December 15, 2025 • 40 mins
Let's wrap the year with a look back on the challenges, developments, and momentum that the physical therapy profession encountered in 2025. Alliance Physical Therapy Partners CEO Richard Leaver talks with Team Rehab CEO Nick Weber, in this final episode of the year.
In this episode, you'll join the conversation about:
- Outpatient PT industry health and developments
- Optimization and technology adoption
- Outlook and priorities for 2026
To learn more about us, visit our website at https://www.allianceptp.com/
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Transcript
Episode Transcript
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SPEAKER_00 (00:02):
You're listening to the PT Leadership Podcast, where
outpatient physical therapyleaders come to share their
insights with your host, RichardLever.
SPEAKER_02 (00:18):
Welcome back to the PT Leadership Podcast series.
I am excited to welcome NickWeber to today's podcast, which
is looking back at 25 andlooking forward to 26.
Welcome, Nick.
Great to have you on the show.
SPEAKER_01 (00:34):
Richard, thanks for having me.
I'm uh very excited to be here.
This is this is my firstpodcast, so you know, go gentle.
SPEAKER_02 (00:43):
Absolutely.
Well, Nick, the reason I Iwanted to invite you to really
look at the year in review andlooking forward is because
you're uh an industry leader.
You you're the CEO of of TeamRehab.
And you know, I've always beenvery impressed with regards to
your perspective to tooutpatient therapy and really
(01:05):
the culture that you've builtwith your team.
So thank you so much foragreeing to be here today.
SPEAKER_01 (01:10):
Uh no, thank you, Richard.
I I I really appreciate that.
We're we're I'm very I'm veryproud team rehab member and you
know, part of that earlier wave.
And I I can't thank you enoughas being a a a young executive
running into you at the Ascendconference who you you followed
(01:30):
one of those awful hinge orsword perk people and got up
there and I wasn't sure what toexpect in the room because it's
my first time there, and you gotup there, and I was like, wow, I
I don't really like what thatlast person had to say.
And then you got up there andyou know basically slapped us
all to wake up and you know therest is history.
Here we are.
SPEAKER_02 (01:48):
Well, it's funny you say that because I've never
actually got feedback from thatsession, and I didn't get many
people come up to me and thankme.
So I I the fact that it wasperceived as a slap probably is
the reason enough why perhapspeople didn't rush up to me.
But anyway.
Moving on.
So 2025, outpatient PT justseems to be a crazy, crazy
(02:11):
world.
And 25, I think, is really nodifferent.
But I'd love to perhaps talkabout what you saw in 25 as
perhaps the main challenges, andthen some positives as well,
because it's easy to focus onthe negatives, isn't it?
I think as outpatienttherapists, we're continually
(02:32):
and leaders at that, we'recontinually focusing on what
isn't working well.
But but you know, along with themain themes and challenges,
certainly want to focus on somepositives.
So love your thoughts.
SPEAKER_01 (02:43):
Yeah, I I I think 2025 was from my lens, you know,
first of all, my lens is alwaysa little bit glass half full.
I'm always looking at the thebrighter side of things when as
much as I can.
And for me in 2025, I actuallykind of wind the clock back to
the end of 24 because I wentfrom being the chief operating
(03:04):
officer in September to the CEO.
And so my first 12 months was,you know, quite a whirlwind.
I I kept the CEO position andand leaned on my team really,
really heavily because I've gotsome great people and I had some
help on the back end as we kindof worked our way through.
And I think the way I look at2025 is for the industry and for
(03:27):
our company, it was a real greatyear.
And I'm I'm I'm super high onoutpatient PT.
I mean, I love it.
I love it.
It's it's I'm very biased to saythat it's the best part of PT.
But I think for 2025, we wefaced a lot of our challenges
head on.
And that they're no stranger,this is no no secret as to what
(03:48):
I'm gonna say.
The challenges were, you know,it's it's margin compression
from whatever side you want tolook at it and definitely
keeping up with hiring andtraining the best people at a
clip that meets the demand.
And I'm really happy with theway our team came together and
the recruiting seems to becoming in a much smoother
(04:09):
direction, you know, for ourmetrics.
You know, we we wound the yearso far, you know, net positive
in hiring.
We have more hours than we hadin 24 and 23.
So we're kind of getting overthat.
It's still competitive, it'sstill really, really hard to
find good people and enoughpeople.
So that's still our our numberone challenge is meeting that
(04:30):
demand.
But I really think the industryis starting to iron itself out
and we're seeing it go in in ina much, much more sustainable
direction in terms of howhiring's going.
But that that to me is kind ofthe the best thing we've we've
really started to overcome in2025.
SPEAKER_02 (04:48):
Yeah, I I feel I could be eating my own words in
12 months' time with thisstatement.
I I could I could certainly uhput myself in jeopardy, but I
feel as if the tide has turned alittle for 25.
You know, if I had to sum it upis the fact that you know we've
been battling, I think, reallyfor a few years, certainly since
(05:10):
COVID, if not before COVID, itwas certainly since COVID.
And and I feel as if we just gota little bit of relief in 25.
I don't know whether things arenecessarily improved.
I'm not sure if they've improvedor whether they just hadn't, if
they didn't continue to getworse.
I suppose a glass half full,glass half empty perspective
there.
But but I feel as if in somerespects we've got a little bit
(05:32):
of a reprieve.
I won't say that that the thethe tide has you know either
started to go out or come backin, but but I get feel we're on
the cusp really.
And my thoughts on that is froman advocacy perspective, I feel
as if we've strengthened ourvoice in 25 significantly from a
(05:54):
reimbursement perspective.
Whilst we've been you knowknocked sideways with a couple
of payers, overall I feel as ifpayers have are realizing that
that they're going to have toacquiesce to at least some sort
of increase for us overallbecause they've squeezed us for
so long.
And then really the the otherthing which you touched on was
(06:17):
the the kind of the therecruitment and I feel the great
resignation is over.
So whilst recruitment is stillextremely tough and will
continue to be tough, I feel atleast the retention component,
which is half of it, has perhapssettled somewhat.
What are your thoughts on thosecomponents?
SPEAKER_01 (06:38):
Yeah, it if we start with where you ended, I the the
recruitment and the retention itis certainly gotten a lot more
attention from our perspectivein terms of really trying to
make sure we're much moreintentional about how we
recruit, onboard, train,advance, and maintain the talent
(07:00):
that that we're able to get.
We we've definitely invested uha lot of time and energy in
trying to really make thatonboarding full of touch points,
you know, to make people feellike they're part of something
early on, whether it's, youknow, skills classes,
post-operative classes, internalclasses, where we're bringing
(07:22):
people who are brand new to thecompany together, whether
they're five, 10 years out ortwo, three months out to try to
give them their community, theirkind of sense of belonging, and
kind of get to know somebody.
And we've we've really tried tomake sure that there's structure
and and touch points throughoutthose first 90 days, 12 months,
where they have opportunities tospeak, you know, and know what
(07:43):
to expect, but also have theopportunity to speak up and out
about how that process is goingversus what it was perceived.
And then we can listen to thatand make that feedback.
That's been something that'sbeen very intentional.
And I think it's it's been apart, a part of our help.
You know, the the the other partthat goes into retention is, you
know, compensation, which comesfrom, you know, we only get paid
(08:06):
from one way.
We get paid by patients, whetherit's the the patient insurance,
it's the patient providing uswith cash or some other payer
that's tied to the insurance.
So making sure that we'redriving our value and and and
not devaluing our services atevery opportunity through
advocacy, through publicrelations, through education
(08:27):
with our patients, I thinkthat's been a really strong
point for us to not give away somany services and definitely
discuss the value of what we'reable to do with our patients,
which we've always done, but nowmore externally on an advocacy
at a local, state and nationallevel.
(08:48):
By doing that, I feel likethat's helped stabilize that
margin compression a little bit.
So instead of getting all of ourmoney from insurance, we are
getting and providing servicesthat are valuable and are paid
with cash in addition to thatmodel, not just being a
cash-based PT program, becausethat's completely different, but
in that insurance model, kind ofproviding value that's not paid
(09:10):
by insurance, I really think hasmade a big difference in in the
perception of our value, whichagain helps lead to that
retention.
SPEAKER_02 (09:19):
Yes.
What I think is for certainexternal stakeholders,
legislators and and payers,whilst we haven't necessarily
been particularly successfulwith regards to moving the
needle significantly as itpertains to reimbursement rates
(09:39):
or or you know offsettingMedicare cuts.
But what I think theconversation has done is at
least made them aware of valueand made them aware that we're
no longer as a profession goingto lie down and continue to take
(10:00):
cuts.
We're going, we've we've wecannot sustain the status quo.
And you know, we have, as yousay, margin compression to the
point where a lot of smallerentities are having to
fundamentally change how they'reoperating or literally shut the
doors.
So I I think they they arehearing us, which to me is half
(10:23):
the battle, whereas perhaps inprior years and up until this
point, I don't know that eventhe right people were in the
room and whether they even heardany messaging.
SPEAKER_01 (10:36):
Yeah, I I I agree.
I I I was recruited to kind ofshow up to kind of back up what
things that I wanted to seedone, and and I dove into
advocacy here in Michigan andand volunteer a little bit and
that and spending time with youand others on APTQI.
I've really understood what it'slike to fight at a national
(10:58):
level for for our value.
And I do feel we're we'regetting heard.
But and I think what's great iswe're taking our real fractioned
profession and starting to kindof piece it together through
formal alliances and you know,informal alliances.
We're, we're, we're reallystarting to strengthen our
voice.
And I do think it is starting tomake a difference on a national
(11:20):
stage.
And I think that the valueproposition that we're leading
with, and and we've franklyalready demonstrated, is going
to be hard to be ignored.
I mean, the the value of PTfirst or PT early or you know,
PT first for MSK, or orrealistically, whether we're
primary care MSK or primary caredown the road, that's where
(11:42):
we're starting to gain afoothold.
And there's some really excitingthings going on across the
country that is allowing us toget to that point.
And Richard, you and I havetalked about how we've provided
value in these, you know, totaljoint bundles and in in some of
these national value-based care.
The evidence is there, and it'sjust a matter of us kind of
(12:04):
continuing to show our value.
And I think if we don't get itby going directly to insurances,
we're definitely going to get itby going to the people who
either need the care or areproviding the benefits for the
patients who use their insuranceto come and see us for their
services.
Absolutely.
SPEAKER_02 (12:21):
What have you felt has been the difference?
And I think we've touched onsome of the themes, but love
your perspective and what youfeel perhaps the difference
between 2024 and 2025 was.
I don't think there'snecessarily any paradigm shifts,
but I definitely feel thatthey're I'm feeling very
(12:42):
different personally today as aCEO of an of the organization
than I was 12 months ago, forinstance.
And I'm sure I'm sure you'reprobably in a similar place to
that as well.
SPEAKER_01 (12:53):
I agree.
I I think your your idea aboutthe tide shifting and you know,
kind of wondering, is it comingin, going out, and and and that,
but it has shifted.
And I think for for us in 2024,we were still trying to get our
footing on all the things thatwere compressing margins.
And we had some doom and gloomfrom payers on the horizon that
(13:14):
we were trying to prepare for.
So we had a lot of preparing tomake the changes that we needed
to make in order to staycompetitive with our
compensation for our employeesand be resources in our
communities for access to asmany insurances as possible.
So it was a lot of preparing andposturing where in 25 we took a
(13:35):
lot of action.
We, you know, initiatives for,you know, cash pay services and
clinics for for us, forinstance, for cash pay clinics
and service was a big deal.
We've had an increase in somemusculosketal technology that
we're trialing for a company,which has been a lot of fun for
clinics to be a part of kind ofa cutting edge.
And then other things likereally buying in on the value
(13:58):
for some of the technologythat's out there in terms of our
AI for our describing, you know,technology for patient
experience and and even for thethe RTM.
We've been able to launch a lotof those.
I mean 25.
So, you know, we're taking thataction.
We're 24, we were kind ofprepping and and dealing with
25.
We were we're really able totake that action.
And I think that's that feelsfeels good because we're seeing
(14:23):
the movement going forward as aprofession and certainly within
our company.
SPEAKER_02 (14:27):
Yeah.
However painful I think the someof these changes have been or
these challenges have been, ithas been a catalyst, hasn't it,
for organizations to double downon change.
I know how there's constantchange in healthcare, but I feel
as if it's it's certainlyfocused us and and the companies
(14:50):
that are reasonably strong, Ithink, have done a good job over
the last 12 months with theimplementing changes to counter
those challenges that we've hadover the last few years.
And certainly see that when Ilook at USET and some of the
tactics and some of theinitiatives they've done.
(15:10):
And and to your point early,really changing perhaps or
enhancing how we have onboardedand managed employees.
So I I think the rubber kind ofhit the road in 25 with regards
to instead of being on our backfoot, we've actually managed to
get a little bit of traction toto offset some of those prior
(15:32):
challenges.
Yes.
SPEAKER_01 (15:33):
Yeah, and I I I think keeping to the key
principles of, you know, the atthe end of the day, this is this
is a people business.
We we we take care of people,they come to us, you know, at a
point where they're asking forhelp, which is hard.
They come to us when they're notwell, which that's not probably
(15:54):
the least likely fun timethey're having.
And and it's it's it's it's sucha rewarding profession.
So keeping that motivation andenergy up to be focused on the
patient while all the variablesaround what it takes to take
care of them and and take careof each other, the people on the
team who are doing that, uhkeeping that in focus um and and
(16:18):
watching the amazing talent ofhow these therapists and people
in behind the scenes kind ofbend over backwards and dodge
all these haymakers that comefrom payers or uh other
environments external to theclinic, it is is is nothing that
shouldn't be taken for granted.
And I think being able to adaptand you know keep your NPS
(16:43):
scores, keep your outcome scoresup through all that turmoil is
is quite a testament to theprofession.
And and I it's good to see thatbig companies who do publish
their data like USPH, they theythey're keeping their their
patients first.
And it's good that thisprofession through all this is
keeping its prof its patientsfirst, and we're just adapting a
(17:07):
lot quicker than we used to, anduh it's pretty impressive.
So maybe that's what it is,Richard.
Are we just adapting quicker,you know, from from 2020 to now?
Like we've gotten I don't wantto say used to the pace of
change, but maybe can keep up alittle better.
What do you think?
SPEAKER_02 (17:22):
I I think that's probably pretty accurate, to be
honest.
People on the whole, aren't theyreluctant to change?
But I I uh we've had to, we'vehad no choice, and and certainly
the speed at which we havechanged, uh I I don't know if
I'm just getting older, but Ifeel that every year the speed
of change seems to to increase.
(17:42):
And healthcare, I think with thechanges that have occurred at
the macro level, both economicand also political, there's just
they've just been buffeted.
And I think we've had to learnhow to protect ourselves very
quickly.
And those that have learnt thator learnt the lessons, I think
are in a much stronger positionfor it currently.
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SPEAKER_02 (18:55):
Moving on a little bit, the uh what what I've
experienced the last 12 monthsis that non-clinical staffing
has seemed to get significantlyeasier to retain and recruit for
compared to two, three yearsago.
But clinical staffing stillremains tough.
(19:16):
I I believe that the retentioncomponent is better, but ret uh
recruitment is is is stillextremely difficult.
Is that what you've experienced?
And also do you get any sensethat that might change in the
next 12 months?
SPEAKER_01 (19:34):
Yeah, the I I I still what I'm happy about 2025
for is you know, we wedefinitely improved our
retention and our overall, ouroverall retention to recruitment
uh overall has improved.
You know, we're we're still notretaining people like we did,
you know, pre-2020, but I Idon't think anybody is.
But uh it certainly was quite ashock to our system.
(19:56):
And I think that, you know, thehard-to-hire areas are still
gonna have always been and willalways be the hard-to-hire
areas.
Finding licenses in remote areasis difficult.
So, you know, attractingstudents, growing your own from
tech to PTA to PT, that's howyou how you can really be
(20:17):
intentional about filling staffvacancies, and they're
definitely more important thanever in these hard-to-hire
areas.
I do see the the landscapeshifting a little bit, and this
is in a direction I don't love.
I was, you know, we used to onlyreally recruit against people
with who wanted outpatient, wewere just recruiting against
other outpatient companies,right?
I I've definitely seen aresurgence in in people new
(20:40):
grads going to hospitals,long-term care and and home
care.
And I think a lot of that is thethe blessing of or the curse of
Medicare Advantage, you know,coming back to pay strongly for
those services as they continueto punish us on the outside and
in private practice.
But it's a subtle shift, but Imean, as far as I'm concerned,
(21:02):
that's, you know, those are notapples to apples.
So we have to really putourselves forward to show why
private practice and outpatientPT is is the best place for for
therapists because of the of thevariety and value you can bring.
So as far as the shift goes, Ithink we're gonna continue to
have challenges, but I thinkwe've got a much better beat on
(21:27):
how to be successful.
And I think that success isgonna continue, is gonna
continue as we move forward.
SPEAKER_02 (21:34):
That's great.
Obviously there's beenpersistent increases in
operating costs.
We talked just mentioned kind ofmargin erosion or trying to
prevent margin erosion.
Optimization has become muchmore important and a focus for
many organizations, includingours.
(21:56):
Has this been an area of focusfor team rehab and and you know,
on a very practical level, whenwe talk about optimization, what
types of things have youexplored or implemented to to
help with that?
SPEAKER_01 (22:09):
I I think the for for us, we underwent uh a very
purposeful transformationproject where we we knew we had
to deal with change quickly andwe needed to make sure
communication was heardthroughout, not just top to
bottom, but you know, front toback, side to side, and
bottom-up.
(22:30):
And we we went on a a journey ofmaking sure we had ways to
create communication touchpoints throughout the
organization.
Simple things that we werefocusing on each week, and we
had a feedback loop within theclinic and external to the
clinic to make sure everybodyunderstood.
So when we had to make a changeor an optimization, it was well
(22:52):
communicated, or I shouldn't saywell, I should say better
communicated than in the past.
And and I think that it alsogenerated a lot of good feedback
and ideas.
So it forced us to listen towhat was needed in the clinics.
And the number one thing thatwas needed was was help with
documentation.
Nobody likes writing notes,nobody has, nobody ever will.
You know, once you think you getit right, the payer tells you
(23:14):
you got it wrong.
So we describing technology weused through our EMR partner has
been an absolute game changerfor us.
That was our biggest focus isnot only getting it rolled out,
but getting it optimized sothat, you know, not just our
laggards were were getting helpto get that giant monkey off
their back, but that people whowere doing it well just got more
(23:37):
efficient so they could justhave more time with patients
and, you know, less time outsideof work worrying about notes.
So that was that was the biggestand best thing we've done.
The other thing we heard is, youknow, in in response to finding
really, really good non-clinicalhelp, you know, those those we
call them patient accesscoordinates, those people who
work the front desk and are thefirst voice and face that people
(24:00):
see.
We want those people to befocused on that stuff, not all
these reports, notauto-generating offs and
referrals.
So we really work to pullanything non-patient facing,
either automated or assisted inany way we could, so we could
just keep them dialed in withwhat they're doing.
And that's what these peoplewant to do.
They want to interact.
So we want to increase as muchof that as we can.
(24:22):
So those are our two bigintentional pieces at the
clinic.
And in centrally, we work toleverage technology as much as
possible, even from, you know,we went from using Google, our
Google Suite, you know, justmaybe five, 10% to maybe we're
up to using 20, 25% of itscapabilities, but it has been
(24:43):
outstanding what it's been ableto do for us.
And the same thing with lookingat all of our central functions
to try and get them a little bittrimmer.
And we we've we've had greatreturn from our central team
looking at the way they do theirwork, using that transformation
communication process to give usideas on how to make the process
better and and where we can, wewe make them and it it has kind
(25:05):
of cushioned that burden alittle bit.
But it's those compression thatcompression is real for margins,
for sure.
SPEAKER_02 (25:12):
Yes, I I find that we've like yourself, we've
implemented some technologysolutions, and I think this is
just really the start.
I I feel that we haven'tnecessarily seen a significant
return on it yet from a from afinancial perspective.
(25:34):
I definitely seen, I think,improvements related to reducing
error rates, you know,satisfaction perhaps.
But I I have a feeling then thenext year or two as we go
further in down the road oftechnological enhancements or
applying it to both the clinicaland non-clinical, that I think
(25:55):
we will see some true financialoptimization associated with it
as well.
SPEAKER_01 (26:01):
Yeah, and I think the the other part to this is by
having more touch pointsthroughout the organization, it
it the I don't want to sayforced interactions, but the it
making sure people were havingnot just interactions, but the
right interactions with theright few key points was
important.
What it also identified was youknow, we needed to have more
(26:24):
training for our leadershipteam, you know, but at all
levels in in the clinic and andcertainly centrally.
So recognizing that gap andbeginning that with
realistically, it's only reallybegun in this last you know few
months, but setting up moreformal training for people who
(26:44):
don't necessarily want to beclinic directors, but still want
to be leaders in the clinic, youknow, really firming up those
clinical pathways for success,really important.
But also like training newmanagers on the RCM or on the
finance side, how to bemanagers, that's also been
valuable because it it we needto grow our own leaders and and
we want to make sure peoplereally have the tools they need
(27:07):
to succeed and and and grow withour company, which is important
to us.
SPEAKER_02 (27:13):
Moving on a little bit, when we when we look at
growth, and I think the wholeconversation around growth has
to be framed.
So as a as a clinician, when youtalk to a clinician about
growth, they they just perceiveit as a as an entity wanting to
(27:33):
fill their pot of money in thecorner of a room or but you know
it's furthest from the truth,isn't it?
You know, it's it's definitely,I believe, the the saying grow
or die, it sounds a littleextreme, but but certainly in
healthcare, if you're notgrowing, then you you aren't
necessarily getting economies ofscale, and you're not able to
continue to provide for the theteam members that you have at
(27:56):
the with the resources, support,and compensation we need to.
So I think it's an imperative togrow.
But how organizations grow, Ithink, varies tremendously for
various factors.
And each year, I think the theprimary method of growth or can
(28:19):
can vary.
So for instance, you know, wehave same-store growth, we have
new clo building new clinics,and then we have new
partnerships.
And whilst I appreciate thisperhaps isn't as applicable for
the for the single clinic owner,but I think for organizations
generally, it's how do you grow?
(28:39):
And what's your thought as itpertains to kind of 2026 with
regards to how how shouldorganizations be looking at
growth?
What what perhaps are the youknow the methods or the the
levers of growth going forwards?
SPEAKER_01 (28:57):
I I think uh you're spot on about the the average
therapist or the averageemployee looking at growth as
maybe not the most positivething.
And I I think establishing thewhy behind the growth for
everybody so that theyunderstand that, you know, if we
can grow, this is what you knowprovides compensation, you know,
(29:18):
to help us attract the bestpeople.
And, you know, as we grow,there's more opportunity for you
to grow and more opportunitiesfor upward mobility, you know,
within or obviously without theorganization, but establishing
that why is super importantearly on.
And and for us, our our methodof growth is tied strongly to
(29:42):
each of our clinics currently at136 have ownership at that local
level.
And we're looking for people whowant to own and you know, create
a patient environment that is isreally positive.
So we want to develop thattalent.
Internally, and then give thosepeople the opportunity to have
(30:03):
ownership.
You know, every once in a whilewe'll get a current clinic
director to grumble, oh, why arewe adding all these clinics?
And like, hey, you remember whenwe gave you a clinic?
You know, you were in the clinicand you went through training
and you went, you expressed likeyou wanted a clinic.
This is to give you the next youthe next opportunity.
And, you know, don't we wantthat for everybody?
(30:24):
And you know, having thoseconversations and really
establishing the why isimportant.
So for us, it's de novo growthwhen we are looking to invest in
people, you know, the people whoare great therapists, who have a
passion for the profession andare just hungry for, you know,
autonomy and entrepreneurship.
And then for us, it is aboutsame-store growth.
(30:45):
You know, we we keep our focusnarrow.
And I think same-store growth isimportant because within your
population and within your fourwalls, there's all kinds of
great things you can add.
Like we we talked about earlier,you know, cash pay, RTM, other
services like that.
So even same-store growth canadd referral sources, niches is
(31:07):
something we're we're hopefulthat we can get spread across
because there's such a demandfor pelvic care, pelvic flow
care, vertigo, concussion, allof those things.
And we want to make sure weprovide those opportunities for
therapists who want to takethem.
So same-store growth and de novois, you know, where we put our
growth growth mode into.
SPEAKER_00 (31:32):
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SPEAKER_02 (32:02):
You know, the reason I went into therapy was to help
people, and the more people Ican help, the better.
But I feel that certainly in 25,there's uh we've experienced
some challenges to same storegrowth.
And that's not because of demandfor services, it's because of of
(32:24):
staffing the clinics to be ableto allow for that growth and be
able to help more people, whichis really quite a change to 10
years ago, where when we werelooking at same-store growth, we
were really looking at how do weincrease referrals.
Whereas now when we look atsame-store growth, I think the
(32:45):
primary challenge is how do westaff to allow it to occur.
So definitely a shift there.
Have you I well, based off ourconversation, I would imagine
that you have experienced somechallenges with regards to same
store, certainly in thoselocations that have had
(33:06):
challenges associated withrecruitment, yes?
SPEAKER_01 (33:09):
Yeah, I I think you know, planning for growth is
great.
And just like any great plan,it's great until you get punched
in the mouth, right?
And, you know, having therapisthours to treat the patients and
take care of those people andthe communities you serve is is
job one.
And, you know, there's gonna bestaff changes, you know, heaven
(33:32):
forbid there's all kinds ofmedical issues that pop up.
I mean, we you know, it's nosurprise that you can lose hours
for all kinds of reasons.
So growth and profitability areare so tied to having people,
the patients, and then thepeople to take care of the
patients.
So we've definitely run intohard to hire areas where we can
(33:53):
see, you know, visits justplummet for no other reason
other than there just isn'tenough hours in the clinic.
And you know, that at that time,that focus, as much as it has to
be, is to taking care ofpatients.
You can't take your eye off theball about taking care of your
current staff, but making surethat you're you're focused on
them and their needs to makesure that they can deliver the
(34:15):
care that's best, and then focuson making sure you leverage all
the tools that you have at yourdisposal to get those bodies.
And then once you get thosebodies in, you know, do a good
job of of keeping them.
And that's the best you can do.
But you're right, that that hasdefinitely been more of a
curveball for how we forecast.
You know, you can't can'tforecast for 50 weeks of a
(34:37):
therapist anymore.
You certainly, you know, 48maybe even is is as brave as you
can go, but it it doesdefinitely cause a nonlinear
growth model for sure.
Yes.
SPEAKER_02 (34:48):
Turning towards 26, I'm actually quite bullish, and
I'm definitely the glass halfempty guy in the room.
I I feel that we will continueto build on the conversations
and the the wins of 25personally.
Do you feel bullish on 26 andwhat do you perhaps see on the
(35:13):
horizon?
SPEAKER_01 (35:15):
Quite bullish on 26.
I think with all the theplanning and thinking we did in
24 and the implementing we'redoing in 25, those lessons that
we thought hard about andimplemented in 25 are looking
really good for 26.
And as a reflection of that,externally on the profession, I
(35:36):
I I see nothing but the demandcontinue.
I think that all these, pardonmy language, pretenders in the
space are are trying to fill ina void that we can't right now.
And the more that we astherapists find ways to fill
that void, it's going tocontinue to lead to furthering
(35:59):
of the profession and respectfor the value that that we
provide to the entire healthcaresystem.
So I'm very bullish on uscontinuing to kind of carve or
force ourselves into the primarycare MSK space for sure, but
certainly the primary, you know,first stop for any MSK injury in
(36:22):
any way, shape, or form.
I think we're going to continueto gain momentum in that space.
I think it's a way we will beable to get around having to
deal with insurance, not payingus more.
And I really think that's ourpassion for the future.
And I think it'll start to matchwhat therapists want to do,
(36:43):
which is focus on taking care ofpatients, not just when they're
hurt, but before they're hurt.
So I'm I'm very bullish on theprofession moving in that
direction.
And that'll also facilitate us,you know, being able to be less
dependent on the wins andfeelings of payers.
SPEAKER_02 (37:01):
I always finish up asking if there's any other
words of wisdom.
And I'm sure that you haveplenty of wisdom, but anything
else to share perhaps with theaudience as we wrap this up?
SPEAKER_01 (37:13):
Well, certainly not as much wisdom as you, Richard.
And I again, I really, really doappreciate the relationship
we've had and how open you'vebeen to not just answering
questions, but being open to,you know, ask me for questions
too, because the, you know, thebest way you learn is you, it's
it's a two-way street and youyou get to learn from not just
the person you're seeking theknowledge from, but them seeking
(37:35):
some knowledge and clarity fromyou.
And I do appreciate that.
And you know, as far as you knowmy wisdom, I I think I I I like
you, I I got into thisprofession to help people, and I
really haven't taken my eye offthat ball ever.
You know, I was definitely thetherapist who squeezed everybody
(37:56):
in and, you know, worked aroundthem and and and did all that
because I loved it and I stilllove it.
And when I owned a clinic, Iwanted to make sure I hired
people who felt the same way,people who could complement my
skills.
So if it was something Icouldn't treat, you know, I
could give it to them.
That way we could we couldcontinually take care of more
people.
And with each of my roles, Ifeel like I'm still taking care
(38:20):
of people, and I just get to doit at a much bigger scale.
So I I think the the best thinghere that I want to make sure we
all do is just stick tofundamentals.
Like we have a super rewardingprofession.
It is such a uh a great field tobe in, and we get to help so
many people, and we get suchinstant gratification out of
(38:41):
what we do, and it's it'sexhausting and you need to take
care of yourself.
But I I love this profession.
I think we do great things, andI think we're we're poised to
take uh uh bigger steps toasserting our value and getting
getting more of the respect thatwe deserve that's been absent
from anybody other thanpatience, per se, you know,
(39:03):
coming up in 2026.
So I'm I'm very bullish and nosurprise, glass half full for
our profession going forward.
SPEAKER_02 (39:11):
Uh thank you so much, Nick, for providing your
perspective and thoughts for the25 and and going into 26.
Thank you for your leadershipand also your advocacy for the
profession generally.
It's quite inspiring.
So I wish you well over the next12 months, and perhaps in 12
months' time we sit down andhave a beer and work out what
(39:33):
actually happened compared towhat we think will happen.
So thank you.
SPEAKER_01 (39:37):
Thank you, Richard.
SPEAKER_00 (39:42):
This has been another episode of the PT
Leadership Podcast, brought toyou by Alliance Physical Therapy
Partners.
Learn more about our team andfind more episodes online at
allianceptp.com slash podcast.
You're listening to the PT Leadership Podcast, where
outpatient physical therapyleaders come to share their
insights with your host, RichardLever.
SPEAKER_02 (00:18):
Welcome back to the PT Leadership Podcast series.
I am excited to welcome NickWeber to today's podcast, which
is looking back at 25 andlooking forward to 26.
Welcome, Nick.
Great to have you on the show.
SPEAKER_01 (00:34):
Richard, thanks for having me.
I'm uh very excited to be here.
This is this is my firstpodcast, so you know, go gentle.
SPEAKER_02 (00:43):
Absolutely.
Well, Nick, the reason I Iwanted to invite you to really
look at the year in review andlooking forward is because
you're uh an industry leader.
You you're the CEO of of TeamRehab.
And you know, I've always beenvery impressed with regards to
your perspective to tooutpatient therapy and really
(01:05):
the culture that you've builtwith your team.
So thank you so much foragreeing to be here today.
SPEAKER_01 (01:10):
Uh no, thank you, Richard.
I I I really appreciate that.
We're we're I'm very I'm veryproud team rehab member and you
know, part of that earlier wave.
And I I can't thank you enoughas being a a a young executive
running into you at the Ascendconference who you you followed
(01:30):
one of those awful hinge orsword perk people and got up
there and I wasn't sure what toexpect in the room because it's
my first time there, and you gotup there, and I was like, wow, I
I don't really like what thatlast person had to say.
And then you got up there andyou know basically slapped us
all to wake up and you know therest is history.
Here we are.
SPEAKER_02 (01:48):
Well, it's funny you say that because I've never
actually got feedback from thatsession, and I didn't get many
people come up to me and thankme.
So I I the fact that it wasperceived as a slap probably is
the reason enough why perhapspeople didn't rush up to me.
But anyway.
Moving on.
So 2025, outpatient PT justseems to be a crazy, crazy
(02:11):
world.
And 25, I think, is really nodifferent.
But I'd love to perhaps talkabout what you saw in 25 as
perhaps the main challenges, andthen some positives as well,
because it's easy to focus onthe negatives, isn't it?
I think as outpatienttherapists, we're continually
(02:32):
and leaders at that, we'recontinually focusing on what
isn't working well.
But but you know, along with themain themes and challenges,
certainly want to focus on somepositives.
So love your thoughts.
SPEAKER_01 (02:43):
Yeah, I I I think 2025 was from my lens, you know,
first of all, my lens is alwaysa little bit glass half full.
I'm always looking at the thebrighter side of things when as
much as I can.
And for me in 2025, I actuallykind of wind the clock back to
the end of 24 because I wentfrom being the chief operating
(03:04):
officer in September to the CEO.
And so my first 12 months was,you know, quite a whirlwind.
I I kept the CEO position andand leaned on my team really,
really heavily because I've gotsome great people and I had some
help on the back end as we kindof worked our way through.
And I think the way I look at2025 is for the industry and for
(03:27):
our company, it was a real greatyear.
And I'm I'm I'm super high onoutpatient PT.
I mean, I love it.
I love it.
It's it's I'm very biased to saythat it's the best part of PT.
But I think for 2025, we wefaced a lot of our challenges
head on.
And that they're no stranger,this is no no secret as to what
(03:48):
I'm gonna say.
The challenges were, you know,it's it's margin compression
from whatever side you want tolook at it and definitely
keeping up with hiring andtraining the best people at a
clip that meets the demand.
And I'm really happy with theway our team came together and
the recruiting seems to becoming in a much smoother
(04:09):
direction, you know, for ourmetrics.
You know, we we wound the yearso far, you know, net positive
in hiring.
We have more hours than we hadin 24 and 23.
So we're kind of getting overthat.
It's still competitive, it'sstill really, really hard to
find good people and enoughpeople.
So that's still our our numberone challenge is meeting that
(04:30):
demand.
But I really think the industryis starting to iron itself out
and we're seeing it go in in ina much, much more sustainable
direction in terms of howhiring's going.
But that that to me is kind ofthe the best thing we've we've
really started to overcome in2025.
SPEAKER_02 (04:48):
Yeah, I I feel I could be eating my own words in
12 months' time with thisstatement.
I I could I could certainly uhput myself in jeopardy, but I
feel as if the tide has turned alittle for 25.
You know, if I had to sum it upis the fact that you know we've
been battling, I think, reallyfor a few years, certainly since
(05:10):
COVID, if not before COVID, itwas certainly since COVID.
And and I feel as if we just gota little bit of relief in 25.
I don't know whether things arenecessarily improved.
I'm not sure if they've improvedor whether they just hadn't, if
they didn't continue to getworse.
I suppose a glass half full,glass half empty perspective
there.
But but I feel as if in somerespects we've got a little bit
(05:32):
of a reprieve.
I won't say that that the thethe tide has you know either
started to go out or come backin, but but I get feel we're on
the cusp really.
And my thoughts on that is froman advocacy perspective, I feel
as if we've strengthened ourvoice in 25 significantly from a
(05:54):
reimbursement perspective.
Whilst we've been you knowknocked sideways with a couple
of payers, overall I feel as ifpayers have are realizing that
that they're going to have toacquiesce to at least some sort
of increase for us overallbecause they've squeezed us for
so long.
And then really the the otherthing which you touched on was
(06:17):
the the kind of the therecruitment and I feel the great
resignation is over.
So whilst recruitment is stillextremely tough and will
continue to be tough, I feel atleast the retention component,
which is half of it, has perhapssettled somewhat.
What are your thoughts on thosecomponents?
SPEAKER_01 (06:38):
Yeah, it if we start with where you ended, I the the
recruitment and the retention itis certainly gotten a lot more
attention from our perspectivein terms of really trying to
make sure we're much moreintentional about how we
recruit, onboard, train,advance, and maintain the talent
(07:00):
that that we're able to get.
We we've definitely invested uha lot of time and energy in
trying to really make thatonboarding full of touch points,
you know, to make people feellike they're part of something
early on, whether it's, youknow, skills classes,
post-operative classes, internalclasses, where we're bringing
(07:22):
people who are brand new to thecompany together, whether
they're five, 10 years out ortwo, three months out to try to
give them their community, theirkind of sense of belonging, and
kind of get to know somebody.
And we've we've really tried tomake sure that there's structure
and and touch points throughoutthose first 90 days, 12 months,
where they have opportunities tospeak, you know, and know what
(07:43):
to expect, but also have theopportunity to speak up and out
about how that process is goingversus what it was perceived.
And then we can listen to thatand make that feedback.
That's been something that'sbeen very intentional.
And I think it's it's been apart, a part of our help.
You know, the the the other partthat goes into retention is, you
know, compensation, which comesfrom, you know, we only get paid
(08:06):
from one way.
We get paid by patients, whetherit's the the patient insurance,
it's the patient providing uswith cash or some other payer
that's tied to the insurance.
So making sure that we'redriving our value and and and
not devaluing our services atevery opportunity through
advocacy, through publicrelations, through education
(08:27):
with our patients, I thinkthat's been a really strong
point for us to not give away somany services and definitely
discuss the value of what we'reable to do with our patients,
which we've always done, but nowmore externally on an advocacy
at a local, state and nationallevel.
(08:48):
By doing that, I feel likethat's helped stabilize that
margin compression a little bit.
So instead of getting all of ourmoney from insurance, we are
getting and providing servicesthat are valuable and are paid
with cash in addition to thatmodel, not just being a
cash-based PT program, becausethat's completely different, but
in that insurance model, kind ofproviding value that's not paid
(09:10):
by insurance, I really think hasmade a big difference in in the
perception of our value, whichagain helps lead to that
retention.
SPEAKER_02 (09:19):
Yes.
What I think is for certainexternal stakeholders,
legislators and and payers,whilst we haven't necessarily
been particularly successfulwith regards to moving the
needle significantly as itpertains to reimbursement rates
(09:39):
or or you know offsettingMedicare cuts.
But what I think theconversation has done is at
least made them aware of valueand made them aware that we're
no longer as a profession goingto lie down and continue to take
(10:00):
cuts.
We're going, we've we've wecannot sustain the status quo.
And you know, we have, as yousay, margin compression to the
point where a lot of smallerentities are having to
fundamentally change how they'reoperating or literally shut the
doors.
So I I think they they arehearing us, which to me is half
(10:23):
the battle, whereas perhaps inprior years and up until this
point, I don't know that eventhe right people were in the
room and whether they even heardany messaging.
SPEAKER_01 (10:36):
Yeah, I I I agree.
I I I was recruited to kind ofshow up to kind of back up what
things that I wanted to seedone, and and I dove into
advocacy here in Michigan andand volunteer a little bit and
that and spending time with youand others on APTQI.
I've really understood what it'slike to fight at a national
(10:58):
level for for our value.
And I do feel we're we'regetting heard.
But and I think what's great iswe're taking our real fractioned
profession and starting to kindof piece it together through
formal alliances and you know,informal alliances.
We're, we're, we're reallystarting to strengthen our
voice.
And I do think it is starting tomake a difference on a national
(11:20):
stage.
And I think that the valueproposition that we're leading
with, and and we've franklyalready demonstrated, is going
to be hard to be ignored.
I mean, the the value of PTfirst or PT early or you know,
PT first for MSK, or orrealistically, whether we're
primary care MSK or primary caredown the road, that's where
(11:42):
we're starting to gain afoothold.
And there's some really excitingthings going on across the
country that is allowing us toget to that point.
And Richard, you and I havetalked about how we've provided
value in these, you know, totaljoint bundles and in in some of
these national value-based care.
The evidence is there, and it'sjust a matter of us kind of
(12:04):
continuing to show our value.
And I think if we don't get itby going directly to insurances,
we're definitely going to get itby going to the people who
either need the care or areproviding the benefits for the
patients who use their insuranceto come and see us for their
services.
Absolutely.
SPEAKER_02 (12:21):
What have you felt has been the difference?
And I think we've touched onsome of the themes, but love
your perspective and what youfeel perhaps the difference
between 2024 and 2025 was.
I don't think there'snecessarily any paradigm shifts,
but I definitely feel thatthey're I'm feeling very
(12:42):
different personally today as aCEO of an of the organization
than I was 12 months ago, forinstance.
And I'm sure I'm sure you'reprobably in a similar place to
that as well.
SPEAKER_01 (12:53):
I agree.
I I think your your idea aboutthe tide shifting and you know,
kind of wondering, is it comingin, going out, and and and that,
but it has shifted.
And I think for for us in 2024,we were still trying to get our
footing on all the things thatwere compressing margins.
And we had some doom and gloomfrom payers on the horizon that
(13:14):
we were trying to prepare for.
So we had a lot of preparing tomake the changes that we needed
to make in order to staycompetitive with our
compensation for our employeesand be resources in our
communities for access to asmany insurances as possible.
So it was a lot of preparing andposturing where in 25 we took a
(13:35):
lot of action.
We, you know, initiatives for,you know, cash pay services and
clinics for for us, forinstance, for cash pay clinics
and service was a big deal.
We've had an increase in somemusculosketal technology that
we're trialing for a company,which has been a lot of fun for
clinics to be a part of kind ofa cutting edge.
And then other things likereally buying in on the value
(13:58):
for some of the technologythat's out there in terms of our
AI for our describing, you know,technology for patient
experience and and even for thethe RTM.
We've been able to launch a lotof those.
I mean 25.
So, you know, we're taking thataction.
We're 24, we were kind ofprepping and and dealing with
25.
We were we're really able totake that action.
And I think that's that feelsfeels good because we're seeing
(14:23):
the movement going forward as aprofession and certainly within
our company.
SPEAKER_02 (14:27):
Yeah.
However painful I think the someof these changes have been or
these challenges have been, ithas been a catalyst, hasn't it,
for organizations to double downon change.
I know how there's constantchange in healthcare, but I feel
as if it's it's certainlyfocused us and and the companies
(14:50):
that are reasonably strong, Ithink, have done a good job over
the last 12 months with theimplementing changes to counter
those challenges that we've hadover the last few years.
And certainly see that when Ilook at USET and some of the
tactics and some of theinitiatives they've done.
(15:10):
And and to your point early,really changing perhaps or
enhancing how we have onboardedand managed employees.
So I I think the rubber kind ofhit the road in 25 with regards
to instead of being on our backfoot, we've actually managed to
get a little bit of traction toto offset some of those prior
(15:32):
challenges.
Yes.
SPEAKER_01 (15:33):
Yeah, and I I I think keeping to the key
principles of, you know, the atthe end of the day, this is this
is a people business.
We we we take care of people,they come to us, you know, at a
point where they're asking forhelp, which is hard.
They come to us when they're notwell, which that's not probably
(15:54):
the least likely fun timethey're having.
And and it's it's it's it's sucha rewarding profession.
So keeping that motivation andenergy up to be focused on the
patient while all the variablesaround what it takes to take
care of them and and take careof each other, the people on the
team who are doing that, uhkeeping that in focus um and and
(16:18):
watching the amazing talent ofhow these therapists and people
in behind the scenes kind ofbend over backwards and dodge
all these haymakers that comefrom payers or uh other
environments external to theclinic, it is is is nothing that
shouldn't be taken for granted.
And I think being able to adaptand you know keep your NPS
(16:43):
scores, keep your outcome scoresup through all that turmoil is
is quite a testament to theprofession.
And and I it's good to see thatbig companies who do publish
their data like USPH, they theythey're keeping their their
patients first.
And it's good that thisprofession through all this is
keeping its prof its patientsfirst, and we're just adapting a
(17:07):
lot quicker than we used to, anduh it's pretty impressive.
So maybe that's what it is,Richard.
Are we just adapting quicker,you know, from from 2020 to now?
Like we've gotten I don't wantto say used to the pace of
change, but maybe can keep up alittle better.
What do you think?
SPEAKER_02 (17:22):
I I think that's probably pretty accurate, to be
honest.
People on the whole, aren't theyreluctant to change?
But I I uh we've had to, we'vehad no choice, and and certainly
the speed at which we havechanged, uh I I don't know if
I'm just getting older, but Ifeel that every year the speed
of change seems to to increase.
(17:42):
And healthcare, I think with thechanges that have occurred at
the macro level, both economicand also political, there's just
they've just been buffeted.
And I think we've had to learnhow to protect ourselves very
quickly.
And those that have learnt thator learnt the lessons, I think
are in a much stronger positionfor it currently.
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(18:31):
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SPEAKER_02 (18:55):
Moving on a little bit, the uh what what I've
experienced the last 12 monthsis that non-clinical staffing
has seemed to get significantlyeasier to retain and recruit for
compared to two, three yearsago.
But clinical staffing stillremains tough.
(19:16):
I I believe that the retentioncomponent is better, but ret uh
recruitment is is is stillextremely difficult.
Is that what you've experienced?
And also do you get any sensethat that might change in the
next 12 months?
SPEAKER_01 (19:34):
Yeah, the I I I still what I'm happy about 2025
for is you know, we wedefinitely improved our
retention and our overall, ouroverall retention to recruitment
uh overall has improved.
You know, we're we're still notretaining people like we did,
you know, pre-2020, but I Idon't think anybody is.
But uh it certainly was quite ashock to our system.
(19:56):
And I think that, you know, thehard-to-hire areas are still
gonna have always been and willalways be the hard-to-hire
areas.
Finding licenses in remote areasis difficult.
So, you know, attractingstudents, growing your own from
tech to PTA to PT, that's howyou how you can really be
(20:17):
intentional about filling staffvacancies, and they're
definitely more important thanever in these hard-to-hire
areas.
I do see the the landscapeshifting a little bit, and this
is in a direction I don't love.
I was, you know, we used to onlyreally recruit against people
with who wanted outpatient, wewere just recruiting against
other outpatient companies,right?
I I've definitely seen aresurgence in in people new
(20:40):
grads going to hospitals,long-term care and and home
care.
And I think a lot of that is thethe blessing of or the curse of
Medicare Advantage, you know,coming back to pay strongly for
those services as they continueto punish us on the outside and
in private practice.
But it's a subtle shift, but Imean, as far as I'm concerned,
(21:02):
that's, you know, those are notapples to apples.
So we have to really putourselves forward to show why
private practice and outpatientPT is is the best place for for
therapists because of the of thevariety and value you can bring.
So as far as the shift goes, Ithink we're gonna continue to
have challenges, but I thinkwe've got a much better beat on
(21:27):
how to be successful.
And I think that success isgonna continue, is gonna
continue as we move forward.
SPEAKER_02 (21:34):
That's great.
Obviously there's beenpersistent increases in
operating costs.
We talked just mentioned kind ofmargin erosion or trying to
prevent margin erosion.
Optimization has become muchmore important and a focus for
many organizations, includingours.
(21:56):
Has this been an area of focusfor team rehab and and you know,
on a very practical level, whenwe talk about optimization, what
types of things have youexplored or implemented to to
help with that?
SPEAKER_01 (22:09):
I I think the for for us, we underwent uh a very
purposeful transformationproject where we we knew we had
to deal with change quickly andwe needed to make sure
communication was heardthroughout, not just top to
bottom, but you know, front toback, side to side, and
bottom-up.
(22:30):
And we we went on a a journey ofmaking sure we had ways to
create communication touchpoints throughout the
organization.
Simple things that we werefocusing on each week, and we
had a feedback loop within theclinic and external to the
clinic to make sure everybodyunderstood.
So when we had to make a changeor an optimization, it was well
(22:52):
communicated, or I shouldn't saywell, I should say better
communicated than in the past.
And and I think that it alsogenerated a lot of good feedback
and ideas.
So it forced us to listen towhat was needed in the clinics.
And the number one thing thatwas needed was was help with
documentation.
Nobody likes writing notes,nobody has, nobody ever will.
You know, once you think you getit right, the payer tells you
(23:14):
you got it wrong.
So we describing technology weused through our EMR partner has
been an absolute game changerfor us.
That was our biggest focus isnot only getting it rolled out,
but getting it optimized sothat, you know, not just our
laggards were were getting helpto get that giant monkey off
their back, but that people whowere doing it well just got more
(23:37):
efficient so they could justhave more time with patients
and, you know, less time outsideof work worrying about notes.
So that was that was the biggestand best thing we've done.
The other thing we heard is, youknow, in in response to finding
really, really good non-clinicalhelp, you know, those those we
call them patient accesscoordinates, those people who
work the front desk and are thefirst voice and face that people
(24:00):
see.
We want those people to befocused on that stuff, not all
these reports, notauto-generating offs and
referrals.
So we really work to pullanything non-patient facing,
either automated or assisted inany way we could, so we could
just keep them dialed in withwhat they're doing.
And that's what these peoplewant to do.
They want to interact.
So we want to increase as muchof that as we can.
(24:22):
So those are our two bigintentional pieces at the
clinic.
And in centrally, we work toleverage technology as much as
possible, even from, you know,we went from using Google, our
Google Suite, you know, justmaybe five, 10% to maybe we're
up to using 20, 25% of itscapabilities, but it has been
(24:43):
outstanding what it's been ableto do for us.
And the same thing with lookingat all of our central functions
to try and get them a little bittrimmer.
And we we've we've had greatreturn from our central team
looking at the way they do theirwork, using that transformation
communication process to give usideas on how to make the process
better and and where we can, wewe make them and it it has kind
(25:05):
of cushioned that burden alittle bit.
But it's those compression thatcompression is real for margins,
for sure.
SPEAKER_02 (25:12):
Yes, I I find that we've like yourself, we've
implemented some technologysolutions, and I think this is
just really the start.
I I feel that we haven'tnecessarily seen a significant
return on it yet from a from afinancial perspective.
(25:34):
I definitely seen, I think,improvements related to reducing
error rates, you know,satisfaction perhaps.
But I I have a feeling then thenext year or two as we go
further in down the road oftechnological enhancements or
applying it to both the clinicaland non-clinical, that I think
(25:55):
we will see some true financialoptimization associated with it
as well.
SPEAKER_01 (26:01):
Yeah, and I think the the other part to this is by
having more touch pointsthroughout the organization, it
it the I don't want to sayforced interactions, but the it
making sure people were havingnot just interactions, but the
right interactions with theright few key points was
important.
What it also identified was youknow, we needed to have more
(26:24):
training for our leadershipteam, you know, but at all
levels in in the clinic and andcertainly centrally.
So recognizing that gap andbeginning that with
realistically, it's only reallybegun in this last you know few
months, but setting up moreformal training for people who
(26:44):
don't necessarily want to beclinic directors, but still want
to be leaders in the clinic, youknow, really firming up those
clinical pathways for success,really important.
But also like training newmanagers on the RCM or on the
finance side, how to bemanagers, that's also been
valuable because it it we needto grow our own leaders and and
we want to make sure peoplereally have the tools they need
(27:07):
to succeed and and and grow withour company, which is important
to us.
SPEAKER_02 (27:13):
Moving on a little bit, when we when we look at
growth, and I think the wholeconversation around growth has
to be framed.
So as a as a clinician, when youtalk to a clinician about
growth, they they just perceiveit as a as an entity wanting to
(27:33):
fill their pot of money in thecorner of a room or but you know
it's furthest from the truth,isn't it?
You know, it's it's definitely,I believe, the the saying grow
or die, it sounds a littleextreme, but but certainly in
healthcare, if you're notgrowing, then you you aren't
necessarily getting economies ofscale, and you're not able to
continue to provide for the theteam members that you have at
(27:56):
the with the resources, support,and compensation we need to.
So I think it's an imperative togrow.
But how organizations grow, Ithink, varies tremendously for
various factors.
And each year, I think the theprimary method of growth or can
(28:19):
can vary.
So for instance, you know, wehave same-store growth, we have
new clo building new clinics,and then we have new
partnerships.
And whilst I appreciate thisperhaps isn't as applicable for
the for the single clinic owner,but I think for organizations
generally, it's how do you grow?
(28:39):
And what's your thought as itpertains to kind of 2026 with
regards to how how shouldorganizations be looking at
growth?
What what perhaps are the youknow the methods or the the
levers of growth going forwards?
SPEAKER_01 (28:57):
I I think uh you're spot on about the the average
therapist or the averageemployee looking at growth as
maybe not the most positivething.
And I I think establishing thewhy behind the growth for
everybody so that theyunderstand that, you know, if we
can grow, this is what you knowprovides compensation, you know,
(29:18):
to help us attract the bestpeople.
And, you know, as we grow,there's more opportunity for you
to grow and more opportunitiesfor upward mobility, you know,
within or obviously without theorganization, but establishing
that why is super importantearly on.
And and for us, our our methodof growth is tied strongly to
(29:42):
each of our clinics currently at136 have ownership at that local
level.
And we're looking for people whowant to own and you know, create
a patient environment that is isreally positive.
So we want to develop thattalent.
Internally, and then give thosepeople the opportunity to have
(30:03):
ownership.
You know, every once in a whilewe'll get a current clinic
director to grumble, oh, why arewe adding all these clinics?
And like, hey, you remember whenwe gave you a clinic?
You know, you were in the clinicand you went through training
and you went, you expressed likeyou wanted a clinic.
This is to give you the next youthe next opportunity.
And, you know, don't we wantthat for everybody?
(30:24):
And you know, having thoseconversations and really
establishing the why isimportant.
So for us, it's de novo growthwhen we are looking to invest in
people, you know, the people whoare great therapists, who have a
passion for the profession andare just hungry for, you know,
autonomy and entrepreneurship.
And then for us, it is aboutsame-store growth.
(30:45):
You know, we we keep our focusnarrow.
And I think same-store growth isimportant because within your
population and within your fourwalls, there's all kinds of
great things you can add.
Like we we talked about earlier,you know, cash pay, RTM, other
services like that.
So even same-store growth canadd referral sources, niches is
(31:07):
something we're we're hopefulthat we can get spread across
because there's such a demandfor pelvic care, pelvic flow
care, vertigo, concussion, allof those things.
And we want to make sure weprovide those opportunities for
therapists who want to takethem.
So same-store growth and de novois, you know, where we put our
growth growth mode into.
SPEAKER_00 (31:32):
Are you ready for the next step in your career?
Do you want to lead your ownclinic?
Our partners may have anopportunity for you.
We're looking for experiencedphysical therapists to start de
novo clinics throughout thecountry.
You may be the perfect fit forone of our growing physical
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Visit life at alliance.com tolearn more.
SPEAKER_02 (32:02):
You know, the reason I went into therapy was to help
people, and the more people Ican help, the better.
But I feel that certainly in 25,there's uh we've experienced
some challenges to same storegrowth.
And that's not because of demandfor services, it's because of of
(32:24):
staffing the clinics to be ableto allow for that growth and be
able to help more people, whichis really quite a change to 10
years ago, where when we werelooking at same-store growth, we
were really looking at how do weincrease referrals.
Whereas now when we look atsame-store growth, I think the
(32:45):
primary challenge is how do westaff to allow it to occur.
So definitely a shift there.
Have you I well, based off ourconversation, I would imagine
that you have experienced somechallenges with regards to same
store, certainly in thoselocations that have had
(33:06):
challenges associated withrecruitment, yes?
SPEAKER_01 (33:09):
Yeah, I I think you know, planning for growth is
great.
And just like any great plan,it's great until you get punched
in the mouth, right?
And, you know, having therapisthours to treat the patients and
take care of those people andthe communities you serve is is
job one.
And, you know, there's gonna bestaff changes, you know, heaven
(33:32):
forbid there's all kinds ofmedical issues that pop up.
I mean, we you know, it's nosurprise that you can lose hours
for all kinds of reasons.
So growth and profitability areare so tied to having people,
the patients, and then thepeople to take care of the
patients.
So we've definitely run intohard to hire areas where we can
(33:53):
see, you know, visits justplummet for no other reason
other than there just isn'tenough hours in the clinic.
And you know, that at that time,that focus, as much as it has to
be, is to taking care ofpatients.
You can't take your eye off theball about taking care of your
current staff, but making surethat you're you're focused on
them and their needs to makesure that they can deliver the
(34:15):
care that's best, and then focuson making sure you leverage all
the tools that you have at yourdisposal to get those bodies.
And then once you get thosebodies in, you know, do a good
job of of keeping them.
And that's the best you can do.
But you're right, that that hasdefinitely been more of a
curveball for how we forecast.
You know, you can't can'tforecast for 50 weeks of a
(34:37):
therapist anymore.
You certainly, you know, 48maybe even is is as brave as you
can go, but it it doesdefinitely cause a nonlinear
growth model for sure.
Yes.
SPEAKER_02 (34:48):
Turning towards 26, I'm actually quite bullish, and
I'm definitely the glass halfempty guy in the room.
I I feel that we will continueto build on the conversations
and the the wins of 25personally.
Do you feel bullish on 26 andwhat do you perhaps see on the
(35:13):
horizon?
SPEAKER_01 (35:15):
Quite bullish on 26.
I think with all the theplanning and thinking we did in
24 and the implementing we'redoing in 25, those lessons that
we thought hard about andimplemented in 25 are looking
really good for 26.
And as a reflection of that,externally on the profession, I
(35:36):
I I see nothing but the demandcontinue.
I think that all these, pardonmy language, pretenders in the
space are are trying to fill ina void that we can't right now.
And the more that we astherapists find ways to fill
that void, it's going tocontinue to lead to furthering
(35:59):
of the profession and respectfor the value that that we
provide to the entire healthcaresystem.
So I'm very bullish on uscontinuing to kind of carve or
force ourselves into the primarycare MSK space for sure, but
certainly the primary, you know,first stop for any MSK injury in
(36:22):
any way, shape, or form.
I think we're going to continueto gain momentum in that space.
I think it's a way we will beable to get around having to
deal with insurance, not payingus more.
And I really think that's ourpassion for the future.
And I think it'll start to matchwhat therapists want to do,
(36:43):
which is focus on taking care ofpatients, not just when they're
hurt, but before they're hurt.
So I'm I'm very bullish on theprofession moving in that
direction.
And that'll also facilitate us,you know, being able to be less
dependent on the wins andfeelings of payers.
SPEAKER_02 (37:01):
I always finish up asking if there's any other
words of wisdom.
And I'm sure that you haveplenty of wisdom, but anything
else to share perhaps with theaudience as we wrap this up?
SPEAKER_01 (37:13):
Well, certainly not as much wisdom as you, Richard.
And I again, I really, really doappreciate the relationship
we've had and how open you'vebeen to not just answering
questions, but being open to,you know, ask me for questions
too, because the, you know, thebest way you learn is you, it's
it's a two-way street and youyou get to learn from not just
the person you're seeking theknowledge from, but them seeking
(37:35):
some knowledge and clarity fromyou.
And I do appreciate that.
And you know, as far as you knowmy wisdom, I I think I I I like
you, I I got into thisprofession to help people, and I
really haven't taken my eye offthat ball ever.
You know, I was definitely thetherapist who squeezed everybody
(37:56):
in and, you know, worked aroundthem and and and did all that
because I loved it and I stilllove it.
And when I owned a clinic, Iwanted to make sure I hired
people who felt the same way,people who could complement my
skills.
So if it was something Icouldn't treat, you know, I
could give it to them.
That way we could we couldcontinually take care of more
people.
And with each of my roles, Ifeel like I'm still taking care
(38:20):
of people, and I just get to doit at a much bigger scale.
So I I think the the best thinghere that I want to make sure we
all do is just stick tofundamentals.
Like we have a super rewardingprofession.
It is such a uh a great field tobe in, and we get to help so
many people, and we get suchinstant gratification out of
(38:41):
what we do, and it's it'sexhausting and you need to take
care of yourself.
But I I love this profession.
I think we do great things, andI think we're we're poised to
take uh uh bigger steps toasserting our value and getting
getting more of the respect thatwe deserve that's been absent
from anybody other thanpatience, per se, you know,
(39:03):
coming up in 2026.
So I'm I'm very bullish and nosurprise, glass half full for
our profession going forward.
SPEAKER_02 (39:11):
Uh thank you so much, Nick, for providing your
perspective and thoughts for the25 and and going into 26.
Thank you for your leadershipand also your advocacy for the
profession generally.
It's quite inspiring.
So I wish you well over the next12 months, and perhaps in 12
months' time we sit down andhave a beer and work out what
(39:33):
actually happened compared towhat we think will happen.
So thank you.
SPEAKER_01 (39:37):
Thank you, Richard.
SPEAKER_00 (39:42):
This has been another episode of the PT
Leadership Podcast, brought toyou by Alliance Physical Therapy
Partners.
Learn more about our team andfind more episodes online at
allianceptp.com slash podcast.
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