Redefining Success in Physical Therapy with Innovation and Self-Care - Anna Friedman

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In today's episode, we're talking about a growth mindset for private practice owners. So listen, growth mindset isn't anything new. We all understand the concept of growth and having an open mindset. But maybe what's unique about today's episode is the idea of how it hits us in the healthcare field in its own flavor of being fear based. Obviously, a fear based mindset is a closed mindset. A courageous mindset is an is a growth mindset. And we're going to talk about Anna. Anna Friedman owns Upward Physical Therapy in Seattle, Washington. And she talks about starting her practice during the pandemic, opening another location and hiring people right before having a baby. You know, she's done a couple of professional moves that on paper wouldn't correlate with some personal events in her life, but she decided to move forward anyway. She's a very courageous individual and her story is going to spark a lot of great interesting question around you and where you are in life. So listen closely to this episode about moments when she's facing a difficult decision and how she handles the fear around it. Going to talk about decision filters, what decisions we need to make before we even make a decision to make sure that it's a good decision. But we're also going to talk about ways to overcome a limited mindset in today's episode. Enjoy. Okay. So, Anna, how do you develop yourself as a leader?

Well, I mean, I think it's a lifelong process. I don't think one day you're not a leader and the next day you are. I think it's always growing and always being willing to change your mind about things, change your goals, change your vision and always being a work in progress. And that's true in my personal life and also in my business.

I love that. So it's a mindset that you've adopted. Is there anything specifically that you do to help you as a leader develop?

I'm always looking for new ideas and.

I like taking classes and definitely having a business coach I think is very important. I have worked with a couple different ones when developing my practice and I think it's just great to have that accountability and great to have people who you can look up to who maybe are even just like a couple steps ahead of you or you know, a few years ahead in their business so that they can kind of their boots have been on the ground and they kind of know where you're coming from and. And that's been hugely rewarding.

That's wonderful. Can you give a shout out to your coaches who have you coached with before?

Yeah, it's called full draw consulting and I highly recommend them. When I was working at my corporate job and thinking about starting a practice, Sarah and Kate are my coaches. They had a class called start your practice. Or it was, it was more at the time, more based on cash practices, but now it's come back to more hybrid practices. And it was like an eight week kind of step by step module class and just like really broke it down like as far as what the, what you needed for the basics to start a practice and just made it seem a lot more achievable and conceivable for me. And that's kind of what made me really decide to do it and go out on my own and with their support. So that was really cool.

You know, that's so smart that you did that. And I will tell you from my personal experience, I wish I had found coaches so much earlier. Anna. For me, it was such a painful journey trying to do it on my own. And then when you find people who have either done it themselves or helped other people do it, it just turns decades into days. There's a whole movement in our industry right now of young healthcare providers who don't want to open their own practice because they see how hard it is for those who do that. Maybe what they're not seeing is, is that there is a middle ground. You can find people who are going to be powerful to help you develop your dream without sacrificing your personal health or your freedom or your balance. And so it sounds like that was your journey because you started your practice during the pandemic.

Yeah, yeah, it was November 2020. I remember it was July that year that I decided and I was, you know, I had a pretty great cush job. I worked at a corporate piece PT company that had about 25, 30 clinics in the area. And I was a clinic director. It was a startup. So I kind of got to design the clinic how I wanted, hired who I wanted. Like, that was all great. Just like during the course of the pandemic, there were some changes that were coming into place that I coming down the pipe that I wasn't quite in agreement with. And I, I also am a very creative person and I like to do things a little like outside the mold. And I felt like that was tricky to do with this particular company. And, and so I'd always had kind of this entrepreneurial spirit. Like as a kid I had lemonade stands like every weekend and just to try to get enough Money to run a movie at the local, like, video.

That's awesome.

And. And I don't know, I was just always trying to find, like, creative ways to, like, make a few bucks here and there just for fun. And. And yeah, I don't know. So I.

During this time we were seeing a few less patients, and so I came up with a business plan during that time. And just to. For fun, I started working on a website. And then finally came time to make a decision. And I, I found a little. A little corner office in a. In a gym that was very reasonably priced and shout out to fuel House gym in Seattle. They're amazing. Um, and I was like, okay, like, I think I can actually do this. And I think, like, I think I can. And I kind of calculated the number of patients I need to. Needed to see to make up my income, and it was a lot less patients than I had been expected to see at my other job. So, like, okay, why not? Worst that can happen is I just go back and work at another clinic.

You know, it's so funny, but so many people don't take the jump because they're so scared of what they don't know. Whereas you're. You're a unique breed in that sense. Sense. You have an organic growth mindset, which is the topic for today. You know, their topic today is how to develop a growth mindset as a private practice owner or future private practice owner. So there's an element of entrepreneurship that's true, that was existing with you since you were little, but there was also this thing about taking risks that didn't seem to really phase you because in your mind you were justifying it, like, yeah, if it doesn't work out, I can always go back and work my other job. So, like, as you're going now, and you and I, before we got had this episode recording, you were talking about expanding to a new location and having a baby. You've had quite the growth here the last few years.

Yeah, there's definitely been a lot of growth, a lot of changes. And I think with that comes, like, it's easy to just get caught up in all of it and not really take a step back. And I think that's really, really important when you have your own business is to, you know, as things change in your life and as. As you know, you go through different phases of your life, then your goals might change too and where you see your life going in the future. And I think it's really important to keep that vision in mind when you're looking at where you want your business to go. Like, I heard, I mean, so many horror stories of people who are like, I'm working, you know, 100 hours a week. And like, I'm, you know, why would you want to start your practice? That just sounds terrible. And, you know, and I, I think what I kind of made a deal with myself when I was opening upward is that I kind of made limits and set boundaries for myself as far as, like, what that would look like. And, and yeah, sometimes it's not easy, but I think you live and you learn over time and you make, you kind of fine tune things as you go and learn what works and what doesn't.

Yeah. So rockstar is what Anna's talking about is a decision filter. So, so this is one of the ways and one of the tools that you can use when you're developing a growth mindset, when you're setting future growth, is that you put parameters in place, decisions that, like, if this, then that occurs. So a decision filter. One of my partners, Scott Fritz, who was my, my coach for over 15 years before he and I started a company together that we still operate, he told me his decision filter is really easy. It's have fun, make money, love life. And it sounds very, like, soft. But for him, he's one of the most objective guys I know. And he'll, as he says, tap out the second some of those filters get pushed up against too consistently. Because when you're starting a business, there are times where you're not happy with life, there's times where it's not fun, but there's an overarching decision of, like, once this becomes a thing that you're questioning constantly, okay, if I'm putting too much thought into this, it's not working. So you created a decision filter for yourself. And, and, and I'm guessing that had something to do with your comfort level, taking the risk because you knew you had an agreement with yourself that if you went beyond a certain parameter, you were going to pull the rip cord and not do it anymore. So what were some of those things that you agreed with yourself? Like, what were those things that you decided? Like, hey, I, I won't get, Once it gets to this point, I won't, I won't do this anymore.

Yeah, well, I think one thing is my schedule with patients. Like, know, when I'd worked at different clinics before, it was, it was more about, like, we're always open, we're seeing everyone. Like, we're, we're just going to be as broad as possible. And what I wanted with upward, my vision from the start was I wanted it to feel more specialized and a little more niche down so when patients came in, they knew they were getting a special experience. And if they wanted just more of a general.

Shop that saw everyone, then they could just go to the clinic down the street. So I limited my patient care hours to hours where I knew that I could get some type of exercise in during the day. Like, for example, I. I didn't see patients like maybe one day a week. I worked until like 7pm but then like three other days I would be off at like three or four and. But come in early those days so that I could make it work for myself and my lifestyle or a certain class that I wanted to take, like a workout class and so I can make sure and fit those things in that I knew would be important for my physical and mental health that. And help my patients as well. If I came in with a, you know, with a better mindset going into that patient care day, it's amazing that.

You prioritize without help. It took me, a coach, to help me see how my physical health was a priority over my business and how it actually aided in its growth or detriment. So I love that you're. One of your decision filters was this idea of like, yeah, I'm. I'm not gonna just be everything to everyone. I'm going to love life, you know, or take care of and. Or take care of myself in a way that's gonna serve me in a way that will help the patients. I think that's an awesome filter.

Yeah, well, and I wanted to practice what I preach too. Like I, you know, as pts. It's kind of funny. It's very ironic because I feel like so many of us feel so burnt out, like in, you know, jobs where we're kind of churning through patients that like a lot of pts don't really have the chance to work out or do like live that healthy lifestyle that they. And you know, that we teach our patients to live and working really long hours. And so like, I wanted to be able to kind of show my patients, like, oh, I just got back from a run. Or like, yeah, I went on this hike this weekend and I actually had the energy to do it and like, have my own goals so that that would show and like the energy behind that would show with, with my patients too. And you know, and now we have a lot of people that come in after seeing other PTs, because. And the PTs will refer them to us because they're like, I know this is what you guys do. And like, you guys work with runners, you guys work with hikers. Like we can only take them so far because we don't have this specialized experience.

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Yeah, so, so like I said, I opened in November 2020. I didn't think I would hire anyone because at that point I was, I was pretty done with being someone's boss and, and kind of managing people. And I was like, you know, like, I'm just gonna do this, like head down and like treat the patients I want to treat, not have to worry about it. But after about six months I started kind of getting up against that. Those schedule barriers that I set for myself. And, you know, I started being like, okay, I guess I'll come in early, I guess I'll stay late. And like, you have to do that somewhat as a business owner. Like, but I started to notice that it wasn't fun. Like, it was becoming not fun anymore. And for me, that, that's a big red flag as far as, like, like, that's not why I did this. Like, I wanted it to be enjoyable and how can I help that? And so that was when I was like, either I need to just be okay saying no and having a long wait list, or I need to hire someone. And. And I decided. And I was also thinking, like, it would be kind of nice if I were to go on vacation. I was, when I was making this decision, planning a trip to France with some girlfriends, and I was like, it would be nice if it wasn't just like the business had to shut down when I left on this trip. And so that helped with my decision too. And so I found someone who.

Had a very similar kind of vision for the way that she wanted to treat patients and just kind of niched down working with these outdoor and endurance athletes. And, and she had her own specialty in bike fits and biking. And I thought that could be a great add on to what I was already doing. And so I hired her and never looked back. That's been amazing. And then when I was pregnant and thinking about going out on leave again, we were kind of in this state of, of like almost bursting at the seams, like, okay, we have patients who can't get in for at least a month, maybe more. I'm about to go on leave. You know, I wasn't seeing a full caseload, but I was probably seeing like 25 patients a week, something like that. And I needed somewhere for my patients to go. So I ended up hiring a couple part time ets. And it was funny, like I trained both of them. And then the day I was done training, I went into labor. Oh man.

And it was like two and a half weeks early. So it was, I, I thought I told them, like, yeah, we'll have plenty of time for you to settle in and like, you can shadow, like, get to know my patients and we'll have this nice smooth transition. And that didn't happen. So the way that they found out I wasn't coming in was I was texting them from the hospital like, sorry, guys, like, here's the baby. I won't be in for a while now.

But how amazing that you had that built out, or you had the systems and you had the people right in the right place. But it started in rock stars. I want to highlight this with Anna. Is that, like, one of the things that she did to shift her mindset was to say no. Like, there's. There's a point at which a growth mindset is about saying no to things. And that's something that we're discovering in your story, Anna, because like you said, starting back off, when you were in that gym, you were at a point where it was no longer fun. So what are you, taller? You know, it's almost like this discussion you had with yourself of, what am I tolerating right now that is making it not fun? And it was, well, I'm tolerating working longer hours. I'm tolerating living at a level I don't want to. And so there's a lot of PTs who are listening, saying, well, I don't want to do those things either. But I think there's a distinction there of understanding the power of saying no, not being everything to everyone, so that we can be a real powerful influence on a select few. So, yeah, so talk a little bit about operationally how you had to shift. You have a baby now you've come back, you've got additional employees. You can't go back to running the things the way you were doing them.

No. Yeah. So in a way, it was like a forced break for me to be able to let go of some control, which can be hard for me. But in this case, like, it was such a blessing because I got to see how empowered my employees were, how they came together as a team. Like, I remember I met with them on Zoom, like, six weeks.

After my baby was born, and they were like, we didn't think you would come back this soon. Or, like, we weren't expecting this. And I was like, but I just want to make sure you guys are doing okay. And, like, if there's anything big, like, I'm still here, don't forget. And. But they had it, and it was so smooth. And then, like, a couple months later, when I slowly started coming back to seeing patients, it was. It was so nice and so, so relieving because I felt like anytime I wanted to go on vacation or if we were to have another kid, like, I feel like I have put those systems in place, and my employees feel empowered and. And feel like they kind of know how things are run and they know that I'm there to support them when I can. But I know that I. They Know that I trust them too. And also during that time, so we were still in this gym with, with three rooms at the time. I started with one and we moved up to three, but there were five of us employees, um, or five pts. I mean. And around that time when I came back from leave, I. I started noticing that.

Like, it was still fine where we were, but I felt kind of this stifling feeling. I think that's kind of when I. Another signal for me that something's not right is when I start to feel a little like, I would love to do X, Y and Z, or I'd love to do this community event or this class or an open house, but. But not feeling like we could because the space, there was no public area for us to do those things. Or like, I'd like to add other disciplines, like maybe massage or something, but we can't really do that here because, you know, there's already. There were like 10 different practitioners within the space, like 10 rooms you could rent out. And there were a couple massage therapists and There were other PTs who had their own business. And we were the only one that had more than one. One practitioner in the business. And so I just felt like we were kind of starting to slowly, like, expand beyond the bounds of this place. And people, like, people of course enjoyed having us there. But I think it was definitely kind of like, okay, like, when are you guys, like, it's almost time for, for you guys to move on to bigger and better.

Everyone could see that you clearly weren't like, fitting into your britches, so. So to speak. And they're just like, when are you guys going to maybe expand and become a real. Yeah, yeah.

But it was scary. I mean, the clinic we moved into about a month ago was. It was basically a shoe in for me because I knew the owners of this other PT clinic that were also moving to a bigger space down the road. And I reached out to them once because the owner has mentored me some and I really appreciate.

Him, but he was like. Or I asked like, hey, just, just so you know, we're thinking about maybe moving sometime soon. Like, do you know of anything available? Or if you do, just let me know. And he was like, actually this might be perfect timing because we are probably going to move and so our space might be available. And it was, yeah, it was super cool. But that kind of gave me this realization of like, oh, no, this could actually be real. Or like, you know, it's. It's one thing if you're just looking at Places for fun. And it's another thing if it's like, we might actually need to do this.

Right, it becomes a lot more real. Uhhuh.

Yeah. And so I looked at comps in the area. I spent like months looking, looking around, and so I was like, this is just too easy. Like, it doesn't usually just like, fall into your lap like this and something must be wrong, you know, and. And I would just try to, like, find every excuse to not pick the easy place, which is kind of funny. But eventually, you know, I think. And I think it was good. I looked around to kind of see what else was available. But eventually I just came to the realization that, like, why not? And this, it's like the perfect spot for us. And. And I geared my employees up and gave them a tour here and made sure that they. They were bought in too. And also, like, got their input as far as where things might go. And like. Like, I want them to be part of the vision too. Of the practice. Yeah.

I think that's a big part of developing leaders. Our number one job as leaders is to develop more leaders. And getting their input is an essential step into getting them not just like, create, but to buy in. Because what someone helps create, they buy into. And Rockstars. One thing I want to point out here as we're talking about growth mindset with Anna, is that there's a balance between saying no and saying yes. I think oftentimes most physical therapy, most healthcare providers in general, are people pleasers. So they have a hard time saying no in general. Like, it's one of those where they might say yes to an opportunity and they don't know how to say no to other things. And that's what's hard, is that we can't say yes to one thing without saying no by default to others. If we're running around trying to say yes to everything around us, we start throwing our decision filter out the window. What really matters to us. And what I love about your story, Anna, is this idea that, like, you said yes to a vision and you said yes to big risks when logically it made sense, no matter how scary it was, whether it was expanding to a new business or starting your business, hiring your first coach probably was scary. I'm sure it cost you money in a way that you didn't know if you could afford. But you were saying yes to those things because it aligned with the vision and your decision filter, right?

Yes, definitely. And that's what I try to base all of my decisions around, is my Values like my values and just life in general, and then also just what goals I have for the future, for the practice. And if it doesn't align with that, then it's usually a no. Unless there's some way to work that in somehow. For example, one thing I'm debating right now is adding a, like a infrared sauna and a cold plunge pool into my practice.

So a little more of like the wellness component, I guess, and making it more of like a recovery space for, for our patients and. But it's a big expense and it's like 10, at least 10 grand, something like that. And so that's something I'm researching heavily and thinking about and thinking about if it's worth like a short term hit for possibly a long term gain. Because it's something that a lot of people have in the area.

Yeah, I love that idea because, like, this isn't as big as like opening another location or starting a business, but it's still a decision. Anna, would you be willing to let me share with you my decision filter that I ripped off from a book called the Gap in the Game with Dan Sullivan? Do you mind if I share that with you?

Yeah, go for it.

Yeah, so there's. It's a. It came from this book. And so like in your case, you go off of your vision and your values. This is an actual like seven question piece that's in that book. It's like, number one, is this opportunity, person, expense, adventure, experience, relationship or commitment aligned with my values? That's what you said right out of the gate, Anna. And if it's no, we stop immediately. The second is, will this opportunity take advantage of my unique ability and make me even stronger? Will it lengthen my stride? Number three, how will this opportunity benefit mankind? Is there a bigger cause or purpose that this will benefit society? Number four, does it make financial sense? Number five, is this transactional or transformational? In other words, is this a standalone opportunity or a gateway opportunity? And number six, my favorite, if I say yes to this, what must I say no to? So just from a place of practicing that out, what were your thoughts on this decision when you saw, when you heard those questions, did any of those ring? Like, oh, yeah, that's a definite yes. Or did you have any red flags on those questions when you were thinking about that filter as it pertains to this decision of introducing this additional service?

Yeah, well, I felt like it was like, if I do something like this, like, I guess part of my overall vision is to create more of a comprehensive space that is very community oriented for outdoor endurance athlete types of all levels and create a space where they come and don't just think physical therapy like traditional, like re injury rehab but also a space they could come learn.

Learn from a workshop or you know, another healthcare provider or like mixers and things like that and a space that they can come and relax at other times or maybe take classes and so, and when I think about this like recovery room or whatever space, I haven't come up with a name yet. I like, I just think it would be a nice way to not have to add another practitioner and not have the variance of that.

And then be able to offer it as an add on which would be a cash pay add on for people to come like before or after a session or even just schedule on their own when they're not, when they're not even coming in for an appointment. So in that way I think it's a good, I can't remember the exact point from what you mentioned before, but I think it's, it could be really beneficial long term. It's you know, an upfront cost but then like if you do the math based on what people are charging for things like this and, and also the be like health benefits for people too. Like there's, there's been a lot of research on just how it can help with the healing process. Both body, mind, a lot of different things. And, and I, I definitely want to be.

Able to give people that type of experience and at our practice and have it be something people talk about like hey, did you know Upward has this and like, you know, nobody else in the area has it and I think it could just be a great teaching moment too for.

Our patients and just for the community to offer something like that.

Yeah, you've sold me on it. It's interesting too because as you're going through your response to that question, listen to this. Is the opportunity aligned with your values? Obviously, yes. Will it take advantage of your unique ability? Yeah. Creating a vision for your community is one of your unique abilities. Will it benefit mankind? You talked about the research helping people physically, spiritually and mentally. Right. Like these things are going to benefit human beings. Does it make sense financially? You talked about being a cash pay option. Right. Is this transactional or transformational? That's what you were hinting at earlier. This idea of like it's going to transform the business and the way you're perspective received because people are like oh my gosh, have you tried it? Now the big question is if you say yes to this, Anna, what would you have to say no to?

I'd probably have to say because we would be giving up one of our treatment rooms. So it would be saying no to what could possibly happen in that room.

And how do you feel about that? And how does that feel? It's pretty small. It sounds like it's pretty small.

At least I feel okay about it because there's actually two rooms we're not using right now.

Oh, there you go.

And so that's one of them. The other one is, I think, what it. Where I'd put more of, like, it might be like a round robin of, you know, massage or some, you know, one or two days a week, something like that. I think it could work. And I think, like, yeah, I think. And I've also been doing some market research, going to different spaces around Seattle that have these offerings, and it's mostly like wellness clinics that, like, it's a sauna space and that's all they have. But just kind of seeing how things operate in there and how it feels to be in there and just like what they. The literature they have available in those spaces and just to kind of be able to give it the take that I. I think we could have on it, that would be a little bit different and unique too.

I love it. So it sounds like the filter, your ability to stay in the growth mindset. You've got the parameters in place, and at the end of the day, guys, it's one of those things where we never know until we try to. You know, it's. It's totally true that no matter how much it meets a filter, no matter how excited we are about a vision, sometimes ideas don't work. But how do they really not work? It's like if they. If they don't work, but they lead us to solving some other problem, or if they teach us something about what we shouldn't be doing, it's still valuable information. So, Anna, I experience you as someone with a very powerful growth mindset. What would you say to someone who maybe struggles with more of a fixed mindset? How would you advise them to go from a fixed mindset to a growth mindset? Any ideas?

I mean, I think I would just think about. Basically, if you're not taking any kind of risk or not going for it or saying yes to something, then you're not going to grow or learn.

Or just see what's around the corner. If you're just kind of stuck in status quo and you feel like you're not inspired or you're not feeling alive or that energy of something new and exciting, then it's just very hard to come out of that without taking some kind of risk. And also I would say everybody makes mistakes. I've definitely tried some things that haven't worked out. I've had workshops that a couple people came to, but I still, those people really appreciated it. They learned a lot. I was able to give them a lot more one on one attention. And you know, sometimes they become patients too, or maybe you tweak it a little bit for next time or do it in a different format. So I think like, you have to put yourself out there to really know what works and what doesn't and, and help form where you're going.

I love that because the whole idea about being in a growth mindset is movement. There's motion and there's movement, right? Rock stars, we can be busy, very busy, but we don't ever move. It's movement that matters most. And movement never happens without taking risk, and risk never happens without having fear. So I think a good summary for today's episode, Rockstars is the idea that like, to know if we're operating in a fixed mindset is, are we listening to the fear in a way that keeps us from moving towards something we want? Because in Anna's case, and I've seen this recently, I had, I spoke at a university recently and the student rose his hand. He's like, my dream was to open a practice, but there's no, no way I'm doing it after seeing this one guy. And I said, my gosh, one negative experience someone else went through is enough to limit you from wanting to go for your dream of having what Anna and I both appreciate, which is freedom, you and I appreciate not just the bike rides, but the chance to be on an episode together in the middle of the day. Like, this is something that we get to do because we value freedom above all things. And it's not at the expense of patient care. It's actually because we're able to provide even better patient care. So, Rockstars, this has been a very powerful episode with Anna. My question to you at the end of this episode, listeners, is what is it in your life that's holding you back? What fears do you have that you're letting limit you and you're tolerating because we're only as great as we tolerate. What is it that you're tolerating? What relationship, what individual, what, what possible outcome that we're afraid of happening is holding us in our seat? And what's the risk that you want to take if you could remove fear right now? What is the risk that you would want to take on towards a vision or a dream of yours that would make it worthwhile? Because in the end, we can always go back to the current status quo. We can always go back to what we were previously doing. Right? So Anna, thank you so much for a wonderful episode. I sure appreciate you being on the show. Thank you.

Thanks so much, Will. I really appreciate it.

All right, listeners, until next time.

Thank you so much for taking the time to listen to today's episode. As a thank you, I have a gift in today's show Notes there's a link for you to join the Stress Free PT Newsletter this is a comedy newsletter for anyone who works in healthcare. And of course we're going to have comedy bits. We're going to have inspirational stories, Leadership bits. It's be going to to be a weekly newsletter just to lighten your week to help you do what you love with more passion. So click that link below and join that newsletter and we'll see you in our next episode.