The Private Practice Section of the APTA established the Peer2Peer (P2P) Network a few years ago and since then has provided a great opportunity for PT owners to collaborate with fellow PT owners and discuss how to improve their businesses. In this episode, Nathan Shields interviews Randy Roesch, PT, owner of Business Solutions Consulting Company, and Steve Anderson, PT, Executive Coach for Orange Dot Coaching. They are also current facilitators for P2P. Both have personally benefited from networking during the course of their careers, making them a great resource about the benefits of networking and what P2P has to offer. Nathan then also highlights his mantra for successful business ownership, which is Reach Out – Step Out – Network.
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The Peer2Peer Network Of The APTA’s PPS With Randy Roesch, PT And Steve Anderson, PT
We are going to talk about networking. I’ve got Randy Roesch and Steve Anderson, both physical therapists and facilitators for the Peer2Peer Network in the PPS section of the APTA. If you don’t know much about it, I highly recommend you look into it and possibly apply because the application process is closing during the month of January to join the network. I specifically want to talk about not only the network but also the importance of networking, whether it’s the Peer2Peer Network or Entrepreneurs’ Organization, Vistage or BNI to name of the few networks that are out there on the country. Networking has provided to the people in my network, the benefits of growth and accountability. I’m sure there’s more to it than that. The Mastermind concepts have been around a long time and seem to be initially labeled by Napoleon Hill in Think and Grow Rich. In terms of growth, usually what I find is that the benefit that leads to that growth is the fact that you’ve got multiple minds coming up with solutions to problems, specifically your problems.
You also now have access to resources, people that may have been there and done that or they may know a company that might be able to help you solve that problem. They might have someone in their network that they can refer to you to help you improve or grow. Secondly, the accountability as owners, we don’t have anyone holding us accountable other than maybe our spouses, but the health of the business maybe. There is no one to hold us accountable to the goals that we set forth initially. We all know that if we have an accountability buddy, we’ll do better when it comes to achieving our goals. That being said, I wanted to highlight The Peer2Peer Network, especially since it pertains specifically to us as PT owners. From a greater perspective, I want to make sure you all understand the importance of networking with whatever network it is. Let’s get to the interviews.
I have Randy Roesch and Steve Anderson. They are both facilitators of the Peer2Peer Network in the Private Practice Section of the APTA. I wanted to bring them on because if you’ve heard my mantra before, it’s, “Step out and network.” Not very often we talk about the importance of networking, especially as independent physical therapy owners, but it is huge. First of all, I want to thank you, Randy and Steve, for coming on.
Thanks for having us.
Randy is the Owner of the Business Solutions consulting company but also a doctor and a physical therapist. Steve Anderson is also a doctor of physical therapy. He’s a former CEO of Therapeutic Associates on the West Coast and is an Executive Coach for Orange Dot Coaching. They both are working hard on the Peer2Peer Network and they’ll share a little bit with us about the details here as we go along. Before we get into the details, I want to learn a little bit about you because you were both successful physical therapists in the past. I want to know a little bit about your path. Randy, do you mind sharing with the audience a little bit about your professional path and what got you to where you are?
I graduated from the Mayo School of Allied Health in 1973. I’ve been a PT for a long time. It started out, as most of us do, in acute care and decided that I wanted to do something on my own. I was practicing in Florida and the director in a hospital. I talked to the hospital about getting a piece of the action and they said no. I went out and started my own private practice. Over the course of years, I built that company. The name of the company was RehabWorks. Some of you may have heard that name. I think it’s still around in some areas. Eventually, I had four partners and we had a company in 26 states. We employed 1,800 therapists at that time. We were in hospitals, nursing homes, school systems and outpatient clinics. It was a wonderful experience.
We finally reached the point where we couldn’t continue to grow without some influx of funding. We pulled interest and joined a company called Continental Medical at the time and that company eventually went public. I’ve been in the corporate world too. It was an interesting experience. I stayed on for four years and then decided that getting back into private practice was what I wanted to do. I joined my husband in his private practice for several years and then started my consulting company. I’ve been working with PTs in private practice for the past years. It is a fun ride.
Steve, how about you? Tell us a little bit about your path and what got you to where you are.
It’s a little bit similar in the sense that I started out as a staff PT. I joined a company that I was impressed with. The name of the company was Therapeutic Associates. I started with that company. In a few years, I became the director of one of the clinics in the company and eventually became the CEO. I was with the same company for 37 years. I was the CEO for 19 years. It’s an interesting company because it is a shared ownership company. It’s a legacy company. It’s owned by physical therapists. When I retired at the end of 2016, I believe there were 50 PT partners. The directors of each of the clinics have ownership. It continues on and it’s doing great in the Pacific Northwest. We also have a hospital contract in Southern California that we’ve had interestingly enough since 1954. I retired at the end of 2016 and I did what has always been my real passion, which is helping leaders become better leaders. I started Orange Dot Coaching. I now do coaching services for executives, NPT and in the business world as well.
Since we’re talking a little bit about networking, specifically the Peer2Peer Network. For either of you, did networking play a part in your progression in your professional path?Everybody is willing to share in Private Practice Section. Click To Tweet
It did for me. I was active in the Private Practice Section beginning in the early ‘80s when I started my private practice. It was an amazing experience. I met many wonderful people. The thing that I found in the Private Practice Section was that everybody was willing to share. It was amazing. You would go to these meetings and people would tell you what to do and what all the resources were. It was great. It was one of the reasons that I’ve stayed active in this section. I wanted to give back because it helped me so much in the development of my company.
For me, I felt like I was on an island when I opened up my own clinic at the younger stages. I thought I had to figure all this out on my own. I felt like it was up to me to figure everything out. Little did I know, once I started networking, that there are other people out there that have already been there, done that and know all the answers or can give you the resources. If I had only tapped into something like that earlier in my career, things would have gone so much smoother. What was your experience, Steve?
The Private Practice Section was great for me too. I’ve heard her say before and I felt the same way that you go to your first meeting or two and you say, “I’ve found my people. They understand me and they helped me.” Some of my dearest friendships continue to this day that I found at the Private Practice Section meetings. I love them. My story also goes in the sense that I was part of this big private practice company, Therapeutic Associates. I was elected by the board to become the CEO at 41 years old. I was excited and felt pretty cool about that. The real truth, I was scared to death.
Just like a lot of my clients, I’m overwhelmed with the enormity of the job and to do so networking was extremely important to me. I got a lot of help from friends in the Private Practice Section, but I also found something that we may touch on here a little bit too. I joined a group called Vistage, which is an international group that puts groups of CEOs together and there were 12 to 15 in a group. I did that for seven-and-a-half years. We met on a monthly basis and that was extremely valuable to me. I learned a lot in that period that we’re going to talk about, how I learned a lot after that type of setting. A huge proponent of it, I felt that it took me to the level where I needed to be interacting in life in that environment.
That’s a great point, Steve, because my business partner and I were part of the Entrepreneurs’ Organization. Much like Vistage, it gives you an opportunity to network, talk with and share issues with people who are outside of the healthcare, specifically the PT industry so that they can maybe challenge some of the perspectives that you have. “Why do you have to do it that way?” They don’t come from where we’re coming from. Sometimes it’s helpful to talk to people outside of the PT industry to look for some of the answers. It gets a little bit different perspective on how things go outside of the industry, what expectations are, what company norms or business norms are. Whether it’s a Peer2Peer Network, Vistage, Entrepreneurs’ Organization or BNI or any number of this business that can be hugely helpful in your ability to overcome some of the issues that you’re having, but also mingle with other professionals.
The key to that set up or organization, which I know Peer2Peer does as well, is that you need to get to a level of trust and vulnerability with people to get to them to the bottom of things. The way they’re set up like that, you can get there because you get to know these people. It’s amazing. There were tons of business stuff that came up, but quite frankly, there was some personal stuff that came up too that shocked me at first. When you’re running a business and you’re working these long hours and doing things, sometimes you have issues at home that you’d like to run by people, “How did you handle this?” If you have that trust and vulnerability, I’m already set into the group, but you can go there and help there as well.
As far as Peer2Peer Network is concerned, Randy, what’s the history around Peer2Peer Network? How long has it been going? What got it started?
A couple of people that were on the board, they always laugh about how they were out having a beer one night. Mike Horsfield and Jeff Ostrowski got to talking about how nice it would be if they had a board of directors that they could talk to and they could share problems. They talked about how they could maybe create this group. They thought they came up with this brand new idea that nobody had ever thought of. As Mike says, we realized that the Mastermind concept has been around forever. It started in the early 1900s. That’s what it’s patterned after is that Mastermind concept. We call it networking on steroids because it’s a way for PTs to network with each other and learn from each other. They went to the board of directors of the Private Practice Section. They said, “We’d like to try a couple of pilot groups and if it’s successful, then maybe this is something the section would want to offer.”
They had two groups, five people, who were in companies with gross revenues of less than $2 million and five people who were in companies with over $2 million. They started working together on how to better their company. They talk about the problems they had and the things that they had in common that they didn’t understand and could help each other with. They loved the experience. They brought that back to the board and said, “How could we make this happen?” They decided to try this Peer2Peer Network. At the point that I joined them, I had been very active in the section as was Steve has for many years. I was very excited about the opportunity to do something like this that would be so beneficial for therapists. We opened it up. During the first year, we had 35 new people join. Now, we have 157 network members and 29 groups.
The groups are made up of 5 to 8 people. As I said, we have this arbitrary cutoff at $2 million. Steve and I interview everybody that’s coming into the programs. We get to know them and then we put the groups together. We look at what your strengths and weaknesses are, so if somebody wants to learn more about social media marketing, we might put them in a group with a younger person who’s got a lot of experience with that. If someone wants to own a building, we’d put them in with somebody who owns a building. We build and put these groups together. The groups meet on an annual basis face-to-face. We have a summit every year in April. It’s a three-day summit and then the rest of the time, they meet on a monthly basis. Usually, video conferencing and then there are tons of emails and texts going back and forth. Most of them have a Dropbox as a way to communicate with documents that they want to share and so on. We’re getting amazing feedback from everybody that’s in the program. The one thing that I often hear is, “It’s the best thing that PPS has ever done. These are the people who saved my practice. They helped me make some of the decisions I needed to make or learn how to move forward. I was stuck.” It’s been a great program.
The person who turned me onto Peer2Peer Network, and I didn’t know much about it at all, was a friend of mine who owned a clinic up here in Alaska. He said the same thing. He met with a group of about 6 to 7 people. He was having issues with recruiting physical therapists, especially up here in Alaska, how to retain therapists and how to move his clinic forward in different aspects. He grew 85% over the course of one year and attributed a lot of that success to Peer2Peer Network. It sounds like that’s not an uncommon success story.
It’s really not. As I said, we’ve had several people who have said that it’s made tremendous in their business. The thing that I find interesting and Steve maybe found this Vistage, but what people are saying is a lot of times, especially solo owners didn’t have to be accountable to anybody. They had great plans but they weren’t accountable. A lot of the stuff, you go to these meetings, you’re all these great things, you come back with great ideas and then you get busy and it goes away. This is like having your own little board of directors and you have to go back and talk to and say, “I did that. I didn’t do that.” “Why didn’t you? What’s up?” These people are setting goals and they’re holding each other accountable. That’s what they say has made a tremendous difference.
Would you agree with that, Steve?
Absolutely. That’s what I experienced when I ran a bigger group. We hold each other accountable. I think for the smaller practices that don’t have that, it’s a huge benefit. People you know and trust, you don’t fool. You don’t show up to the meeting and BS them because they’ll call you out in a second. Sometimes, as humans, we need that. I would totally agree with Randy on that.
I’ve recognized the same thing as I’ve been in some of those groups. It’s hard to make excuses for some of the things that you didn’t get done and that you had committed to because they’ll call you out on it. They’ll say, “You can’t use you are busy as an excuse. We’re all busy. How are you going to prioritize and get things done?” I love that you brought it up, Randy. That accountability piece is huge because who’s holding the owner responsible to get things done? If it’s an employee, they can huff and puff and maybe they might even leave. It’s nice when you don’t have to get to that point and someone else out of empathy and an environment of security is providing that ability to hold you accountable. That’s huge in the growth of small business owners.
In the groups, we talk about the rules of engagement. The things that people learn and help each other with is that they trust. They have this huge trust. As Steve said, that was important in this group, the commitment to the group. They show up for the meetings. They schedule these monthly meetings and everybody shows up unless there’s some kind of emergency. Everybody comes to the summit every year. They work hard on balance sharing so that everybody’s talking, sharing and not just one person taking over the group. It’s important. We don’t have any competitors in the groups. Number one, we have a wide variety. We have people who have been in practice for 30 years and people who have been in practice for three years and they might be in the same group.
We also are very careful that they’re from different geographic areas. That vulnerability, you’re not to talk about opening a clinic if you know that your competitors sitting there. I’m moving into that area. The confidentiality piece is extremely important and then the ability to play well in the sandbox. We’ve been fortunate because we’ve had very good results with the people who have been in the program. Very few people have left. We’ve had a few people who have left because they sold their practice. One of the criteria is that you’re the CEO in your practice and an owner and some people are not able to continue anymore. We’ve had a few people who have said, “This isn’t quite for me. I’ve gotten all that I could get.” We’ve had less than 10% attrition. I think that’s pretty good.
What are the criteria? I think you’ve covered a few of them.
It’s a PT or a PTA and you have to be a member of the Private Practice Section. You are the chief executive in the company, which typically is the owner. I think we only have one person who was the CEO and not an owner, but he was the CEO of the business. There’s a fee. It’s $750 a year and that covers the costs of the summit as well as what we do for the program. It also covers benchmarking. PPS, we developed and started in Peer2Peer Network. Some people have probably heard about benchmarking opportunities through PPS. We have twelve KPIs that we monitor. That’s done on an annual basis. We have an outside firm that does all the work. It’s all anonymous, but we use it so that you can compare yourselves regionally and nationally to all the benchmarks and the groups use it to extensively compare to each other, “How come your cost per visit is this? Let’s talk about how we can make me more like yours.” That’s been a huge benefit for the members of Peer2Peer.
That is huge, especially when we don’t have the business acumen and the ability to compare some of those finances like, “How much of my gross revenues am I spending on the payroll? What is my cost per visit? What is my average number of visits per new patient?” Those kinds of KPIs you want to compare and see where you’re at. Am I below average? Am I above average? It’s good to have an idea of what’s happening in your clinic compared to the industry. There aren’t a lot of benchmarking data out there for physical therapy owners. It is a huge benefit to have that available to us.Solo PT clinic owners do not have to be accountable to anybody. Click To Tweet
We’ve expanded it now. We’ve opened it up so that other members of the Private Practice Section can also get into the benchmarking program. I think we are offering 500 slots, but we thought the more the merrier. We can have more information and more data. That’s why we opened it up beyond Peer2Peer.
Steve, you’re talking to some of these people who are considering joining the network. What are some of the issues that they have that you have to address? What kind of encouragement do you find yourself reiterating to the PA owners that are considering joining the network or any network?
Whenever you’re running a business, it doesn’t matter the size of it. There are two things that I see. One is being overwhelmed like, “I know I’ve got so many things to do, but I still have to treat patients. I still need to do this. How am I going to get it all done?” Seeing what others do and how others have handled that is extremely important. The other thing I see in my clients a lot too because I know I have it big-time is what’s known as the impostor syndrome. When you’re sitting there thinking, “Everybody thinks I know what I’m doing because I have a successful practice and I don’t have a clue.” That’s a hard thing to deal with. When you’re in a group networking like this, there are two things that happened. One is you hear about people in the same boat so you can say, “I’m not weird thinking this.” Secondly, people are going to reassure you that you’re not clueless, that you do have some skills and you are successful for a reason. You can build on that and that’s what that group brings to you. They say it’s lonely at the top and I would totally agree. Sometimes you need people that are very objective and willing to tell you what you need to hear and not just tell you what they think you want you to hear to the organization.
Randy, what are some of the common concerns that they bring up as to why they don’t want to join the network?
I don’t talk to very many people that don’t want to join because my job is to find people who want to join. I would say that some of the people who have decided not to remain, it’s been primarily a time issue. They don’t feel like they have the time to devote to it. Even though in my mind, it’s not a huge time commitment. It’s probably a few hours a month for the call and then some emailing back and forth and those kinds of things. I don’t know if it’s the true reason why they didn’t want to stay with it. To reiterate what Steve was saying, we’re finding that a lot of people, no matter what size the practice have a lot of similar problems. They appreciate the opportunity to be able to have someone to talk to about it and learn from other people.
To add to that, I find this with people I do work with as well. Sometimes they said, “I really want to do this, but I don’t have the time.” It’s a funny thing to say because the reason you do it is so that you can find more time and be better at what you’re doing. It’s like, “I need to hire somebody, but I’m not going to hire him because I don’t have time to train him.” You just need to find the time to bring them on and train them and then help you expand it. The same thing goes with leaders is there’s never going to be a good time. There’s never going to be, “Now it’s exactly the time to do this.” You have to decide, pull the trigger and go.”
I think you have to recognize that and I want to get your feedback on this as well, whether it’s networking or something else that you might commonly recommend the PT owners do, but they’ve got to take the time to put on the owner hat and recognize that they are the leaders, the owners of their company. Sometimes, if they’re treating patients full-time, they do not recognize that. They’re putting on their owner’s hat sometime around midnight when they’ve already lost a ton of energy. They’re neglecting parts of their business because they’re not fully executing in that ownership seat. If you were to go back and talk to yourself or maybe a younger version of yourself that owned a clinic like some of these owners do, what are one or two things that you would highly encourage them to do? What kind of mindset or encouragement would you give to them at this stage if they are treating full-time, not much time to run the business type of situation? I’ll start with you first, Steve.
You mentioned earlier when we first started about working on the business and not in the business. We probably all read The E-Myth book and understand what that means. It’s one of those things where I find that when you’re in small business and you’ve got all these pressures on, you tend to think very short-term. What I try and tell leaders is that you need long-term strategies so you can kill it for six months, nine months, a year, maybe a couple of years and do well and be profitable. At the end of it, you can’t sustain it. A long-term strategy is what can I do to set things up now so that when I am 2, 3, 4, 5 years down the road, I can sustain what I’m doing and continue to grow because otherwise, you’re going to hit it. There are only so many hours in a day one person can do and you’re going to tap out unless you’re preparing for that growth along the way.
What would you share, Randy, in terms of talking to that younger owner?
I think Steve’s spot on. They use the phrase, “We’re running our business by the seat of our pants,” and that’s how it feels as a PT because we didn’t learn any of this stuff in PT school. I think as Steve said, we can work as we all did really hard, but at some point, you got to figure out how you’re going to run this business and be able to not be working 80 hours a week and trying to have a life besides your business. Looking ahead and trying to make a plan, you got to start somewhere and you’re going to work hard for the first few years. It’s important not to neglect thinking about your goal, where you want to take this thing and how are you going to get there and plan it out rather than go day to day and figure that somehow it’s going to work.
I love that you shared the long-term aspect because a lot of times we were thinking short-term, how many visits are we getting this week and new patients and not looking long-term as to what we need to grow in terms of company. If someone wants to join the Peer2Peer network, Randy, how did they go about doing it?
We take applications and the application period is open now until mid-January. They go to the PPS website, which is PPSAPTA.org. There’s a networking tab right on the main page of the webpage and that’s where the Peer2Peer Network lies. Once they go into networking, they’ll see Peer2Peer and they’ll see the application. There’s a list of FAQs in that tab. Steve and I are also available to chat with anybody at any time to talk with them a little bit more about the program and see if they think that it’s right for them. We often do that.
Is your contact information on that webpage? Would you be willing to share?
I’m willing to share it, but our contact information is on that webpage so that they can send us an email and then we get back in touch and talk with them, answer their questions and do interview calls with everybody to where I’m in. We want to make sure that they feel it’s a fit, that they’re going to enjoy the experience. My email address is RRoesch@Ymail.com.
They can reach out now. You said that the application period starts now, but did that start in September or October?
The application period is open all the time but for the class coming up, we’re going to have to cut off probably about mid-January. Steve and I interview everybody who’s coming into the program. We put the groups together and then we do some group calls before the summit in April. We have a lot of work between January and April. We try to get things tied up by mid to late January. If people are interested, they need to apply as soon as possible.
It only comes around one time a year.
We do a new class and we bring in 50 new people a year. That’s 8 to 9 new groups every year. We’re continuing to grow at that pace, which is great. We’re very excited about it.
The exciting thing this year is the conference is in San Diego, which I’m excited about.
We held it in Alexandria, Virginia, which is where the Private Practice Section headquarters are. We did that for the first four years and we have people from all over the country, like, yourself, from Alaska. We had people asking if we could possibly consider moving it. We said, “That’s only fair.” This year we’re on the West Coast, in the beautiful San Diego.It's important not to neglect thinking about your goal, where you want to take it, and how you are going to get there. Click To Tweet
That’s April 22nd to 24th or something like that.
The meeting starts on Wednesday afternoon. We end at noon on Fridays, so people can get back home for the weekend.
Anything else you want to share, Steve, in regards to the Peer2Peer Network or some of your insight to the audience?
I think we’ve covered most of it, but it’s a wonderful program. I commend the people who came up with it, Mike, Jeff and Randy for driving it for the first few years. It is a top-notch thing in the Private Practice Section. I believe everyone could benefit from it. My advice to you is don’t say you don’t have the time. Find the time. It’s not very expensive. If you take a look at Vistage and some of those other groups, you’re spending some pretty big dollars and this is done very economically. I don’t think the cost is an issue. You just need to find the time.
Thank you, both, so much for taking the time to join me here. I appreciate it. Thank you so much for sharing your insight and the work that you’ve done in the past.
Thank you, Nathan.
It has been fun being on the program.
- Peer2Peer Network
- Think and Grow Rich
- Therapeutic Associates
- Orange Dot Coaching
- Entrepreneurs’ Organization
- The E-Myth
About Randy Roesch
Dr. Roesch began her career as a Physical Therapist, graduating from the Mayo Clinic School of Allied Health in 1973.
She practiced at the Mayo clinic for 6 years and then moved to Sarasota, Florida where she was the Director of Rehabilitation at Blake Memorial Hospital for 4 years.
In 1983, Dr. Roesch opened a private practice outpatient clinic and began providing rehabilitation contract services to local nursing homes, Easter Seals, and the local school system. Over the course of the next 6 years, Dr. Roesch acquired 3 partners and grew her business, known as Rehabworks. Rehabworks employed 1800 therapists, and provided rehab services in outpatient clinics, hospitals, long term care facilities and school systems in 26 states.
Rehabworks was sold to Continental Medical Inc. in 1989. The new company then went public. Dr. Roesch stayed on as Chief Operating Officer for 4 years. In that capacity her primary role was to value and acquire businesses as well as lead the transition team for these new acquisitions.
In 1994, Dr. Roesch started Business Solutions, a consulting company to provide services to therapists in private practice. Today she concentrates her business in the area of succession planning and practice valuation.
Dr. Roesch has been very active in the Physical Therapy profession over the course of her career, including volunteer service with the APTA. She has served on the Board of Directors of the Florida Chapter, the Private Practice Section, and as Director, Secretary and Vice President of the APTA Board of Directors. She served as the Interim Executive Director for the Private Practice Section. She is currently a Trustee and Board Secretary of the Foundation for Physical Therapy Research. She is also the Facilitator/Director of the Private Practice Section Peer2Peer Network program. Dr. Roesch has received our professions’ highest honor being named as a Fellow of the American Physical Therapy Association in 2016.
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