What Are The 5 Stages of Cash Medical Practice Growth? | Episode 19

Business is very predictable if you let it be. And one of the things that we find in this room is that people are at different stages. I can tell you right now, I know there's some of you in this room that have done zero cash procedures, and there's some of you in this room that are doing $3 million a year in all cash. So the question is, is, well, what stage are you in? And then how does like what we're applying and discussing apply to your practice? All right. So we're going to go a little bit deeper on some of those things, and we're going to talk about the 5 stages of a medical practice and its growth. So that's what we're going to cover. And then we're going to talk about a specific avatar, and we're going to talk about the journey of a prospect to a patient. We are going to talk about my elbow, specifically my life, my left elbow. And I want you— the reason I'm going to show you that is I want you to understand the journey that your prospect is going through before they decide to whip out their credit card and pay money with you. Okay, so let's talk about this. This is the doctor's paradox, and this is why you struggle in business. And, you know, if your business skill— how many people in this room, your medical skill on a scale of 1 to 10 is at least an 8? Okay, and those of you that didn't raise your hand that it's at least an 8, you're just not playing along, or you don't want to be part of the reindeer games? Because if you're not at least an 8, then I don't want you touching me. Okay. All right. By the way, how many people in this room are at least a 9? How many people are at least a 10? Where are my 11s? Anybody an 11? That's my Spinal Tap group. It's an 11, it goes louder. Okay. Thank you for laughing. It's— see, they get the younger generation. They don't get that joke. I posted a Spinal Tap joke earlier and like my kids are like, what, Dad? What is that? Okay. So, but here's the problem. You go to an event And what do you do? You think you're gonna get your business better by making your medical skill improved. You're not. That would be like me trying to improve my, you know, like, so let me back up a second. So then if you look at your business skill on a scale of 1 to 10, 10 being the highest, how many people say your business skill is a 5 or below? Okay, that's why you're here. So if you look at this, You'll notice this quadrant in your upper left, the struggle quadrant, that is doctors that have a medical skill of 6 or above and a business skill of 5 or less. And the problem is, is that when you go to improve the business, what do you do? You go to a medical event. You think learning one new way to do an injection— I'm going to turn the beveled edge like on its side, or I'm going to— Stand on one leg and I'm going to breathe through my eyelids like the lava lizards of the Galápagos Islands, and that's going to get me better results, right? That's what you do. I go to the events. I watch you all stand around and you're like, "Oh, look at the way he opens up the sterile bag! Oh, that's amazing. Do that again," right? That has nothing to do with your success in business. You're already good enough. Okay? And by the way, that lower quadrant. Below struggle. That's the doctor that was in med school that you wouldn't let them treat the dead people. Their medical skill was a 3 and their business skills were 3. They always go bankrupt. Where I want to take you is I want to take you— my goal is to get your business skill to at least a 6. If you have an 8, 9, or 10 medical skill with a business skill of 6, your business is going to scale. And as you continue to improve your business skill, you're going to get more and more freedom. Okay, so these are the 5 stages of medical practice growth. Are we going to hand those out? Yes, we're gonna have— we have a handout for you. How about that? Look at that. So we're gonna go through the 5 stages of growth, and then we're gonna talk about how we scaled my practices, the system that we used to scale my practices from startup to 3 locations in 18 months doing $6.5 million a year. For those of you that don't know the story, I got involved in the cash-based medical practice business, and I opened up my first practice in 2014. We had a doctor on staff. Don't worry, we were doing it legally. I own the MSO and we scaled. We were in the erectile dysfunction business and we were doing anywhere between 80 to 100 PRP injections in men's penises throughout the 3 locations. And we were doing 75 to 90 HRT insertions. Funny story, by the way, when the patient would come in for a PRP injection into their penis and the pellets at the same time, we called that the pancake procedure. You know why? 'Cause we would draw their blood, put it in the centrifuge to spin it, we'd numb their penis, we'd flip 'em over, we'd do the pellet insertion, put the ice pack on it, sterile Steri-Strip, ice pack on it, flip 'em back over. By that time, the blood had spun and we could inject in their penis. Thus the pancake procedure. So it'd be like, Doc, got a pancake in 2, and then a pancake in 4. That's supposed to be funnier.

It's a good one.

What the hell? Like, I'm working over here. Come on, work with me a little bit.

Okay. All right.

Let's talk about the 5 stages of growth for a cash practice. If you are doing less than $50,000 a month, all I want you to do from this event is I just want you to get 10 premium patients. That is it. And to get 10 premium patients, that's less than $50K a month in cash. There are things that you need to understand. The stairway system, which I am going to introduce to you in just a moment, it is what we use to scale our practices from startup to 3 locations in 18 months. It's what my clients use today. The key components that you have to understand is you have to have a signature solution. We're going to teach you that over the next day and a half. I'm going to show you, I'm going to prove to you scientifically Why your pricing is too low and you're going to go out of business. Price is scientific. And I know for a fact every single one of you in this room are not charging enough. And you cannot make it up on volume. Medicine is not a volume play. It is a high-touch, high-price play. And the sooner you embrace that and snuggle up next to it, and wrap your arms around it, the faster your business is going to grow. You cannot ever low-price your way to success in medicine. There's too many time constraints and there's no economies of scale. You cannot measurably impact the cost of the materials and your, your staff is specialized and you're gonna have to pay more than market rate. That simple. It's an economics of business. Okay, so what I want you to do in this stage, all I'm asking you to do is to generate $50,000. I love simple math, maybe because I'm Irish. That's supposed to be funny. That didn't— Roddy, you're gonna have to help me out here, okay? Like, laugh harder. Come on, John, that's why I got you here, buddy. Okay, so all— it's really simple. All I want you to do is sell 10 of your patients at $5,000 apiece. That's $50 grand. Matt, I've never sold anything for more than $500. Don't worry, I'm gonna show you the math and the logic behind it, and I'm gonna prove that with marriage, which we'll talk about later on. The next phase is you want to create demand. This is what people will call marketing. This is why, by the way, how many people here have paid a Facebook person to generate leads for them, for their business, for their practice? How many people have paid for online advertising? Worked great, didn't it? No, didn't work. You want to know why? Because it's violating the science of business. You have zero relationship. Facebook leads are the lowest life form of leads on the planet. They're the lowest intent. That's why they're so cheap. Okay? That's why they're so cheap. So to create demand, once you're over $50,000 a month, I want you to go from $50,000 to $100,000 in a month in cash. Now, by the way, these are not 6-month cycles. These are getting to $50,000 in the first 60 days. That's what our average client adds, $50,000 in new cash revenues to their practice within 60 days.

Documented.

Okay. The next phase is creating demand. The whole purpose of marketing is to make sure that your client, your prospect is pre-educated, pre-qualified, and predisposed to doing business with you so that selling is not required. How many people like the idea of not having to sell your patient? Okay. And I'm in sales and I like that idea.

Okay.

I'm not here to teach you any neuro-linguistic programming or trial closes, and I'm going to make you a killer ninja when it comes to closing people. No, we're going to let the system— I'm going to show you a system that makes selling superfluous, unnecessary.

Okay.

So in this phase, you start pruning insurance. We take the mafia approach. We whack the least productive.

Okay?

You're gonna invest 10% of revenues into marketing, and you wanna have what's called a predictable NPE. An NPE is if you know that you have 20 new patient evaluations on your calendar for that week, you know you're going to make $40,000, $50,000. Understanding the number, this NPE— every business has its own set of language. When you understand how many— with the power of a new patient evaluation, when you have the right systems in place, everything becomes incredibly predictable. Business is not unpredictable. It's unpredictable to rookies. Is surgery— come on, Roddy, is surgery really that unpredictable?

No.

You've done thousands of them.

Right?

Okay. It's unpredictable when the hospital doesn't do their work or people don't show, right? But at the end of the day, boom, bang, boom, bop, beep, beep, let's go. There's a system, there's a process. And what we do is when we're creating demand, you're going to utilize— we're going to show you how to utilize video and dark social like what Ariana was just talking about. Dark social is you're going to build— you have to understand, you only need to dominate A 25 to 40 mile radius around your practice. That's it. And if you're in California, you got to dominate like 3 miles because that's an hour drive. No? Thank you. Dear God. Holy cow, you guys are tough. I tell you, I get no respect. Okay, so we're going to use— I'm going to show you how to use video and dark social. Okay. I will tell you, it is the The most powerful discovery that we've had in the last 4 years in marketing our practices. If I were to open up a new practice today, that is what I would do.

Okay?

And you'll see some heads nodding around here. It is incredibly powerful. The next phase is you're doing $100,000 to $150,000 a month in cash. And this is where you start focusing on systems and support, i.e., staff. Now people are like, well, why didn't you talk about building systems before we did all of that? Because nothing matters in business until you make a sale. Nothing matters in business until you make a sale, and then you have to sell 10 of them. Once you sell 10 of them, then you know you have something. So you all have it backwards because this is what they teach you in medical school. Gotta get everything right, everything's got to be perfect, I got to think through everything, I got to get the right machine, I got to get fully trained. You know what business people do?

What?

Fuck it, let's see if 10 people will buy it. That's what we do it all the time. Ask Atiba. You know, Atiba and I are working on a new business model on something, and we're like, fuck, can we get 10 people to buy this? I don't know, let's give it a shot. And not 10 people we know, like, let's see if 10 people will give us their credit card. Maybe we'll figure something out. Okay, so if you're starting a practice, please, for the love of God, do not spend a lot of time looking for a location. Go sublet something in a med spa. Don't buy any big machines. And we got a lot of great vendors out there. No offense, Jackie. We got a lot of great vendors out there, right? Like, but don't dump all your capital into buying a machine. Like, rent one. Go sell 10. Keep your exposure low. See, you do everything opposite that they teach you in med school. What do they teach you in med school? Let's get up to our eyeballs in debt. Okay? And then if we're gonna get something, we have to go spend all this money and get even more eyeballs up in the debt and get it ad hoc so that we can never leave. You know what that is? That's called slavery. That's exactly what they've done to you. You are no different than a sharecropper post-Civil War. Don't know what they did with sharecroppers? Those were the slaves that were working the land. You know what the landowners did? I'm going to front you cash and you're going to work that land. And at the end of the year, if you have enough, you can pay off the loan. Oh, you didn't pay off the loan? We're gonna give you another loan. They created a whole new level and form of slavery post-Reconstruction in this country. Lasted up until the 1950s and 1960s. It's called sharecropping. You wanna know what they did in medicine? You're sharecroppers. Here's the good news. We're gonna get you free.

Okay?

'Cause we're not gonna lie to you. We're gonna tell you the truth. In this phase, you start replacing yourself. You need to have an ops manager. Notice how I didn't say an office manager. No offense to the office managers in here. You hire a chief operating officer. That is vastly different than hiring an office manager. That is a completely different set of skills. Catherine, wave to everybody. Catherine is my chief operating officer. She runs the show. I don't make any decisions, quite frankly. People go, people People on the team go, "Hey Matt, what do you want to do?" Blah blah blah blah. I go, "I don't know. Talk to Catherine." Hey Matt, can we spend blah blah blah on this? Go talk to Catherine. I got one job at standing on this stage. Okay, this is my surgery room. You all are my patients. This is my giftedness. This is what I do. Okay, and I understand business very very well, but I also know that the founder's job is to take at least six weeks off.

year.

No cell phone, no email, no checking in. My wife and I, after we drop off my son, my youngest son, last one out the door, off to UNC Wilmington. Yay, John, right?

Woo! Woo!

Go Seahawks! Go Hawks! We're jumping on a plane to Paris for 2 weeks. Okay? No cell phone, no email, no checking in. All right? Why? Because we focus on building systems. And this is the stage that you're leaving insurance behind. Caveat again, I'll say this a million times, I'll say it over and over again. I'm fine if you keep insurance around to generate leads for you. It's actually one of the best ways to generate leads in the orthobiologic space. However, don't use it for anything else. It's free lead gen. At least you're gonna get paid $49 for somebody coming in the office. You'll get paid 90 days later, but at least you'll get paid $49 for them coming in the office, and then they'll clot back.

Yeah.

Okay, don't you love that? Hey, we got this new way for you to make money and we're gonna let you make all this money and 2 years later, hey, you remember that $1.5 million you made from us? I got a client right now, he had $2.5 million clawed back. $2.5 million clawed back.

What procedure? IV.

Told by the insurance companies, this is how you code it and this is what we pay you. Yeah, he's in the middle of fighting that one. Isn't that fun? Okay, then the next phase is when you're between $150,000 to $350,000 a month in cash. You're gonna double your take-home pay. This is where you're gonna 2x your personal pay and you're gonna pay yourself quarterly profits. And this is what we call a 5 days model, meaning that you're only in the office 5 days. If you still want to see patients, then please, for the love of God, see patients. If you want to volunteer your time at the local health clinic because you feel that that's important, In order to provide outstanding healthcare for your community, please, for the love of God, do that. If you want to travel to Honduras, if you want to— whatever, wherever you want to go, do that. But don't volunteer your time to the insurance company and get treated like a sharecropper. Okay? Because that's basically what they treat you like, an indentured servant. Okay? So Go, you know, treat your patients. But if you want to give, volunteer your time, then please volunteer your time. Lord knows our community needs it. And then final is scale, acquire, or sell. So let's talk about this scale. This is where you're $350,000+ a month. You can have more locations. Every facility is going to have a cap of its size. Rarely— I think the largest location one of my doctors has is 6,500 square feet.

Wow.

At that point, it becomes almost untenable for her to have any more space, so she opened a second location. You can acquire your competition. There's a lot of your competitors that are not in the room right now. You can buy them for pennies on the dollar and then make them work for you. You could sell. I find that most doctors don't want to sell.

Just don't.

Acquire or sell. sell and exit your practice by being the CEO or chairperson of the board and not ever going in. Do what makes you passionate, what you love to do. You know, Arianna spends a lot of time out on the road and she's on different boards and foundations and things like that, and that's what she loves to do. So great, utilize the practice to do the thing that you want to leverage what you love to do, okay? So what stage are you currently in right now? What stage are you currently in right now? I didn't realize that was going to come up again, so we're just going to bypass this. There you go. It's like reliving the past. Okay, so here's my question. What stage are you in right now? How much cash are you doing in your practice per month right now in cash only? I don't care about insurance. Write it down. Can we— do we have the other sheet? Do we hand out— do we have that other sheet for the handout? Thank you. We're going to hand out another sheet for you. So what are you doing right now? Where are you? And then the next question is, so if you're at this stage, where do you want to be in 3 years? You know what's fascinating about life is that you grossly underestimate, well, where you'll be in 3 years, and you grossly overestimate what you can get done in 1 year.

That's what they say about tech. It's the same comments we've made about tech. Yes.

Yep. All right, so think about this. Business isn't about 2xing it. So again, let's say you're doing $50,000 a month in cash. So don't ask, well, gosh, you know, I'd be pretty happy in 3 years if I was doing $125,000. Why don't you ask the different question? How many people know Dr. Ayni Trong?

Annie Truong.

Annie Truong, right? I think that's how you pronounce her last name. Do I have that right? Truong?

Yes.

So she asked herself this question. She's not a client of mine. We were talking, we were hanging out in Pensacola last week, and she says to me, you know, I was doing a quarter of a million dollars a month, and I asked myself the question, why am I not doing a million a month? Guess what? A year later, she's doing a million dollars a month in her practice. You have to ask a different question to get a different answer. So where should you be in 12 months? You should be doing a minimum of $2.4 million a year in cash. And that track, on that track, that's $200,000 a month. Pretty simple. It's 20 patients at $10,000 apiece. See how easy that math is?

Yeah.

I don't care where you live.

All right.

How many people realize their patients are pissed off about insurance? As pissed off as you are, I'm a patient. I'm 2.5 times more pissed off than, than you are. You want to know why? I went and got an MRI 4 years ago. Had an issue with my prostate. Elevated PSA numbers stayed up. Exam. Yeah, we probably want to get this checked out. MRI looks like there's a shadow. Okay. Guess how much the MRI— and my wife has— she has phenomenal corporate health insurance. She's a— she's an executive with an advertising agency, pretty large agency. My deductible, my part was $1,100. You want to know what the MRI company got paid?

About $300.

So I gotta pay $1,100, the people that run the machine get $300, where's the rest of the effing money go? Right into the pockets of the insurance executives. Let me tell you right now, you'd probably already know this, the insurance companies don't give a crap about you, and they certainly don't give a crap about the patients. At all. 6 weeks ago I went and got an MRI for my back before Osh and And Arianna did my back procedure. They walked in and they said, what insurance provider? I said, I'm paying cash. They go, okay, $250, no problem. Whip out my wallet, 1, 2, there's a $50, $250 cash. It's never gonna get better, folks. You're gonna walk out of this room, you're gonna say, I can do this, or I'm gonna go sell my life to the hospital. That's it. There is no survival if you were going to stay on your own. It can't happen. It doesn't work. Okay? So where do you want to be in 3 years? Do you want to fully fund your retirement? You know, look, it's not about jets. It's not about expensive cars. Maybe you just want to coach your kid's Little League baseball team. Or play more golf, or take nicer vacations, okay? Or stay in better hotels, right? Everybody's got their thing. For me, it's golf. I spend a stupid amount of money on golf, okay?

But—

and cigars. But you know, it is what it is. So, so where do you want to be? What do you want to be doing? Never ask you that question, right? Because we don't want— they don't want you thinking 'Cause when you start to realize how bad a deal you have, you will leave insurance tomorrow.

Okay?

So the next thing we're gonna do is that we're gonna dive into the stairway system. And do we have that handout too? I think we do. Yep, it's on the table, it looks like. Looks like you've been handed that.

Okay.

This is the system. I believe in systems. I love systems because I have ADHD or ADD, I can never remember.

ADD.

I can't stay focused long enough? No?

Okay. All right.

Oh God, we're gonna need closed captions or something. More coffee. So the stairway system, let me tell you how this started. We started the ED clinics in January of 2014. The first 7 days we were open, we did $70,000 cash collected. February, we had a snowstorm and we were only open like 2/3 of the month. We did like $110,000. March, we did like $150,000. In April, we did over $200,000. Yes, that's a lot of penises. I have seen my fair share. I will— if you want to hear the stories at the cocktail hour tonight, I am more than happy to go into them. I will not here.

Okay.

And my partner comes in and he goes, let's open another practice. Let's open another location. And I looked at him, I said, are you out of your effing mind? I'm about ready to stick a fork in my eye. Because we didn't have a system. I'd never run a medical practice. I never— the closest I'd been is my first wife went back to— she went to nursing school as a second career at that time, and she was working in the ER. Okay. I didn't know anything about this. Hell, I wasn't even sure what HIPAA was. We had paper files. Imagine that. Okay. All I know is that we were running ads on TV and radio, and we were booking 50 new patients a week, and we were doing $50,000 a week in cash. We'd give the guy an injection of Trimix in the office. He hadn't had an erection in 2 years. We'd give him an injection. He'd come— we'd come back in 10 minutes later. He's fully erect. At that point, they're, they're going to buy the medications. They're going to buy the program. If they haven't had an erection in 2 years, like, what are you going to do? Of course you're gonna spend the money. And the only reason why they didn't is they didn't have the money or a place to use it. That was it. That was the only reason why they didn't buy. Okay? It was insane. I've never sold any— I've never had anything like this in my life. Yeah, they see— now I understand that. So you're that kind of humor. You want the sex jokes.

All right.

We got the— duly noted, Arianna. They want sex jokes. Okay?

Exactly. Okay.

Bathroom boy high school humor. And so I said, you got to give me 6 weeks. He goes, why? I said, because I got to figure out the system. It's May 1st. This is the system that when we put it in place in July, we did $300,000 for the month. We had a $100,000 week. In November, we opened our second location. In June of that next year, we opened our third location. And they worked like this.

Okay.

Here it is. This is the first part that we're gonna teach you right now, and this is the concept called the beachhead. Arianna talked about it a little bit. We're gonna dive into it a little bit more, but this is where most of you fall down. You violate this rule, this science of business all the time. You have to, in order to be successful, you have to be having one message to one market with one offer to get them to come in the door. We call it the rule of ones. Okay. Now how many people here— where are my World War II fans? Where are my World War II buffs? Okay. All right. So remember the invasion of Normandy, World War II, opening up the Western Front. What did we do? 200,000+ ships, 250,000 men, planes, the whole thing, and we concentrate all of our efforts on a very narrow beach area, beachhead area. In Normandy. Okay? The concept of the beachhead is rooted in military science. This allowed us to get the— the red is where they got to at the end of day 1. This was our beachhead so that men and materiel could get into the European continent so that we could defeat the Nazis. Okay? We used it in the South Pacific in island hopping. It is a standard military strategy and tactic. Why is it so important? Because you focus all of your energy in a very small area. Thus, one message, one market, one offer. The problem is, is all of your businesses look like this. Oh yeah, we do that. Oh yeah, we do that too. Oh, we do that. Oh yeah, I do. I have ozone. We can do that. I know you are violating the beachhead concept when I click, go to your website, and I click on conditions treated and it fills up. It looks like the menu at a Greek diner.

Right?

Last night we went to a steakhouse. What did I get?

Steak.

Steak. Okay, when you go to Ruth's Chris, what are you gonna get?

Steak.

When you go to McCormick and Schmick, what are you gonna get? Seafood. You don't have the money To be all things to all people.

Okay?

So I want your business, as I like to say, if you're in a Mexican restaurant and it has fettuccine Alfredo, you know it's going to be bad. True story. My wife Katie and I got married just under 2 years ago. I'll tell you more of that story tomorrow, okay? And how it relates to business. And we're in Cabo. How many people have been to Cabo?

Yeah.

Cabo's awesome. If you love golf and looking at the Pacific Ocean and not going in the ocean, it's awesome. I do love it. And so we're in downtown Cabo and we're like, hey, let's get something to eat. And we walk into this restaurant and it's a Mexican restaurant and I swear to God the menu was like this. And I open it up and literally there was fettuccine Alfredo next to the enchiladas. I said, we're outta here. There's no way you can do fettuccine Alfredo well if you're making enchiladas. It's not possible. Less is more. Less is more. Less is more.

Less is more.

Less is more. Less is more. 80/20 principle. The more you can do this, and what happens is you grow when you get to this place, right? You get to $2 million or $3 million a year, and all of a sudden you're like, yeah, we do this and we do that and we do this and we do that. And you get stuck to the concept of, if I get rid of this one thing, then I'm gonna lose the money. And what I'm trying to tell you is you're leaving 10x behind. You're leaving it on the table. How many people here are farmers?

Prune.

Anybody understand the concept of pruning? Anybody here ever been to Napa? You know what they do twice a year? They drop a third of the grapes on the vine. I have a friend of mine, he owns a vineyard, Kelly Family Vineyards. I get 60 bottles from his vineyard every year, have my label on it, my own— I have my own row of vines. I have an investment in his vineyard. I have my own row of vines. He sends me bottles of wine that are fantastic, and they have my name on them. Okay, I don't make any money because it's a vineyard, but I get free wine, so that's a good deal. Okay. And Gene's got me out there, and he's going, yeah, so twice a year we have to go in and we cut 1/3 of the wine, of the grapes, and we just drop them on the ground. I go, what do you mean you drop them on the ground? Can't you use them for anything? He goes, no, we can't make jelly out of them. We can't make drink out of them. We can't do anything with them. I'm like, wow, well, why do you do that? He goes, well, that makes the remaining 2/3 more robust. And I go, oh, okay, that makes sense. And then he goes, then we come through and we drop another 1/3 of the grapes.

I go, what?

And he goes, yeah, I've been— he's had this vineyard in his family. It's the second generation. So he's Gene's 65, I think, 60 or 65. He's been working this thing for as long as he can remember. His dad owned it. And he goes, yeah, because without it, the rest of the grapes aren't any good. If we were to keep all the grapes there, they would suck all the energy away from the grapes and we'd make shitty wine. The only way we can make great wine is to prune. I love to grow flowers. What do I do when I want flowers, my roses? What do I have to do? I have to get rid of the underperforming roses to get more beautiful roses. Why do you think that you can violate nature in your business?

Why?

Because you're special? Because, like, nature's vortex doesn't exist where you live? The rules of life are all around us. You know them, right? The human body, right? What do we know about the human body? All bleeding eventually stops. Right? No? You want me to go back to the dick jokes?

Yes.

You want me to tell more penis jokes?

Yes.

Okay.

Okay.

All right. So we have to get really focused.

Thank you. Okay.

So this is what I want you to have. I want you to have one very specific offer to get people in the door. It's just about getting people in the door. In our clinic, it was come to the clinic one time, meet with the doctor, get a test dose. If you don't see results in 12 months or less, you owe us nothing. That's our guarantee to you. We sold them erectile dysfunction medications, Trimix. If that wasn't good enough for them, if they had Peyronie's, if they had venous leakage, one of the purple ones, that was PRP. We sold HRT, we did hair restoration. All of that was behind what I call the veil, but it was not on the site at all. We were in one business. We were not in the business of erections. We were in the business of orgasms. That was our business. And we made $6.5 million a year, and we dropped 20% net to the bottom line. That's $1.2 million for those of you keeping score at home, after we paid myself and the other partner a quarter of a million dollars a year in salary. And we sold it for a very nice multiple.

One thing.

Okay, so then let's talk about how we get to this. How do I identify the market? Well, we're gonna build the perfect patient, and Arianna talked about this, and I'm gonna take you on a little bit of a journey. Okay, oh, here's what we do know is the absolute best— now we have clients throughout the US and Canada, we now have a client in Australia. He's just getting started, so I guess that makes us really international. I guess if you're Canadian, you're only partially international, but yes, now that we have Australia, we are now fully international.

Okay?

And this works no matter where you are, and the reason why is human nature is human nature is human nature is human nature. Human nature doesn't change. Humans are the same. Okay? And so here's the best market for you. Here are the people that are, that's the 20% that are gonna drive 80% of the revenue. They're gonna drop $10,000 and $15,000 per procedure with you in regenerative medicine. You ready? Men 55 to 70.

Boom.

That 20% is going to drive 80% of your revenue. In the functional medicine space, it's 2 markets: women that want to lose weight, dudes that want to have sex. There is no other market. From a primary market of a beachhead offer that gets in, and I have clients in both. My group of clients are 50/50. And when we mash them all together and we put all our functional medicine people together with all of our regenerative people, those are the markets. But Matt, what about the— I had a 42-year-old in the other day and he is a CrossFitter and he spent 10 grand. That's what we call an outlier in business. That is fool's gold.

To chase.

I own percentage of clinics in weight loss and regenerative and men's sexual health, women's sexual health. Women for HRT, the only thing that they respond to that makes us money— weight loss. Everything else pales in comparison. Every woman wants to lose 10 pounds, especially if they're 45 plus. And every guy wants to have a little bit better sex life. Thus, now we know why there's conflicts in everything in life, right?

Okay.

I mean, this is really simple stuff.

So you—

in my world, it's simple. This is like, you know, when you tell me, oh yeah, surgery is simple. It's complicated to me. But in my world, this is very, very simple. We've learned through discipline over the years, if you chase 2 rabbits, both disappear. You will do more if you focus on the few. Okay? You can make the offer to everybody that comes through. We're going to talk about selling to your list later on. But again, just from this concept. So let's talk about building the perfect patient. The whole role of your marketing is to pre-educate, pre-qualify, and predispose your prospect to doing business with you. I get asked all the time, Matt, should I have a salesperson on staff?

Eh, if you want one.

I think the doctor should do the selling or whoever's meeting with the patient. I think as soon as you get somebody else that you pass it along to them, the sale's gone. Our work for the last 6 years has proven that to be the case. Okay? But Matt, I don't like to ask them to talk about money. Get over it. I'm dead serious. You are the best and the brightest that our society has created. You have been through the hardest training in the world, and you want to tell me you can't learn this? Bullshit. That's a limiting belief. Ask my clients in the room. I've said this all to all of them. I'm that blunt, by the way. Mavericks are direct, okay? We actually have a whole list of sayings. If you want out, remember what I said in the first session? You have to be willing to do the hard work. I'm not asking you to become a great sales closer. I'm asking you to be real and authentic and care about your patients. And no one, nobody other than the doctor and the patient should be involved in the decision of care for the patient. Yes?

Yes.

Okay. This is why you got into medicine, because you care about people, because you love them. You've been told a lie. You were told a lie in med school. Matt, we shouldn't talk about money. Who told you that? My college professor, my med school professor. Really? What the hell do they know? That'd be like me telling you you shouldn't make an incision in a knee this way. It should zigzag. Would that work, Roddy, if I made a zigzag? No, it's just a straight—

maybe.

We haven't tried it. Okay.

All right.

Like, You've been lied to. Why are you lied to? Why do you think they lie to you? Why do you think they tell you a doctor shouldn't talk about money? They don't want you to leave the Viking slave ship. They don't want you to stop being enslaved to them.

They're also not responsible for any of your costs.

Yeah, they're not responsible for your costs. They're not responsible for your malpractice. They're not responsible for any of it. What's the number one job of the insurance companies? To Make profit to the tune of $16+ billion last year. Okay, think you can get pissed off enough to get over yourself about talking about money? All right, we're gonna talk about the system of how you talk about money. Arianna, later this afternoon, is gonna show you her million-dollar consult. It's freaking amazing. I'm excited. And it leads people to a very logical conclusion. They have no choice but to spend money with you. That's all sales is.

Okay?

So here's your audience. Here's how I want you to think about it. There's 80% of your market, 80% of your list right now, 80% of the people that come through. These are the customers that are not ready. I don't care about them at all. There's the 20%. These are the better customers. But what I want you to target is the top 5%. These are the people that will pay premium dollars to get premium results. I, by the way, am one of those. I'm 56 years old. I send my last son off to college in a couple of months. I no longer have to pay for travel soccer and lacrosse and Boy Scout trips and horses and All that shit. I'm on marriage number 2. Okay? She makes great money. I make great money, right? We have a nice lifestyle. I don't have a lot of debt except for the mortgage. Okay? And I'm in the prime of my life. I'm in the prime earning time of my life. And I no longer want crap. And I'm sick and tired of going to my doctor and them saying, well, let's try this and come back and see me in 6 weeks. And let's try this and come back and see me in 6 weeks. And let's try this and come back and see me in 6 weeks. Imagine you have a leaky pipe, you have a leaky bathtub in your house. You call the plumber and he goes, yeah, we're going to try this and come back in 6 weeks and see how it's coming. If that doesn't work, we'll do something else. No, you want the plumber that goes, I'm going to fix this. I'm gonna stay here till I get the job done right, and you're not gonna have to worry about it afterwards. How much? I don't care. Just get it fixed. That's your core customer.

Okay?

So that's the 5%. Think about it this way. That's your top target. In reality, 80/20 tells us that 5% of our customers are gonna generate 95% of our revenue.

Okay. Okay.

Scientifically, mathematically proven.

Okay.

Don't believe me? Where are my Allman Brothers fans? How many people like the Allman Brothers? This is on Spotify. Their top 2 songs, Midnight Rider and Ramblin' Man— love Ramblin' Man— are over 471 million plays. Songs 3 through 10 are only 386 If you pull up Def Leppard, how many people— where are my Def Leppard fans? How many people love Pour Some Sugar on Me? Come on, how many people love the song Pour Some Sugar on Me? I wanted to make that my walk-up song. Pour some sugar on me. Okay, 471 million plays.

Plays.

The next closest, I think, is Hysteria. It's like 98 million. 80-20 on Spotify. I play Ramblin' Man probably 4 times a week. Pour Some Sugar on Me is on the regular rotation when I work out. It's a great way to start out a workout. I want to play guitar like that one time. One time in my life, I want to know what it's like to fill a football stadium full of 65,000 screaming fans and them to sing your song back to you. Can you imagine that rush? That's got to be a pretty good rush. Or play the Sphere and have them sing the song back to you. Okay, here's the thing you have to understand though. Every single one of your patients goes through an extensive journey before they call you. So let's talk about my elbow. Let's talk about the patient journey. All of you think your patient journey is like this. Patient journey is they get injured, they come see me, they fix me. Nope, your patient journey looks like this. They start and they do some kind of path like that, and I can show you it based on my elbow. Okay, the end. So let's talk about my journey for elbow pain. For those of you that don't know, I'm a former PGA golf professional. I never played on tour, but I played a pretty high level. I'm a 5 handicap right now, which is actually pretty bad for I'm 56 years old and I've decided that my side thing is I'm going to play competitive senior amateur golf with the goal to qualify for the US Senior Amateur. Okay, that's my goal. If I could ever stay healthy for a year— I've got the elbow fixed, I've got the knee fixed, and I've now got my back fixed, so hopefully I'm not getting anything else fixed. Okay, but I love to play golf. I've been playing golf since I was 6 years old. Okay, and I have been knowing about PRP. We did our first PRP procedure for erectile dysfunction in 2015.

Okay?

So I'm pretty well-versed, even though that's not technically a joint, but from regenerative medicine therapies, like I work with Ariana and Don Buford and like I'm at all the IOF events, like I know this space fairly well.

Okay?

And I injured my elbow doing CrossFit because every 52-year-old guy should do CrossFit. Stupidest damn thing I've ever done in my life.

OK.

And I injure my elbow. OK? So let's go through my journey. In the fall of 2020, I injured my elbow at CrossFit. I asked my trainer, Matt, nice 28-year-old guy, and he said it was probably tendonitis and told me to stretch it, ice it, and take it easy. So what did I do? I iced it. I stretched it. And I took it easy. I went home, did some basic research. In the winter of 2021, I went back to working out, and within a day I was hurting again. And then I went and bought my first of 6 sleeves. I actually went back into my Amazon account. I did a screen capture, but I couldn't figure out the right way to like present all of this. I kid you not, I bought 15 different types of sleeves and bands for my left elbow. I had the sleeve. I had the sleeve that, like, just was half. I had the sleeve that compressed up top. I had the sleeve that compressed below. I had the little thing that— the little thing that you put around it that, like, you know, was just that thing, whatever that is, right? I got— I had sleeves that had ice. I had sleeves that had heat, right? I had black sleeves. I had gray sleeves. I had beige sleeves. I had them— I had sleeves with copper. I had all of these.

Okay.

And I'm working out with the sleeves, and that was okay. I could play golf, but the elbow would hurt that evening. So I could play 18 holes, and I'd have to go home, and I'd have to ice it, and I'd wake up in the morning— like, I'd wake up in the middle of the night, my elbow would be hurting. And if I tried to play 2 days in a row, it was brutal.

Okay.

In the summer of '21, I went to see a doctor, and he did a prolo shot.

Yay. Okay.

Told me to take it easy for a few weeks. Did my prolo shot. I was able to work out a bit for a bit of time. No soreness while playing golf. Winter '22, I injured again. Summer '22, I hit a golf shot and it bothered me. And I began lots of stretching, worked on a better position at impact. So my golf teacher's like, you know what, your impact, I want to see it more solid in your back left hand. He goes, you know, you're coming in a little bit too cupped. That's putting too much pressure. I talked to my Titleist TPI, guy, which is a fitness instructor for, for golf. And he said that's where they see a lot of those injuries come from, is the position of the ball impact is not very good. Let's get that more solid. So I worked on that. Okay. In the fall of '22, I injured it again, but winter was coming, so I played sparingly. And then in March of '23, a year ago, I hit a shot on the 8th tee. I hit it fat. For those of you, that means I hit the turf first before the ball. And I immediately knew something was wrong. I hit the turf and what came out of my mouth was, oh, fuck. I knew something was wrong by the 12th hole and I'd quit playing. I was playing with one arm. I basically was just hitting the golf ball with my arm, right arm. My elbow was the size of an orange. At that time, I was taking pictures of it and I was sending it to Dr. Arianna Demers, Dr. Don Buford, Dr. Mark Petropalli, and a few— Dr. Schachter. Couple of other folks, and I said, "Look what I did!" And of course, immediately they're all like, "Yay! We can fix something!

Woohoo! Yay!

We get to play doctor!" Because the next week we were in Sarasota, my mastermind. Ariana brought her travel ultrasound, and she did the ultrasound on my elbow. And this is never a good thing when the doctor is doing the ultrasound on your elbow, and they go, "Ooh," and I go, "That's not good." She goes, "Yeah." Ooh, okay. Grade 2 tear, right? Do I have that right? Grade 2 tear. And we did a PRP injection in my elbow. 4 weeks later, I'm hitting golf balls at 50% speed. Elbow's been fine ever since. Now I want you to think about this. I'm in the business. I work with— I'm blessed, I get to work with some of the best regenerative doctors the planet has created. Many of them are on my cell phone, just pick up a phone call. And I didn't call them because I thought I could figure it out on my own. It wasn't until there was a catastrophic event that I said, I'm gonna get it fixed. Now think about your patient. Your patient's doing exactly the same thing. Your job is Is to stay in front of them and educate them about what's going on. And in our next session, we're going to talk about the power of educate and excite, because you never know when the thing is going to happen. Now, I got better when my back got bad and it was bothering me for like 2 months. I'm like, hey, Arianna, can you ultrasound this thing? Because we were at Asha's place and she again went, ooh, you need an MRI. And when you come back here in 2 weeks, we're gonna inject your back. So we did. But this is your patient. They don't— they're gonna find any other excuse. We used to say about this in the ED clinic, we wanted them to have a 2-year failure prices of pills, potions, pumps, and porn. A guy that suffers from ED, what do they do? Well, okay, let's watch a little porn. Maybe that'll help get me aroused. That doesn't really work all that long. Then what do they do? They talk to their buddy or they get— at that time they got ED medications from Canada. Now you can just get them delivered directly to your house via Roman and stuff like that and Hims and all of that. And they try all these other things. They try horny goat weed, they go to GNC, they do all these things. And we wanted them to come to us with 2 years of not being able to get an erection. If the patient walked in, they go, well, I just, you know, didn't work all that well the other night. We'd be like, I'm sorry, we can't help you. You're out the door. Why? Because they weren't in enough pain. You want your prospect to have a bleeding neck. What would you do if you had a bleeding neck, Ryan? What would you do if your neck was bleeding? What would you do?

Get help.

As fast as possible. Yeah. If you skinned your knee, what would you do?

Yeah.

Most of you are trying to sell people with— that need Band-Aids. I want you to sell people with bleeding necks. They will pay anything. They will do anything.

Okay?

You want people that have failed. You want people that have tried to do all the things online themselves, and they will write any amount of check to finally get the best medical help.

Okay.

That is one message to one market with one offer to get them in the door.

Okay?

So next week, PRP injection. By May 1st, I was hitting golf balls at 50%. That is the first step of the stairway system.