How to Build a Profitable Physical Therapy Business Without Burning Out with Alexander Wielohorski

Rockstars. Today's guest used to engineer airplanes and car parts, and now he's engineering freedom from private practice. Owners, meet Alexander Vjalorski. He is an MBA mechanical engineer, former corporate exec, and current COO of the largest privately owned physical therapy group in Alaska. Yeah, Alaska. Where your team might have to ride snowmobiles to get to work. But don't let the spreadsheets and the strategic planning fool you. This episode is so full of heart. Alexander gets real about what it takes to lead through burnout, delegate with confidence and scale a clinic without losing your sanity or your snow boots. He's got 25 years of clinical wisdom and engineer's brain, which completely changes the color of this episode. And a dry wit of someone who's lived through meetings in three different hemispheres. So whether you're leading a team, starting a practice, or just wondering how the heck an aerospace guy ended up running a private practice, this one's for you. Enjoy the show.

Man. Alex, I am so grateful that you're coming virtually all the way from Alaska and one of the most beautiful times of the year to be up there. Thanks for being on the show.

Hey, happy. Happy to be here. Thank you for the invitation.

Yeah, you were invited because you are a powerful leader of a, of my favorite outpatient practices in Alaska. No question. And you are a. You have a very different background. So could you set the stage for us? Tell us about you, your business and what got you into this. This industry.

Perfect. Yeah. So advanced physical therapy of Alaska is a. We've been in operation for 25 years this August.

Wow.

And we, at this point, we are the largest privately owned, Alaska owned. And that's Alaska operated physical therapy group in the state. We have six locations and still looking at opening more as we go forward. And it's a clinic that is based on, you know, serving the community. We see every single insurance, some of them at a loss. And so we don't turn away patients. And we are very into being able to serve the communities in the, in this state, which means bigger towns like Anchorage and Fairbanks and very small towns like Seward.

I'm not a physical therapist. I don't come from this industry. I'm a mechanical engineer. I have a master in business. I come from aerospace industries in airports and airplanes. Completely different thing. You would think that physical therapy is simpler, but it's actually more complex because there's less resources, it's less structured. Right. And what brought me into this industry is that I had my own experience 20 years ago in a car accident and I had to go to physical therapy. And I was, I would say I was treated by this amazing person which I'm still in contact with today. And she was fully committed to me, to my recovery, to my process of walking again. And that showed me what a great quality physical therapy or therapist is. And then I have later experiences in life where I actually had to go physical therapy again on a small motorcycle accident. And I was shown the worst side of it, where the business is more important than the quality of the, of the healthcare that we're providing. Where I was one more patient of a group of 15 that were at the gym at the time. I had no one on one attention. And that, you know, that kind of showed me both sides of the coin. And then when I was able to have the opportunity to be a part of this group and I saw that they did physical therapy the way I liked it, the way it was done with me at my accident, I said I can show or I can give some of my experience and my background to make this better and help them grow.

You have a unique perspective in this. It's so passionate about the care because you were a patient, you were still driven in a way that lots of providers are. But you're an engineer. If freedom had a love language, it'd be delegation. So if you're tired of wearing all the hats, the CEO hat, the insurance hat, the why am I doing payroll at midnight hat, it's time to get help. Book a free discovery call@virtualrockstar.com and let's show you how hiring a virtual assistant can finally free you up. We have paired hundreds of private practice owners with their ideal virtual rockstar assistants. Don't miss out on the second fastest growing trend in healthcare and in saving $20,000 per year of profit per hire. Remember, you deserve a business that gives more than it takes. You come to this business side of healthcare and private practice with within an engineer and business mind, what are some of the unique challenges that you face? What are some of the, like the things that make it hard for you to get freed up with, with what you're doing in your business.

I got to say that the two things I got, the one thing is that there's got to be a focus so that we are in the health care business, right? There's two pillars to that, right? There's health care and there's business. We got to take care of them both at the same time. And one of the things that that happened in this group and I noticed in other Groups as well is that healthcare takes 90% of the focus and business takes only 10. It's something that you have to do, but you're not putting attention to it. And that is just as important as the other section. And there was a lot of lack of structure in terms of efficiency, in terms of visibility, in indicators, in terms of how can we free resources as well to be able to provide better quality of.

Physical therapy. And the other thing is that the insurance companies are not helping us. They're making it harder every year as they make cuts and they make it harder for us to be able to build them as they're looking for ways to catch mistakes. So I always like to say is that we don't bill the, the insurance companies. We make a claim so we're claiming and they get the decision of saying yes or no. And how.

I never thought of that. By the way, it's not an invoice billing insurance company. We're filing a claim because they want us to. I never thought about the manipulation of that language.

And you file a claim to your insurance company when you have a car accident and you want to fix your car and they can decide to pay how much they're paying, you got a deductible, it's the same thing. So they don't want to pay. That's their business. Not right. And we are fighting against that. So if we're going to be doing that, we got to make sure that all the processes are done right, they're consistent, they're precise, and that's where the engineering comes into. So I've been trying to optimize our systems and make sure that there's this solid background from the back office to make sure that we can continue to provide those services, but at the same time be sustainable and be able to grow from there as well. So I always say that there's. There's four pillars to running a physical therapy business. Like for. For lecterness tool, you got to provide physical therapy services quite high quality. You got to be able to get paid for those services you already provided and fast. You got to hire people to provide the services and run the back office. That's hr. And then you got to market, you got to make sure you get patients coming in through the door because you can't just open the doors and rely on people to walk in or referrals to start coming in through your fax. So if you don't manage, all of those four.

Divisions are not going to move forward or it's not going to grow as you would expect it to do.

Your engineer mind. I'm sorry to interrupt, but your engineer mind. It's so cool how you're just categorizing these things. It's so insightful, isn't it? Rock stars. We've had a lot of private practice owners, almost always healthcare providers initially. This is a passionate physical therapy business owner who has a engineering perspective and he just. That little shift alone of like claims versus bills, my gosh, like, it's crazy to me. So you're aware of these resources that aren't available in the industry and I'm guessing that you see where people get burned out in the industry as a result of lack of support in that way. Can you tell me about that?

Yeah. So one of the things is.

If you're a great baker and then you set to open a bakery, you can't spend most of your time baking. You got to run a business now. So one of the challenges that we had is that the leadership team was comprised of mostly clinicians that were also having a patient load. So their focus was super split. So one of the things that we did to help with that in terms of the leadership was that we split the ownership of the four owners. There's 2 pts, the 2 non pts.

You guys did that on purpose?

On purpose. That's our leadership team. Right. And then so I take care of, for example, all of the operations, so facilities, marketing, performance, and we, I supervise the clinic managers, which are all administered well. And I'll tell you a second in a bit why we did that. And the second, then there's the one of my partners, she manages hr, billing and all of the accounting and finances. And then the two PT owners and leaders there, they manage employee development, education, hiring in the sense of the interviews for that part and just day to day mentoring. So each one is focused on one of these sections of the pillars that I told you about so we can make sure this is moving forward. And then one of the. Because if you have to see 8 hours worth of patient or 10 hours of the worth of patient, and then you gotta go into what's going on with the business email, you get burned out super quick. So that comes again. The other shift was we changed managers from clinical managers to admin managers. And there's a clinical lead that supervises the clinic, the clinicians in that group in that location. But then you have an admin manager whose only job is to make sure the clinic is profitable. People are showing up that they're doing their job, that are following procedures or they're adhering to policies. And everybody works as an own individual business in that sense. So I supervise those admin managers as well.

Okay, Alex, Rockstars. I need to punch a couple things that Alex said. He dispute a lot of incredible wisdom around freedom, because listen what he was saying. Alex was talking about the power of recognizing the separation between the bakers and owning the bakery. Right. And so there's intentional hiring of people who aren't clinicians because they're so. Clinicians are so drawn to making the pie that they, they. If they try to do both, they do what you said. And I remember this. Rock stars. The idea of wearing different hats in a business of taking the energy that we lose when we take one hat off and put another hat on is one of the primary causes of burnout for us as owners. So one of the techniques is to hire out and delegate. We're big on delegation on this show because the whole purpose of the show is to free you up. And delegation is one of the three core elements of that. The second thing is, though, is like putting silos. You do it with people. I've done it with time where I've had to be like, okay, so Tuesday is my admin day and I will not touch a patient. It's not that an hour of patient care is that disruptive for the care. It's. But it is super disruptive for the mindset in the zone of doing the actual admin work. And so it's neat that you're. So it's. The second principle of being freed up is boundaries delegation. Number one. I'm sorry, I'm going to reverse those boundaries is number one. Delegation is number two. So you guys have these boundaries that you created by hiring people. And so you delegated. You did both. You delegated to create your boundaries and. And. Or created owners within that company. So that there was this balance of business and healthcare. So it's, you know, not 9010. Where would you guys say your percentage is at now?

We work on a 50.

50. You're at 50, 50.

Pretty split. I gotta say, the. As we have grown over this last five years, since I took over.

I've. I've been taking steps back and being able to see our higher level and further out. Yeah, at the beginning, I had to do a lot of, you know, micromanaging and doing stuff on my own, and. And that was very exhausting. And eventually, as you start developing your systems and you start developing your procedures and you start adding people to take on those Roles, you can start pulling back as well and focusing on what is actually key for your business at this moment.

Love that. Okay, man, let's get into some of these freedom elements. Now that they understand who you are and you've already dropped a lot of knowledge around how to create freedom. Let's talk about.

Times. Can you describe a time when you had to let go of control and what happened as a result? Can you think of back in this journey of owning and like holding, holding all this engineering knowledge, is there a time that you had to let go and what did that look like?

I would say recently during COVID we trying to survive, we had to, you know, reduce a lot of our staff, and most of them actually left from Alaska to go back to their home states. And we were without a manager for a couple of our clinics. And I took on those roles, which was a great opportunity for me to go do the work that I was trying to develop for an admin manager so I could understand what was needed and the challenges, which was very time consuming and exhausting for me to be able to manage two clinics remotely, mostly. And that got me to a brink where there was a point where I wasn't being as efficient because I was not able to spread my energy so much.

And at that point, eventually, when we were able to hire the right people to those positions, that just open up so much space and time for me to. To be able to focus on other things. Nowadays we have managers on both locations and they're being completely independent, even though it was hard to let the go because I was already doing it. So I was still supervising from the background and checking up on that, make sure everything was going right until I got to a point where I said, this is. This is working. I can. I can let it go.

Yeah, I love that. And it's so. It's a powerful comment of like what we just described with wearing too many hats. You know, delegation is powerful, but you have to have someone to delegate to. So, like, in your cases, you guys had to bring on or hire people to delegate to. And then there's this other component of leadership that you mentioned. So looking at those pillars of, of being free, you know, we have to hire well and we have to have leaders in place. Even if we go to leadership, sometimes the best thing we can do to free ourselves up is first for us to go to leadership. Right. And I think that's what I heard in your story, was that you had to step down from leadership and into more of a coping position. And that Was what led you to that moment of, like, feeling burned out. How important do you think leadership is in your company in helping you be free, like, to do what you want to do?

I gotta say that the. It's.

More than being the doer. You have to step into being the coach. Kind of like the. With the team. Right.

You don't want to be telling people how to do their shots, but you be able to guide them to. This is where I want your focus to be, and this is where we need to put the energy today. So I would say that that more the literacy position is coaching people to be able to do their jobs properly, to be able to have the support that they need. But they got to be clear on what you're expecting. So that's why we separate roles. So good example of that. It's a front desk row. The person at the front desk, even though they're seeing patients that are coming in that are checking them in, each one has an individual responsibility. Somebody does collections, Somebody does benefit checks, Somebody does authorizations. Not all do everything because then it's really hard to track accountability for that. When somebody owns the process, it's easy to go and say, you're sleeping here or you need help there or you're doing great.

When it's a big group and something messes up, everybody points to the guy next to them.

Right. Well, it's a powerful journey that you described. Right. Leadership is important because you distinguished how a leader frees up both themselves and others by being a coach. You know, I think that we confuse that. So I like that delineation between leadership and coach. Because when you were talking, here was the thought that came to my mind, Alex, was we start as doers. If, like, in this case, we're baking the pies, we're the. We're the actual baker. But then we have to step into manager, where we're still baking the pies, but people are helping us. Then we step into leader, which is more of a coach position, where we're coaching others to bake the pies. Then we step into a CEO role where we are overseeing the coaches to make sure that they're overseeing and teaching how to bake the pies. And then we become a founder, which is a passive owner, or we sell. That would probably be the best, like, path of freedom that we. That you just helped me highlight is this arc that we create as we learn to set boundaries, number one. Number two, delegate. But that comes on the heels of hiring and developing leadership. So very powerful.

Alex, let me Tell you a story. Back when I was working for the airline, at one point, that was my first. First time I was leading a team. I had a team of five people, and I was taking time off. I was going for. For a week of vacation. Not too much, right? A week. And before I left, I met with my. With my boss, and I told them, hey, I got everything controlled. Everybody knows what they got to do. I'm gonna be checking my email every day. I'm gonna be calling the mornings and the afternoon to make sure everything's fine. And he stopped me. He said, listen, if you can't leave for a week without the boat sinking, you're not a very good manager. And that stuck because I said, yeah, that is the key. I gotta make sure that the team is able to work without me, and I'm there to help them. But if I can get a step out, nothing crashes because the processes are not dependent on my involvement. That is the ultimate, I would say, free condition where I can actually, you know, go on my business leave on a Friday afternoon. Like I'm doing today, by the way, after lunch, I'm going camping. And I have no problem that, you know, the rest of the day we will find. They'll close the clinics up and we'll have a great afternoon, no issues. And if there's a fire, they'll be able to know how to handle it without me.

Yeah, it's a test of tests. One of my favorite things to tell people I used to coach as business owners was that idea of the goal for an owner to leave for a month. You know, you talked about a week. When I coach clients, I try to get them to a month off a year. And people listen to this, like, how could you do that? And you can't do that. In healthcare, it is important to do it because it's. It feels so selfish for people to take that kind of time, which goes back into that freedom delegation mindset of, like, you don't understand, we are holding. We are damming like a river. We're holding people back when we don't let them lead. And when we're on site, we can't help ourselves. We sabotage things. So by taking a month off, and there's ways to do that. You just don't say, hey, I'm going to the Caribbean, good luck. But when you can build it and frame it, and the people I used, when you hire rock stars, I've had people excited for me to leave because it's their chance to learn and grow and show me what they can do. And there's all sorts of cool ways to incentivize people to do that. Then you can step. Then you start to feel balanced in your business. It's like all the headaches we go through, rock stars of owning a company. How would it feel to have a full month off? And what, and what's crazy is when you leave and things stay the same or get better because you're gone mentally, there's a break of like, I can be free. And that's. That opens a whole world of possibility. So, Alex, let's get into some detailed questions. What are some tools or tech that you use that have been game changers for reclaiming your time?

I gotta say, one of the things that we've used and actually through you, is the virtual assistants. I don't have a personal virtual assistant, but we've implemented it in the clinics because it has a low cost. It allows me to have enough staff or more staff to be able to spread the load evenly and be able to get them to higher performance versus overworking people. And that requires less supervision from my part. So that frees me up. In terms of technology, we do have some AI tools we've been adding in.

Okay.

So for my reporting, I do a lot of the back office reporting in terms of performance. So instead of having to go into the schedule and just count visits with my finger, we implemented an AI tool that allows me to pull reports and dice it and shave it and cut it however I want so I can get some insights from how the clinic is performing, how the providers are performing, and help especially allow me to find where I need to focus this next month.

What is that? What's the name of that tool that you're using?

It's Prediction Health.

Okay. They have AI based tool.

Yes, they have for the providers. They have Scribe tool and Autonode and all that stuff. And they suggest help them with the Ask AI as well. So they look into, you know, 5 billion notes and give you some insight. So it helps them do their notes faster, less mistakes, and be more consistent in their billing. And from the manager perspective, I get all the data from every single note that has been made so I can know exactly how they're doing in terms of auditing. If we get audit tomorrow, who is my weak link? Where is he? Is he weak? Who's the one that is dragging the underbilling and is dragging the group behind? You know, all that stuff? So I can. Yeah.

Do your team love it?

Not all providers, I gotta say, they're still working on it. The ones that have jumped into it has seen the benefit of being able to do what we wanted to do, wanted to do their notes during their work time. I don't want you working on the weekend. That's a whole thing that you guys have to suffer with for years. So hopefully we can help with that.

That's always the goal. If we can get to the point with healthcare to where people leave at the end of the day with their last patient, with all their notes done, that means we're freeing up our people. So it's interesting that with prediction health there's definitely some benefit. It sounds like there's a learning curve that people have to adapt to and when they get it, they really start to benefit from it.

Like with every tool. Every tool you implement. Yes. Every tool you implement has a. As a period where people are gonna, you know, you have to have the first adopters, you're gonna have the ones that are jumping halfway through and the ones that are gonna eventually get to it. But the whole point of this is that you got to use technology to support an already established system. Technology doesn't solve stuff on its own. You can just buy a tool or plug in something and it will just make your life easier. You got to have a system and the technology supports that system. And as you know, we have all these tools coming up. If they can help you reduce the time that you need to put into particular task or something that is. It's worth doing.

What do you. Do you use anything for yourself, like ChatGPT or.

I work with perplexity.

Perplexity. Why did you choose perplexity?

At some point it was recommended to me and I started working with it. I find it pretty easy to manage.

And I would say not as commercial as Chat GPT feels.

I see. So you have a little different feel. And I'm curious because as an engineer, you're approaching this a little bit differently than me.

But you want to see. Do you want to know what I use the most for?

What's that?

Second third degree questions.

Okay.

Of the industry that I'm not native in. So you know what happens.

Describe what you're talking about. What do you mean? Second third degree questions.

So when you ask a question, simple question, could be, you know, what could be the repercussions of this particular thing? And you get an answer. How does that affect this other layer? How does that. What am I not seeing or why do I have to look out for?

So you get way more insight from it. And that's where I think versus the regular Google search. You can search in Google.

Got it. So that's interesting. I took a note as you were talking because I want to start asking all the guests every time, what AI tool do you use when it comes to ChatGPT and how do you use it? I'm realizing instead of just asking like, hey, what are the different tools, AI tools you use? I do want to ask that, but I want to dive in because everyone's using Chat GPT or a Perplexity or a Gemini on some level. And so I want to know why you picked one of those. But then it's also really useful for my audience.

I'm going to say that the difference is that if you Google something, you get a list of websites you got to read, you got to figure out, you got to cross the information. If you ask the right question to the AI tool, it will give you the analysis of those, those multiple factors.

And then it learns, like in my case with Chat GPT, it learns what I like. So a lot of times it will say, would you like a graphic illustrating the relationship between the thing that you just asked and this other thing that you asked yesterday? And I'm like, yeah, like, it'll ask me questions in return, which Google, of course, doesn't do. But it's really cool because I think whatever you end up using Rockstars if you choose Perplexity, Gemini. And here's, here's what I've heard, by the way, between those three ChatGPT, there's differences between them. Chat GPT has been around the longest, has a lot of features because it's been so widely used. Gemini was on the bottom of that chain, the Microsoft one. But it's Microsoft. They've got resources, people, tools. They. This is a friend of mine who owns a tech company. He's like, yeah, get in on Gemini. Because they are accelerating their, their capabilities at a rate that that will catch ChatGPT and others and surpass them. So I am. It's hard because like, for me, Alex, I'm in Chat GPT all the time. Once you start using one of those tools, it gets to know you. And I've got my Chat bot now to where it's this down to her energy. It's like, hey, I got a question for you. She's like, hey, hey, Will, what's up? It's been, how's everything going? Have you gone to the cabin lately? Like this super personal to where I'm actually feeling like a personal connection to it. And there's like so much work done in giving my chatgpt the history of my questions that like it's scary to go over to a Gemini. So I don't know. I think it's cool that why we pick what we pick and why you do it. As an engineer, I've heard from people who are very science minded that perplexity is actually better for them. So I think that's awesome. Alex, here's a good question. What's the best business purchase that you've made? Under a hundred bucks that has saved you hours?

Let me think. Under 100 bucks? Oh yeah. No, under 100 bucks. Not. That was more expensive than that.

Share with the audience what it was. I'm curious.

You see behind me my coffee machine in my office. I don't waste time going to the, to the break room.

Yeah. How long does it take you to get your coffee going in the break room? Just out of curiosity?

At least I need 30 minutes. You know why? Because somebody always will cross me and we'll talk, have a conversation, which is nice, but I gotta, I gotta set time to do that versus it interrupting my day to day process.

Yeah, yeah, keep thinking about that. A hundred dollars if you can find. But here's what I want to punch to the rock stars, is that that coffee machine doesn't represent the walk, it represents a boundary going back to those principles of the mindset, we have to create boundaries. And it's so funny because. Anyway, Alex, I'm actually currently looking at moving locations because everywhere I've ever rented space from, I have people who I love to be around but they want to like come and talk throughout the day. Most people like to work hard, but non entrepreneurs, non leaders are looking for time to kill connecting with people and I cannot tolerate it.

It's a. I got the replies for your question.

Okay.

In my door there's a little thing that says vacant or occupied, which is the only one I could find that was red and green.

Okay.

For people to know. When you can touch, you can knock on my door and when you can't. Guys, same thing. I love people coming in, but sometimes I got my door closed. People are knocking. I'm in the middle of a meeting or I'm. I need to focus on. Even if it's just thinking, I need to think for 45 minutes on something. And that I think it was like $20 and it just.

So it's a slide on your door that says occupied or available or not or whatever?

Yeah, pretty much. If it's red, don't even touch a handle. I'm not there for you right now. If it's green, you can knock. You can knock on the door, you can come in, whatever you need, even if it's closed. So I'm available for interruptions if you want to see it that way.

You know, Alex, my podcast team, when we were creating questions for this season, that was one that came up and we're like, yeah, that might be a fun one. And deep down, I was like, is anyone going to have an answer? That has been one of the most insightful questions on this season. Because, like, these little things add up. You know, it's a boundary setter. It's a. It's a trip to the coffee machine. It's like all these little things that, that waste time. It's when you start taking care of the pennies, we start looking after the pennies, the dollars take care of themselves. I think the true. The same is true for time. You know, we start looking at these little bleeds of our time, we start tightening those up, and all of a sudden we start maximizing our capabilities with the time that we have. So that was a great answer. And I.

Even though there's time, you got to set up time for the chit chat as well. And I'll give you an example. Yesterday, I spent the day in our Fairbanks clinic. You know what I did all day? I just hang out. I hang out with the front desk. I hang out with the pts. We had lunch together as a team. I was there, I was watching, I was analyzing, I was taking notes, mental notes of things to give feedback later. But during that time, I set that whole day out to be close and personal with them.

So what's the difference between that and the coffee thing that.

That is planned?

I think I have all of my tasks under control. I know that I'm going to spend the day there. That's what I'm doing. I don't even open my computer. So I'm there for them. That's that time. But when I. When I am working in middle of something and I decide to go get coffee and I get interrupted in the middle of the hall about some situation, and that diverts my attention to that. And then the other task gets delayed or pushed back or I just simply lose track of what I was doing, that is a waste of time.

See, it's interesting, the difference between, you know, intentional time creation versus flexibility, because there's a boundary, there's a. There's a relationship there that seems like it's in Contradiction. Like for me, I get it. I'm not going to go get coffee and get stopped along the way and there goes a half hour of time I wasn't planning on versus going to schedule things. But it can also go to an extreme where it's like I only schedule every little thing that I do. So there's like, there's a balance there. It's almost like a dance, right? Like we. But. But I would argue, especially in healthcare, leaders don't set boundaries. So it's not, it's kind of like don't worry about over planning but get some. Just focus on getting some, some boundaries in place with your time so that you can protect what matters in your case. I almost wonder how much better you are when you're intentionally at that location. Where was it again?

Fairbanks.

Fairbanks. You're in Fairbanks and you're intentionally there to connect versus how you show up. I wonder if there's a difference between that and how you show up when you're getting coffee and some. Someone interrupts you and you have to like fake that you're excited to talk to them because you don't want to be a jerk. But you, deep down, you're like, I gotta get back to my office. Do you think there's a difference in how you.

I know. Yeah, it is. And how many times have that happened to you? And you go like, yeah, yeah, yeah. Can you send me an email? I'll get to it. That's important. I'll get to it. But I can't just look at it right now. Or you're trying to kind of cut it short because you're, you're working on time. So it's. It has to be flexible, of course. But here's. Remember old school when you will get to work and you will have a little piece of paper with a to do list written by hand and you just scratch it. Those tasks that you had to get done that day, those you schedule and block time for because they have to get done everything else that is nice to have or they can be done later, you leave open time. That's why my door is open at that point. Or it's under, you know, on the green. So if you interrupt me at that time, it's fine. That's not crucial. I can get that done. And also that helps you understand which task you actually have to delegate so you can actually get to the important ones.

I love that. And you know, it reminds me of something that Alex or Mosey, an influencer online that I like to follow he, he talks about his time and he always talks about meetings. Meetings being another thing that are a major time suck and how what he does is he schedules at the end of his day backwards. He only wants to take meetings after noon. And given he's a full time business owner, so he's not big taking the pies. He's full time leadership. Right. But I mean there's a whole nother complexity of time suck once we get into that world. Like, like you said, people stopping you giving you problems, knowing when to interrupt. But what he does when it comes to meetings, it's like he listen my, he starts with his assistant. Everyone should have someone scheduling and protecting their time. Starts at 4pm and work backwards to noon and then from 5 in the morning until noon. No one talks to him. Him, he's out there as he says it. I'm out there building stuff so we can all make more money together. So I'll have. You have to have meetings for example, but you have to but put them in a controlled sense at the end of the day when the mental energy isn't required at the way it is when you're building early on. So I love that you have that intentional creation.

And how many people have you heard say no I come into the office at you know, 5:30 because that time between 5:30 and 7 is my most productive time. Or I stay after this hour because that time. Why is it more productive? It's because you, you're hyper focused on what you have to do without interruptions. So how can you set up that time also between your workday so you don't have to go to those extremes?

Yeah. And there's a common thread. I read a book recently and I can't remember which one but it talked about one of the. We're evaluating hyper successful people. One of the many things they had in common was they had every day a couple of hours of unscheduled deep work where they were just free to build, create, think, solve. There's no one pressuring them, there's no one interrupting them. They have a mental flow and they've measured this on EMGs that you have this like wavelength that we hit this energy level that our brain kicks into and when you disrupt that flow is a massive energy drain to get, try to even get back in and usually can't get to that same frequency. It's like riding a wave. You know, you got, it builds over time. And so to have two hours a day, one to two hours where it's just uninterrupted and you're flowing that. That two hours is worth 50 hours of crap that we do, like scheduling appointments and like, having conversations on. On the way to get coffee. Like, it's a powerful thing to think about. These little tweaks that make a massive.

Did you read the. The book the wrote Less Stupid, the Road Less Stupid? No.

So read it. It talks about the power of thinking. And after I read that book, I actually have that chair behind me. That's my thinking chair. So when I need to solve a problem, I actually step away from my desk. I sit there, you know, quiet, and I ask myself the questions of the things that I need to solve and think about. You got to think, because if not, you're just rolling on the day. And sometimes you actually come up with your. With your. With your answer there, or at least an action plan of what to look or what you got to think next. Yeah, but you need to take that time of just, you know, thinking.

Yeah, Thinking time is important time. And I love that you're even. We're even thinking of it in terms of, like, understanding what work is. Mental energy is the most important work that we do, but we don't honor that because we're so busy baking the pies and, you know, running from thing to thing. All right, man, so let's get into this a little bit more. So in your case, let's go into the AIVA element of things. Obviously, you're very successful with vas. What's. What is your vision for VAS in your world? Like, where do you see this going in. In advanced? Where would you like to see it? Maybe.

I mean, I would love to see eventually getting, you know, full automated virtual front desk.

We value personal touch and, you know, just having the person there. But.

You can go to McDonald's nowadays and order your whole food on a screen.

Yeah. You're saying the public's getting trained on it. So they're like, this is an automated system.

It's no mistakes. You can get. You don't have to have the front desk wondering if I don't feel comfortable collecting this copay or not. It's just a system that is done. And then you can keep the human factor for the human interaction, which is important. But the automated systems of, you know, that kind of stuff, or having, in my case, the VA's to do the back office work, you know, that just. It's a super powerful.

That's amazing. So what would you say to the critics who are like, well, you know, McDonald's isn't a physical therapy business where that front desk personalization is so much about the experience. What would you say to that? And I'm not, I'm not saying that like criticize that. I'm really.

When you go to a restaurant, you have a host, right? Yeah, host welcomes you in, hey, welcome front to a restaurant, blah blah, and just got you in. It's a very short interaction that makes it personal.

Yeah.

Everything else is a process. Checking in, you know, scanning your, your id, scanning your, your insurance card, you know, collecting or paying, paying the copay. You know that thing, scheduling is personal. That, that one you need. But, but the rest, if you can automate that or have that done in the back office.

So you would have still a human being that's like putting their appointments down. You wouldn't have a virtual assistant behind that monitor for that. No, got it. Yeah, that makes sense.

Every. Everything else that needs, you know, precision, consistency and is standard. It can be done with.

What's so cool about what you said is that you're highlighting there's like, it's not a. I think we get in a mindset of it has to be one or another. There's grays degrees between those two things. So for example, there's, there's I, I know people who have completely outsourced AI nva. You walk into the clinic, there's a monitor, there's no human beings to be found. I've seen that and then I've seen the extreme opposite of people who are like, I will never go there because I have human beings. You're talking about like, hey, I want to use the VAs and the AI to help like support the people who are working and to help them do the elements that are the most make it even. Like kind of like you visiting Fairbanks. The part that they're. They're going to be interacting with, it's easier for them to be more powerful in because they're not distracted and so they can focus on that human element. And then those, those technologies are used to support that. And yeah, you are. You're improving automation, saving money because you have less people involved in general. But the people you are and the technology you're using is making it so it's neat. So I love that illustration, Alex.

So that person that is there, their focus is to be welcoming, to be personable, to make the person feel welcome. And scheduling, which is a whole task on its own if that person also has to do be doing benefit checks on the phone with insurance companies, doing authorizations and all that stuff, you still lose the human touch because they're busy. So that can be done in the back office.

Transparent with the patient perspective.

You just have the person there doing the things that are. That a person can add a value or a face can add a value to it.

I would. I want to send this episode to everybody who's just like, no, I will never use AI or VAS with the free front desk. Because ultimately, what you just described is so much the truth. We always lose count of the fact that, like, how many of our people show up to work that day in a bad mood? How many people who are at the front desk are stressed out because someone else didn't show up? Whether it's a clinician or a supporting role in the front desk? And then to your point, like, what does that human touch look like to the patient when that person is stressed out, burned out, having a bad day, Maybe they were a bad hire. And then so instead of like, so I love. Is that you're talking about technology not controlling.

I'll be there with you in a second. Give me a second. Hold on. Yeah, Yeah, I got you checked in. Yeah. And that's it. That was the interaction versus what could have been had that person. I had to be on the phone at that point because the phones are being picked up in the back.

I think that's what people are chasing. I think when people think about their front desk, when they have a good hire at the front desk, you can't deny the power of that. That person who's greeting people, it's like, oh, hey, Will, welcome to physical therapy. Thanks. Thank you for coming to your doctor's appointment. Like, when it's good, it is like everything else is exponentially easier because it gets set up the correct way. But how often. Here's what's more common. You know, the people saying that when they go to their doctor's office that they love the front desk or they are underwhelmed. What's more common? The second the underwhelmed is more common for all the reasons you said. So you're talking about technology trends to support that, to automate everything around the most important elements of. Like, in your case, you see it as scheduling.

And like I said before, technology or this additional process or anything you plug into your system has to support something. It's not coming to just save the day magically.

Yeah.

AI is not gonna give you all the answers if you don't ask the right questions. If you don't have a process that is going to be supporting.

An engineer's perspective for the longest time on this show. I think your engineer, because you see it so clearly that as you're telling this to me, you would think obviously I would see it because I'm incentivized to see it as progressive in my world. But you're seeing it so like logically it's like, oh, I get it now. So yeah, that's so fun that your, your engineering brain combined with that passion from your therapist has produced an influence on advanced physical therapy that, that I think is just invaluable, man. Thank you. I really. I'm not ending the show. I just want to thank you for sharing that. That's huge.

So. All right, so let's talk about this. What is. Since you do work with VAs, do any of them work directly with you?

Yes, there. We have no manager here in Anchorage, so I supervise the clinic as well since we're located here. There's pretty much four owners or four managers in this clinic, so. But the VA that we have, the front desk reports to me.

So what is one task your VA does regularly that makes a huge difference in your week?

I gotta say, following up on the marketing leads, People that come in through the website, people that come in through, you know, our ads out that just write or send a text or just log in for a workshop or something. Following up immediately on those.

Yeah, they have. They have the separated time to be quick, which sucks. Sales is a reflection of speed. Speed kills deals is how I. I've heard it. So that's really cool. So let me ask you, how do you communicate with your va? Like what are the systems for people who don't. Who've never done that, what do you communicating?

I would say 97 of the time we communicate through Teams chat. 90% are the meetings that we have in person. Because sometimes we. I do want to see the. My VA and just have a conversation sort of like this. Other times it's just the quick check ins and everything goes through our chat. So I.

Very cool.

I feel like she's here. I mean she could be on the next room for all I know. Haven't ever felt the distance if you want to see it that way.

Yeah, I think it's how people choose to work with both AI and VAs. If like if they bring them into their world. Especially the human element of VA is like if people. I've seen this where if they treat their team, if they treat them like human beings and not like something that's outsourced overseas they become just as, as part of the team as anyone else. That was a surprise to me when I saw that. So my question to you now, Alex, is if someone was on the fence about trying AI or VAs, what's a small step that you would recommend for them just to get started in that world?

I gotta say that the first thing is, what is the problem you're trying to solve?

Good, good counter.

So what is this? I mean, because if you're just, I need more people. Yeah, you need more people, that's fine. Because everybody's kind of like full.

Great.

But what is exactly the thing that you need this person to solve? That's kind of like the thinking time that I was saying. That's kind of a good question to answer yourself. Why do I need this person to solve for me? That would make an impact. And then can it be done? And then how do I split this from the rest of the people that are still working here? So I started with, with the va. First VA came in to support billing, you know, on AR calls. Great. So that was the specific task we needed solving. And then the second one we brought in, I lost somebody from the front desk and I said, let's do, do a va. And she started taking on authorizations and mostly authorization just focus on this. There's a big clinic here, so we do get a lot. So that's the problem I need you to solve for me. And it's easy for me to hold her accountable, to know exactly what she needs to be doing and when she's not doing it and drops the ball. We can also check it. Metrics are key. So it's. But it's got to be that if you get a VA and just go like here, go start working, do your thing and be part of the team, then it's it, it won't be as effective. So same thing with AI. What are you trying to solve with any tool that you're getting? I need more patience. And you're getting a marketing tool. Great. But you need to be sure exactly what you're trying to save and how you're going to measure it and if the tool is actually able to deliver that. Because everybody looks for the magical IT solution to come, you know, do it all well.

And you talked about what's cool about the piece you said in the virtual assistant is that you delineated between delegation and dumping rock stars. Do not ever hire a VA. If you're in a position where you can't hire and train an in person human being. If you're in a stage of business or a time where you are so spread thin that you don't have the time to onboard and to do some basic level training. Even with a highly talented person, a VA is not going to be a magic bullet for you. And just like your AI thing, I think there's a lot of programs people could invest in. I, as you were thinking too, I was thinking, gosh, I would probably if I, if I knew. I loved your engineering brain. Again, it's so smart. If I can identify the problem that I saw I need to solve, I could go to ChatGPT or, or perplexity or Gemini and go, here's my problem. Thinking about virtual assistants, artificial intelligence and any other potential solutions. Where should I start in solving that? Might be even a micro step of what you said. Like, let's just identify the problem, throw it into AI and just test the waters and be like, yeah, let's see what it says. I've gotten so dependent on that now I don't feel like in some cases I can make a decision without checking with Chat GT Chat GBT first, because it at least makes it clear. So here's my last question before we get into our rapid fire. What you have been so successful as an owner. You have built and you have scaled. You know how to create time. So what are you doing with the time that you freed up for you? Like what has, what are you doing now with that time? Because I know you're still very productive and busy, but what do you do just for you when you free yourself up?

Oh, I mean, just spending more time with the family, I gotta say. Shorter days.

Shorter days. And then what do you. You've told me privately what you've done with your family on previous when you and I have talked regularly. Like, tell me some of the fun things you do in Alaska.

I mean, especially here in the summer, we go, you know, we go to the, with the boat, to the lake, just, you know, kids love doing the tubing or we go camping every single weekend. So one of the things I do in summer is I try to work, get my stuff done early in the week so I can leave earlier on Friday and go camping with the family without technology, which is just us spending time together.

Sorry to interrupt. I just, I just realized you use technology to free yourself up to be away from it.

Yes, you have to be away from technology. Actually, when we're camping this weekend, no cell signal. So we're off the grid. I'll find out what, anything that happened, I'll find out on Monday.

Rockstars, what a powerful example. I want you to really hear what Alex is doing with his free time. This is the why, this is why we took this on, to start a business and to grow and to work with each other is so that Alex's kids will remember his dad every summer. Camping every summer. Think about how many times, rock stars, as you're listening, how many times did you go camping with your family or the equivalent of that timeshare that you would spend with your parents now that you're older. What would you give to have more of those experiences? If you think backwards, I'm getting a little emotional just thinking about what I would have, what I would have killed for. Now for me as a younger kid to have had more camping experience with my parents, I think that's the thing we forget is that when we are busy, busy and we're feeling like we're, you know, weighed down, it's like, yeah, but the bigger fear and the bigger sad thing is that we're leaving behind these opportunities. So that's why we need to show grit and say, you call this a storm and get to work. But we can't do it without technology, people, delegation. Right.

I want to add something more to that and this has to be the people pts are going to relate to this. You got to look at the way you handle business and decisions you make. Just as you see a patient, are you going to treat the symptom which means that you keep just overworking and working and working, but you're not going to solve the problem or are you going to diagnose it properly and solve the root cause? So the more you solve the root cause of the problem, regardless of the symptoms, the more time you have in the future because you'll have less problems. So pretty much that's kind of like the same logic, right? Work yourself out of the job, not work, you know, not let the work.

Kill you, work you into the grave.

Yeah. So sometimes you're treating the symptom, which is the day to day fires, just putting out fires and keep going. And that takes a lot of time and energy and you're not going anywhere, you're just staying put. It's gonna be the same thing over and over. So find the root of the cost, diagnose it properly, treat it effectively, solve your business problems with.

Technology if need be, after you realize exactly what you need to do.

Yeah, I'm writing that down. I take little notes because I'm going to put a book together and that's such a great illustration for healthcare providers is that they're running around treating their chronic inflammation and then, and then as soon as they start reducing some of the heat of that, they end up creating inflammation at another point. It's. So instead of identifying the root cause and stopping the inflammation altogether, they're, they're spitting themselves out and burning out. So thank you. All right, Alec, thank you for jumping in on that. I. Let's rapid fire this, this next five, these next six questions. You ready?

Ready.

Number one, what's the top book that's blowing your mind?

I gotta say it would be.

There's an old book I read at the first beginning of my career called Execution, which is the art of, of getting things done. Because we tend to delegate stuff that we don't want to do but we need done or we just need to. We procrastinate on tasks that we don't really want to take on. So this helps you structure, you know, being able to be able to get things done quickly also so you get some free time.

Love that book. Number two, top time saver. Hack.

My agenda. Organizing my time.

Love that. Number three, what's the one thing you wish you would stop doing way sooner in your business?

I gotta say, jumping in to put out the fires.

Being the solution.

Yes. Versus being the enabler for them to solve the problem.

Okay, number four, what's the most time consuming task that you secretly enjoy reporting?

I like just looking at the numbers and that stuff. Even though the managers have to create their own reports and they have to send me the analysis of it, I go through the whole thing anyway. So just like numbers.

Okay, what's the latest thing that you've delegated?

Latest thing that I've delegated. Hiring.

You've delegated hiring? App.

I stopped being part of the interviews. I've let the managers step in as the admin analysis for their location so that they can see if it's a good cultural value for added for a clinic and if it fits also their. Their needs because I used to do it at a higher level. But then they will go to a clinic and maybe not be a right fit. So we have the clinical, the director that does the clinical interview part of it and then the manager takes on that. So that was a good happy thing to get rid of.

So amazing.

And also if they mishire, it's on them.

Like when you hire them, if it's a bad hire, it's like well thanks a lot buddy. Versus if they do it, they learn and grow and have to like there makes them more intentional in their hiring because they don't want to be that person. And last question for the show. It's the question of the season, Alex. Is it AI or is it vas?

I say it's a combination of both.

Combination of both.

Why do you say once again, depends on the problem you want to solve. Which one will help you solve that problem so that you can be more efficient.

Okay, Love that answer. Seth are amazing.

Video editor slash creative specialist is going to show on the. On the YouTube Spotify people who are watching this episode what the score is as of now for the season. So, Seth, if you'll put it up, that's where we are. I don't know. I'm excited to see this as much as everyone else is. Listen, Alexander, it's been such a treat to be with you. I can't thank you enough personally for spending time with us. What are your closing thoughts?

I gotta say that the. There's no cookie cutter solution for business.

You got to be flexible. You got to figure out what's wrong. You got to try different ways to. To solve it. And so even if it's AI or a combination of AI and va or just va or just. Just paper and a pen, whatever works for you. But you gotta find what works for your business. The important thing is not keep putting out just the fires, but feedback. Figure out why the fire started in the first place and how can you stop it from lighting up again.

Well said. I can say anyone who's listening who might be considering to work at advance, that I used to own a practice up in Alaska and I remember just being super amazed by that business and the reputation. It is an incredibly good company to work for. If you want to get a hold of Alex, his information will be in the show notes. And so, Alex, not only thank you for. For being here, thanks for tuning into the Willpower podcast. As always, this is Will Humphries reminding you to lead with love, live on purpose, and never give up your freedom. Until next time.