimes 40, 45 minutes from St. Charles county to our main clinic to see us because of our reputation. And that's great. But we also get lots of people who are like, oh, do you guys have a location in St. Charles County? Do you have a location closer to me? And, you know, a lot of our clients are, you know, moms with young kids. So just imagine having to take 40 minutes both ways, plus find a babysitter, plus do the physical therapy. I was like, it's a big chunk of time out of their day. So we actually. Someone reached out to me, a colleague reached out, who has. It's a dental practice and a chiropractic practice that are in the same building, their husband and wife out in St. Charles County. And they're like, hey, we have all of these extra treatment rooms, and we're looking to kind of build a practice where we have all different types of practitioners who work with kind of the same patient population, but in different ways and that. And so it's the chiropractor, it's a pediatric dentist who also does lip and tongue tie release. It's a speech pathologist, it's a lactation consultant, it's a chiropractor. So they're like, we have a room like, you know, are you interested in potentially renting? So my second location is very different than my first location in that I'm literally renting a treatment room inside of another practice. And so we just kind of manage that room versus our main location is, you know, three private treatment rooms, plus a gym and front office. And, you know, all the usual things you think of with the clinic. So it's a very different situation. And we're starting small. You know, we're starting there two days a week and filling that up. And then, you know, we'll add a day at a time where it's like, okay, now we're at three days, four days, five days a week with the goal of, you know, having that that clinic time out there filled 40 to 50 hours a week.

So, yeah, that's. That's an amazing model, you know, starting small there. And then, you know, if you're like, hey, I got. I have those patients that are really coming in the door, well, then you can build it out. You know that, that's awesome. And it's. I know I get a lot of questions of Kelly, should I go into another office with a doula or with a massage therapist or with whoever. And I think, you know, it always depends. It always depends on the lease contract. It always depends on a lot of different things. But in this case, it seems like it's. It's really working for you and it's. And it's going well.

So that's.

That's really good.

Yeah, it keeps my overhead low and I'm just gain small amount of rent out there. Have like, you know, great potential to partner with the different practitioners in that specific location.

Right.

Get us in front of people who we potentially wouldn't be in front of otherwise. You know, we're still figuring out. We're a month in and we're still figuring out some of the. The nuts and bolts of it. So we don't have our own front office staff at that clinic. So there's having to learn to schedule, learn to take credit card payments and do some of that. We learned the hard way that we needed to schedule more time there. Like, so we typically schedule hour long appointments for evaluations and follow ups. And at our St. Peter's clinic, we have to schedule an hour and a half for evals because there's no front desk there. So the therapist has to spend the five to 10 minutes on the front checking them in and the five to 10 minutes on the back checking them out. And we're, oops, we didn't do that at first. And we're like scurrying to try. And that's okay. It's like, okay. We have learned that evaluation appointments need to be longer out there.

That's right. Yeah. We got to pivot. And the faster you can pivot, the quicker you can make everything work. And it sounds like that's what you're doing. That's amazing. Yeah. So how are you guys handling Covid and the snow? And you know, we have the snow here in Covid and it's just been. It's been a monster over the last month of us trying to pivot and really hold it together. I almost feel like it was kind of more Covid over the last month. Two Months than it was like all of the pandemic.

I feel like, yeah, it's been kind of crazy. I mean, originally when the pandemic first started, we shut down and went virtual for about eight weeks.

Okay, wow.

That we opened a backup very. On a very limited basis, you know, where we were, because no one knew anything exactly. Like, one therapist and one front office person could be in the clinic at the time. We couldn't. We didn't want people overlapping and stuff. And then I'm. But pretty quickly we built that back up to our full schedule. And so we were able to build that back up. And we'd been running with a combination of virtual and in person appointments. So one thing the pandemic pushed us towards was to actually get virtual options out there. It's been something like, I should do this, I should do this, I should do this. And then a pandemic happens. It's like, okay, we're doing this and we're doing this today. We learned on the fly and we did it. So now it's just an option that's there for when a snow event happens. When a mom calls in and says, hey, my babysitter canceled. It's like, oh, we don't need to cancel. Do it from home. Let's. You know. We're still working on how we best utilize that. We have a lot of people who still would much prefer to come in. And I think I. Honestly, a lot of my therapists would prefer people come in, but I try to phrase it as like, okay, pretend it's your friend who lives across the country from you who's asking you for this advice. And you can't put your hands on her, but you still want to help her out. What would you tell her? How would you help her out? Right, that's going to treat this patient too, because you have all this knowledge. It's just a different way.

Exactly. Right.

Learn to share it.

No, that is just. You just nailed it on the head, I think so often than not, we're taught in PT school, hey, use your hands, do tons of manual therapy, and it's us providing the outcome. But in reality, it's really our brain and our mind able to come up with a program that's actually going to allow the patient to stick to that program and be very consistent with that. And it doesn't matter if they're in clinic or not. And so I know, at least at our clinic, we phrase it on the initial evaluation. We tell them, hey, we expect you to be here for 12 visits. Actually, couple of these visits will be virtual. Like, we already put it out there because we know childcare is going to come up. We know Covid is going to come up. We know snow days are going to happen. Right. And we know how beneficial to telehealth can be in saving time for the mom, especially because she doesn't get the kids like you're talking about. You know, some they may come up with work, whatever. They don't have to drive to the clinic. Also, the other positive is we can see their environment. And by us seeing their environment, they can actually be more compliant. Because it's not just manual, manual, manual. We're making it a reality at home of what the daily activities actually need to be. Because I always tell my therapist, at least look at. You can give them, you know, 20 different exercises, but 20 different exercises. Yeah. Doesn't. Doesn't outweigh them. Sitting for eight hours a day and you start to get this disconnect. And every single day kind of builds up and we really need to be teaching the practical of how are you standing at your desk? And so telehealth can really bring that reality into our world and use our mind and use the camera to be able to really make this a lifestyle change so they never, ever have this pain or this problem at the level that it's at ever again.

Yeah, no. And what you said about bringing it up from the get go is so important because that's one of the things when we were reassessing processes and how we were doing things, because we were like, you know, my front desk brought up that we are not getting a lot of people to switch to virtual when they call us to cancel Brooke. And so we looked at that process and we realized that none of the therapists, myself included, were really bringing it up at the eval. Like, hey, this is an option and this is going to be part of your treatment. So the patient was first hearing it when they were calling to cancel from our front desk, saying, oh, well, we don't have to. You can go virtual today. And they're like, yeah, no, exactly, not going virtual. So, you know, we realized that, whoa, we need to be talking about this right at. From the get go, as well as bringing it up at various times throughout the treatment so that they know that this is an option. They're not surprised with it when they're calling to cancel.

Exactly. No, I think that's so huge. And even just promoting it out, like, we even have slides of, hey, we do telehealth. And this is the benefit that we post, like, weeks before the snow comes, because we know it's coming, and we just want to be like, just remember we can do this. So, yeah, I think. I think the field is actually moving in that direction. I think it's. It's a really good thing that we have kind of been pushed to do it, you know?

No, that's true.

Yeah. Yeah. Well, that's awesome. Brooke, we're super, super impressed by you. It's awesome that, you know, you've had this growth and that you've moved to that second location. We just want to thank you for coming on to the Pelvibiz podcast. Can you go ahead and let listeners know, like, where can they find you? Where can they find your clinic, your Instagram, all that?

Yeah. So My clinic is www.legacytherapystl.com. and all of our social media handles, Instagram, Facebook, YouTube and Pinterest are legacy physical therapy. STL are all the handles for those. And so, yeah, we put out a lot of different videos for patient education. Trying our hand at Pinterest. That's always an interesting one. And Instagram and Facebook are the usual there. And then we also do a. It's called Our Mom's Made Strong. Facebook community is a free community of. I think we're up at around 1,000 people now where it's for moms and moms to be and longtime moms, because that's where I'm at. Talking different fitness options and sharing recipes and, you know, talking about their struggles and that. So we do a free Facebook community there, too, to try and. And, you know, talk to our patients and keep them involved with us in different ways.

So that's awesome. Well, thank you so much for coming on, and we appreciate your time.

Happy to. Thanks.

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