Cash based practice as a physical therapist is new. Learn about hiring associates, setting fees, medicare, clinic setting, his coaching, answering the phone and we discuss Dr. Jarod Carter’s twins spinal muscle atrophy journey.
Big tip is to find a great mentor when first out of school.
We talk a little about his time working for a wealthy couple that would fly him around to do private physical therapy. He learned some lessons during that year that helped him in his own view on money as well as being able to help his coaching clients.
Speaking of coaching, he started a cash based physical therapy clinic when going cash was a rare option and thought of as a poor business decision. However, after quickly making it successful, many people were asking him questions on how to do this too. Listen to some interesting details on the episode about how he created an online business to help others go cash physical therapy.
There is no limit to the amount of wealth potential that you can see for yourself and for your patients. Need to have that abundance mindset because in reality, it’s the truth.
Seeing the inevitable squeeze the insurance companies were putting on reimbursements all the while expenses keep increasing was one reason he went cash based only. He also noticed that patient treatment started to be geared toward what will your insurance cover instead of what’s actually best for the patient.
What has he seen as the best start up scenario: work in a gym, home visits, rent a room from another professional, work full time with someone else and build up your own clinic, 3000 sq ft dream office etc.
Keep your expenses low so when you are considering equipment and software and all the gadgets, really ask yourself, “what will the return on investment be?”
When should you take that online seminar or subscribe to that monthly membership site that will take you to the next level?
Should you do per Diem work (pick up shifts around town) while you grow your cash based practice?
He had his infusionsoft and other marketing platforms up and running for a while before getting electronic records, listen to find out the decision process in picking one.
How do you figure out How You Charge, What You Charge and those considerations for a cash practice? What considerations should you have if you expect the patients to still submit out of network claims to the insurance company?
He has a unique way of setting his cash based fees on the standard insurance 15 minute increment. You really want to tune in for this extended answer.
What level of documentation should you have for a cashbased practice?
What courses and management and customer experience classes would he recommend?
What does an hour session look like in Dr. Jarod’s office and how does a higher price but fewer visits attract clients? Extended answer provided.
When should you consider branded products, if ever?
The “do you take my insurance” is an important question to answer but listen to Dr. Carter give us the deeper reasoning and the way to best answer it.
Things to look for (positive and negative) in hiring a coach.
Medicare and Cash Practice: what documentation is necessary and please consult your local medicare rep to learn more about your particular case (we aren’t lawyers). He wrote a book specifically for Physical Therapists about this topic so his answers on all things Medicare while may have cross over with chiropractic and other professions, might be different for you. His site has 20 pages free.
What are the 3 relationships you can have as a provider with medicare and which seems to be the best option? He discusses self-claims, disclosures, screening the right patients and the other important details so you do everything correctly.
Associates: How do you know when to hire a second doctor? Payment options, vacation relief, extra headaches, what if they like the new doctor better than you and more will be answered by Dr. Jarod.
In general, you should always have your eyes open for potential excellent front desk workers, assistants and even doctors. You want to hire slow and that means when practice growth explodes or your staff quits, you have a rolodex of potential candidates instead of hiring the first person you interview.
What is the cause of many DPT’s burnout? We learn what a “typical PT” visit looks like, why it bothers Dr. Carter and why he advocates for the 1 on 1 doctor-patient ratio. Spoiler, we all have a stereotype that isn’t flattering about our profession and for those of us who do more/better it’s frustrating to hear someone say they “tried PT” but got a canned version of it.
I’m not going to be good to anyone if I am burned out, so you take the vacation. Set up a side business so you have other streams of income to pay the bills during those times away.
Be weary of taking a substantial pay cut to learn from some big name doctor/clinic because at some point the novelty will wear off and resentment may creep in.
One key to remember is that most clinics are operating much like a cash practice because of how high deductibles of insurance are these days. Read some of the books recommended to get your headspace right to be comfortable asking for fees and realizing your value.
Full Slate is his own site appointment booker.
IntakeQ for HER
Patient Sites Lead Generator
At the end of the interview he talks about Type 1 Spinal Muscle Atrophy because both of his twins have it. He tells about their story and some of the insanely expensive gene therapy drugs they have received. It’s an inspirational, heartwarming story and if you have any desire to help the link is below. www.teamcartertwins.com
Motor Neuron Regeneration in Stem Cells – if you know anything about this, please reach out to Dr. Jarod.
Marriage- have communication and create a safe space environment to discuss the hard things in life.Books: Daniel Pink- Drive, To Sell Is Human, Dan Ariely – Predictably Irrational, Robert Cialdini – Influence
Podcast: Mind your Business, Science of Social Media
Show notes can be found at http://www.adoctorsperspective.net/132 here you can also find links to things mentioned and the full transcript.
Justin Trosclair 0:06
Episode 132 cash based physical therapy. I'm your host Dr. Justin trosclair. And today we're Jared cars perspective
2017 and 2018 podcast Awards Nominated host as we get behind the curtain look at all types of doctors and guests specialties. Let's hear a doctor's perspective.
Welcome back. Thanks for tuning in. If it's your first time I really do hope you enjoy it. If you're a longtime listener, really appreciate it. Let me know your thoughts on the financial series we just covered. We talk student loans 401k is Roth life insurance using life insurance as a retirement vehicle estate planning so many good things. I just get excited about it. Sometimes. You might say, well, I also have a weird series, but realistically, you know, doctors come out with 200 $300,000
in debt. Some don't make more than 80,000 for a long time. So what are you supposed to
Do when you have a $2,000 payment a month. So there's options, you know, we gotta retire at some point. So you got to start saving early on, what's your options, so I was really excited for it. Hope you enjoyed it. As always, if you can take a second pause it write a review for the show, it's really motivating for me and helps others to discover what we're doing here at a doctor's perspective. There is a link a doctor's perspective.net slash reviews. And I'll take you directly to the app that you listen to for your phone. And you can just write it right there would pretty cool to me, check me out on Facebook, if you'd like as well. At this point, we did get a new business profile on Facebook. So Justin trosclair
MCC, why MCC media commerce chiropractic? Yes, that's a debate as we were talking about to say, I don't really want a web page for my clinic and for my side business and for this other thing that I do. And so what do I do? And I kind of pull in some people and they're like, you know, you as you hear your brand, so just use your name and I thought about that and
You have an opinion different, let me know. But you got the podcast going on the chiropractic clinic going on, as well as books and T shirts and coaching and marketing, all those things wrapped into one Facebook page. Alright, well, today's guest is Dr. Jared Carter. He has his own podcast called the cash based podcasts for physical therapists. He's got over 90 episodes, I really like talking to other podcast hosts because they don't just have their opinion. I've got 100 so I was hoping you'd be able to be in the block of cash practice physical therapy Episode 106107 and 108. I tried to get them on, but it wasn't we got them now. So we're going to discuss the ins and outs like the Medicare aspect of aging population. He wrote a ebook about it, because it's such a common question and nobody wants to get in trouble on that scale for doing something wrong. weathers negligent, just didn't know better, whatever. And then we'll talk about how do you figure out what price and then the mindset to ask for, you know, physical therapy typically is covered by insurance. They might work in a hospital and so to completely go
against that, there's some hurdles. And so we'll discuss those like, you know, even answering the phone. And because he does this so much, he has a coaching aspect of his business. And that's pretty cool, because we'll get to see the different aspect when he goes by himself, how's that working with an associate, and then later on in the episode, we find out that his children have a spinal muscle atrophy. And that completely changed the way he practices. And so it was a good thing that he had the associate his good thing, he had the business coaching on the side as well to help out with all the finances that go along with that. We'll talk about square footage, how you should set up your clinic a little bit, the software that he uses to keep everything flowing, we'll cover burnout a little bit. And I said at the end, we actually go into pretty deep about what spinal muscle atrophy is kinda like a public service announcement, as well as his twins story with that. And he also has a request at the end that you've seen in the show notes. If you want to help with the cause. And his family, there's a link, you can do that as well. And ways to keep his marriage strong with you know, several businesses, they both work having kids with special needs as a lot of stress and on marriage right there. And so how do they overcome that so they stay strong. So let's get down to business, a doctor's perspective, net slash 1323. Find all the show notes and transcript. Let's go hashtag behind the curtain. Live from China, the great city of Austin, Texas, we got a wonderful guest today he's got his own podcast that is all about cash based physical therapy. And you guys all know, we had a cash PT series a little bit a while ago. So I'm really happy to have him on. And now he's gonna be able to stand out even more than he already does, among the others. He's got probably 300,000 downloads more than that, at this point, is a wealth of knowledge when you're talking about setting up something for cash, because he's interviewed all these people love his show. And welcome to the show. Dr. Jared Carter,
Unknown Speaker 4:58
thank you so much for having me really appreciate it. I've been I've been looking forward to this for a long time. I know it's been kind of a long time coming trying to figure out when our schedules would would both make it possible. So I appreciate your patience with me.
Justin Trosclair 5:10
Absolutely. All these kids getting in the way I tell you
Unknown Speaker 5:13
right now, man. Well,
Unknown Speaker 5:17
I'll give people a quick little background. And then if you want to indulge them a little bit more for those who don't know you, from
Justin Trosclair 5:24
what I've gathered, you used to work like private PT for like a couple that would fly around the country. And you were to their private go to physical therapist was thought Wow, that's a pretty amazing thing. And then at some point, the you transition into having your own place, and definitely we'll chat about, you know, should you start small work in a gym or just go out on your own and get a 3000 square foot dream office? Which I can't imagine if you had the funds go for it. But most of us, you know.
So filling the blanks for us, what's the backstory?
Unknown Speaker 6:02
Let's see. So I've been out of PT school now for, I guess, come 1213 years like that. And right out of school is important for me to get a great mentor. And I found an awesome one here in Austin. He's still a mentor. But about a year into that I got a call from a buddy and PT school and said, hey, man up. He's up in Aspen, it's I've been treating this couple they want me to travel with them, but I can't I don't want to leave this job, my girlfriend, whatever Would you be interested in? I said, Well, yeah, put me in contact and so flew me up to New York and, and we all decided it, it seemed like it could work and, and so yeah, I left my first position to become a private physical therapist for that couple. And they're just constantly on the go hard, hard workers, obviously a lot of wealth, and it was really eye opening thing to kind of be exposed to their world and to that amount of wealth, but also a lot of misconceptions that I I saw in myself about like, you know, when when people had attracted a lot of wealth or create a lot of wealth or, or that there was some kind of evilness to it or that, that there was, you know, that it was just handed to them. And, and that was definitely not the case with them, or many of their the people that, you know, they surrounded themselves with. And so it was a real eye opening experience as far as my mindset and focus on health, healthcare, and the importance of taking care of oneself. And the Yeah, it's just really, really a unique experience. We traveled all over the world, they had a, they had a place in Italy, it was it was really something and but after about a year, and I was still young in my career, and the novelty kind of wore off, and I was not really growing professionally. And, and I decided that it was time to move on. And so at that point, I spent another, I think year two total, working back in the Austin area, I did a little bit of personal traveling well, and then decided to start my own practice when my last lawyer, as I say, kind of made me an offer, I had to refuse, he wanted to change up the kind of pay scale essentially make me full commission, it was a cash based practice charging to time was like $365, just for the first hour with us and wasn't getting a lot of support to actually fill my schedule. Everything, everything in that practice was basically done by word of mouth. And not not not to say that there's anything wrong with word of mouth, it's a very powerful thing. But you know, if you're going to, especially if you're trying to sell people on that high of a price tag, you really need to have a lot of different irons in the fire, so to speak, marketing wise, if you want to do something that's beyond just like a solo, or, you know, solo practitioner kind of style thing that he was trying to do. And so at that point is and I think I'm going to find something else and, and pretty quickly how a number of people seeking me out online and for treatment. And so I said, You know what, I'm just going to go for it. I thought about starting my own practice for a long time. And I thought, if there was ever a time to do it, this is it. And, and I'm not going to do the insurance thing, I'm going to see if I can make this cash based practicing work. This was, you know, probably eight, nine years ago. And, you know, back then there weren't, there was no one online talking about cash based practice or how to do it, you didn't really know about many of them, it seemed like it was just one of those really mysterious rare things to come across a cash based practice. And now, of course, there are hundreds or thousands of them. And it's just been, it's been quite a journey since then, after about a year into it. And things were going really, really well. And people were asking me how I was how I was able to start that kind of practice and get it busy quickly. That's when I the light went off. And I decided to start to teach about it online. So all this time, I've had my own kind of offline cash based practice business, and I've had my online business teaching how it works.
Justin Trosclair 10:04
But something else right there, they just be tired of that lifestyle. Do you think the exposure to that that kind of money allows you to kind of get out of that cash poverty mindset that a lot of us have
Unknown Speaker 10:15
very much man I like I'd said just now, the, the effect on mindset was really one of the biggest things that I've learned with them. And the idea of I think a lot of people like myself, who grew up with very little kind of paycheck to paycheck, Star family, single mom for a good bit of my upbringing, who was a nurse, hard working, you know, in the healthcare round, not getting paid, you know what she should and but just really paycheck to paycheck, and not really much of an abundance of anything or an abundance mindset, you know, within the household, you know, we don't have money for that, and this and that. And, you you it's very easy to get into the idea that, you know, wealth is something you know, for other people, you know, that's what that small, tiny percentage of people get. And it's usually handed to them and all these misconceptions. And also this idea that there's actually like a limitation on the amount of wealth in financial, you know, financial wealth and otherwise, in the world. And they're really, I mean, if there is a limit, I have no, it's astronomical, you know, it'd be an incredible number. And so there really is no, no limit to the amount of wealth, you know, created in this world. And, and seeing that being exposed to, to that was a big part of, I think, what helped to kind of help me to transition into this idea of, I can create a business I can attract, you know, wealth into my life, it's not an evil thing is no limit to it. Those were really important takeaways from my time with a couple.
Justin Trosclair 11:56
And let's chat about this for a second. I'm sure you've heard horror stories, your physical therapists, most people assume you're going to be insurance base hospital, maybe have your own clinic, but insurance heavy. And as a chiropractor, we're like, that's pretty normal to be on your own and have to like fight and claw for your own stuff as a, you know, a business owner. So when we're talking the stories behind why you decided not to go into insurance, what are some of the common reasons that people do that?
Unknown Speaker 12:22
I had worked in both insurance based practices, private practices, and you know that that cash practice that I mentioned, just seen, for one, the difference in amount of time we could spend with patients, the freedom, we had to give them really what they needed, not what an insurance company dictated, you know, that they needed or would pay for. So just the ability to practice in a way that I knew I wanted to, you know, get provide the services in the way that I wanted to, that was a big part of it, for sure. That was a really big part of it. The other part was, was even back then a 10 years ago, I could see the writing on the wall. They were, you know, my practice, my mentor, he was already talking about, and I was already hearing from all your colleagues and other practice owners about the squeeze that insurance companies were putting on practices. And you know, even though the cost of doing business is certainly going to go up every year, insurance companies expected you to take lower and lower amounts for your services every time that the contract was renegotiated. And I could see that even though it was, it was very, very scary, back then, to do something so different and say, Look, I'm I actually don't bill insurance, you know, on behalf of my patients, you know, they pay me up front to do that was extremely scary, but an even bigger risk than doing that was entering or staying in a system that was, at some point going to become unsustainable, it's kind of like the amount of people paying into the Social Security and Medicare systems ratio getting smaller and smaller, you know, in comparison to the people taking out of those systems. At some point without major changes, those the Social Security and Medicare systems are also unsustainable. So in order to keep those solvent, they're going to have to make major changes, especially to the amount that, you know, providers are paid for their services, unfortunately, and same thing with private insurance, if they clearly, we're not going to reverse and all of a sudden, after two decades of cutting rates for our services, you know what, we're going to just start paying you guys more and take less profit for ourselves, right? It just wasn't gonna happen, right? It's never going to happen. Even though it's really scary. I just thought, you know, long term. If I get into accepting insurances, at some point, I'm going to be in the same situation, all these other practice owners are with their back against the wall, saying Holy crap, you know, UFC now wants me to accept $55 a patient, but I just did the calculations, and it takes me $58, you know, per patient, just to keep the doors open. Now, I'm losing money on every year Ha. UMC patient, I get this, it doesn't make sense, it mathematically doesn't make sense. And so that those are the kind of two main things is the kind of care I can provide, as well as making sure that I dictated how much money I made for my services. And I was able to give myself and my, you know, my staff, and everyone arrays, you know, as my cost of business goes up, I was also going to charge more.
Justin Trosclair 15:27
And that's a horrible situation to be in where you have to start thinking, What do I do now? Do I do a third unit of neuromuscular? Oh, they're not going to pay for that? Do I have to do ultrasound? Now? I gotta create things that even make up the money that I was going to lose, but then they end up capping how much you can get paid per visit. It's a real ethical dilemma it is, and especially when you're trying to get the patient the best they need, and you just know that they're not gonna allow it. Yeah, so I can see that. So I kind of alluded to it earlier, when we're one to the switch just starting out from scratch, should you start small, like working maybe in another physical therapy office, the gym, you know, get a clinic of your own 3000 square feet? What have you noticed, with all those interviews, you've had the best scenario?
Unknown Speaker 16:06
Well, I can tell you that I've seen the full gamut, you know, I've had students and audience members and podcast guests who have started, you know, as small as you possibly low risk as you possibly can just continuing to work literally full time for an employer. And then just doing mobile, you know, I'll see you at your home kind of visits on the weekends and evenings, you know, literally just the cost of gas and liability insurance and treatment table that can fit in your trunk, and you're ready to go all the way to, you know, the dream practice, you mentioned the 3000 square foot, I had a recent podcast guest that I think he he put 100 k into some really high high level equipment that has paid for itself, by the way, because he understood how to market it and utilize it but but, you know, he he between that and and, you know, the actual cost of the Spaceman, he was really, he was really invested for sure and had a lot of space and a lot of high level equipment. But so so we can work in all scenarios. I think my my tendency just because not only do you want to have people set up for for success, but also you don't want people to be like totally just, you know, gray hair and, you know, heart attack city along the way is to try to figure out how to keep your overhead as low as possible starting out. It doesn't mean you don't invest, you know, whether it's equipment in space or information doesn't mean you don't invest, but you really do look at what's the likely return on investment? And can I, you know, can I find another way can, one of the things that I found along the way that that end up costing me a lot of money is that I get an idea about something, and I would invest in like that, that platform, that online platform or that or that online course or or something, but I do it, you know, months before I was actually in a position where I was going to be able to execute and utilize those things. Yeah. And sometimes these would be like a monthly membership kind of thing or monthly fee. And it's like, Man, you know, I could have waited six months to subscribe to this, you know, social media scheduling platform or whatever. And then just started, you know, subscribe, right? When I was all ready to go had all my content ready, whatever the case may be, and saved all that money. So you really want to look at your expenses in that way. And don't don't pinch pennies, just to pinch pennies, you know, sometimes, you know, if you've got something that's going to cost you $1,000 a month, but it's going to score you easily two or three patients a month. And you in like, in my case, in my clinic, we average about $1,000 in revenue per patient. That's an amazing investment. I if I could find 10 of those investments and spend 10 k a month for 30 K, you know, I mean, I do I do that all night, all day and all night, right? But right, so don't pinch pennies and go like extreme low overhead just for the sake of those things. Look at what the likely return on investment is when you're making those decisions. You know, and I would say, you know, the great thing about, at least in the physical therapy world, is that there's always so much PRN and per diem work that you can pick up if things don't go as fast as you want. Or if you wanted to start out as a side hustle and not dive in headfirst, you can, you know, have a job where you're working three days a week for someone else to pay the bills, and then you get to or, you know, you're hustling four days a week to work on your own practice. And that's probably the way that I see the majority of practices start is lower overhead, often working at least part time somewhere else, and then building it up kind of as a side hustle to the point where they're like, Okay, I've got enough business flow, I can jump off and still pay the bills and just be full time in my own practice.
Unknown Speaker 19:54
And that makes sense to me. Because the guy you were talking about earlier with the hundred thousand I listened to that episode. Yeah, it took him like almost two years, like him doing everything in the office himself to just be able to make it and had a second job working 30 hours. I was like this dude was hustling.
Unknown Speaker 20:11
He was hustling. And I think he's got like four or five kids now. And he's amazing. And that's if people wanted to listen to that one, you can just look up my podcast, cash based practice podcast. It's Kevin Vandy was at 82 when you just eliminated through Yeah, so then like for you, Dr. Jared carter.com. forward slash 82 will take you directly to that page on my website, too. But yeah, he had some really cool stuff in that episode about utilizing fairly complex Facebook video ads series, you know, like, they have to watch a certain percentage of each Facebook, you know, video on Facebook to in order to see the next one, but in utilize those really high success rates of filling workshops. And then the workshops were set up, you know, to be high converting into actual customers. So they had they created a really great system and look at that forward slash 82. at my website, think I'm pretty sure we have like the download that that kind of delineates exactly how they did that and kind of some resources there. Yeah, so definitely check that out. Go download that information,
Justin Trosclair 21:13
man. We're just plugging each other. This is great. I love it.
It's good stuff. Do you happen to use electronic records? Is that a mandatory thing for y'all?
Unknown Speaker 21:22
It's not mandatory. But just recently in my practice, got into electronic records, I I shied away from it for a long time, because I had had a lot of like marketing systems on Infusionsoft and some other patient sites and some other platforms that I wanted to make sure also like my online scheduler, I use full slate, I wanted something that could sync with all those so that those automated email marketing systems and other components of those those like onboarding, new patient onboarding systems, that it all kind of synced together, and I couldn't ever find one that worked, right until recently. Yeah. And now it's not necessarily that it sinks perfectly, it's just that it's set up in a way that I can continue to use my full slate as my online Booker. And that is an online schedule. That is like what syncs to Infusionsoft and patient sites and like triggers all these campaigns. And then I can just use the HR separately, just enter patients in or my me and my staff can enter patients in as they as they arrive. So I use intake queue for that. It's a great, it's a great little model for cash based practices.
Justin Trosclair 22:32
Okay, because I think I had to manually put the emails I'm get the, you know, there's certain integrations that work as like, you know, what, I'm gonna just go to a Weber or MailChimp, you know, yeah, new patient put their email in.
Unknown Speaker 22:43
Exactly. And that works perfectly well. Yeah, yeah, we just kind of, I don't know, I kind of geek out on it and got a little complex and like, So for instance, if somebody I kind of wanted, I wanted new patients to be able to, to arrive, having received certain emails that ahead of time, and then also receive emails after the fact. And so so things like a Weber and MailChimp, you can't really set it up to be like, based on a date in that way. But in Infusionsoft, you can you can have them go out before an event date and after an event date, and then I had it set up where, let's say they cancel or reschedule, I wouldn't have to remember to go back into Infusionsoft and like, say, Okay, now the eval day is, you know, five days later, it would just automatically pick that up and made the change in our online Booker. And so it took a while to set all those things up. And that's why for a few years, I kind of shied away from doing the EHR EMR thing. But now, yeah, it's been great. My my staff PT, set the whole thing up, we've loved in take you It's been wonderful.
Unknown Speaker 23:46
That's amazing. Don't forget, this guy has an entire like online business, like with Medicare and running practice, you know, cash practices, and I think mastermind groups and all that stuff, too. So this whole other thing that you had to deal with, so make sense that you're using Infusionsoft and all that.
Unknown Speaker 24:01
Yeah, yeah, I use that for both businesses, patient sites, lead, automate, or is a great platform for automating your lead generation and nurture campaigns. There's a lot of great stuff out there. And if you've got a lot going on, you do want to figure out, Okay, how can I create systems? How can those be automated and those that can't be automated or semi automated? You know, who can I hire to? To help me with that?
Justin Trosclair 24:25
And on this show, there's a lot of marketing conversations as well, we don't want to go too deep with any of that. But here's the question, we're not allowed to price fix and cornered the market and all that kind of stuff. But how does somebody figure out? Are they going to be hourly? What rate should that be? Should they just charge a flat fee? Or like a per case? How does someone go about that, especially when you're into the is cost $58? for treatment with insurance?
Unknown Speaker 24:49
So we're so just to be clear, we're saying like, as a cash based practitioner, or practice owner, how are we deciding between, you know, flat hourly rate, what we charge all that kind of stuff?
Justin Trosclair 25:02
Yeah. And sometimes you get caught in the at the charge for an hour, but we are done in 35 minutes. Now, what do I do?
Unknown Speaker 25:08
I say, Okay, so what we do is, we still go based on the 15 minute, you know, time kind of code, because everything we do, we have to make sure that it's in line with what we're going to provide to the patient that they can utilize to send in to their insurance as a self claim. 99% of our pay 99% of our patients have insurance, they had health, and it's not just a bunch of you. So they're doing out of network. Yeah, they're just sending in submitting self claims, you know, to themselves to their, to their insurance provider, in hopes of reimbursement or application deductible or whatever. And so we have to make sure that we have things set up such that that's done legally, you know, that they can provide those things. So, at my practice, we offer 30 minute sessions and 60 minute sessions. And now this will be a little complex about i think it's it's a great question, I think, I'd like to explain it fully, For those wondering about this out there, because it's, it has legal implications, it's important. So we will we charge more per minute for our 30 minute sessions, then we do for our 60 minute sessions. And that's for two reasons. One, there's a higher administrative burden with more, you know, paperwork and whatnot, when we have two patients in an hour rather than one. And two, it's in hopes that the higher cost per minute price will will compel the person to do the higher priced full hour session, right. But we offer both of those because it's important to offer more than more than one option, especially in the cash base world, you know, you get to the end of your free consultation or your evaluation, can you say, you know, it's 150 bucks, yes or no, or it's, we have 30 minute sessions for you know, hundred and 10 and, and full hour sessions for 155, or 150, which one do you want? Right now, our pricing is at 185 for full hour, and 125 for a half hour. And so the way it breaks down with codes is that we we charge was 25. So we charge I think it's 6250 per unit, no matter if it's all of our units of all of our CPT codes are the same cost. So manual therapy is 60 to 50. therapeutic exercise and neuro rehab, they're all 6250 to keep it simple. And so if we do two units, so 215 minute units, then that adds up to their 125 30 minute session. But if they do four units, so you 60 minutes, then adds up to $250. But they get and this is an established policy that we have, if you choose the full hour sessions, you get a full hour provider discount, that brings them down to 185. And so in that way, the super bills that we provide that it's all delineated there with the CPT codes, ICD nine codes, everything that's needed for those self claims. And it all adds up to the correct amounts. And so if they only need 30 minutes, and we booked an hour, and we're like done at 30, which does occasionally happen? Well, so you know what, I really don't know that we need the full hour, let's just do a 30 minute session here. And if we wanted to, because, you know, they'd signed up for the hour, we could even add an extra like discount to give them the same permanent rate, if we wanted to. But, but yeah, that's typically that's kind of how we do it. And that's how we address that issue of, you know, if they don't need the full hour, then we have that kind of as a fallback, and it still is in line with what is legally necessary with their super bills.
Unknown Speaker 28:42
So you're able to put on the insurance, you know, the super bill agents weren't that our discount?
Unknown Speaker 28:48
Yeah, the full hour discount? Yeah, it's on there. It's a provider discount, buy an item discount underneath the subtotal? Yeah.
Justin Trosclair 28:54
Now, do they ever ask for your records, I mean, you should be taking good records anyway. But I know some people get lazy because they follow. You know what I mean? So these two have to write down all the notes. So that way, if their interest is like, hey, prove us that you were doing all these therapy and exercises, for instance, the notes up
Unknown Speaker 29:10
to that level. So the I have heard of, of, you know, I've had students and, and audience members who have had notes have note requests from insurance companies for that purpose of like, is, you know, is this medically necessary is it documented that, you know, in the assessment that they really need this amount of therapy, etc. But my practice know, most of time with note requests that has to do with like, if somebody has had a had been in a car accident, or something like that, and it's now and again, an insurance company will request notes. But the thing is that we, you know, we take full payment info at the time of each session. So, if the insurance company says, look, we don't think that this was necessary, and we're not going to pay for it, I mean, the patient is signing off in the getting on their intake paperwork, and their their contract that they understand that, you know, they're paying, they're paying at the time of service, and there's no guarantee of what their insurance company is going to reimburse them for. And, and, and, in the cases of that has happened with me or with, with, you know, any of my students, I mean, that's, that's an area where we say, look, you know, this is what insurance companies do to providers, and in the cases of, you know, people sending in self claims to their own insurance, you know, this is, this is how they operate, to sell, they make millions and millions a year, it's by denying, denying, denying, and that's why I had to get out of that system, because became literally insolvent in many cases in many insurance contracts, to actually accept that insurance and be able to actually provide decent levels of care. And so most of the time, they understand when that happens, it's just, you know, see insurance company doing what insurance companies do. But back to your original question about like, kind of the detail you need to have with with your documentation and a cash based practice, really just, you need to make sure that that you are documenting in a way that you are, you know, you're covering all your legal bases, if if something happens, and you end up in court, or someone gets hurt, or whatever, you need to have documentation that's sufficient for covering you in those scenarios. And of course, you need to make sure that holds up to your state Practice Act or whatever, you know, depending on what field you're in, whenever the those documents are called your, you know, your licensure, your board is going to have some details of the level of documentation and notes that you need to take. And you got to make sure that those two bases are covered. But generally, those are a lot lower level and less tedious, you can say, then say what you'd have to provide to get in network, you know, insurance space, you know, services covered or Medicare Services covered,
Justin Trosclair 31:47
and there's a certain level of documentation that you should have, because if they come back six months later, uh, I don't remember what we did, you
Unknown Speaker 31:55
get to be able to guide your own guide your own treatment, as well, that's actually kind of how I document I, I probably document in more detail than most cash based practitioners that I know of, specifically for that reason, really, because I like to write like the response to each technique, which is a little more tedious, but it tells me I'm with Becca, this technique work this one didn't so much. This we made a huge difference, okay, and that helps guide my my treatment, for sure.
Justin Trosclair 32:23
And plus, you know, the activities of daily living this improve that didn't have much improvement. Are there any techniques that we should hone in on if you're going to be cash based, like SF ma or McKinsey or anything like that, um,
Unknown Speaker 32:36
honestly, I think the most important thing is, is understanding how to provide a great customer experience and a great human interaction is actually more important than if you you do that via McKinsey, or Mulligan or Paris or, you know, SF ma are all exercise or all manual or mix of everything or neuro like, it's not that those things don't matter by any means I have, you know, some good to, you know, things that I probably use more than anything else. But I think the most important thing is if you're going to be in because you'd you'd asked specifically about the cash based realm is this, of course, applies to any private practice any business, if you're in the human, you know, serving business, which we all are, you're losing a lot of business, and you're losing a lot of the value that you could get within each customer, if you're not maximizing the customer experience. And that starts actually way before they become a customer in some cases, just even first connections with your brand. And it should continue way after they discharged from their first plan of care. So they become customers for life and, you know, raving fans, and and so thinking about all the little details of their interactions with your customer with your business, whether in the clinic or not, and honing in on like, how can we how can we really wow, people time and time again, every time they come in, and even between the sessions, I believe, as far as as far as the business goes, is actually much more important the and the techniques you use with your hands. If you want, I can talk more about techniques to but I just want to plug the customer experience goes way beyond the techniques we can use.
Justin Trosclair 34:19
That's finally we've hit some of the buzzwords for those who are even following they've heard those before, I just didn't know if you had a you know, like a go to this is something that I always go with, or it makes it look better for the patient. You know, if they're paying these higher rates, we do these certain things, or we have certain equipment that rules them and Taoism. And I don't think that actually is necessary. I was just curious, your opinion on that?
Unknown Speaker 34:40
Yeah, well, I mean, our practice and not that this is needed for success in a cash based model. But we are very, very manual based, you know, we're very hands on we probably are doing, I'd say 75% of our manual techniques are a little more soft tissue focus, and maybe 25%, a little more joint focused. And then we we take, you know, whatever time is necessary from the hour to teach them the Home program stretches, exercises, self treatment components, that they need to support the work in the clinic. But we spend very little we don't have them doing anything in the clinic that they could be doing on their own time. And I think so that as a model is very attractive to our ideal client, we are who are the types that are willing to pay more for a higher level service. And a lot of them have already been to PT or other types of practitioners where it's like, here's a stretch cord stand over there with those three patients pull on this 10 times. And you know, next time you come in, we'll do it 11 times, it's, you know, it's a joke. It's an unfortunate reality, and a lot of a lot of clinics, especially those who have gone through that and seeing the level of care that they're getting there. And then they see our videos online, or they read our testimonials, or they you know, our blog posts, whatever. And they see how different it is that's big part of what gets them kind of over the hump, so to speak, and say, Yeah, okay, I know this is going to be $185. But I'm probably going to have to come maybe half as many times break away from family and work half as many times I'm going to get higher level care when I am there, etc, etc. So the that model was is does kind of set us apart from your typical, especially insurance based option in our area.
Justin Trosclair 36:25
I like that idea. Because yes, you do have to probably teach them what they can do at home. But outside of that those few minutes, the rest of it is I'm going to take you through some motions and some exercise that you can only do here under my guidance, because that's what you're paying me for.
Unknown Speaker 36:37
Yeah. And the hands on stuff. Right? Yeah, that which they can't reproduce on their own. That's what we really, you know, the majority of time is spent on
Justin Trosclair 36:45
no doubt. Do you recommend any swag? You know, mugs, t shirts, golf bag, you know, some clinics are really into the doing that kind of thing? Because it gives a wow factor. I didn't expect that, or is that just dumb?
Unknown Speaker 36:57
I don't think it's I don't think it's dumb. I don't know that it's where investment should be made early on. You know, if you're really bootstrapped and don't have a lot of surplus or a big flow of of profit in the beginning, I wouldn't be investing in those things. But I do think you know, if you're going to go that route, you want it to be as public facing as possible. As far as that goes side. Certainly go you know, t shirts over coffee mugs, hats, you know, things like that we can get your your brand out there in the community in that way. Yeah, yeah. Even even like if you if you consistently are giving out, this isn't as public facing, but if you're consistently giving out like lacrosse balls are like soft tissue, kind of self treatment tools that you can, you can easily and cheaply. You know, put your logo on and things like that, I think can make sense, but only when you're really profitable. And you know, there's a lot of other ways I think you can more effectively spend money to get in front of your ideal customer,
Unknown Speaker 37:53
like $500 on Facebook ads, have videos of testimonials and such.
Unknown Speaker 37:58
Yeah, yeah, I mean, that's one that's one way for sure. But you know, that's, that's a whole topic of the different if you're going to get into that, yeah, if you're going to get into the into the paid advertising realm, you either need to make sure that you can, you can do it really, really well and that you're in it for the long haul. But you're not just going to try it for a month and see how it goes. Because I promise, it's probably not going to go, well, you're not going to get an ROI in one month, you know, you need to have whether it's you or a firm, you hire somebody that's really good with those things to be able to test and tweak and find something that's getting you a good ROI, then it can be amazingly, amazingly effective. But like just throwing 500 bucks at it over a couple months and not really having you know, any real expert doing it with you or for you. It's tough. It's tough to make it work as it is, since you
Justin Trosclair 38:49
handle a lot of people. What are some of the biggest hurdles that you people experience when you're in the midst of cash practice?
Unknown Speaker 38:57
That's a good question. I think that
Justin Trosclair 39:00
it could be as simple as how do I answer the question on the phone? How do you take my insurance? Right?
Unknown Speaker 39:06
Yeah, yeah, exactly. That actually in my my course is a whole module is just on how to answer the Do you take my insurance question, because that is a big, huge, and it's not just it's not just a matter of knowing kind of what to say it's getting, it's doing it so much and practicing so much that you get comfortable and confident with the answer. Like earlier, when I was saying, you know, the customer experiences probably as important or more important than the techniques you use to get the results? How you answer that question. And the confidence you have in answering the question and presenting your rates, once you've had that conversation is just as important, if not more than, like the actual words you say? It really I mean, it takes it takes a combination of all of it, you know, knowing what to say, but also how to say it and then building the confidence. So that is a big one, you know, when you to your original question of what are the things that people struggle with, I think that's a huge one. Because of most of the time, we're coming from a world of people being used to spending, you know, 1020, maybe $50 a session with us, and things being insurance based. And we're not used to placing a really high value on our time, or asking anyone to come out of pocket nearly as much as we have to in a cash based business business. That the mindset component of that and just getting comfortable with those conversations, is you nailed it, you know, one of the biggest things that I think just, there's a lot of is a lot of I know that so and so's doing this, and I heard so and so on your podcast doing that. And people just feeling really spread thin and not having a firm direction and maybe like kind of a step by step knowledge of what to do now and what to focus on next. And how to follow up with, you know, this activity to optimize, you know, and maximize the use of your time, and all your marketing efforts. And just, there's just a ton of different things around marketing, we as clinicians, we don't I know in PT in the PC World, we don't get much of that at all. And chiropractic, I think you guys get more of it than we do. Since so many, you know, chiropractors are, you know, end up going into private practice. I think there naturally should be the I would guess that there's more of a focus on it in chiropractic school, I could be wrong on that you can tell me but but I know in the PT world, that it's very minimal. And so most clinicians that decide to start their own practice that just not prepared for, whether it's the logistics, the nuts and bolts, and you know, the insurances, and how to find space and review a contract and blah, blah, to the actual, you know, marketing of the practice, especially in the cash based world, we're asking people to come out of pocket so much more, you really got to know how to sell your services, and it's just not something that we're equipped with. So you have to seek out that advice in those methods, you know, from those who have learned how to do it,
Justin Trosclair 42:02
that's the hardest part about I think being a chiropractor is we don't get it in school. And so you know, you don't know, you would think at this point, well, you know, the schools, they don't want to wrap their brain around some company, and then come to find out that company gets a bad rap for doing something stupid, and now you're tired. You know, I think that's part of what it is. But um, there's so many companies and gurus, you know, you got one guy that knew how to do it, and now he sells you on this program, but it's all based on like one person instead of, you know, a lot of people anyway, there's lots of help out there for us, you just got to be smart, because a lot of people take your money and really don't deliver as much as they promised they
Unknown Speaker 42:36
could. So yeah, and that's where I think it's look for the testimonials as people reach out to people that you know, have been through programs, you can learn also learn a lot just from the free content that's that's out there available, you know, from podcasts like yours. And, you know, just doing your homework, doing your research. And there's, there's going to be a lot of stuff that said, a lot of things that repeated in from multiple different people. And, and a lot of the information is going to be the same or similar, I think when you bounce around, and where you find big differences is the style of who's teaching it.
Unknown Speaker 43:11
And so you're buying the personality.
Unknown Speaker 43:13
Yeah, finding someone that has the right personality for you. I mean, there's some people that are you they they need someone who's like really high energy and motivational and some people don't really need that, but they need someone who's kind of a little more, you know, focusing on the details and the nitty gritty, you know, logistics and maybe others need someone that's really no nonsense and like, get off and do it. And then you know, really hold them accountable. And so finding, you know, searching, if you're looking for a teacher, finding someone that you can tell is going to be a good personality fit because not that all the information is the same, but there is going to be a lot of crossover and overlap. Very true.
Justin Trosclair 43:51
It's an important topic, I want to say 10,000 people get on Medicare every minute until the year 2023 or something like that. Cash PT, you cash practice you cash based, you got to document if you see a Medicare patient, you're still supposed to submit it and all that type of stuff. So do you just exclude anyone over 65? In your clinic? Do you jump through the hurdles?
Unknown Speaker 44:14
No, we we don't this is obviously a big topic. I'm happy I've got time. If you do, I can dive into it a little bit. And really, and this I promises not just to plug myself but I did write a book on this topic because it is so vast. Yeah, I also want to preface this with its and thank you for asking. But this is all specific to physical therapy, I can't even really apply this confidently to like occupational therapy, because there may be some differences there. I'm not sure. But I really don't know with chiropractic if, if what I'm about to say is is in line with what the rules would be for cash based chiropractic practices. But in the PT cash based realm, or I'm sorry Justin the PT around in general, you can have one of three relationships, so to speak with Medicare, you can be a participating provider and being kind of sort of, say like in network with with Medicare, you can be a non participating provider, which is still a contractual relationship with Medicare. And then you can have basically no relationships The last option, and that's it we are we were not non participating, we're not participating, we have zero connection to a relationship with Medicare. And the relationship that you as a practitioner, as a practice in the PT world have with Medicare dictates when you can and cannot provide covered services on a cash pay basis. And it gets really tricky. If you if your listeners who are physical therapists wanted, like the first 20 pages of my full length ebook, you can get for free, I think if you just go to my website, forward slash newsletter, you'll get it, you'll get the download, and I'll give you like a really good overview of the whole thing. But essentially, in my practice, we don't turn all of our potential patients who are Medicare beneficiaries away, but we only accept those that have told us up front that they are 100% sure that they don't want Medicare involved in paying for their physical therapy with us. They understand that they have Medicare billing options, and you know, with participating providers in the area, but they want to see us and they're happy to pay out of pocket for it. And they won't be sending any self claims or anything like that. And they also sign off and agree that they won't allow family members or any other legal representatives to send in claims as well. Because the times that I've heard of students and audience members, kind of getting an angry letter from Medicare as a cash based practice saying, hey, you were providing covered services and not sending in claims to Medicare, which is part of what's called the mandatory claims submission rule. That rule being if you provide what would be a normally covered service to a Medicare beneficiary, it's mandatory that you send a claim in for that for that service. So they get these letters saying you you need to refund all of this money. The only times that's happened is when either the beneficiary or more often than not like their adult child, or their adult son or daughter said, What do you mean, you paid out of pocket $4,000 physical therapies cover Give me those receipts and they send them in, right. And so that can be an issue as well. So we really do screen people and make sure that they're like, dude, I do not care if Medicare is involved at all, I don't want them involved. I want an hour one on one with you this this level of service you provide. That's what I want, I'm willing to pay it a pocket. I'm not worried about you know, getting reimbursed, blah, blah, it really gives us that confidence that essentially they are utilizing the one exception to that mandatory claim submission rule.
Unknown Speaker 47:57
And you're signing a special paper that says that
Unknown Speaker 48:00
Yeah, payment agreement, it's not a an ABN Oh, that was wondering, it's not an ABN ABMs or for for when a Medicare beneficiary was, you know, using their benefit or wants to use their benefit, but it may not may or may not be covered, it's just a different thing is Yes, totally different thing. We we call it a payment agreement, and they sign off on that, if we've you know, we've not had any issues so far, because we're really cautious about it. I know a lot of practices that they do a bit of convincing, you know, if you come here and pays cash and whatever, and they kind of convinced them and for me, it's like now if they're not convincing me to take them in as a patient, then we we usually refer them out just to be safe. In some some attorneys on the subject would say that if you're not if you have no relationship with Medicare, then does the mandatory claims submission rule and this loophole and all these other components to it, does it actually apply to you? It actually destroys as I understand it, and they understand it, it hasn't been tested in court. No one's gotten one of those letters that didn't have a relationship with Medicare, and said, Okay, I'm going to fight the federal government on this, let's go to court. They're all just like, okay, you know, tail between their legs and refund my money. And yeah, here you go. So I think that's an unanswered question. But I don't really want to be the one to answer that question. Yeah. And so we're pretty cautious. And then there are definitely practices out there that want to take zero risk, and they do what you originally suggested. And your question was, I'm sorry, if you're a part B, Medicare beneficiary, we cannot see you period, even though I believe that when they say the things that I just mentioned up front and really want to see you and are fine with, you know, Medicare not being involved. I feel like we do have the way the laws are in that we do have the opportunity to take them on as a patient. But again, that's just me, that's not legal advice, or what anyone else should do. You should always check things out with your own attorney. a disclaimer, we're both not lawyers.
Justin Trosclair 50:02
But chiropractic goes, what you just said, is pretty much the same thing with us. Is it? Okay, yeah, I was a participating. And when I go back to America and decided to do my own thing, and I'm just coming, I'm like, Can I, you know, I'm not expecting you to answer this. But I'm just like, Can I get out of it? and be like, completely not associated? Can I just surrender my number? And I don't know, I could be like, stuck for my career where I have to
Unknown Speaker 50:23
just No, no, I mean, again, I don't know about chiropractic. But I know like in the PT world, you have to re credential you have to kind of basically confirm that you want to continue to be a participating provider every I don't know if it's year two, or something like that. And so after a few years, if it's anything like PT, that relationship would have lapsed, and you just got to confirm that it has an IT. And then if you wanted to actually actively get out as a PT, there's a process for that as well for getting, excuse me, for getting rid of the of your participating or non participating provider relationship with Medicare, you can do that as well.
Justin Trosclair 50:59
Okay, our capital, see, there's always mandatory documentation seminars, you know, a piece of our education, and it pretty much comes down to these are the Medicare guidelines, these are the important part exam, and you have to make sure you have these things documented. And when you look at it to me, I'm like, well, that's stuff that you should just already be documenting, because you need to as a doctor, but if you don't do it quite
Unknown Speaker 51:20
right, then you got a problem, and you can get the reimburse money. So just a little more scary, you know, just gotta make sure those T's are crossed correctly, you know, exactly being being even a non participating provider, you know, you are then open to audits and you know, fines if you're doing things wrong, and a lot of times people are doing things wrong, they don't even know they're doing it wrong. They're not like being malicious, you know, but then they get audited. And I've I mean, I've heard about practices, literally losing six figures or having to refund six figures, and going broke and doing so back to Medicare. I know, PT practices, going through audits, where they found Okay, for years, you've been doing this wrong, and therefore you owe us all this money back and they were broke, which is so crazy. Like, it is really unfortunate. Right? It's crazy. You know,
Justin Trosclair 52:07
they said, hopefully this is a somewhat accurate for every dollar they come after for a chiropractor, they get anywhere from three to $5 back, because so many companies have horrible they
Unknown Speaker 52:16
find a lot of issues.
Justin Trosclair 52:18
Okay, well documented document something? Well, yeah, you didn't put the muscle therefore this whole is not gonna count you like times how many visits that I do over the past?
Unknown Speaker 52:29
Exactly, like whole know.
Justin Trosclair 52:31
So yeah, it's a little scary to to take Medicare, in my opinion. Yeah,
Unknown Speaker 52:35
I'm not I'm not telling people to shy away from it sometimes with your niche or whatever, it's, it makes absolute sense to do it. Like, you know, for me personally, and in our niche, it's not really necessary, but you know, we're not, you know, we're not doing we're not doing outpatient orthopedics in South Florida. With all the retirees or anything, you know, so it's it's different some some scenarios that makes a lot of gear in the Parkinson nature, you know, bounce and falls and things like that. And I have a few people in my mastermind group that are in those niches, and some of them for that reason have chosen to participate once non participating, and one is doing it with no relationship, actually. So you but I think it makes total sense in some scenarios to have that relationship to have access to those patients, when you're not on par. Just as for the PTS curious, when you're not participating with Medicare, and you do have that relationship with them, you actually can accept payment at the time of service directly from the beneficiary. And in fact, you can build them 109.25% of the Medicare Physician Fee Schedule, so you get about 10% more that you can build, and you get it at the time of service. But you still have to submit all the claims to Medicare, and if Medicare is going to reimburse, they reimburse directly to the patient. So it's a little bit different of a process than if you're a participant provider. And it can work well with kind of cash based practices in a niche in the geriatric niche.
Justin Trosclair 54:04
Okay, you got one more business question for you.
Unknown Speaker 54:07
Sure. Yeah, I'm good. I'm good on time go for
Justin Trosclair 54:10
you, at least from what I've heard, have a second hire another PT in your office? So what are some of the options here to ask how do you know when you're ready? In financially, you might be busy enough, you know, you gotta have the finances to be able to pay that person's salary. Or maybe there's a better way, you know, per person that they see fit on their schedule? Is it worth having that second person based on like, the amount of managerial effort it takes? What are your thoughts on that?
Unknown Speaker 54:37
Yes, it's, it's very worth it. If you if you have the systems in place, and a bit of luck, and you find a great staff, PT, staff, chiropractor, even, you know, administrator, when you find really talented, hard working people, and know how to properly motivate them, it changes everything. I mean, it's, it's so worth it. It's so, so freaking wonderful, I gotta say, you. And I can say like, even if life doesn't throw you curveballs, it's really, I think, great to have other people doing good work on your behalf. It's just for me part of creating the lifestyle that I've been working to create for a long time, even when I was a solo practitioner having at least a part time, Assistant, you know, to take the little things off your plate, to answer part of that question of is it worth it? Yes. Now, are you going to speak with plenty of private practice owners who their biggest headache is staff management? Yeah, I mean, but a lot of that goes back to bad hiring choices, keeping people on who need to be fired, but keeping them on to way too long. And not really having just like, you know, we don't come out of school, knowing how to market our services, we also typically don't come out of school, knowing how to manage people. And so that's another area where it's important to, to, you know, learn and really study and become proficient in it. Because if you don't know how to manage people, and you want to grow beyond solo practitioner, then you're in for a bumpy ride. Yeah. And and I'd say, you know, one of the things I say a lot about hiring and management is, is the old adage, hire slow fire fast, most people do the opposite. And so along the way, well, before you're ready to hire us, when are you ready? You should, you should actually be looking for that, to gather a handful of great candidates, well, before you are ready, start the process early, start interviewing people, let them know, hey, I've got this practice here, I spend an hour one on one with each patient. I'm not ready to hire now. But I'm looking to gather, you know, a handful of really talented potentials. And if you're available, when I am ready, great. And if not, no worries, at least now we've made a connection. And you know, we can have a professional relationship. But there's no harm in saying upfront, like, I'm not ready right now. And I'm not sure when that might be, but I'm just trying to meet talented people, so when so then you get to hire slowly, you're not stuck, like, Oh, my God, I'm on a three week waiting list. And I'm already seeing patients on Saturdays as well. And now I really, really need to help, I need to hire someone because, you know, my admin fire, you know, quit or I, you know, my child's about to be born or whatever the case may be, you don't want to be rushed in that scenario. And so you can work well ahead of time to gather some in you know, yeah, some of them may be in a position to, to move forward when you're ready, and some of them may not. But if you have a handful of them, then you're starting off in such a better position.
Justin Trosclair 57:38
Not everybody wants to work one hour on a person.
Unknown Speaker 57:41
Right? Yeah, I mean, whatever, you know, if you if you have, if you have a practice, that is that is attractive, you know, to your typical chiropractor, a therapist out there, right, because you've done something different than just loading them up with five patients an hour and making them do mostly evaluation. So the tech can, you know, or the massage therapist, whoever can take them through most of the hands on one on one stuff. Like, you know, that's just burnout city. And unfortunately, in the PT world, that's where a lot of staff pts are at. And so if they don't want to start their own practice, they want something different and don't have to change careers. A practice, like mine are like a lot of cash practices out there is very, very attractive, and they would be happy to be on kind of a call lyst are I'll tell you first when I'm ready, scenario, and you know, at that time, if they're still in a, an employment scenario that they're not crazy about, then they might, you know, make the shift and come over to your practice if if you end up choosing them. So if you want to finish out that idea, just don't wait till you're needing someone to hire to start looking for talented folks. And then if you've ever hire someone, and usually we can tell pretty quickly, if they're going to work out well, we, you know, once they start to work, if they're, for whatever reason can be a wide variety of things. But if you start to really get the feeling like man, they should have this by now, they're not following through in this way, they're not following my instructions and not doing this or that. They're not correcting with my feedback, don't don't wait a year or two, they're going to drag you down. And you know, just make sure you're again, that goes back to having that really solid list of talented folks, you can easily replace people when you're in that position of power. But don't hold people, you know, beyond when you've really seen you know, what, good enough is not good enough. just good enough is not good enough for my business. It shouldn't be for anyone's business, if you want to really be successful. And I can tell you, as someone who's had both employees that I had to fire, and employees that I've been so overjoyed to have and just amazed with how much they can they can add to the business, you the difference in what it means for your business long term, the experience that people aren't going to have, how many people they tell about your business, it's just like this spider web effect, that when you have someone that's giving kind of a just good enough experience versus someone who's just really wowing people, including you as their as their business as their as their employer. It just, you can't even put into words. So going back to your original question of Yes, it is absolutely worth it. But knowing how to hire and how to manage is really, really important to make it worth it. Because otherwise if you bring on wrong people and you and you hold on to them too long, it ends up being this kind of downward spiral constant headaches scenario. So but it can, it can change everything. I mean, the last year with what's happened, since my twins were born, if I hadn't had great staff in both of my businesses, everything would have fallen apart when I wasn't I mean, literally, there were times when my son was in the hospital when I I only had I could put maybe an hour into each business a week. They kept, they kept moving forward, they kept pushing forward. I wish I shouldn't say an hour. You know, when I look at like all the texts and quick phone calls to my staff. That's that's what it became is no longer was I executing it was just getting the staff to do everything that I normally would have been doing. And they stepped up and things not only, you know, didn't fall apart, they went really well. They continue to to grow and push forward. So it's really important to have great staff.
Justin Trosclair 1:01:30
Was your ego ever bruised? When a long time patient said no, no, Dr. Carter, I'll take your other doctor today.
Unknown Speaker 1:01:38
I am always overjoyed when I hear that, honestly. Because really like, I'd started to kind of pare down how many days a week I was actually seeing clients. As my as my twins were, you know, getting closer and closer, I went from kind of like three or four days a week to two, and then to one, I just see patients on Wednesdays and I've stayed suspects e patients on Wednesdays. And so I'm always in my particular scenario, I'm always overjoyed when someone has a great experience. And it's like happier to see them than me. And I will I'll brag that point when people call a lot of times, you know, because my name has been I own the practice. And it's been attached to it for so long and have been established in the community. People call and they see my name and a lot of testimonials and they want to see me and I'm like, Look, I'll tell you what, you know, you let's schedule you with me. Since I'm only seeing patients on Wednesdays, that's going to be six weeks from now. But why don't you just start with a free consultation with my therapist. She is amazing. And and I'll just tell you don't be surprised if you want to push forward with her. Because 99% of people that see her first or even co treat with between the two of us, they end up requesting to be on her schedule. Hmm. And usually that will at least sell them on like getting started with her. And she's so amazing that it is true. Most of them are like, yeah, okay, I'll get some of them would still want to see me at that, you know, six weeks out, but they've already gotten in most of their therapy at that point. And they're doing great. And so I actually use those ego bruising moments to sell her on new clients
Justin Trosclair 1:03:16
as awesome. Do you end up having to charge a surplus for you, since you only are there one day and do have a waiting list?
Unknown Speaker 1:03:22
No, we I you know, I know that like say if you look at a legal practice, you know, some of your some of your hourly rates are going to be vastly different between the the person that's been there for years or own someplace compared to a new associate. But I don't really know, I think you could probably pull that off in a PT clinic. But there'd be some legal legal components to it. I shouldn't schools registered. Yeah, I don't think that you'd really be able to make that work even with like an established like, we have the full our provider discount. Like if you had an established protocol of Okay, they saw this provider. So they got this discount versus they saw this providers, they didn't get a discount off the total, you know, the the higher level fee schedule,
Unknown Speaker 1:04:08
but I don't think I know, I'm confusing to 99 business.
Unknown Speaker 1:04:12
Yeah, I think that could be trouble. So we've for that reason, not looked in that direction. And, and the other part of it is, I think that you probably shouldn't hire anyone, and have anyone providing care that you wouldn't trust to give as good of a service as you and I know, that's a big statement. If you're hiring someone that's relatively, you know, early in their career, and you've been doing it for a long time, you know, there's going to be a gap in this skill set and interactions and, but but you should do your best to hire someone that you would feel totally comfortable giving 100% of your patients to seeing them. And then you don't have to really run in or think too much about should I be charging more for my time then then there's
Justin Trosclair 1:04:54
you made interesting comment about burnout for pts. When you get hired and say like a musculoskeletal based place versus like, you know, brain rehab and all this are you all turn into like glorified massage therapists and in the staff people do the systems do the exercises?
Unknown Speaker 1:05:11
and cash? I mean, that would probably be a good question to ask kind of like a variety of of pts that are actually in those working scenarios. Okay. But the way I see it, what I see a lot in the we call like money mill clinics, or you know, these clinics where they're seeing so many patients is it's not as much that they're glorified massage therapists, they literally don't get the time to barely put their hands on the patients at all. Oh, in the in the worst case scenario is what I see is the PT. There'll be like one PT for every three texts are PTs and the PT will do the evaluations because I believe in all states, the Practice Act states that the evaluation has to be done by the PT, right then the actual treatment, you know that the following of the plan of care isn't handed off to the tech that's you know, under the supervision of the BT PT is just loaded up with evaluations all days and revaluations, they're going to do that. And then every 30 days, they do the reevaluation. And they're just basically doing evaluations, re evaluations and a ton of paperwork. Actual Yeah. And the provision of care is, is by the lesser paid employees. So that's the worst day that I see. And then yeah, and then there are some scenarios where they're not just having to do that, do they do patient care, but it's very rushed, you know, it's like, Okay, I've got 10 minutes to do a few manual techniques. And then I gotta go to the next patient. And you're going to be with the tech to pull on a stretch cord for the rest of the hour and hang out on a hot packet, or call back or whatever. Okay. Yeah. So that's kind of the way I've seen or what I've seen in our field. And this is, you know, not to piss anyone off. But it is the reality of what's going on in a lot of clinics, and it gives us a bad name. So honestly, I don't really care if it pisses anyone off, because if they're perpetuating that, as what people get when they go to physical therapy, will Shame on you. You know, yeah, people deserve better than that. And they deserve one on one care with higher level practitioners. They deserve to not be standing there with five other patients next to them, you know, someone watching them out of the corner of their eye while they're mobilizing someone else's shoulder. Yeah, it's just, it's just not high level care. And most people, I think, when they really honest with themselves, if they were in a scenario like mine, where they had a full hour one on one, they would admit, yes, my patients would get much better care, I would be able, I would be less rushed. I'd be able to really utilize the skills I work so hard to obtain in school and beyond. You know, so I yeah, I kind of get on a soapbox with that. Because so many of our clients come to us and say, Yeah, I already heard what really gets me is when I'm out at like a party or some networking thing. And someone's like, Yeah, I got the shoulder thing, blah, blah. And I'm like, Oh, yeah, it sounds like this man. psyche. You know, that's certainly treat all the time. And they're like, Well, no, I already already tried physical therapy. It didn't work. Okay, well, well, let me just ask a few questions. Did you when you went to physical therapy? Did you was you know, were you in kind of like an open gym setting, pulling on stretch cords? Well, you know, whoever you were working with was actually working with other patients at the same time? Yeah, yeah, that's Yeah, that's what happened. Okay. Did they ever text you? Maybe like, every few sessions, they do a little massage. Okay. But like, 510 minutes? Yeah, yeah, that's it, you know, a lot of hot packs and ultrasound. Yeah. Oh, yeah. Every time every time. Okay. And I say, Well, look, you got glorified Personal Training, and actually bad personal training that That's not at all what we provide, you know, and then I explained a little bit about how we're different. And I say, unfortunately, you went to a place and just didn't provide really high level care. And there's no, and and i'm not surprised that it didn't work for your shoulder, because this isn't necessary, what you're telling me is what would really be necessary for your shoulder to get better, and you're not going to get that point on a stretch cord? With nothing else? I'm not I'm not bashing exercise. It's a huge part of what we teach what we do. But you know, just that, that approach to treatment. And so yeah, I mean, I don't, I'm careful and tactful, I probably am not that blunt about it. I don't want to like throw colleagues under the bus, even if they're given us a bad name. But at the same time, I am very clear with people who say I tried physical therapy and didn't work that not all physical therapy is created equal. And part of what I'm doing in helping others to create practices where they can spend as much time and give the level of care that they really know their patients deserve. I'm changing, I'm trying to change the perception of physical therapy as a whole throughout the population.
Justin Trosclair 1:09:46
See, that's what's fun about listening to other professional podcasts, because you get to hear these stories where other beauties are also bashing other clinics like that, like this is trash. This is not what you get here. pet peeves is like when you hear chiropractors complaining about other current like, same scenario, I tried Chiropractic and you hear what they went through, and you're like, oh, boy, and they're anti Vax. Oh, boy. Okay. All right. Well, we're not all like that we're not all going to cure your diabetes with adjustments in your spine. So yeah, let's open the book and try again.
Unknown Speaker 1:10:18
Yeah, I try to avoid like that the technique, or, you know, you see, like intervention based arguments, because, honestly, my focus has been so much more on business and like, customer service, learning, as opposed to like learning new techniques or approaches to treatment, you know, there's probably plenty of stuff that I do that maybe research is not supporting so much, even if my patients are still getting better. You know, I don't get deeply into those. And I think that there are a lot of like, purely exercise based therapists that get awesome results. And like, I think that a mix of a lot of different things is super important. Yeah, that's just my opinion. But it's this, it's just whatever your approaches, if you're, you know, rushing from patient to patient or forced to rush from patient to patient and know you're not providing what you could if you had the time and the opportunity, then I mean, I feel like in that scenario, you've got to make a change, whether it's to another practice, or to your own. Yeah, to creating your own. Yeah,
Justin Trosclair 1:11:17
I'm with you. Like being in China, that's a big focus in LA like business procedures, and learning a lot of that stuff more than before. And just recently, I'm like, you know, I need to take a different seminar to like, brush up on some skills that kind of maybe fall on the wayside a little bit, because I don't get to use them too much. So like, let me get a refresher course, or something completely new this year. So I'm really excited about that this year, like, you know, techniques, stuff, and not always marketing and business.
Unknown Speaker 1:11:41
Justin Trosclair 1:11:42
Let's switch gears a little bit. You're busy, man, you
need to take vacations, you got to take a break? How are you able to do that? This could be a pre kid.
Unknown Speaker 1:11:51
Yeah, as well. Yeah, I was gonna say it's everything is different now with the kids and the health issues going on. But you know, before before, when I was a solo practitioner, it was that goes back to the whole, like, needing staff thing, because that was painful. Like I, I have family in Australia. And when I went to Australia, and then also when we did our, we went on our honeymoon, like, think the Australia trip was three weeks in the honeymoon was three weeks. And in Italy. And at those times, when you don't have staff and anyone seeing patients, I had my own my business, so I was fine. But I can imagine not seeing patients not having any revenue for three whole weeks, you know, that's a tough thing to do, unless you've got a lot of savings, you know, over over a year. So So how I did it in the past was literally just have this, you just have to say, I'm not going to be of any use to anyone, patients or otherwise, family, friends, whatever, if I'm totally burnt out, and you have to just schedule the vacations and I'd say well in advance, you know, at the beginning of the year, say right, or the you know, six months before you know you have, you're going to have the capability, really just putting it on the calendar and not budging, not scheduling patients in that time, you just have to make it a priority, when you have staff to hold down the fort, it's a whole lot easier to do that. And when you have like more than one business and passive income, then that changes everything, you know, when you know that you can be in Italy for three weeks, you know, for your honeymoon, and you're still going to make you know, decent money. Without seeing clients. That's a wonderful thing. It's a really wonderful thing. And so it's not something I'd suggest to everyone because it really is a lot of work. But setting up other side businesses that that can make income passively without your hands having to be on anyone, it really has been a game changer and a lot in a way like kind of a family saver for us with this past year. But, but right now, I mean, we are going to be moving we're getting more routine, we are going to be moving back into figuring out how we can do how we can take some vacations when we get a little further out of this. But I think just at the end of the day, you've got to just schedule it and then pre plan well for it, maybe work a little harder leading up to it see some extra patients to account for that which you're not going to see. And then of course, if you have staff, then those things aren't as big of a concern, just making sure that they're well trained and have all the the guidance and feedback ahead of time that they're going to need to keep the ship steering in the right direction.
Justin Trosclair 1:14:28
That's true. It's tough. I mean, especially, you know, when staff I'm thinking, I'm thinking like front desk, but you actually saw my like, if you have a second doctor, you actually stagger your vacations, and that would be a bonus, you know, because somebody orders they want to give the the junior partner or whatever a week, you know, you didn't take any vacation. So you get a week, because I have to give it to you,
as you just think about it differently, you could take off three weeks, and then I could take off two weeks, you know, not at the same time. And you know,
we're in January, and maybe one in October, and everybody wins. And like that's a really happier
associated, I would think
Unknown Speaker 1:15:02
staff happiness is, I think, overlooked in many ways and making sure that people do have the ability to recharge again, again, it goes back to if they're if you've got staff that are burnout, and they're not getting there, you know, sufficient vacation and recharge opportunities, that's that's going to have a much more negative effect on your business than giving an extra five days a year. Yeah, you know, I've paid time off, I've heard I promise, I'll
Justin Trosclair 1:15:29
listen to some podcasts. And they were discussing what's a livable not a livable wage, but like a salad that you could be happy with. And you might have somebody who's good and stick with you for a long time. And you may never get to the first year. But you know, between 80 and 110, there's a lot of docs, I think, based on the workload, if they have enough vacation, their CDs are covered, and they make that kind of money, they'll probably stick with you for a really long time. Because that's a lot easier than having your own clinic.
Unknown Speaker 1:15:53
It is it's true. I mean, if you can set it up where it benefits the Bennett, the businesses is doing really well with them still making that kind of money. That's a big one, when we the way I haven't set up with my current therapist is, is a base salary. But then commission beyond a certain number of patients each week, I looked at exactly what I needed to cover all overhead. And beyond that point, she gets a little extra for each patient she sees. And if she stays really busy, you know, she could easily be making 90 K a year. But she has that base salary as like a good cushion, you know, to make sure she can pay the bills. So that's just one of many ways you can slice it up. But there's a good book that, that you and the viewers or listeners may want to check out if you're, if you're interested in actually, you know, having staff or you already have staff is recognizing that not everyone is driven by money as their kind of primary point of motivation and how long they stay in practice and are taking a job in the first place. The books called Dr. I think that might be Dan pink, I think Dan pink might have done that one Daniel Pink, who also did to sell us human, which is another read, highly recommended book. But drive is great because it really dives into what drives us as humans and how that can differ vastly from one person to the next. And figuring out what drives your employees when they come in is really important, not just putting the stamp of everyone must be driven in the way that I'm driven. You know, like you'd said earlier, maybe maybe not everyone wants to spend a full hour with their patients. Maybe they'd be like,
Justin Trosclair 1:17:30
Well, no, I
Unknown Speaker 1:17:32
don't want to spend a full hour there, you know, but some would just you know, give their left leg for that. They're in the money mo clinic. So understanding early on and throughout the process and reviewing like reminding yourself of what did they fill out on this like motivation index form that I have everyone fill out, like what really drives them. And sometimes money is really important. And sometimes it's it's one of the lower things on their list,
Justin Trosclair 1:17:56
as long as you can cover your bills, and you can have a
somewhat comfortable life. Dean, I think it's easy to get into. These are the other actual things I like in my life. Like I like to have a little more control and power, maybe do a little bit more marketing or blah, blah, blah. But if I can't even pay my bills without a second job, that's a problem. Of course, yeah,
Unknown Speaker 1:18:13
I mean, that that's kind of like that, given minimum, they've got to be able to pay the bills. And, and that's it, that's a little side warning is like don't ever hire someone that says they're okay with taking a big pay cut, because they because they really just want to work for that company. Because over time, the novelty is going to wear off, and they're going to have resentment about having taken a big big a big pay cut, I made that mistake, once really talented person, I really want to push this business forward, you know, I think we can I can help grow it and then you can afford to do this or that. And it just did not work out. So the were on that. And on that end of things as far as when we're since we're talking about pain management, and all that kind of stuff.
Justin Trosclair 1:18:53
Perfect. You mentioned a couple of books before we jump into the last
Unknown Speaker 1:18:56
little piece of the interview any other books or podcasts that you you would recommend?
Unknown Speaker 1:19:01
Unknown Speaker 1:19:04
Let's see here. Yeah, I think Yeah, few. Let's see here. So predictably, irrational is a really good one by Dan Ariely. It talks, it really gets into the psychology of decision making. And if you really understand that, I think especially as a cash based practitioner, and as an aside, most insurance based practices now are essentially operating as cash practices until these huge deductibles are met, you know, and these high co pays, and people are having to pay so much more these days. So this is all very applicable to them as well. But knowing how people make decisions is really important and help in allowing that to guide the way you interact with people, the way you market the message you have on your website, your your ads, or whatever really important, then, influence is another one along that vein of you know how psychology works, how we can influence people to make the right decisions about their health. It's not about influencing them to to buy anything they don't need, but it is you know, if you truly believe in your product, then you have a duty to sell that product, you know, to your prospective patients. Because if they don't choose you, and they choose something that's going to give them a lesser outcome, then that's on you. And you know that I mean, that's not fair to them. It's not fair for you to not sell your services to them if you're providing a bad product and service right, period. And then so then that book I mentioned earlier to sell is human is a good one. And any other kind of think of it like mindset books, as far as podcasts go, I really like mind your business, the mind your business podcast by James Wetmore is great lot of mindset based components to being an entrepreneur being just a an effective person, a happy person that can run an efficient and effective business really like that one. And then what I've been listening to a lot lately is, is the signing social media. If you're interested in social media at all, that's a fantastic one, because they're really bite sized, actionable, just valuable. Really, really actionable. podcasts. 10 to 20 minutes long buffer put on Yeah, from buffer, which is, which is a platform I also use for my scheduling. That's a great one. So I'd check out those two podcasts. Yeah, I mean, those are kind of the ones that I really like, I'm not going to plug my own again. Unless you unless you're interested in cash based practice, but but for for just business as a whole, those are kind of the things that I I've been listening to lately, and some books that I like to recommend to everybody. Awesome.
Justin Trosclair 1:21:37
Now we've mentioned it, we've alluded to your son's, he has some beautiful twins, son and daughter, because
double perfect scenario there. So they're fraternal, fraternal twins, boy and a girl. Amazing. But they have a health issue. So if you don't mind chatting about that a little bit, I know it's been a
up and down. But there's some really positives that I've heard on your podcast. Yeah, as far as that goes. So if you could give a little public service announcement of what they have, and if you, you can discuss however much you want. And I know that there's a link that you want to share at the end, I would like you to share it at the end.
Unknown Speaker 1:22:10
Sure, sure. So my son and daughter gray and add away they were born January 2018. So at the time of this recording, they're a little past 15 months old, they started to show some signs of weakness between kind of like months four, and five, and maybe even a little before that. And so we started PT. And they really weren't gaining quickly, as quickly as we thought. So we did some neuro workshops. And at about seven months old, they both received a diagnosis of type one spinal muscular atrophy, which is a really devastating neuromuscular disease, or genetic syndrome. And was was quite literally fatal. And 99% of cases, bye, bye. You know, the first few years of life up till just a few years ago, there was no, there's no treatment, or no cure of any sort. Few years ago, the first FDA approved treatment came out, it's been amazing, called spin, Rosa, we got them on that as soon as we got as soon as we could, you know, we got the diagnosis and really pulled a lot of strings. And you know, we're talking about kind of bashing insurance companies earlier. But I gotta tell you, anytime I get a chance to praise Aetna, and how they just so quickly moved that process of, you know, approving the use of this drug, which is $750,000 per child, the first year that $350,000 per child, every year after, oh, now they get it, yeah, every four months, now they get this injections, like I think it's 120,000 or something via I'm looking at these vials, when we go into that I Holy crap, man's hundred and 20 K, two of them actually, you know, sitting next. Unbelievable. So then, you know, but just to just to praise that they've really just come to our rescue even with like coverage of other things beyond that, they've just been amazing. And they've done what insurance should do, you know, they, we pay for it. And when you need it, they they came through and they come they're coming through. And and so then my son got sick, common cold. Right after they started the spin Raza and he was still, I mean, they're still very, very weak, it's helped a lot. But they're still very weak, comparatively, and he got cold, and it put him in the hospital for three months. And that was grueling. Of course, his his twin sisters at home, still breastfeeding. And my wife had to continue to work full time in order to maintain the insurance. So she's working full time at her job as a school counselor, then basically having to take care of Adelaide as as much as possible breastfeeding her. And I pretty much lived up at the hospital, we had some family and friends that would come, you know, give us relief and do an overnight stay here in there. But for the most part, it was a divide and conquer kind of thing is very, very difficult. But when we were there, found out that there is this amazing gene therapy that was in still in trials, but was likely to be approved, which actually may happen this month, we'll see. And I found out they had a compassionate use, kind of program. And we ended up it was it was a long process very difficult to make happen. But we made it happen. And they got this incredible gene therapy that actually gives them the gene that they're missing. And it's not necessarily like a, like a total cure by any means. Because it doesn't necessarily reverse the damage that have been done. And it's not guaranteed that it gets to every cell in the body that needs it, or in the spinal cord. But man, it has been really, really amazing to see what's happened since he got back from the hospital. And they both made the day before he got out of the hospital, they both got this gene therapy dose and talk about expensive stuff like this thing is probably going to have a price tag of anywhere from two to $5 million.
Unknown Speaker 1:26:12
Yeah, because it's basically a one dose kind of thing. And, you know, is said with the results of kids in clinical trials, it's like unbelievable. The early especially those that got it, you know, in the first few weeks of life, it's just incredible. They're walking, some of them are even jogging first few weeks of life. Wow. Yeah. Yeah. So they know, you know, their screen, they they know coming in, or they're screened, you know, at birth and find out, okay, they have spinal muscular atrophy, we gotta we gotta move. And if they were in one of those trials, and got it early on, they're doing like, amazingly well. But I mean, yeah, the kids now knock on wood have stayed healthy, stayed out of the hospital, and they're making great progress, you know, we're still way behind. And we don't know how far you know, these treatments are going to take them, we're running a tight ship around here, they get a lot of therapy. And actually, that's, you know, that's really what we raise money for is that is to get them, you know, way more than what, what's being what would be covered or is covered by our Medicaid insurance. Yeah, you know, it's really not a lot. So we were getting them to therapy sessions, like four days a week, and then one the other three days a week. And then of course, I'm a therapist, so I'm like, working with them a lot. And just kind of everything is a little bit of a therapeutic play. You know,
Unknown Speaker 1:27:33
form to it. But yeah, I mean, it's, we're, yeah, we're we're spending about $70,000 a year on therapy on on physical occupational speech therapy. So yeah, I mean, the the link that you had mentioned wanting to share, and I really appreciate you saying that is is weaken. If you go to Team Carter, twins, calm that just right now forwards to the GoFundMe page. And even if you didn't want to donate or share anything, if you just wanted to follow their story, I, you know, probably like, once a month, I'll put up some new videos and just update everybody that's been supporting us. And it's been an amazing outpouring of support us and unbelievable, and it's titled Help Help Adelaide and grey walk someday, because that's, that's our goal. It's not just a survival thing, like, like it was in the past, this is where we're going for them to be able to walk and live completely, not that you have to walk to live an active and independent life, but we will, that's what we're pushing for. And so we've got a long, long road ahead. And it's, it's pretty crazy, I become now pretty much a full time stay at home dad, PT, nurse assistant, and, you know, run these businesses with a couple hours of time a day at most. But that's just, that's just life right now. And we're pushing forward, as joyfully as we can as inspirational. So the gene therapy, and the shots, the shots still have to be done, you know, they have the genes to make everything sort of, I mean, they don't they don't necessarily have to be done in Adelaide and gray, we're actually I think, just the fourth and fifth children in the whole world to have both. And in now, that's going to change once it's FDA approved. But I think that what's going to happen? I don't know for sure. But I think that insurance companies are going to say, look, you can't, you can't get both You got it. It's they're expensive, as I'll get out, as you heard. So it's like one or the other. And I think a lot of unfortunately, a lot of parents are going to have to make a very difficult decision in that way. But to answer your question, the the reason that they are continuing to get the spin, Rosa, is that there, they have different mechanisms of action. And I won't get into all the genetics details. But whereas one gave them a big dose of the gene that they were missing, and it's delivered by a virus into hopefully as many of the cells as possible. rasa actually helps to create this protein that this the miss the gene they're missing creates this protein that's needed for neurons to stay alive motor neurons. And so this spin, Raza actually helps this backup gene to create more of that protein. So for any of the cells that that need, that protein that didn't get that gene, which I'm sure there are plenty, you know that this thing had to get across the blood brain barrier and incorporate into a lot of billions of cells. So, so having that as like an ongoing increase of that protein that's needed is very important. And we're down the road, I'll be looking to get them re dosed with the gene therapy somehow, when, when it's possible right now. They couldn't be even if we had 4 million bucks and said, Look, let's do it again. We couldn't because they're, it's delivered by a virus. So once you get it once, you're going to usually have antibodies to that delivery via man. Yes, exactly. Or there's, there's someone in Harvard that I'm falling, probably soon connect with it's working on. This is a problem amongst all gene therapies that are delivered by a vector virus is this idea of, well, if it would be beneficial to have another dose, we can't. And so they're working on reducing technologies. I'm also if anyone, if anyone hears this, I'd like to put a little request. Anyone who hears this that knows anything about motor neuron regeneration and stem cells, it's something I'm just starting to look into and figure out is there anything, because I don't think there's a lot going on with it specific to the regeneration of like, damage themselves for kids with muscular dystrophy, spinal muscular atrophy, I think most of that kind of research has been based on looking at spinal cord injury, and some a lot with ALS, which is kind of similar in some ways to SME. So I'm just starting that process. And if I don't, honestly, if I don't find that there's a lot being done, I would not put it past myself that in a few years, I have a stem cell company focused solely on that. So if anyone out there could could save me the trouble of having to do that. Great. You have any information on on you know, really cutting edge themselves. nerve growth, not not motor, not I'm sorry, like brain neurons in the brain. But the lower motor neurons are actual, you know, peripheral motor neurons is what we're we're looking to figure out, can we reverse the damage that happened, you know, in that in that those first seven months before they started getting treatment, because a lot of damage to happen? A lot of damage happened here,
Justin Trosclair 1:32:35
which is amazing. Like, there's us caught
Unknown Speaker 1:32:36
it around for months. And these I guess these other kids, this hospital was like, we're going to screen every newborn for this one test so that we can include him on a research study, because no one would generally was happening there is that there are a few states that have SM a on there. And you know, every every state has like certain things they scream for, you know, within that first week that prick their little heel and do a little blood sweat on the, on the test on the little piece of paper or whatever it is. And the Yeah, so spinal muscular atrophy is not on most of those for most states. And that's some of the kids found out that way. But more often than not, it was when a couple of had a child who had spinal muscular atrophy. And then whether purposely or accidentally got pregnant again. And that second child they knew would have a 25% chance of having it Oh, so they have they got them checked immediately. Or even maybe even a neutron. That might be possible. But at any rate, that's where you had these scenarios where they found out so early and probably get treatments or
Unknown Speaker 1:33:40
Yeah, this one is like, Man, you wouldn't even notice and
Unknown Speaker 1:33:43
you wouldn't know that. Yeah, you wouldn't know to check. And I mean, you know, another another public service announcement, if you look just because even if you've had kids that don't have it doesn't mean that you and your partner are not carriers are, you know, are missing one of these copies or two copies of this gene. And and so every birth has a 25% chance if you're both carriers of having a CMA. And so whether it's your first kid or not, please like spend the extra couple hundred bucks to just make sure it's a very low chance. It's like one in 10,000. But I can tell you, man, you never would expect to be that one in 10,000. Right, and man to have it with twins, and they weren't identical. So they both had a one and 25% chance it wasn't like if one had it than the other one necessarily would have. We just got really freakin or lucky. Yeah, you know, but at any rate, please, you know, with whoever's listening to this, have your kids screen for us, and I just make sure that they don't have it.
Unknown Speaker 1:34:43
Well, I appreciate you sharing that. And we've only got one more question for you, your doctor, you got your special needs, kid, you got your own business. And that can really be a struggle for marriages. You kinda before the show, my brother was especially he couldn't walk he was in a wheelchair and all that kind of stuff. So I've seen it. Luckily, my parents stayed married. So what is something that you're doing to keep the love alive? Keep your marriage strong?
Unknown Speaker 1:35:07
Good, great question. So we have just, we've really made that a priority. Because we've we've heard and known that, you know, these kind of scenarios can can just be incredibly taxing on even the strongest of marriages. So we have a weekly date, happy hour, we call it, we can't really go too late. Because of the situation here with nurse nursing change over we have 24, seven nursing for Greg is came out of the hospital with a ventilator. And so we have to kind of be back for certain things, but from basically four to six every Thursday, you know, we get some we get a nice date, and then on the weekend when they're down for a nap. So just taking that time, just the two of us is really important. And something that we make a priority. And then just open communication about it, we feel like something is is shifting in a way that we don't want to see it shift. And and just you know that being kind of just that that spoken rule of if something is wrong, if you're not feeling right about something, then it's even if it's uncomfortable to bring up, please, we have to bring it up. We have to keep talking. And just having that as as just that, you know, we're This is our safe place, you know, from what was that movie? Yeah, that we're in the same place? No, but like it just constantly be like, always, it's a safe thing to bring up concerns, because I know, we've always had that but not all relationships do. And if you're in a tough scenario, I'd say probably applicable to every every relationship, that if that is the way you operate, and you have that open line of communication, and you're really adamant about communicating if not just when things are going right. But when things are going wrong, then I think that that's going to that has been a key to us, you know, getting even stronger rather than you know this putting too much stress on us as a couple.
Justin Trosclair 1:37:06
It's a great answer. And what are the links that we can get more information about yourself and your businesses?
Unknown Speaker 1:37:12
Great, thank you my website where I teach practitioners how to become cash based practice owners. That's Dr. Jared Carter. com ton of information there just a ton if you're interested in that business model or even adding some cash based services and having a hybrid practice. You should be able to find your answers there. If you want more in depth training, there's also opportunities there for joining the mastermind or taking my my online course. And then yeah, if you wanted to follow the story of our beautiful twins as they get stronger and stronger that's team Carter twins calm. If you want to check out my clinics website, it's Carter PT, calm.
Justin Trosclair 1:37:51
Okay, that's what I really appreciate you spending this much time with us and share as much information as you can. I know the audience is going to get a lot of good value out of this. I really appreciate your time.
Unknown Speaker 1:38:00
Yeah, thank you so much for having me. I hope they do and and thank you again so much for for having me on and you know allowing me to have your podcast as a platform to pass on some what I feel are really important things.
Justin Trosclair 1:38:19
Another great interview has ended. As always say I hope you listened critically think and implement something so that your practice life family life can improve this week, one hit you up with a few links today, if you'd like to know the top episodes of 2018 and 2017, or you just go to.net slash top 1718. And you can get a PDF of all those episodes is like 22 of them. If you're interested on any of the programs that I've actually been interviewed on, just go to net slash as heard on supply on as, as you know, you know, so as heard on, if you didn't know, the needless acupuncture book sales page has been revamped. So it looks a lot better. You know, sometimes when you look at a web page, it doesn't look like it's put together with like, Man, I'm not sure about this thing. But it's been redone looks better. And also, if you have an Android device and you curious about it, you can actually download the same five protocols, blueprints, if you will, right there on your phone at the newest acupuncture app. And for less than $4 you can get the whole book on your phone from the Android Google Play Store. So here's the check that out, the electric acupuncture pin is still available at a great rate, you can get it on its own or as a package, seeing it the book, The E pin, as well as the regular points. Now, some of the things that I'm recommending blueberry hosting, that's who I use, I really like them a lot. I'm not gonna lie to you. Fiverr is where I get a lot of my music done my logos, I don't know if you noticed on Facebook, I believe my picture is now a face with a bunch of words and just saw that real quick, was cheap. Wanna try that for a while it's fine. Turtle pillow is a travel pillow it actually like an HP minute so you can rest your neck and your chin on that. So you don't get like the chicken Bob, where you you know, you sleep and you wake up really fast. And you know, those those U shaped ones, I just don't they work very well. So for me, it's worked really well. I've traveled about 10 different countries with it across the pond, as they say really highly recommend that if you're into instrument assisted soft tissue manipulation, two options, you got hot grip. So that's that's hot grips, and also net slash edge, you can get tools there as well. But they also have way more than just tools they've got how to get to use Google Apps as your EMR blood flow restriction cuffs, there's a lot of research on that device and you can check that episode from the past, you can get an automatic 10% discount on all the products from the edge mobility equipment. One of the devices I used to, to send out snippets of the podcast via picture and quotes from the text that I write on the show notes is missing letter, they just took all the last E and letter.com pretty much you know you can do a blast and two months and like five weeks or two months, I like to do nine emails over 12 months. So that person who was interviewed last month doesn't just get lost, right? You know, so every day I have a new episode at a highlight and a all automated really cool, definitely check it out. If you need to record your screen like screen cast o Matic also j lab audio speakers have said it before I love them. It's a great company and now I get to actually be an affiliate for them. So if you end up buying into their products, it's like anything I get a little piece probably have like three or four different products. I mean, they just the battery lasts longer sounds quality is amazing. And for the price that came live it have been. And of course the show notes. Anytime you see a book link by it, it comes to me and net slash t shirts will help us out. And lastly, again, something I don't talk about too much. But if you need coaching, whether it's via the today's choices, tomorrow's health need some help with taking those small steps and accountability so that you can actually lose the weight or start exercising more or get your budget in order just let me know I can up with that. Also, if you just need some minor marketing coaching or things like that, I can help you out with that as well go to net slash support. And of course on there you can also buy the course the cup of coffee are even more than that. There's different options available. So thanks for tuning in, and we'll see you next week or on the mini so
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giving you a doctor's
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