How to Bring Up Metrics and Money to your Clinicians with Rhonda Shishkin

From an owner, it's like, well here's the number. This is what we're going for. You got to reach this number. And then when the follow up question is why? Why is that important to the patient experience? They're like, I don't know, what do those numbers actually mean?

How to get smarter in business and in life. This is the question and I'm on a journey get you that answer. I'm going to interview the world's top entrepreneurs and deconstruct their winning secrets. Going to talk about everything from marketing money and living a bucket list life. I'm Rick Lau, healthcare entrepreneur. I grew and exited my 127 locations in my 30s. Welcome to the Clinic Boss Show. Hey everyone. Welcome to Clinic Boss Show. And this week we got a, an amazing episode. I'm super excited. We got Rhonda Shishkin and she is currently our clinical educational lead for clinical Sailors. She's working with about 7, 800 clinicians within the clinic of our community on caseload management and she has over 20 years of experience and she's worked with at the highest level with Canadian sports including the Husky Athletics Canada basketball team and athletics. Did I, did I get this right, Rhonda?

Yeah, the women's national basketball team, Athletics Canada and a very long stint at Husky Athletics at the University of Saskatchewan.

Wow.

Wow.

And, and so did you do a lot of traveling when you were working with like those, with those teams?

Yeah, within Canada west with the university football program, there's travel pretty much every other weekend across Western Canada and then the fortunate travel with things like Athletics Canada and Canada basketball is around the world and you get the opportunities to take in different prep tournaments, different world championships, different multi sport games. So yeah, it's been really fortunate to be in a lot of different countries.

Cool, cool. So you also probably have a lot of certifications like behind your, on your business card and your name. So you know, because every time I talk to Daryl or any other, you know, like super clinical person, like their business cards are stacked with like you know, acronyms and, and certifications and so why don't you list the ones that kind of follow the back of your day. Rhonda.

Right. So I'm a physiotherapist and I have my diploma in sport physiotherapy. So that credential from Sport Physiotherapy Canada, I'm also a certified athletic therapist and have that credential as well. I recently participated in the Sports Scientist Canada High Performance Practitioner program. So I'M certified as a high performance practitioner through them. And that's pretty much the, the world that I kind of weave in and out of as far as sport physiotherapy, athletic therapy and high performance.

Sounds like you got a stacked resume and it's. And it also sounds like, you know, you could lean on a lot of like, performance management with, like, athletes with performance management of clinicians, which is kind of the topic that we're talking about today. You know, we're going to be talking about caseload management. You know, caseload management, caseload management, leaks. And one thing that I've always thought was that one of the easiest things that an owner could do to boost their revenues is just add two more visits to the care plan, you know, and so, you know, like, mathematically, if you, if you get. For every 10 new patients that you get in a week, if you add two more visits, that's like an extra $100,000 of revenue each year, you know, and, and so. But yeah, like, let's kick this off. So I'm just curious, you know, because you work with a lot of owners, but also with a lot of therapists within our community. And so I just want to maybe hear from you. What is the. What is the craziest story that you've heard when it comes to a clinic owner talking about metrics or like, you know, telling their therapists, like, with. About boosting their caseload? I'm just curious, like, what have you heard, like, the craziest story that you heard?

Well, within the boot camp community, there's certainly a focus on the metrics and the numbers. And I think when we were doing some of the scoreboard reviews, when they could come back and talk to me about this number, a lot of them are like, I'm supposed to have this number. I'm supposed to get this up to this percentage. These are my targets. And then I come back and say, what does that mean? And then often the challenging part is like, I don't know, I was just told that's my target. And so I think when I think about how well the owners might be sharing the information about these targets and numbers, they're kind of just getting targets and numbers. And so there's a little disconnect between those targets and numbers are patient experiences. And so I'm always interested in hearing from the clinicians in boot camp. What do those numbers actually mean? And so from an owner, it's like, well, here's the number. This is what we're going for. You got to reach this number. And then when the follow up question is why? Why is that important to the patient experience? They're like, I don't know. So it's always interesting to kind of get that.

I'm told, why is that? Why is that? Is it because, like, that owner might have, you know, read something or learn something, and then, you know, next they know, they're like, you know, like, hey, like, get your numbers up. And then, you know, like, why do you think, why do you think these clinicians feel this way?

I think part of it is just the different lenses that they approach these from. Right. And so the, the clinic owner is looking at these numbers from a clinic management perspective. Right. Trying to figure out how to pay the bills, how to pay the clinicians, how to offer mentorship programs, how to best drive those revenues. And that lens comes in with metrics. Right. What do I need to see? And the experience from the clinician certainly needs to be understanding the metrics as an opportunity to improve their patient experience and to see if their strategies that we're teaching them in boot camp are actually showing improvement, improvement inpatient outcomes and successful graduations. And I think sometimes the owner's lens of business isn't maybe all that important to the clinician's lens of patient experience. But if somehow we can blend those two views and see that they're both going to the same place, they're both about graduations and successful outcomes. The clinic owner knows if we change those numbers, it also reflects patient visits. But the clinician is like, it's all about the numbers and not understanding that the numbers are patient experiences.

Well, it's interesting to say that, you know, like, I just remember the days when I used to run my clinic with my clinicians. Every time I had this talk about the metrics, they would just see me as that hungry, money, soul sucking owner. Right, right. And, you know, and it didn't make it. Yeah. And so they would think that of me and like, I could never actually get them to be bought in. Like, forget the metrics, you know, I couldn't get them to do anything because it, because of just there's that friction, you know, maybe you could talk more about that. Is that something you see a lot with, you know, clinicians that you kind of work with, like, with this mentorship?

Yeah. I think when I come back to the clinician and have the conversation about it, I try to relate, what are you using to track the success of what you're doing? And that's really, to me, what the metrics are about from a clinician perspective is if you would like to fill your caseload and have the money that you want to make and the, and the satisfaction that you want. You don't want to be 100% full, you're going to burn out. You don't want to be 80% full, you don't have enough patience to sustain that revenue you're looking for. Where is the sweet point and what are you doing to ensure that all aspects of the patient journey are the best they can be so that your utilization, your cancels, your. All those things that we measure help you to achieve your goals and your patient goals. And so when we talk about some of these things, I don't even really talk, chat to the scoreboard as much as I chat to the experience with your patient. How come you don't think they came back? How come you don't think that they booked out what you had? Where are the gaps? And then when we talk about how do the metrics help us? Well, we just implemented a strategy, let's look at this a month from now, two months from now, three months from now to see if you're being successful. And I think that's the lens that I take to the clinicians about how the metrics help them. But it's not necessarily like driven by this number has to change, this patient experience has to change, the patient outcome has to improve.

Yeah. So it's interesting you say that, you know, because I think as like, let's be honest, like clinicians, you know, things are getting expensive. Clinicians do care about money and like the cost of living and, and how much they get paid, you know. Right. Whether it's hourly or percentage wise. Right. You know, and um, and so I just struggle that why is there such a disconnect with like owners, a clinician be able to like talk about money and caseload when we know that it is, it is like a real conversation. And then they always. And then there's always that like, call it, how do I say this? There's always that like, objection relating to patient care, you know, but they all care about the money. Right. You know, would you agree or no? Because it is part of, is part of like, it's part of like everyone's day to day. Right?

Yeah. I mean they're going to be the first, the clinicians are going to be the one to come in who say, I've been here for a year, I would like to have this change, I would like to have this rate, I'd like to have this performance bonus. Right. I think I've been, you know, asset to your clinic. And then my question would be, okay, well, tell me how or show me how or show me why we should be having this conversation about renumeration or whatever. And the numbers help you to show your value to the clinic. Right. I'm not gonna.

ABC Clinic down the street is paying such and such, like X amount. How come I can't pay that amount, you know?

Yeah. And I mean, that's the conversation to be had. And from the clinician, I want to show that I can maintain a caseload. I can be as full as I need to be. I've got great word of mouth referrals. I've got, you know, this many assessments to carry my caseload. I don't need twice as many. Right. And so there's lots of things that I can show and use the numbers for, but if I don't have any data, I don't know where does the conversation start?

Okay, cool. I love what you said here. So maybe let's do a quick recap. How would you, like, what advice or experience can you give to an owner who's going to use metrics and talk about money, you know, with their clinician? What would say, like maybe like, you know, three things, you know, you would.

You would share from where the metrics would be the topic of conversation.

Yeah. Like, how would you, how would you get an owner to approach like money and metrics, you know, to their. To a clinician, you know. Right. In. Yeah, just kind of what we just talked about now.

Yeah. I think some of the things that I think are valuable would be looking at that number per graduated case. Right. And so like you said when you started, if we have two more visits with a patient, so how many visits per successful graduation? That's an opportunity to change revenue. And I would suggest that if we had a conversation about that number of visits per closed case and we reviewed some of those cases, did we actually test our patient appropriately to close that case? Was there an opportunity to look at dosage and look at their ability to have the capacity and resiliency to not come back and see us with a re injury? And so that's a great number. I think that reflects that we're truly taking a patient through the plan of care and it reflects in more. Sorry, each patient on average is worth more to you in the clinic. We can't get away with two visits per patient, but if we had two more more per patient, that's a revenue generator that changes what we can do for you as a clinician and that extra things that we can provide for you at our clinic when we have that revenue. So that to me is one of those numbers as well. If I look at another number looking at utilization, that to me shows the value of my clinician making a connection to their patient where the patient is buying in and believing in the plan of care and booking out what we expect them to book out based on what we think is the best for them to reach their why. And I think utilization, utilization rates show the value of that clinician to their caseload and their connection. And they're probably a clinician that has greater word of mouth referrals as well too, when they're in these sort of higher utilizations. So to me, it's a valuable number as well.

Yeah. Okay, and then. And what's a good utilization number?

I think for each clinician? Like, I kind of look at it through the span of their time in my clinic. Right. And my expectations for someone who's a new grad taking on a new caseload versus a new hire as we go. But I think that's a target that's set between the owner and the clinician based on the type of practice that they have, the amount of min and other kind of tasks they have relative to their caseload too, because it depends on how you want to measure.

Like, what about general, like, what about typical, like orthopedic clinic? Right. What would be a good, like, target for like a new grad and maybe someone after, you know, like three years out of school?

Right, yeah. Like, I think that most of our clinicians are quite happy and confident and sort of not overworked at that 90 to 92% utilization rate. It allows them to have a little bit of a break here and there where they can get caught up on, you know, calls, patient connections, opportunities to send letters and referrals, but not charting, Charting, charting and all those things. Right. And still, you know, earn the income that's necessary for them to be a part of the clinic. When we get higher than that, they're taking work home, they're doing things after hours. They're not necessarily as fulfilled in their job. And that to me is the burnout. If they're lower than that, then I'm concerned that they're not kind of keeping up their end of the bargain.

Okay, cool, so 90, let's just say a 90 utilization. And what about in terms of graduated care plans? Right, Because I think that was a metric that you just brought up as well, Right?

Yeah, I think that's a real interesting one too because I would like to see like what is my percentage of completed cases, right. That have actually done what I want and have had that successful graduation. And so if we put kind of that percentage of successful graduations versus our fall offs, right. I think if we can get up over the 60s and towards those 80s, those are the numbers that we're looking for. We might have some patients who, depending on your definition of successful graduation, maybe we just haven't confirmed that and they might fall into that as well, but we're looking for that. Satisfied? I am better patient. And what's the percentage of cases for that?

Okay, cool, cool. And then what about pva? Because a lot of owners use patient visit average, which is, hey, on average, how many times should a patient come to your clinic after their first visit? Like, what is your thoughts about this metric and whether it is the right metric to use?

I think it's valuable for sure. I don't like it in isolation because I think there's a lot of other indicators that we track that allow us to see opportunities to develop our clinicians in different ways or celebrate them. But as a pva, it's a very nice indication that, that your patients are buying into your agreed upon plan. And so at the beginning I've seen numbers down, you know, with our new grads and new hires are looking at twos and threes and we're like, okay, we're starting out, this is where we're at. You're going to have a lot of assessments because you're building your caseload versus the number of treatments that you have at the beginning. So that might not be a higher number, but I would love to see you get into the eights and the nines pluses to be able to maintain that caseload. Because getting new assessments in the door is hard. Right. And so if I have to give you 10 to 12 assessments a week for you to maintain your, your caseload, that's not very realistic. I would love to see that assessment number lower, that treatment number higher. And that's what the PVA is a reflection of. So I would say that when we're setting those averages for our clinicians, again, we're going to maybe a little different. If I've got a pelvic floor caseload, if I've got a vestibular caseload, if I've got a lot of third party payers, but can we get into that 8.0 plus for that PVA to show that we have a good buy into our plan of care and a successful outcomes for our patients.

Yeah, interesting. So I see most clinics being stuck at a PVA around 5 or 6, right?

Yep.

And so at a clinic level. And so to get it to a PVA of 8, that's like, let's just say they're at PVA of like six. The PVA of eight means two more visits, Right? You know, Right, Yeah. So two divided by eight, what is that? Two divided by six? It. So if you could actually add two more like plans of care onto like, sorry, two more visits, plan of care, like going From PV of 6 to 8, that's like a 33% increase in your revenue. Right.

And I think it's a huge growth opportunity for our clinicians and a place where we can really mentor and, and show some growth in their ability to manage what happens from that initial assessment to the successful graduation once they've completed phase one of like, I'm starting to feel better. I think sometimes our clinicians confidence drops off and that, I kind of call it that middle section where we're building capacity, strength, functional resiliency, endurance. And sometimes I think the challenge that I see from clinicians in Slack is how do I progress them in the clinic, how do I continue to challenge them adequately to get to the graduation? And I think there's true opportunity there for our clinicians to be mentored on. Well, how do you know they could graduate? How did you test them? How did you challenge them? And if we add on those challenges to ensure that they truly have met their why with intensity, capacity, volume, all those things, it often takes two more visits and we get stuck at. They feel better, my pain is better, but we haven't really said, okay, so now let's test your ability to do what you want to do that why to the best of your ability through this next phase. And I think that's why we see fours and fives is because we're using them at the pain resolution and maybe one successful golf swing as opposed to multiple.

As an owner, I get so upset when I see like a PV of 3 or 4. Right. Because you know, like you like. Yeah. And. And they still have an empty caseload and they come back and still say, I'm not busy enough, I need more new patients. Right. But like, it's just like there's only so many new patients coming into a clinic. Right.

So yeah. And again, I think that comes back to our mentorship and how we can go over those opportunities with our clinicians to Say, let's go over that case that you discharged at 3, right? Tell me what you did, what did you look at? What was the goal? How do you know that they were safe to discharge, confident and competent to continue on their own? And I think when we bring up those conversations, we can give the, those clinicians the opportunity to go, oh, I see what you're saying. Maybe I could have done this. I should have added on this. I could test them more in this capacity. And maybe sometimes, you know, with some of our newer clinicians, it's the idea that I didn't even think about that. I didn't know that I should be doing that with some of our more veteran clinicians, I, I think depending on, you know, how long you've worked and what you're doing, patients say, I'm better, I'm great. You're like, wonderful. Done. But changing their mindset to, to like, did we get to function? Did we get to capacity? Did we truly get what they wanted? Some people will be gone in three, you know, and I look at the files for some of these clinicians and I'm like, so and so went back to school. Great. My next question for them is, when are they coming back and are you reaching out to them? Are they on a list for you to, you know, have a contact at the end of school? But I think that that three to five to me indicates that we made them feel better. And that was rule number one, not goal number, graduation.

Love it. So, you know, we talk a lot about metrics. What should, like, how should a clinic owner who's never brought up metrics to their staff bring it up for the very first time, you know, like, how would you approach that? Because once again, we talked about three metrics today. We talked about utilization, graduated, like care plans, and we talked about pva. Like, how would you bring it up for the very first time? They've never done this before, you know, and like, and I think this is where usually the clinician or the therapist gets super upset, you know. Right. So what advice can you share? Right.

Well, it's interesting because as someone who worked over 20 years in sport, I didn't have metrics. I had metrics in the sense of I tracked, you know, how many people per team got injured, how much time lost we had in each sport based on that. And then we, you know, and we looked at some numbers for how, how many patients came back and how many had every injuries looking at those numbers. But to come into private practice after doing sport, and first of all, Learn that I had a scorecard. I was like, what the heck is this? And why do I need a scorecard? Right. And that would be the first question that I would want to hear from the owner is, why do we need this scorecard? Right. So you're going to show me that we're going to have these numbers in these metrics, tell me why I need a scorecard. And in a sense that I don't want to be feeling like this is something that's punitive to the clinician. And I'm just looking to see if you're performing well enough at my business. And if I'm given these numbers in that sense of, like, the score card as a reflection of my capabilities as a clinician, only then I view it from that lens of it's like a tracking device on me. But I would like to know that this is something that we measure for overall clinic performance, overall health of our business opportunities to invest in you for mentorship and guidance when we see areas of challenge. And then at the end, it really is a performance card for you. But our goal is to help you to have the, you know, the goals that you have when you joined us. And these are one of the ways that we can look at that. And when I first started looking at the scoreboard for my numbers, I'm like, well, crap, that's kind of a crappy number for me. And I've been doing this for 20 years. And then it's just about, okay, why is it a crappy number for me compared to what you think I should have? And then we can have a conversation about what does that number actually mean? So I think how you address it and. And the value of it to your clinic and what your outcomes are for the clinic as a whole, then I'm more likely to accept this as a monitoring document of clinic health and patient experience, as opposed to, we're using this to track how well you do at our clinic. Yeah, you are, but for lots of different reasons as well.

Okay, interesting. And what you just said, what you said, what you just said right now, you know, is that effective for both, like, new grads and like, maybe some of your senior therapists that are changing their ways? Or. Or is it. Or do you just leave them alone?

Right. I was that therapist of 20 years, and I've. I'd never written a plan of care at a university setting. Right. And so coming in, you'll have to let me know what the value of these tools are. Right. And you'll have to let me you know, ask me, do I think this will fit in with what I'm currently doing? Is this something that you think would be table for patients? What's going to take for you to make this change in your practice and how can I support it? Because we're asking somebody who has a very set assessment, a very set interaction with the patient, a very set protocol to now value 10 plus minutes of patient interaction with a document that the patient's going to leave with. And it certainly was a change in practice for me. So I think the implementation with a senior therapist is a very different conversation with my new grad who's just trying to learn how to live their life in private practice. And to me, it's a great tool for them, the new grad, to make sure that they are having great conversations with their patients. They don't know what to say. This is your guide that they're explaining things well to their patients. They don't have a clue what to tell them. This is your guide and it's a real strong tool for that new grad to build habits and connection. But for that senior therapist, you have to approach it from a very different lens of how it will integrate into their current practice and why the why the clinic values it as a tool for their patients and how it fits into our.

Because they're going to make more money. Right? The senior therapist. Right.

Great. If that's the lens that they want. Right. But I got to read the room and see who's there having this conversation.

It's not a straightforward answer. That's what we're saying. It depends on what their why is. And professionally, professionally and personally, what makes them tick. And that's the conversation that you need to include in there, right? Is that what I'm hearing?

Very different reason for everybody in front of you, right? Why you might go, go and have this conversation with them and how it's valuable to them. Right. How it's. Why do they want to do it? Why would they want to do it?

Yeah, because, yeah, this is, this is super fascinating because I get a lot of people who might have listened to this podcast or maybe they read a blog article, they come to the event, they learn these metrics, right. And then next they annoy it, they go back to the clinic, they have a one on one and they steamroll their therapists. Right. You know, right. These are the metrics. Let's talk about PVA and blah, blah, blah. And the next thing I know it like, you know, like what we talked about earlier, that therapist Just sees that owner as all they want to do is make money off of me. Right. You know, it's like this mercenary type of relationship. Yeah.

I think my conversation maybe doesn't start with the metrics. It starts with, you know, what are your strengths and weaknesses? What are you having challenges with? Where can we support you better? And then connecting that to the metrics that I have in front of me. Right. And seeing where those metrics reflect that clinician's challenges and identified strengthens weaknesses. And then I can use that knowing that if these are the numbers that I'm seeing, they're probably having these challenges. These are probably the things that they're struggling with. And if they tell me those things first, you know, and they say, like, I don't know why so and so didn't come back. Like, I expected to see them for five or six more visits, and I saw them twice. And you're like, oh, okay, well, that's interesting. I know that reflects on the scoreboard. Right. And I can see that number there. And I'm like, okay, well, what are we doing about that? What is our strategy going to be? How can I help you support that? And then, hey, if we do this, let's track it here. This is what I kind of remember we talked about. Those numbers here was what I expect to see changing. So to me, to come in scoreboard first is a little intimidating, especially for some of those younger grads who are like, I just want to keep my job. You know, I actually want to make money and I want to figure out how to do that. And. But if I come in from that lens of challenge, successes, strength and weaknesses and opportunities, I can pretty much predict what they're going to tell me because I know their scoreboard.

Yeah. Wow. Yeah. Versus saying, hey, these might just tell me that you suck, you're wrong. And that you're a bad clinician. Right.

Yeah. And all you want is are investing in clinician development. Right. For the purpose of improving that organizational performance. So let's make sure that what we're investing in is meaningful to the clinician as well.

Yeah. All right, let's talk about the next juicy topic. What is your thoughts between hiring part timers versus full timers?

You know, it's a challenge. You know, I'm now a part timer in the clinic I work in. It's a very different experience. Right. And it's where I want to be in my career. Like, I want to be working part time, part time, patient experience. Right. My. My hands can't work full time anymore. Right. There's reasons to be part time in my world, but I am a different person and I'm a different part of the culture than I was when I was a full time clinician. So to me it's one of the things to really consider in your organization is how do you continue to build your culture when you have part timers, full timers, quarter timers, to have everybody feeling a part of the organization, being able to contribute, be valued, be heard, because it is very different. And I'm, and I'm not working at another clinic, I'm just at one location. Right, but you do have people who are at one clinic here, one clinic there. And I think it's, it's a real challenge, right, to build that connection and culture. And so I can see the value of it from I can fill a room and I can fill this opportunity to have this space with some part time people and two or three different part time people providing a service that I maybe don't have full time needs for yet. And so I bring that in part time and do that. But I think there has to be a real effort to make culture and connection when you have part time, quarter time affiliated practitioners in your business.

Is it possible, like I think we're talking about, like you're in an interesting spot because, you know, you are a part timer, you know, and in my world, and maybe in Daryl's world too, is, you know, we believe, right, that part timers are like clinic killers. Right. You know, right. And, and, and, and the culture is one can be. Right, right? The culture is one piece, but the second piece is that like if you're only working two days a week, right? And let's just say like, you know, you don't have a caseload. Like it's different if you have a, like, like someone like yourself who's part timer, you have, you know, like 10, 20 years of caseload that follows you wherever you go. Like you have a caseload. But some of these therapists like working two days a week, right? Two mornings, maybe one morning, one afternoon, and maybe occasionally the Saturday morning, they can't build a therapist, you can't build a caseload for a patient coming two, three times a week, you know, it just, you just can't. So you got to feed them. And if they have a PBA of 3 on top of like them being part time, you would have to feed them like insane amount of like new patients, right? To keep that schedule just full for these awkward. And that assumes that, that, that also Assumes that that that patient has a flexible schedule enough to actually join to come like a couple times a week on your random like schedule. If you enjoy my content, I write a clinic owner newsletter. I share with you what's trending right now in marketing, selling your business, recru, front desk and more. Become a better clinic owner. Join over 22,000 clinic owners who get this free newsletter each week. Go to clinicowner.com to sign up today.

Yeah, I think one of the things that I looked at when I created my schedule was if I'm available to this particular patient who can come here, I have to have that opportunity for them more than once a week. So I couldn't. I don't see myself being able to manage my caseload with a morning one day and an afternoon another. That's not the same patient. If I have a patient who can come at 4 and 5, they want the after work time and if I only have one a week, I will not have a successful plan of care with that patient. So my schedule is exactly the same, hours of availability two days a week. Right. And then when I do manage that schedule, I have to be very effective at booking up my plan of care or my patient will not see me for three weeks and then I'm going to lose them. Right. So that part time clinician has to be even more successful at book to prescribed ratios, getting them to fill out their plan of care, managing, you know, a wait list so that the cancels can get in when they need to. Otherwise I am not going to have successful outcomes because I can't see a patient once every four weeks because of a scheduling challenge. And that PVA is going to be very low because they're going to be a fall off. So there's got to be some real clear expectations around what the part time hours are, I think to make it successful from a patient experience point of view, from a caseload management point of view. Right. And then what do I need to carry my caseload realistically? Like I need an assessment a week for the hours that I work to a week. Right. If I get four, I'm kind of screwed because I have no place to put them.

Yeah, yeah, but, but your situation is a little, your, your situation is a little different because you actually have caseload that will follow you to whether you go to this clinic or that clinic because you're so well known in the community. Right. You know, but what I'm seeing in the other clinics inside our community is that they have these like newer grads or Maybe like a couple years out of school. They're a bonds between two clinics, you know, or three clinics all part time, you know. And so you see clinical owner a, who has, you know, like, like, you know, majority of their staff are part timers and they wonder why their case will never like they can't grow their business.

Right.

They always feel like they don't have to do patience, you know.

Yeah. And I think that's, that's a reality of that model for sure. And can you have a consistent part timer who's consistently full? Sure. If you figure out how to make that the most effective version of that with consistent times and consistent opportunities and a clinician that can manage a caseload and can book out a schedule, could you get there? You could potentially as effectively as a full timer. Maybe not. Right. Patient flexibility, availability, those sorts of things are important to, to the, to the client. Right to the patient. And if they can't come in that time, well, what's the strategy? It's, it's a management challenge for sure. Because the other thing I don't think our patients love is oh, you can see this person once because you can't get in with me. Right. What's the value of that? And is that what your patient wants to.

It's like going to walk in clinic and you have a bad experience with like, you know, all these random doctors that don't know who you are. Right.

Yeah.

So.

Yeah, yeah. So maybe there is the right clinician profile to make part time work.

Someone like you who have a caseload and they only need one new patient a week to carry two full busy days. Outside of that, I'll be straight up. I would not hire, I will hold off from hiring any part timers and just hire like full time people. I would wait and here's the other reason why I would wait too is because if they're, if they're ping pong it between two clinics.

Yeah.

And your clinic is not as busy or your clinic culture sucks, you know, and the other clinic is busier and they have, they pay a bit more and their clinic culture is fun and it's closer to home. You will lose this person because that clinic over time will move them over. Right. So you've worked all these like months or years to build up this caseload and you're gonna move on and then you feel like, hey, why is it that everyone is growing like 20 or 30 a year and I'm just flat every year because I'm losing my caseload to like, like these These people.

And so after making that investment in the clinician.

Yeah, yeah, yeah. So if I'm going to make that type of investment, I'm like, hey, I want you to be all in. Right. And being part of all in is like, hey, you know, there's these things that we do differently here. Right. And I'm going to invest in your mentorship and like, yeah, I need to be committed to, like, work full time. We're going to give you like a case, so we're going to work with you and then like, blah, blah, blah, and we help you check off your personal goals and your financial goals. And, and. But if I'm going to spend that type of investment with like, people on my team, do I want part timers? Because part timers to me are hired guns just to do a job. Right. You know, or in your case, like, I would bring something like you on because, like, you have a guaranteed caseload.

Right.

I don't need to feed you like 10 new patients a week to fill up your two days a week.

Yeah, that's right. Yeah.

Right. So you agree or no?

No, I, I agree. Right. And as someone who's been a clinic director, not clinic owner. Right. Like, it's a different lens.

Yes.

Right, yes, 100 director. My lens is clinic culture. Community. Community connection. Right.

Yeah.

So that's, that's sort of a challenge there. But from a clinic owner perspective there, it's a big. And every clinician's a big investment. Right. And you want to make sure that investment sticks around. And, and so, yeah, I can appreciate the full time versus part time. I'm just happy as a part timer. There's an opportunity for people to stay in the business, keep up skills. Right. As they're working to retirement.

Yeah. But once again, we talked about what is your, like, if you have a part timer, this is the ideal Persona. Right. Because they have a caseload. You could go anywhere in Saskatoon and your patients will follow you, hopefully. Right.

Yep.

So, all right. And then here's a. Here's another question. How many, like, you know, how many new. For. For every full time. For every full time physio, how many new patients would you give them each week so that they would be full?

Oh, I'd like to. I think there's two kind of answers to that. One is, I'd like to see they can maintain a caseload on seven or eight assessments a week. So kind of like one a day plus a one here or there from a caseload management. You can book that out. You can get, you can get some great outcomes by seeing the patients, as we would expect, within that PVA number moving forward. The other part, I think is there's nothing worse than like four assessments in a day and the paperwork that comes with it. As a clinician too. Right. So from a, from a clinician satisfaction, I don't want that person having to have that many. From a business perspective, I don't want to have to bring that many in. Right. So I think if you see seven, you know, assessments a week, eight a week, I think you can maintain your caseload.

Yeah, I think that, I think, yeah. You know, like, I hear Daryl and Paul talk a lot about that and they actually implement this within the front desk is that every single full timer, they really need about five to six new patients a week. And if they manage their caseload and then do some of the stuff that you talked about, they will have a full caseload, right?

Yeah, I think so. And it's going to ebb and flow. And we know that it's different, you know, around holidays and vacations and different things like this. But if we look at that overall, I think that when we say to our, our clinicians, you know, we're going to provide you with new assessments as a part of, you know, our program here, if they're thinking they're getting 12 to 13 a week, that's really not realistic.

Yeah, love it. And so I'm curious, I'm curious what your thoughts about this is that we're seeing more and more clinics be multidisciplinary. Right. You know, and so, so cross referrals is a big deal now. Right. So what strategies or tactics can you share to get a physiotherapist to cross refer to a chiropractor?

Right.

You know, what have you seen that is effective and not effective?

And it's interesting you asked that to someone who doesn't have a lot of clinics like this in Saskatoon. Right. It's, it's not super common to have Cairo's physios, massages, all in the same clinic in Saskatoon. Working collaboratively together. And from a sport world, it's all I know. Like we, we work interdisciplinary all the time. I'm always working with other professionals through there. I think the reason it works is that there's a communication strategy and an expectation on what the referral means that I'm sending to you between what I'm going to do and what you're going to do with them and what our goal is for the patient. And that is very Clear from the beginning. And I think that, you know, what I see here is, well, are we on the same page? Like, well, that philosophy from that practitioner is not mine, so why would I do. Well, I'm going to send them there and they're never going to come back. Right. And I think having that idea of how does cross referral work in your clinic, what are the expectations from each provider and what are we doing to manage the patient can make it very successful. And it's a great opportunity to address the financial barriers of our patients if there's another healthcare provider that can provide a particular service within the plan of care and meet that expectation for them as well. And I think the biggest challenge that I've seen in the slack channels that we have is it doesn't seem to be set up smoothly because the patient's like, oh my God, it's my third plan of care in your clinic. Do I have to do all of these plan of cares? Do I have to do them over and over with every.

You got a plan of care from the physio, you got planned care of the chiro, you gotta care with the massage therapist.

Oh my gosh to me, then that's not a case manager, like one person kind of being in charge of the case for the patient, who's bringing in the other practitioners from the clinic to get the base patient best patient outcome. It's three separate practitioners treating a patient towards their best skill set. And I think that's not the most successful way to do it.

So how do you break that down then? How do you solve that, like, problem?

Well, I think if I was looking at it from a clinic perspective, there's got to be that entry point into the clinic for that patient. So who is that first practitioner that they.

Let's just say it's a physio. Right. Became the physio, like they're on their plan of care. Yeah, yeah.

So now we've got that person looking at the bigger picture for what is this person's problem list? What's the best way I can address it with the barriers that they might have.

Yeah.

At that point I can address the other members of my team. I can talk to massage, I can talk to chiropractic about what I think this patient's goal list is, what I think they can contribute to their plan of care. And what can we do with your skill set? Your skill set and mine, and then have that conversation with the patient about what each person is going to bring to the table for them. And so within the communication to the patient, they're hearing sort of one plan from that clinician. We're having the opportunity to connect and meet. Whether we decide that's through some sort of a group chat about the patient. In the chart note, somewhere there's this communication tool, but we're connecting on. I'm moving on to this. I saw this. Could you address that? It's just, it's a, it's a time commitment, I think, to multidisciplinary manage. But it can be such a value added to our patient to be able to have all those different expertise available to them in the clinic. And it can be my, you know, skill set here. And then maybe I'm done. And then maybe they're continuing on with the other practitioner too. Like, great, now they're on a wellness program with somebody else.

Yeah, yeah, yeah. It's very, you know, it's interesting. I, I, I had a, I had a, I had a dental practice owner on my clinic. And they are very multidisciplinary. Right. And they have a very team approach. And each week they do, they do like caseload reviews. Right. You know.

Right.

And so the team's caseload reviews and they do it together, you know, and they force that, you know, And I think, and then by doing that, I think it allows more of that cohesive, like one plan of care versus the three. And, and which I could totally see as being chaos. Right.

You know, so again, but that's another investment in that, that philosophy, in that approach. And so I think if you are going to do it right, you recognize the investment that it takes.

Yeah, cool, cool. And then what would you say is the number one mistake owners make, Right? You know, from getting buy in from their teams with doing reactivation calls?

Oh, I think that there's fear in the clinicians. Right. So that's the first thing that I hear is like, I don't know what I'm gonna say. I don't know what I'm. What do I say if they say this? What if they think I suck? What if they didn't come back because of me? Right. And so I think the clinic, the clinic owners need to address this reality, which is the clinician's fear, the clinician's confidence in making these calls. And so one of the things that, you know, when we do get them to do it in boot camp and we do have people making these calls, very rarely is it because you suck, like, hardly ever. Right. And so when we can look at that and say most of the time, it's this, this, or this, and we just haven't addressed it correctly. We can help these clinicians feel more confident about making this call, but I think when we want them to do that, we need to support them in either providing them a script to be able to go by being able to role play it before we actually ask them to do it, come up and come in this role play, have a couple adverse responses from patients that they're prepared for so that they feel confident in saying, I'm sorry to hear that. What could I do differently? Or however they want to do it. But to ask them to make a call and not coach them and not sort of teach them and support them in that. Maybe they get to do the calls together at the beginning. Maybe they get to watch a senior clinician have those conversations. But I think the biggest thing is just not addressing that their fear is real and their confidence is not very high. And so when we're doing those calls, it's just putting that gut rot into them that they're going to have a really bad experience. But they don't have to if we set them up for success.

Yeah, yeah. Because I think a lot of them feel like, hey, it's a sales job and I don't want to, like, make that phone call. Right.

Yeah. And I think once they do make them and like, and then I follow up with them in Slack, it's a patient experience phone call. It's a connection phone call. Right. Is the reason that we're doing them is we're reaching out and they're like that. You know, I did three calls this week and they were also happy to hear from me. They were all surprised from here. For me, they couldn't believe that their physiotherapist or their chiropractor called them. Right. So it's a very different reality once they've done some of them than what they think is going to happen. And I think when we can frame it around that this is a part of our patient experience and we're trying to show that we care and make that connection to our patient and figure out how we can support them to come back to the clinic or address any, you know, misconceptions they had or misunderstandings they had about what we were doing. But we have to give them the skills and the comfort level to have those conversations. Because in the end, if you want to talk about clinicians and their. And they're worried about, like, reimbursement and stuff, you get that patient back. That's worth an awful lot to you. And most of the time the reason they didn't come back is because they forgot to call back in. They didn't know what you were going to do next. Right. And they thought they were done. Right. So those conversations are really patient centered. They're not salesy centered.

It's all the patient objections to your care plan or maybe how you communicated with them, like when they actually saw you. Right. So which falls back to patient experience again. Right.

So, yeah, and for me as a clinic director and mentoring, you know, clinic directors, it's about having the opportunity then to mentor them and. Okay, so they didn't understand what you were doing next. What can we do different next time? How can we do this even better with the next patient so that they don't have the same challenge?

Yeah, I love that. So, yeah, that was, that was gold, Rhonda, you know, and you know, like you said, you've been in that clinic director role, worked with like, you know, like, I think when you were a clinic director, you were probably working with like eight or 10, like therapists, like at your clinic, right?

Yeah, 12 to 14, probably.

Yeah, 12 to 14. Now you're also, you know, managing and leading our clinic director program. You know, what would you say are the top, like, what do you. What makes a good clinic director? Like, what are like their top, like, attributes that you would, that you would. Yeah, that will make up a good clinic director if an owner was looking for one.

Yeah, well, we, I think first of all, they're a good clinician to start with. Right. So a lot of them have a great skill set already. They have some confidence in what they do and, and so they can be looked at as someone who has, has some skills and knowledge in the area.

So if they're shady, that can be a good clinic director then. Or they don't treat.

Right. You have to have. And it doesn't mean you have to been around forever. Right. Like, you can be, you know, five years out and be just kind of cruising along in your, in your community. But I think once you've kind of got that little bit of streak cred to you, then I think the next thing that I try and discuss with them is like, what type of leader do you want to be? Like, how do you want to be perceived as a leader in the company and that leadership role? Right. And I think the great ones are ones that, who have the ability to listen, they have the ability to support and mentor. They have that ability to have the difficult conversations with confidence. Right. And so that big, it's like, it's communication, Right. And connection. And I think those people who take the opportunities to engage, connect, communicate are the ones that are probably going to excel in your, in your clinic as a clinic lead because they've already got some of the buy in and connection from the people in your clinic. And so, you know, it's not me, the part timer, who isn't connected. Right. It's that person who is already showing you that they're getting a good vibe of the clinic, that they have the ear of the different clinicians, that people are coming out and popping into their office and asking them for support and questions. So the best leaders to me are listeners, communicators and connectors.

Yeah. And the ability to be able to, to persuade or influence. Right. Would you agree? Because you're influencing change of the clinician. Right. Because you know, like you're trying to influence them to use treatment plans or do, or to do like reactivation calls when they've never done this before. They're fearful.

Yeah. And to me, when I think about the people that I thought were excellent leaders, I think that comes from a place of passion and I think passion can lead to influence. Right. When I show that I'm super passionate about this clinic experience, about this patient, about this opportunity to work in this area, I think we have a great reputation. Like all these things that I'm passionate about that comes through and then I have the ability to connect and bring those people together to influence change. Right. So in the end, that's what we want our leaders to do. Our leaders are people who get people to take action towards change. And that's kind of what influence is, right? Is you can connect the group on a common cause to see a great outcome. Right?

Yeah. Yeah. Cool. So last question, Rhonda, is that do you think it's easier for an owner to influence change of their clinicians with a clinic director or like with or versus them doing themselves? Right.

Well, that's an interesting question because I feel there's some value to the buffer role of the clinic director. And I think having that person who is kind of in between the owners and the clinicians, that can have that ability to hear from the owners about what they're seeing and challenges are and influence the change below, but also to hear from the clinicians about what their challenges and things are to bring it up to me, right. I might get information that wouldn't be given to an owner and I might give information that will be received better than if it was Coming from an owner. So I think there's an interesting role for a great clinic director to be able to influence change. And I think that's two ways I'm influencing owners to create changes that might be beneficial for clinicians in processing.

I love that.

Right. And then the owners are saying, we got to see a change in this because this is the clinic reality. Right. And I can have that opportunity to take the message from the business lens and bring it in a meaningful way to the clinicians. Right.

And so you're like a translator. You're a translator of, like, business terminal. Like, call it business, like penils to, like, clinical patient experience outcomes. Right.

And I really think that's what great clinic directors can do. They can live in the middle. Right. But it's hard to transition from clinician to clinic director and change that relationship. Right. And then it's interesting for your perception of what your relationship is with the ownership from those clinicians. Right. And I have to be seen as on the side of clinicians and on the side of owners. Right. And that's, to me, where when you have that middle ground, you can be like, oh, owner. I would not go at it that way because this is the vibe on the floor.

Yeah, yeah.

And I'm a little closer to the. To the door, if you will. And I'm hearing the things that they might never hear.

And you likely have more trust with, like, call it your peers. Right. Than the owner. Right. Because, you know, actually what's going on. They confide with you, you know, probably more what's going on in their personal lives because they still chat with you in the lunchroom, and they run away from the owner. Then the owner who just comes in and say, hey, your numbers suck. Get your PV up. Hey, by the way, are you coming to the Christmas party? Right. Let's have some drink.

It's a unique place of trust, Rick, because I have to be able to get that information, which is sometimes not flattering to owners. Right. And not be just the tilly tattly up the chair and say everything to owners. There's got to be a place where they know I'm safe to have those connections and communications, and then I have to have some established communication about, you know, how would you like me to bring this up with the owners? How would you like me to address this? It's obviously a concern for you and the three other people that we're talking to. Is it coming from the group? Is it coming from you? How would you like me to present it? So there's there's some real trust from both sides that a great clinic director has to earn and keep while being responsible to the outcomes that they're supposed to be responsible for.

Wow. Love it. That was amazing. That was awesome. That was part of one of my favorite questions that we kind of. That we talked about on today's pod. Right? So cool. Awesome. Rhonda, thanks for being on the show. And yeah, it was awesome to talk to you again and connect and hear all the awesome stuff that you're doing kind of within our community. Right.

Happy to be here. Thanks.

Okay, we'll see everyone next week on next week's episode of the Clinic Boss Show. All right, bye, everybody. If you found this helpful and want some free resources to help you be an even better clinic owner, head over to clinicbosstools. Com. We've got tons of free stuff on getting new patients, phone scripts, selling your clinic, managing clinical teams, and much more. Head over to clinicbosstools.

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