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Transcript

Clinic Benchmarking Live with Flex Physio · No Appointment Necessary

• 0:00
  Michael: So on today's podcast, we are doing something very, very different.
• 0:03
  Michael: Today was, and excuse me as well, I haven't slept for about five days.
• 0:08
  Michael: I'm absolutely done because the private practice barometer, our mega mega industry benchmarking survey, came out this morning.
• 0:15
  Michael: So this podcast is going to be very different because we're going to do some live benchmarking.
• 0:20
  Michael: Let me quickly talk to you about the survey because some of you may not know about it.
• 0:25
  Michael: We came up with this idea about 80 months ago of providing a benchmarking survey within the MSK industry.
• 0:31
  Michael: And the reason for that was that I have noticed over the years that clinics simply didn't have the data to benchmark.
• 0:37
  Michael: They didn't know what was good, what was bad, whether that was even on simple things like appointment pricing.
• 0:43
  Michael: But the question is like how much revenue should a clinician be generating?
• 0:46
  Michael: What's a good number?
• 0:48
  Michael: And how does that vary by region?
• 0:50
  Michael: What am I earning enough?
• 0:51
  Michael: What do other people earn?
• 0:52
  Michael: What's my profit margin?
• 0:54
  Michael: But we went even deeper.
• 0:56
  Michael: I will link um the uh link to the barometer in the notes so you can go and have a look.
• 1:03
  Michael: It is incredibly in-depth and a lot of fun.
• 1:06
  Michael: So um, yeah, I'm a little bit tired.
• 1:08
  Michael: I may stumble a little bit, but we've got Alexon.
• 1:12
  Michael: I will not pronounce his last name.
• 1:14
  Michael: We will do it.
• 1:15
  Michael: Uh we've got Alex on, who's a long time customer um of HMDG, uh, owns Flex Physiotherapy, which is a very cool practice.
• 1:21
  Michael: And I was involved in from literally the very, very start.
• 1:24
  Michael: I still remember Kieran um phoning or WhatsApp going, ugh, we're fucked.
• 1:31
  Michael: And we don't we I think it was like it was something like the last 500 quids, and it was like, right, let's go spend it and let's make some find some patients.
• 1:40
  Michael: And it was really it's been really amazing watching their journey because they've gone from a a small kind of clinic into something that's really fascinating, offering an absolute array of different services.
• 1:52
  Michael: So I it's been I'm so proud, like genuinely so proud of you guys for achieving it.
• 1:56
  Michael: And so what we're gonna do today is just go through some benchmarks, some of the more common ones, some of the more obvious ones, just see how you stack up.
• 2:02
  Michael: And it'll be interesting listening, I think, for anyone else to also kind of think about their benchmarks and where they stack up and a nice introduction to the survey.
• 2:10
  Michael: So enough of me rambling.
• 2:12
  Michael: Welcome, Alex.
• 2:12
  Michael: Alex welcome Alex's last name.
• 2:15
  Michael: If you could give us that and a little uh brief intro in who you are.
• 2:18
  SPEAKER_00: Thank you, thank you.
• 2:19
  SPEAKER_00: Um, I'm Alex Kiriyaku.
• 2:21
  SPEAKER_00: Um it's Greek, so don't worry.
• 2:22
  SPEAKER_00: Yeah, so I'm one of the co-owners of Flex Physiotherapy in Bergus Hill, which is in Sussex in the southeast, and the other co-owners are Matt Prout and Kieran Barnard.
• 2:31
  SPEAKER_00: The um two of them actually started the business probably nearly 10 years ago now, even, and um they were dipping in and out of different sort of satellite clinics, gyms, it never really worked.
• 2:40
  SPEAKER_00: I think they they did the failure bit to then allow for some of the success going forward.
• 2:45
  SPEAKER_00: Um and then around 2019 I got involved as a self-employed associate, um, was driving to a small leisure centre in East Princeton um to do a Tuesday evening clinic.
• 2:56
  SPEAKER_00: And you know, on one day I got an email saying, Do you want to be part of this uh business, you know, and and have more of a say?
• 3:04
  SPEAKER_00: And um that was that was that was that.
• 3:06
  SPEAKER_00: And yeah, we've not looked back.
• 3:08
  SPEAKER_00: We uh a bit of a COVID success story, so we moved our satellite clinics to two GP practices in Burgess Hill.
• 3:15
  SPEAKER_00: We were ferrying around a box of like tape and theraband and a shockwave machine and sharing all of that between our clinics day to day.
• 3:22
  SPEAKER_00: And yeah, we got busy, ironically, just after COVID, and um we've now got a um yeah, 1200-foot clinic for clinic rooms, gym space, 13 members of staff, and yeah, we haven't looked back.
• 3:35
  Michael: Yeah, and it's really interesting because you you were almost, I call it the classic entrepreneurs, um, but you weren't naturally so.
• 3:42
  Michael: You know, you all worked your absolute socks off, uh you know, set up wherever you could and and and and lived a half hard life and and uh and have kind of got to where you wanted to get to.
• 3:54
  Michael: There aren't that many kind of clinic owners who um necessarily follow that same story, which is kind of interesting.
• 4:02
  Michael: Yours was was definitely tough, particularly in the early days.
• 4:05
  SPEAKER_00: Yeah, no, it definitely was, and you know, but whilst whilst working in the NHS still, yeah, it it it was tricky, you know, trying to balance you know the NHS work and running the business, setting up the business.
• 4:15
  Michael: Well, that's interesting as well.
• 4:16
  Michael: That's a really interesting point because you're all working in the NHS whilst building the business, but most people when they get to the size that you get to or got to, they are then full-time private.
• 4:28
  Michael: But that didn't happen for you guys, you continued with the NHS work, which was really surprising to me, and and quite honestly, privately bonkers.
• 4:34
  Michael: We chat a lot, don't worry, I'm not abusing them.
• 4:37
  Michael: Bonkers to me, but you did continue in that uh down that route, didn't you?
• 4:41
  SPEAKER_00: Absolutely, and and it's still the case, and you know, the bombshell I was gonna drop here is well from my end, I'm still full-time in the NHS, believe it or not.
• 4:48
  SPEAKER_00: Yeah, I'm still full time.
• 4:49
  SPEAKER_00: The the paradigm sort of changed for me personally and for and for Kieran and Matt, because we were thinking, well, we've got a business that's successful, profitable.
• 4:58
  SPEAKER_00: We're doing what we need as directors, and we're present every day of the week, um, where our diary allows, and there's always leadership there.
• 5:06
  SPEAKER_00: Why burden the business?
• 5:07
  SPEAKER_00: Because if I'm gonna be there, that's time for me, and time's money.
• 5:11
  SPEAKER_00: So if the business is churning and and and you know working well, why burden the business?
• 5:15
  SPEAKER_00: Should things grow, that would be different, but at the moment that the model works, uh yeah, yeah.
• 5:21
  Michael: It's an interesting one because I I've not I I don't think I've seen that before in your size of clinic.
• 5:27
  Michael: Um generally you see that in much, much smaller clinics and owner operated or two or three staff members, but certainly not um not how you've done it.
• 5:35
  Michael: I suppose it does help in terms of full-time equivalence between UMAC and Kieran.
• 5:40
  Michael: You probably would you say that's an interesting one, full-time equivalent between UMAC and Kieran.
• 5:44
  Michael: Would you say you are a single yeah, yeah, yeah.
• 5:47
  SPEAKER_00: Single.
• 5:48
  Michael: Yeah, okay.
• 5:49
  SPEAKER_00: So clinically, I mean, um, you know, I I'm at Flex on a on a Friday, that's my sort of day off from the NHS, and I I see three or four patients, you know.
• 5:59
  SPEAKER_00: We we're very much off the tools now.
• 6:00
  SPEAKER_00: Matt Prout less so because he's sort of our injection lead.
• 6:03
  SPEAKER_00: But myself and Kieran are very much the time we're there, it's operational, it's mentorship, it's one-to-ones, it's supervision, it's it's meetings.
• 6:11
  Michael: Could you have imagined where you are today when you first started?
• 6:14
  SPEAKER_00: I think the vision's always there.
• 6:15
  SPEAKER_00: What it looks like, no.
• 6:17
  SPEAKER_00: I think we found it bonkers that we can pay ourselves to not see patients, it just didn't feel right.
• 6:24
  SPEAKER_00: Um, the it was the best thing we did because that allowed us to have the time to then strategize and you know.
• 6:30
  Michael: Yeah, I mean this ties into the survey a little bit because I often get clinic awesome who are quite down on themselves, and I have to tell them that they've done fucking brilliantly, to be honest, because anyone who's managing to run a business in this industry, and I've said this before, you know, first of all, your business model is to get rid of customers.
• 6:48
  Michael: That's insane.
• 6:49
  Michael: I mean, that that is completely insane.
• 6:51
  Michael: Then beyond that, you've got someone offering your exact service but for free down the road, and then you've got people that come in and say, I want everything half price because I pay a few quid as an insurance company.
• 7:01
  Michael: So, you know, if you are managing, and we spoke about this before, but if you are managing to run a successful business despite those constraints, that's that's just incredible.
• 7:10
  Michael: And and I often say to people, if you if you go back to when you were 16, because I did this myself, you go back to when you were 16, imagine a life you have now where you are your own boss, you are earning good money, you are doing well.
• 7:22
  Michael: I think people should praise themselves a little bit more, and and that's what the survey actually is about because I've had enough of hearing people saying, I'm not doing as well as everyone else.
• 7:31
  Michael: Well, you probably are.
• 7:33
  Michael: It is it is actually quite incredible what the survey shows us and that that you aren't out there, you shouldn't be you shouldn't be worried that you aren't performing because actually many clinics aren't.
• 7:43
  Michael: There aren't clinics out there turning over millions of pounds of profit.
• 7:46
  Michael: I mean, all right, there's the odd outlier, but even the big ones aren't turning over millions of pounds of profit often.
• 7:51
  Michael: They maybe have a revenue of 20 mil, 10 mil, but often they're losing money.
• 7:56
  Michael: So that's what the survey's all about.
• 7:58
  Michael: So let's get into the survey.
• 8:00
  Michael: We're going to go through um a few different areas.
• 8:02
  Michael: We'll rush through some of them, and maybe some of it requires a little bit of discussion.
• 8:07
  Michael: But let's start with um a really interesting one, which we often get asked about pricing, the initial consultation fee.
• 8:13
  Michael: What do you charge for an initial physio appointment?
• 8:16
  SPEAKER_00: So at Flex, we've got two tiers.
• 8:18
  SPEAKER_00: We've got a sort of a clinical specialist or clinic owner fee, um, which is£85 for 45 minutes as a new patient.
• 8:27
  SPEAKER_00: Follow-up 45 minutes lot will be the same with us, um, or£75 for a half an hour appointment.
• 8:33
  SPEAKER_00: And then we've got a um the senior clinician tier, which is our employee employed physios who are all MSc trained anyway, which is£60 for 30 minutes, new patient or follow-up, um, or£75 for£45 minutes.
• 8:48
  Michael: So for the South East, it was£71.45 as a median across across all clinics.
• 8:54
  Michael: The national physio median for everyone is£74.
• 9:00
  Michael: So uh that is national and obviously skewed a little bit by by London.
• 9:04
  Michael: Well, I say a little bit, a fair amount by London, but as a as an average is£74.
• 9:08
  Michael: But you can see in the southeast it's it's£71.
• 9:11
  Michael: Did you raise your prices in the last 12 months?
• 9:13
  SPEAKER_00: Yes, we did.
• 9:14
  Michael: And that's another stat, which is 73.5% of clinics did also raise their prices.
• 9:20
  SPEAKER_00: The last 12 months.
• 9:21
  SPEAKER_00: I think I mean with w the way life is and and you know, the way life, you know, we're living life and finances and things, you know, you want to give people pay rises as well.
• 9:32
  SPEAKER_00: Um costs are more expensive, but I think that an element of that revenue needs to come from from you know our prices, really.
• 9:40
  Michael: So that's an interesting point as well, because you are in a small group of people that consider the variables that impact pricing and then change your pricing accordingly.
• 9:51
  Michael: Many people don't do that, they just say it's January, we should increase prices.
• 9:56
  Michael: They're scared of doing so, so they increase them by two pounds.
• 9:59
  Michael: Very little strategic thought to it.
• 10:01
  Michael: Again, I don't ever want to sound like I'm blaming anyone because that's that's not the point.
• 10:06
  Michael: But you can see a large degree of success coming from those clinics that do think strategically, even about something like pricing.
• 10:14
  Michael: Um, and I mentioned this on the launch show for us yesterday.
• 10:17
  Michael: When it comes to pricing, people are often scared about increasing pricing.
• 10:21
  Michael: Have you had less patients since you increased pricing?
• 10:24
  Michael: Have you seen a big drop?
• 10:27
  SPEAKER_00: Only more.
• 10:28
  Michael: So this is the same thing with everyone I've ever worked with.
• 10:33
  Michael: You increase prices, your numbers go up.
• 10:35
  Michael: But here's what's quite interesting: you will often find that the higher your price, the higher your retention rate.
• 10:41
  Michael: And we see that in the survey data.
• 10:42
  Michael: I don't have it on me exactly now, but it does turn out that as you raise pricing, your your retention rate goes up.
• 10:49
  Michael: I think potentially that is simply because it's very difficult for me and a general person to tell whether someone is good clinically.
• 10:59
  Michael: First of all, you can't do it before you meet them anyway, and even once you've met them, who the hell knows?
• 11:02
  Michael: So, how do customers judge you?
• 11:04
  Michael: They judge you by your price.
• 11:05
  Michael: We all do it.
• 11:06
  Michael: When you see two things and one's 50p and one's£1.50, you think£1.50 is better, and so on and so forth.
• 11:11
  Michael: So actually, I think read increasing your pricing can often account for um a more perceived quality and therefore more patient appointments.
• 11:20
  Michael: Okay, quick question on podiatry price pricing, because you offer podiatry.
• 11:23
  Michael: How much do you charge for a podiatry appointment?
• 11:26
  SPEAKER_00: So the initial assessment is 95, I believe.
• 11:30
  SPEAKER_00: Follow-up 75, and that's 30 minutes.
• 11:32
  Michael: Yeah.
• 11:33
  Michael: So you're 95 and 75.
• 11:35
  Michael: Nationally, it's 81 and 61.
• 11:38
  Michael: So you are well above the the average, well above the average um across the country.
• 11:43
  Michael: So that's another interesting one.
• 11:45
  Michael: And I guess that's because of um location, and you simply can charge at that level.
• 11:50
  SPEAKER_00: Yeah, I think I think there's that.
• 11:51
  SPEAKER_00: And I think um the Sometimes with these fees, depending on the specialist services, it also depends on the the clinician what you're you're employing as well.
• 11:59
  SPEAKER_00: Um the the dietrice we've caught is you know an advanced practitioner, very renowned, and I feel can justify that some of those fees um versus maybe someone less experienced.
• 12:09
  SPEAKER_00: But um, yeah, it's so that's interesting that we're above on that domain.
• 12:13
  Michael: Okay, fantastic.
• 12:15
  Michael: Let's move on to so that was our pricing.
• 12:17
  Michael: If people are always interested, what pricing is across the country, and and and hopefully you got a good idea there.
• 12:22
  Michael: In terms of team and HR, let's go on to the next topic.
• 12:25
  Michael: Something that people don't often think about, but is actually really important, is your admin to clinician ratio.
• 12:31
  Michael: Now, we just so happen to use the same accountant because I recommended our accountant to you guys, and he's probably the best thing I've ever done in my business.
• 12:39
  Michael: Um, and I think you could probably say something similar.
• 12:41
  Michael: So you should know the answers to some of these questions, but you also know why it's important.
• 12:45
  Michael: So, in terms of admin to clinician ratio, where are you?
• 12:48
  SPEAKER_00: Pure ad, so we've got three administrators, three receptionists and a bookkeeper.
• 12:53
  SPEAKER_00: It's probably near enough one to one, nearly.
• 12:55
  SPEAKER_00: Nearly one to one.
• 12:56
  SPEAKER_00: So some of our uh wider clinical team are part-time, maybe a little bit more in favour of the clinicians, but um yeah, we've got four admin staff and well, including ours, clinicians, eight, nine clinicians.
• 13:08
  SPEAKER_00: Yeah, okay.
• 13:09
  SPEAKER_00: Yeah, maybe maybe just shy of two to one.
• 13:11
  Michael: Two to one.
• 13:12
  Michael: So from the survey shows that um roughly, well, it shows that clinics with higher admin support generate a median of 70,000 revenue per clinician.
• 13:24
  Michael: So when you have the support, when you have the support stuff, your revenue would be around 71,000 per clinician versus 57,000 for lower admin support.
• 13:33
  Michael: So that's a that's a big difference between um having support and not having support.
• 13:38
  Michael: That's a 14k per clinician difference.
• 13:41
  Michael: Now, what is quite interesting is that that that doesn't mean that you should just stack up on on administrators, more receptionists and practice managers, because that's also that can lead to a massive negative.
• 13:52
  Michael: Because you know, as a as a business, you should be at somewhere around 100,000 pounds.
• 13:57
  Michael: For a successful business, you should be around 100,000 pounds revenue per clinician, depending on where you are.
• 14:02
  Michael: Okay, but 100,000 pounds.
• 14:04
  Michael: Now, if you are um trying to grow and trying to scale, having 18 administrators against that, it doesn't matter how much they're making clinicians are making, you've got a big, big space there.
• 14:14
  Michael: So um, but I'm interested in whether you consciously invested in that admin staff or whether it sort of just grew organically.
• 14:25
  SPEAKER_00: We definitely consciously invested in the stuff at the point where we felt, right, there's operational tasks that we can't hold, even literally just manning reception, you know, there's only so much that we could have done.
• 14:35
  SPEAKER_00: So we definitely needed that admin support, and then also, you know, arranging team meetings, minutes, contacting suppliers, you know, arranging audits, doing the audits, all sorts of stuff.
• 14:46
  SPEAKER_00: But you know, one may think what you described there, the 70 grand a uh a year per clinician with admin support and the 57.
• 14:53
  SPEAKER_00: Someone might think actually that should be the other way around.
• 14:55
  SPEAKER_00: It's like surely if I'm not paying for admin support, then I'm just taking it all on, I can just crack on and things.
• 15:00
  SPEAKER_00: But actually, there's probably something around like burnout there, and you know, the single owner, the single clinic owners taking on all the admin burden, and they haven't got the time or the headspace to see the patients and yeah, so that's exactly it.
• 15:14
  Michael: Uh we have this thing called the messy middle.
• 15:16
  Michael: It's honestly it's such a great bloody survey where it actually shows um exactly where you are compared to everyone else in terms of burnout and happiness.
• 15:26
  Michael: Most people, until they get to 500, when they're between sort of 250, 300, and 500, are not particularly happy and they're earning a lot less um than they otherwise would.
• 15:36
  Michael: I've lost count on the number of training owners who say I'd earn more if I just did it on my own for my bedroom.
• 15:40
  Michael: So it's uh it's a really common thing.
• 15:42
  Michael: But no, I've you know, same for us.
• 15:44
  Michael: The more admin staff, not admin, but the more staff in the business that we have, the more time I can spend speaking to clients or doing podcasts or whatever.
• 15:51
  Michael: It's just it's it's one of those things.
• 15:52
  Michael: So it's interesting that you did sort of actively do it as well.
• 15:55
  Michael: In terms of uh, because this is the next one, which is something that always comes up, and what's better and what's not better, which is PAYE versus contractor.
• 16:04
  Michael: What's your split?
• 16:05
  Michael: How does it work?
• 16:06
  Michael: Who's con or how many people have contracted versus PAY?
• 16:10
  SPEAKER_00: Uh sort of today we offer probably five.
• 16:13
  Michael: And I'm sorry, just to be clear, just to be really clear on that, I'm only talking clinicians, not Yeah.
• 16:19
  SPEAKER_00: Okay.
• 16:19
  SPEAKER_00: So the so the only clinicians that we have at Flex that aren't pay UIE are is the podiatrist who comes in once a week um and has a podiatry clinic for for several hours, and then we run a women's health clinic at once a month at the moment.
• 16:33
  SPEAKER_00: Um so arguably negligible, everyone's employed.
• 16:37
  Michael: Okay, interesting because so I've always it's very difficult, particularly when you're paying out 50% of your um of your turnover of your top line to a clinician if they're on the 50% deal.
• 16:49
  Michael: Um, it's very difficult to grow a business.
• 16:51
  Michael: It's very difficult to make make money on that.
• 16:53
  Michael: Um I I think that it's a the way that you should do it when you first start out, and then it is almost inherited.
• 16:59
  Michael: Um you can't go paying someone 30, 40, 50, 60, 70,000 pounds on day one and uh and you have the opportunity to do contractors.
• 17:07
  Michael: We used only contractors in the first year, six to eight months of working, but it was in in in this industry, it seems to be inherited.
• 17:13
  Michael: As you grow, you continue that model, which is why I think many clinics get stuck at a certain level.
• 17:19
  SPEAKER_00: But yeah, I agree, and I think it's costly.
• 17:21
  SPEAKER_00: The self-employed model is really costly, you know.
• 17:23
  SPEAKER_00: A 50% uh cut is like uh a band 8B or about band 8 C, which you'll never see as a physio in the NHS if you're like you know working at a premium clinic and things.
• 17:35
  SPEAKER_00: My theory behind some of this is where some clinics have self-employed clinicians is and they don't grow and they might say that they're burnt out, they stop.
• 17:43
  SPEAKER_00: I had a clinic and I whatever, I closed it down, or we blame something else.
• 17:47
  SPEAKER_00: Self-employed clinicians, this just my my my opinion, are never going to be invested in your business mentally and physically.
• 17:53
  SPEAKER_00: I think they'll do a good job, you know, the busier they are, that they'll take more money, the clinic will take more money, you know, everyone's happy.
• 18:00
  SPEAKER_00: But to get that buy-in and like, you know, I want you to think about what could be the next steps for my clinic and things, you know.
• 18:07
  SPEAKER_00: I feel like as an employee, you you've got a sense of like a duty of clair to your patients and your owners to want to progress.
• 18:14
  Michael: I think it's difficult to get that investment and that culture from contractors.
• 18:19
  Michael: It's not that it can't be, I've seen it done, but it's definitely more difficult.
• 18:23
  Michael: You know, if you go hop off on holiday, you guys all hop off on holiday, someone's gonna be changing light bulbs, right?
• 18:29
  Michael: If you are only if you all you have is contractors, who gives a crack?
• 18:33
  Michael: I'm just a contractor.
• 18:34
  Michael: And quite honestly, and I don't mean this in a bad way or pejorative way, but you do run the risk of becoming a room rental business, not a healthcare business.
• 18:43
  SPEAKER_00: You know, and and that model's gotta work.
• 18:45
  SPEAKER_00: You know, my barber, for example, he he's um he's very successful and he's a very good barber, and he he he's very busy himself, but he also runs a rent a chair model.
• 18:55
  SPEAKER_00: When you scale that, it's great because he's a passive income.
• 18:57
  SPEAKER_00: Um but if you haven't got that ability to to have 10 rooms where you're you know you're you're you know they're they're paying you 100 pounds a day, say for for a room, yeah, it might seem that it's not much, but if you've got 10 rooms, 100 pounds a day, a grand, you know, a grand a day, it's a good model, you know, of a passive income.
• 19:15
  Michael: So looking at it, looking at the data, a million plus clinics lean towards 60% PAYE.
• 19:20
  Michael: They still don't all have full-time contractors.
• 19:23
  Michael: Oh, sorry, full-time staff, PAYE staff, but they it there is a correlation between PAYE and certainly getting up um out of the box.
• 19:32
  Michael: What is interesting though is staff turnover because it turns out that you are more likely for a staff for you staff turnover to increase if they're on PAYE.
• 19:45
  Michael: They're more likely to stay on contract.
• 19:47
  Michael: So that is an interesting one.
• 19:48
  Michael: I had no idea that that was going to be the case, but that is the case.
• 19:52
  SPEAKER_00: So if they're employed, they're less likely to leave or they're more likely to leave?
• 19:56
  SPEAKER_00: They're more likely.
• 19:57
  Michael: It's fully employed people are more likely to leave than if they are on a contract.
• 20:01
  Michael: And by the way, there's also some evidence um and some data that shows if you're giving out if if your way of retaining people is bonuses, um, that's actually having the opposite effect.
• 20:11
  Michael: You you you tend to just not get as much um benefit from bonuses as people as people think.
• 20:18
  Michael: Um, that's a big one though, isn't it?
• 20:21
  SPEAKER_00: Yes, but there's so many facets to that.
• 20:23
  SPEAKER_00: You know, if someone's employed, who's employing you?
• 20:26
  SPEAKER_00: Do you see your owners?
• 20:27
  SPEAKER_00: Do you see the directors?
• 20:28
  SPEAKER_00: What's the leadership like?
• 20:29
  SPEAKER_00: You know, do you feel empowered to do it?
• 20:31
  SPEAKER_00: I think there's so many, you know, if if you you own HD, or you own HMDG at a time, and you if your team, you know, are seeing you and you're present and you're they can see the growth, then there's a culture there.
• 20:41
  SPEAKER_00: Whereas if you're a corporate clinic or a corporate company and it's all top-down, and yeah, there's gonna be a sense of yeah, I think there's lots of facets to that.
• 20:52
  Michael: I agree, I agree, and touch wood, but we rarely have anyone leave.
• 20:58
  SPEAKER_00: Why is that then?
• 20:59
  Michael: Well, what's what's what because you just said if you're employed, the majority of your your team probably are the reason that in clinics uh people leave, and this is anecdotal, my opinion, not data.
• 21:12
  Michael: Uh we don't have data on this, but I think it's to do with um progression.
• 21:16
  Michael: I think they want to progress.
• 21:17
  Michael: I think that they are not getting paid as much as they would if they were on contract for tax reasons and so on and so forth.
• 21:23
  Michael: So I think it's a perfect cocktail for you know, explosion, basically.
• 21:27
  Michael: When it comes to us, it's not necessarily a fair comparison.
• 21:30
  Michael: We spend God knows how much every year to take the entire team to a Bether or for a week or to Marbella.
• 21:36
  Michael: These are things you can't and the average clinic can't do.
• 21:38
  Michael: But I think for me, it's more than just those nice trips.
• 21:42
  Michael: I think it's the culture within the business.
• 21:44
  Michael: I think that every team member knows that we will protect them against anybody.
• 21:48
  Michael: Like we we once had a a client who basically said something, well, it's happened a few times, who have said something quite mean.
• 21:55
  Michael: Who pay us money?
• 21:56
  Michael: My first reaction is get lost.
• 21:58
  Michael: Like you're you're gone.
• 21:58
  Michael: If you're not nice to us.
• 22:00
  Michael: Don't expect to be staying, and the team know that that we protect them in that way.
• 22:04
  Michael: We are very, you know, if a team member has a personal problem, their personal problem comes first, not the company.
• 22:09
  Michael: Yeah, exactly.
• 22:10
  Michael: So, you know, we've offered we we we have done things that most companies wouldn't ever dream of doing when it comes to medical things.
• 22:19
  Michael: Um I don't want to get into too much, but you know, if someone said their boiler had broken, they need five grand to fix it and they don't have it, we'd we'd pay it.
• 22:25
  Michael: Um, because I think it's really important that that that people when they have outside problems, they don't have to worry about those so much, they can worry more about the business.
• 22:35
  Michael: We also do flexible working.
• 22:36
  Michael: I mean, there's a lot of things that we do that can't necessarily, but I think leadership is a big one.
• 22:40
  Michael: On our site, HMDG, go to our articles.
• 22:43
  Michael: I did an article on leadership and what I think leadership is all about.
• 22:47
  Michael: And because you see all these people, it's a post on LinkedIn all the time, right?
• 22:50
  Michael: Leader, I think leadership is showing up.
• 22:52
  Michael: I think it's being the first in, last out, it's working as hard, if not harder, than everybody else.
• 22:59
  SPEAKER_00: Setting the examples, and and we have these discussions a lot at at Flex, and um, we wanna we've got like a flat hierarchy, and yeah, that there is a hierarchy, but in clinic, every there's a flat hierarchy, and we want to empower our clinicians to say, you know, you're in that room, you're the consultant, you're you you're the you're in charge of that, and you're in charge of the clinic.
• 23:17
  SPEAKER_00: When we're not there as you, if you've got a patient who's not you know, there's gonna be a patient who's not very happy or you're running a bit late, you haven't a shit day, you know, book it free of charge, fine, no problem.
• 23:27
  SPEAKER_00: Extend the appointment.
• 23:28
  SPEAKER_00: Don't feel like, oh, it's half an hour, I've got a you know, you've got that that and we want to convey that autonomy and that or that empowerment.
• 23:35
  SPEAKER_00: And you know, if you're feeling rubbish, just go home.
• 23:38
  SPEAKER_00: Like, you know, if you want a day off, just you're not great, just to speak to us.
• 23:42
  SPEAKER_00: And so that's why we I did a post on LinkedIn recently around supervision.
• 23:46
  SPEAKER_00: So we do an hour of dedicated one-to-one um uh week with our our sort of mentees, if you like, from a clinical and pastoral perspective, and you know, all sorts comes out of that, you know.
• 24:00
  SPEAKER_00: And we went on a um a networking event recently, myself and Kieran in mid-Sussex around sort of different businesses, and um one of the bits of advice was go and do your one-to-ones, go and do them outside, and um even better, like throw and catch a ball because it dissociates sort of the brain from the from your mouth, and you just get a bit more bit more of a raw perspective of that person and how they're doing it, it works.
• 24:23
  SPEAKER_00: But communicate with your team, be there, be present, and yeah.
• 24:27
  Michael: Yeah, I I think so.
• 24:28
  Michael: I think um leading by example, like if people are late for a meeting.
• 24:33
  Michael: I mean, um we could be very strict, and certainly I was if you're late for a meeting, good luck to you.
• 24:38
  Michael: Um you you won't be late for another one because there won't be one, but at the same time, I'm not ever late for a meeting, I make it on bloody time.
• 24:45
  Michael: So um, and and you said about flat flat structure, we had that as well.
• 24:49
  Michael: It was like I remember two of the team having a bit of an argument.
• 24:52
  Michael: I was like, guys, I'm up here, everybody else is down here.
• 24:55
  Michael: Like, we do not work in that way.
• 24:58
  Michael: You're all equal, and you are all your own bosses of your own little space.
• 25:02
  Michael: And you do not need to ask me for anything.
• 25:04
  Michael: If you want to change a process, change it.
• 25:06
  Michael: You I've employed you because you're better than I am at that process.
• 25:09
  Michael: Yeah, so you can do it.
• 25:10
  Michael: Let's talk about self uh turnover though, because how many clinical, how many b clinical team have you had to replace in the last 12 months?
• 25:18
  SPEAKER_00: If you're happy telling us that, you don't have to, and I'll just as in the fi the f so the so the core teams, obviously the physio, we haven't we haven't uh had any one leap.
• 25:27
  Michael: We've only added the national average is seven to nine percent.
• 25:33
  Michael: Okay, that's quite low.
• 25:35
  Michael: In in in the last year.
• 25:37
  Michael: In um the 500k to a million pound revenue clinics, it's fourteen percent, which is really interesting.
• 25:45
  Michael: So that 500k to a million, 40 if that's your revenue, 14% is your turnover rate.
• 25:52
  Michael: Under that, it's 79%, which is actually quite high.
• 25:57
  Michael: Um and and and quite surprising in a way, but then in a another way not.
• 26:02
  SPEAKER_00: It's one in ten, isn't it?
• 26:03
  SPEAKER_00: It's one in ten per year.
• 26:05
  Michael: Yeah, exactly.
• 26:06
  SPEAKER_00: Yeah, and and slightly more if you're a bit uh bit bigger, yeah.
• 26:11
  Michael: Higher, yeah.
• 26:12
  Michael: So let's talk about owner role on well-being, because there's lots of stuff we'd wanted to do in here about well-being.
• 26:18
  Michael: So uh you've answered the question on, so I'll run through this one, but you've answered the question on on patients.
• 26:24
  Michael: So question is sort of um what percentage of patients do you personally see, or what how much revenue do you do you bring in?
• 26:31
  Michael: It's very minimal for for most of most of you.
• 26:35
  Michael: We have this S curve, right?
• 26:36
  Michael: Which is like where people are on a happiness scale.
• 26:39
  Michael: So the data is solo owners generate 84% of revenue at 92k total.
• 26:45
  Michael: So that's a solo owner that will generate 84% of the revenue.
• 26:48
  Michael: CEO stage owners, so those people who are at the the top, um, they generate 10% of revenue, and it shows that the happiest owners are um the CEOs, and I think that is very simply because they they don't have to work 24 hours a day just to try and make some money and to keep afloat.
• 27:11
  Michael: I I think that it it's the less work you do in the clinic, the better.
• 27:16
  Michael: What I will say though, before anyone goes and jumps off and hires a physio and goes on holiday, um it is a very precarious thing to do, to to take yourself away clinically and and and become a CEO if you like.
• 27:30
  SPEAKER_00: Yeah, I mean it's a it's a really interesting stat that because the game just went back to that me that networking event I went to, we did like a questi sort of question and answer thing at the end, and everyone got a little card with a question on, and mine was what are you do since being a leader, what are you deliberately doing less of and what are you deliberately doing more of?
• 27:49
  SPEAKER_00: And I answered it sort of to the panel and said that I'm a physio and I'm deliberately being less of a physio and being more of a a leader, a friend, a mentor, a clinic owner, because that's what the clinic needs now, you know, and I think the reason why people that that that 10% are happy is because they're able to do the things that influence the the wider team, you know, they're seeing the clinic working well, they've got uh you know team members in that are great and you know are really top of their game.
• 28:18
  SPEAKER_00: And when you when you really compare to other clinics or NHS, you know, you're you're really providing a gold standard, and and one of our sort of missions is gold standard, and we can talk about that a bit later, but how it time it ties into the retention side of things as well.
• 28:33
  Michael: Um I think that uh before anyone gets carried away though, of course, people uh tend tend to be happier.
• 28:40
  Michael: Not all but tend to be happier when they've got a bigger business with more money and you know money takes stress away.
• 28:46
  Michael: Often, not always.
• 28:47
  Michael: But I I actually responded to a post yesterday on LinkedIn where I called someone out for being a bit of a dick because he was talking about uh it's it's dangerous if you don't scale, if you don't make lots of money, and that's easier.
• 29:00
  Michael: It's more dangerous, more dangerous doing that often because I I I I like seeing clinics growing.
• 29:05
  Michael: I did a post on this actually.
• 29:07
  Michael: Um go check my Instagram, my my LinkedIn.
• 29:09
  Michael: Um I like seeing clinics grow, it makes me really happy.
• 29:12
  Michael: What you guys have done is very amazing, but I see the other side far more.
• 29:16
  Michael: I see the struggle and the pain and the misery, sometimes the bankruptcy of what happens, you know, when people come to us and say, We've got nothing, I don't know what to do.
• 29:25
  Michael: You know, so it's scaling is not for everyone, being big is not for everyone.
• 29:29
  Michael: There are some very, very positive stats for actually small clinics, one to two clinic owners in the survey, where and I'm sure many clinic owners have thought about going back and just being doing it on the their own one other person.
• 29:42
  Michael: So I don't want um anyone to feel like you must grow, these are the numbers, I need to be rich, because that isn't the case.
• 29:48
  Michael: It simply isn't.
• 29:49
  Michael: And on that, you'd be surprised how little less people at that scale earn versus people at lower scale.
• 29:57
  Michael: And we will go into that same point later.
• 29:59
  Michael: In terms of um uh yeah, on a scale of one to ten, how happy are you?
• 30:07
  Michael: How would you raise your mental health?
• 30:09
  Michael: And scale of one to five.
• 30:10
  Michael: Specific to the clinic or in general?
• 30:12
  SPEAKER_00: Uh in specific to the clinic, I guess in general.
• 30:14
  SPEAKER_00: I'd probably say maybe like a six.
• 30:17
  SPEAKER_00: Outside.
• 30:19
  SPEAKER_00: Maybe maybe a three.
• 30:20
  Michael: A three.
• 30:21
  SPEAKER_00: So I'm I'm definitely in the in the positive side of you know the half, if you like, but um it comes with it, it can wax and wane.
• 30:28
  SPEAKER_00: You know, some some months it might be a four, some it might be a two point five.
• 30:32
  Michael: People who provide less than 10% of the revenue contribution are at a 4.35 average out of five.
• 30:40
  Michael: So that's again the CEO.
• 30:42
  Michael: The least happy of the leaders, which is that kind of um the messy middle where you haven't quite escaped um the atmosphere, you're you're in that middle three, five hundred, their score is three point nine two, and that is a uh uh another thing to show that actually you're you're you you can be very happy at that top level, but actually staying smaller can be below that 300k can actually also um not necessarily match it, but and and going back to um when I was talking about burnout um and and growth and all of that stuff and being unhappy.
• 31:18
  Michael: Do you feel I know the answer to this?
• 31:19
  Michael: Do you feel you take enough time off?
• 31:21
  Michael: Definitely not yeah, you're always on Buddy Holiday, actually, or is that what you tell me?
• 31:26
  SPEAKER_00: I think I think yeah, do I take enough time off?
• 31:29
  SPEAKER_00: Because a large portion of my time is, like I said, I'm still in the NHS.
• 31:33
  SPEAKER_00: Um it really depends on that as well.
• 31:35
  SPEAKER_00: In terms of flex, I I love being there.
• 31:37
  SPEAKER_00: Um being around the team, I love you know being present.
• 31:41
  SPEAKER_00: I take the time off when when I need it, when I when I know I need it, as opposed to just for the sake of it.
• 31:47
  Michael: So 61% of people say yes, 39% say no, and the 39 is a kind of a high-risk burnout cohort.
• 31:53
  Michael: Um, I want to talk about burnout just very quickly, because I saw I saw an interview with Sam Altman who said something that really resonated with me because I've been massively burnt out, but he described it in a slightly different way.
• 32:03
  Michael: He said he doesn't believe in burnout the way it's currently described, and I now agree with him.
• 32:08
  Michael: When things are going brilliantly, everything's just working well, you're making money, everything's great, and you're motivated.
• 32:14
  Michael: You know, you don't get burnt out.
• 32:15
  Michael: You can do all the work in the world if you don't get burnt out.
• 32:17
  Michael: Last week I've done more work than I can remember, but you know what?
• 32:21
  Michael: I was not burnt out once.
• 32:22
  Michael: I loved it.
• 32:23
  Michael: Okay, I'm up at 4 a.m.
• 32:25
  Michael: doing some survey stuff.
• 32:26
  Michael: I don't care because it's so much fun and so cool.
• 32:28
  Michael: Burnout is where you are unhappy, it's where uh things aren't going right, it's where you try and do things, a staff member leaves and you've got to do the extra work.
• 32:37
  Michael: You probably wouldn't have felt burnt out if you just got more patience and had to do the extra work.
• 32:41
  Michael: It's the fact the staff member left and now you've got a cover, now you've got to find someone new.
• 32:45
  Michael: I don't know if you feel the same way.
• 32:47
  SPEAKER_00: Yeah, I don't I agree.
• 32:48
  SPEAKER_00: I'm uh a bit of a workaholic and the art is dedicating time to do sort of business work and then to do everything else that you enjoy, your gym, your family.
• 32:57
  Michael: And I suppose for you guys as well, it's slightly easier because there are three of you.
• 33:01
  Michael: Yeah.
• 33:02
  Michael: You do have you do have things to share with each other.
• 33:04
  Michael: It's like me and Hannah doing this together, it was great because you could you could you could talk over dinner and you would both understand what you're going through.
• 33:12
  Michael: And and then use there's also two of you with you guys.
• 33:14
  Michael: Most clinic games don't have two other people that they can answer either.
• 33:18
  SPEAKER_00: It's been a great, you know, and I think the the foundations are there for flex to to grow because of that.
• 33:25
  SPEAKER_00: And um it's great to have experienced, you know, mentors like Matt and Kieran.
• 33:30
  SPEAKER_00: For me, you know, Kieran used to be my mentor when when I was sort of more for junior physio and he and we we got close working in the NHS.
• 33:37
  SPEAKER_00: He gave me opportunities with next to surgeons to you know and and present things that I never had.
• 33:42
  SPEAKER_00: It's about giving yourself that dragging that person out of the ditch, you know.
• 33:46
  SPEAKER_00: If I'm having a shit day, I know that Kieran and Matt can support me.
• 33:49
  SPEAKER_00: If they're having a shit day, I'll support them.
• 33:51
  SPEAKER_00: And it's that it's it's a bit like marriage and and partnership, isn't it?
• 33:55
  SPEAKER_00: You know, if you it sometimes you've got to go above the 50%, and um that's that's been the real value of having the three of us, and just you know, if I'm angry or upset or emotional, then actually I've got a sounding board there.
• 34:08
  Michael: I think most of the consulting that I've ever done, people think that what they want is help with growth and systems, and a lot of the time it's actually they just need a mate to talk to, um, they need someone to bounce ideas off and tell them that it's it's all okay and that you know they're gonna be all right.
• 34:24
  Michael: I I remember one client, um he was doing pretty well, killing himself working, which he loved doing.
• 34:30
  Michael: Certainly no burnout for him, but it was it was I don't want to say expense of his family, but certainly um he could have done a few things more.
• 34:39
  Michael: So actually, I think the most valuable thing I told him to do was go on holiday um in December, take take two weeks.
• 34:45
  Michael: And he said, Oh, I can't, I'm not gonna be able to afford it.
• 34:48
  Michael: Like, how much is this bloody trip?
• 34:49
  Michael: Because you've got the money in the bank account, go.
• 34:51
  Michael: And he's he sort of went okay.
• 34:52
  Michael: And I think he did, if I remember rightly, he did Lapland with his kids and his wife.
• 34:56
  Michael: And he came back and he was like, It's the best thing I've ever done.
• 34:58
  Michael: But to actually take that time, spend it with the family, see Santa with the kids, because that's that's sort of time you don't get back, right?
• 35:06
  Michael: And so I think it's really important, yes, take time off as well.
• 35:10
  Michael: But it's really important to have someone, even if it's if you don't have a partner in the business, try and find someone that you can bounce ideas off and and talk to.
• 35:17
  Michael: Generally, you want someone in the industry.
• 35:19
  Michael: I think it's a shame there's not more collaboration, but I remember what I did, which was go and find another agency owner.
• 35:25
  Michael: I'm sure no one's ever said no when I've asked people things.
• 35:28
  Michael: I'm sure if you reached out to another clinic that was maybe not in your local geography and said, Listen, would you mind creating a little club?
• 35:35
  Michael: I'm sure you would find someone who would say yes.
• 35:37
  SPEAKER_00: So we've got connected, haven't we now?
• 35:39
  SPEAKER_00: So we're all right.
• 35:40
  Michael: Yeah, you do, HMTG customers do, but uh other people don't.
• 35:44
  Michael: To be a customer.
• 35:45
  Michael: There you go.
• 35:46
  Michael: Right, operations and diary utilization.
• 35:48
  Michael: Another question always gets asked.
• 35:51
  Michael: Um, what would you say if you had to estimate um what percentage of your slots are normally filled week to week, month by month?
• 35:58
  Michael: Like what's your average?
• 35:59
  SPEAKER_00: February data came in the other day, and I think we're looking at about 86% overall.
• 36:05
  SPEAKER_00: And that is clinical capacity that excludes splots, slots, it's everything.
• 36:10
  SPEAKER_00: It's the it's the slots that patients can book into.
• 36:13
  Michael: And that is uh generally you're between the 80, 75, and 85% at any point now?
• 36:18
  SPEAKER_00: Our average from uh from August to January was 77%.
• 36:23
  Michael: And 77 is probably only that low because October, November, December, you know, if you're if you're doing a uh a summary or a uh you're looking at across the year, probably including December is not the best um idea of doing it.
• 36:38
  Michael: But um it is interesting because 77% is still is actually still quite high.
• 36:44
  Michael: Generally, uh my advice to anyone is if you're hitting 77 or 80 or 85 percent, either hire more people and if you can't put your prices up.
• 36:53
  Michael: Um basic economics.
• 36:55
  Michael: Um because you are actually once you get to that point, you're turning patients away.
• 36:59
  Michael: So it's super super important.
• 37:01
  Michael: If if anyone's know the sweet spot, um according to the survey is 70 to 80 percent.
• 37:07
  Michael: So the industry average is 72.3 percent, which is actually far higher than I thought it would be.
• 37:14
  Michael: So at 73, 70, yeah, call it 72% round down 70-80 is is the sweet spot because at 80% wait times spike exponentially, basically.
• 37:25
  Michael: So you think about uh I think it was the stat is increases to 5.5 days once you get to 80%.
• 37:33
  Michael: And we all know patients want to be seen the next day, and so you're doing two things.
• 37:36
  Michael: One is you're not helping your brand, two, you are you are pushing people to competitors.
• 37:40
  Michael: So if that's if that's not the case with you personally or fine, but across the businesses that we surveyed, uh that is the case.
• 37:48
  Michael: So be very careful when you're getting over 80% and and and thinking about how to manage them.
• 37:53
  Michael: 26% of clinic owners think that they're fully booked 90% of the time, but the actual data shows 72.3.
• 38:04
  Michael: That the clinic is fully booked.
• 38:06
  SPEAKER_00: Right.
• 38:06
  Michael: But it's not actually the case.
• 38:08
  Michael: Okay, no show rate, which isn't always an interesting one.
• 38:11
  Michael: What's your average no-show rate?
• 38:13
  SPEAKER_00: So ours is very low, um, and it might be questionable, but it's approximately 1%.
• 38:18
  SPEAKER_00: Now there may the nuances of these, some of this data obviously is subject to how each clinic presents what they present.
• 38:25
  SPEAKER_00: You know, if we get a patient who's called in an hour before and say, Alex, literally I'm I'm at desk door or I've just had it's not you're not going to go down as a DNA, I'm gonna reschedulate you.
• 38:34
  SPEAKER_00: You know, see that won't that I won't mark that as a DNA.
• 38:37
  SPEAKER_00: Through DNAs, it's it's very, very few at our clinic, whether that's the appointment reminders, how they're worded, you know.
• 38:44
  SPEAKER_00: I'm on my operation side, is the attention to detail and any extra words, any extra paragraphs, anything that doesn't flow in a in an appointment reminder or confirmation email is costing you your appointment.
• 38:56
  SPEAKER_00: Like I said, our our DNA rate is extremely low.
• 38:59
  Michael: Yeah, I I think um I think a lot of that is really important.
• 39:03
  Michael: It does fluctuate.
• 39:04
  Michael: There are some things to do very well, some things to do that do less well.
• 39:08
  Michael: I know for me as a patient, uh it's clinics have to do things, or not even as a patient, as a customer, clinics have to do things the right way.
• 39:16
  Michael: Uh what is interesting, do you you don't do you don't charge pre-appointment deposit or booking, no?
• 39:22
  Michael: I think there's been a bit of a trend towards charging, and that has potentially lowered um the DNA rate, but from what I've seen, anecdotally not as part of the survey, my opinion, is that actually that's dropped a few other stats.
• 39:37
  Michael: Retention strat stats is one.
• 39:38
  Michael: There's some soft stats around brand, which is another, and the other is simply less patients, uh higher cost of acquisition, which is which is interesting.
• 39:47
  Michael: That is my personal opinion.
• 39:48
  Michael: It may not apply to you guys who are listening, but it's what I've seen across a lot of clinic owners.
• 39:54
  SPEAKER_00: It'll be interesting to know, I don't know if you've got a stat on this, but uh percentage of DNA new appointment versus percentage of DNA follow-up.
• 40:01
  Michael: Because I think this is across the board.
• 40:06
  SPEAKER_00: Because I think there's something in that, in the sense that okay, I've met the clinician, they've probarred in an appointment in two days because they need this they've told me I need to have 10 mo sessions.
• 40:16
  SPEAKER_00: Don't really buy in.
• 40:17
  SPEAKER_00: I couldn't really say no because it's not my character, and then I'm just not gonna turn up, you know.
• 40:21
  SPEAKER_00: So I think there'll be it'll be interesting to see where where the percentages lie, new patient versus product.
• 40:27
  Michael: Yeah, that's a good point.
• 40:28
  Michael: We can certainly answer that if people have the data.
• 40:31
  Michael: Um, but we didn't give everyone the answer.
• 40:34
  Michael: The survey servage.
• 40:36
  Michael: I'm honestly I'm done.
• 40:37
  Michael: I'm ready to go to bed, I'm off on holiday on Sunday.
• 40:40
  Michael: I will sleep.
• 40:41
  Michael: Survey average for DNA is eight to eleven percent without automated reminders, which drops to 6.3% with them.
• 40:51
  Michael: So the first lesson is just do automated reminders.
• 40:53
  Michael: It doesn't matter if they're crap or not, just bloody do them.
• 40:56
  Michael: The harder you work on the automated reminders, the lower your percentage will drop.
• 40:59
  SPEAKER_00: So that's six-fold.
• 41:01
  SPEAKER_00: That's interesting.
• 41:02
  Michael: There are some systems that have very good automated reminder functionality, mainly.
• 41:08
  Michael: So uh there are some stats about Clinico here.
• 41:11
  Michael: I'm not gonna get into the stats around systems live on air because there's some I I want people to look at the the data actually, but there are differences in booking systems and in terms of retention rate, in terms of DNAs and so on.
• 41:23
  Michael: So definitely go and look at the survey at the survey.
• 41:25
  Michael: I just don't want to tackle it here in a short space of time without getting into it further, because I don't want anyone to come running it suing it suing me.
• 41:33
  Michael: Right, patient rebooking rate.
• 41:34
  Michael: Let's look at that as a percentage.
• 41:36
  Michael: So of every 10 patients who come in for their first appointment, how many book a follow-up?
• 41:41
  SPEAKER_00: Uh so again, I've just got this here actually.
• 41:44
  SPEAKER_00: I looked at it last night.
• 41:46
  SPEAKER_00: So the um data from August again to January, our rebook rate was 78%.
• 41:52
  SPEAKER_00: Okay.
• 41:52
  SPEAKER_00: Which that's across the board.
• 41:54
  SPEAKER_00: However, that also includes clinicians like uh our podiatrist and um also our injector who would typically see patients somewhat less or maybe as a one-off, especially for the injections, obviously.
• 42:07
  SPEAKER_00: So Matt Prout, for example, who injects so we we've removed that, those numbers, and it it shoots up to about 81%.
• 42:13
  Michael: And and that's interesting because I think lots of people forget to adjust their DNA, sorry, their cooking rate, especially when they have certain services that are just not relevant in that in that.
• 42:24
  Michael: I think also um that can even apply as simply as um taking sports massage out and giving that its own rate, because there's a very big difference with sports massage physio.
• 42:34
  Michael: I I I I'm a stickler for numbers, I will be doing DNA rates against complex issues, medium issues, and sports massage and injections and so on.
• 42:42
  Michael: But but in any case, the average uh or the median uh rebooking rate, so out of every 10 patients, it's 80%.
• 42:51
  Michael: Clinics in the top 10% see nine in ten patients.
• 42:55
  Michael: Top percent, it's nine out of ten patients.
• 42:58
  Michael: So I think uh the survey finding most counterintuitive rebooking is almost entirely driven by clinical trust communication, not price or size or anything like that.
• 43:08
  Michael: And I think that's that's kind of obvious.
• 43:12
  Michael: People don't think of it, and it's one of those things where it's so obvious that you don't it doesn't come up in your mind.
• 43:16
  Michael: But I think um I've often said this, I think that if I were poked into your clinic to be a physio for a day, I'd get better rebooking than the average physio around the country, because even though I don't know what I'm doing, because it's about being really having a certain way of of of speaking to someone and working with someone.
• 43:35
  SPEAKER_00: That's a whole different podcast.
• 43:36
  Michael: Yeah, that is a whole different podcast.
• 43:38
  Michael: And I've learned so much over the years from some clinicians who have some very cool, very cool things they do.
• 43:43
  Michael: That I would I remember someone found out the concept of never talking to the patient outside of the treatment room about their treatment.
• 43:51
  Michael: I'd never I'd never thought of it, I'd never heard of it.
• 43:53
  Michael: It's years ago.
• 43:54
  Michael: And I'm like, that's actually quite clever because what you're doing is you're leaving the negative stuff in the treatment.
• 44:00
  Michael: Treatment room, and as you go out, you're talking about are you going on holiday next?
• 44:03
  Michael: What are you doing?
• 44:04
  Michael: And it leaves them with a much more positive feel rather than the negativity of the appointment.
• 44:09
  Michael: So it's kind of an interesting, interesting way of doing things.
• 44:12
  Michael: So, what is your rebooking rate, everyone?
• 44:14
  Michael: We are now going to talk about average sessions per patient.
• 44:18
  Michael: So this is for a single episode of care.
• 44:20
  Michael: What's the average number of sessions?
• 44:23
  SPEAKER_00: So ours again, I haven't deducted the other the sports massage or the injectors or podiatry team, and ours is about 5.3.
• 44:32
  SPEAKER_00: So it's probably a little bit higher than that.
• 44:34
  SPEAKER_00: It's probably near enough for six mark, I would have thought, per visit.
• 44:38
  SPEAKER_00: And that and that's the important bit because the rebook rate is important, but um then it's what's after that.
• 44:44
  Michael: Yes, no, exactly that.
• 44:46
  Michael: And on the median, so of course the median is five.
• 44:50
  Michael: Exactly five.
• 44:51
  Michael: If you're below four, it's significantly below the industry norm.
• 44:54
  Michael: Above six is top tier.
• 44:56
  Michael: Now, this does vary very much by discipline, service, chiropractors.
• 45:01
  Michael: For example, will have a you know, they do a lot of maintenance, not all, I'm I'm generalizing here, but there are many chiropractors that do maintenance care 25, 30, 100 sessions, whatever.
• 45:12
  Michael: So it does depend.
• 45:13
  Michael: I think podiatry can be another one, which can be very different if you're doing routine care podiatry.
• 45:19
  Michael: Um, because it may go right down if you're doing orthotics, right?
• 45:23
  Michael: You so it always always bear that in mind.
• 45:26
  Michael: But I think um that that number of five is is kind of where a lot of clinics are.
• 45:31
  Michael: And please note everyone, I said uh, I didn't say should be, because at no point should anyone ever be thinking, especially clinically, but we should be at this booking rate.
• 45:42
  Michael: I think it's so nuanced and there are so many things to consider.
• 45:45
  Michael: For one, for example, I would definitely be splitting up numbers by complex versus non-complex, because you can absolutely say that someone that's coming in with a complex issue, the rebooking rate should be X.
• 45:55
  Michael: But somebody comes in with a click in their elbow, you can't, I mean you can, but you should be careful about counting that because there's nothing you can do with that unless you are being incredibly unethical.
• 46:06
  Michael: Um, so I think the rebooking rate is often overstated and over focused on.
• 46:11
  Michael: And I will say that some of the absolute best clinics I know, they they look at it, they know it, but it's not a founding or found the basis of everything that they do.
• 46:20
  Michael: So I did want to say that.
• 46:21
  SPEAKER_00: Yeah, I think that's a really good point because what you'll find is yeah, you'll get that clicky elbow, it just needs a bit of reassurance, and they'll have maybe a session or two, whatever.
• 46:29
  SPEAKER_00: And um, but then the the the more sort of in-depth clinics, I guess, or the that higher end of the spectrum might invest in those who actually need the the core rehab, might need the like an ultra-self scan for their tendinopathy, and then you know, a loading program.
• 46:45
  SPEAKER_00: You know, we're great at l uh spouting out literature at phys as physios, gluteal tendinopathy, say, which you know, some of the literature says, right, you need two to three sessions of rehab per per week for 12 weeks.
• 46:55
  SPEAKER_00: Well, you're quoting the literature that says supervised rehab, are you offering that?
• 46:59
  SPEAKER_00: So do it in an ethical way.
• 47:01
  SPEAKER_00: Know the, you know, this obviously data's come out, you know the benchmark if you like, but don't oversell something that isn't necessary, and don't undersell where actually you should be seeing that patient twice a week for supervised rehab because and and if they're motivated to get better.
• 47:16
  SPEAKER_00: Um, and that's where you're gonna find the um the difference, I think.
• 47:22
  Michael: Exactly that.
• 47:23
  Michael: And this is one of the reasons I hate packages.
• 47:25
  Michael: I I just think, well, we we also know that the uh most profitable businesses, the best run businesses tend not to offer packages.
• 47:34
  Michael: I don't want to say best, I want to say revenue.
• 47:36
  Michael: It tends to be in terms of size, the smaller clinics tend to run packages more because it's a blunt instrument to not have to teach the clinicians how to sell properly, how to treat properly.
• 47:46
  Michael: It's just we need cash flow, we'll do a thing.
• 47:48
  Michael: And if if that's if that's where you are, that's fine.
• 47:50
  Michael: There's no criticism there.
• 47:52
  Michael: But certainly from a business perspective and running things optimally, packages are not where it's at.
• 47:56
  Michael: I don't think it builds trust or anything like that.
• 47:58
  Michael: But it is a blunt tool because as you said, say, there are so many differences.
• 48:03
  Michael: I mean, for example, I often hear my physio says he doesn't want to push people into more treatments because they don't need it.
• 48:10
  Michael: Well, then don't bloody push them in.
• 48:11
  Michael: But if your physio is saying I can't be asked to push people into more sessions, even though they want it and could need it, but I I don't think it's it's clinically necessary.
• 48:22
  Michael: Well, now we've got a problem because what you think is not necessarily as important as the patient thinks.
• 48:26
  SPEAKER_00: Yeah, well much.
• 48:28
  Michael: Yeah, it's about the patient.
• 48:30
  Michael: Not that if you say, you know, gives a happy ending, you need to be giving out happy endings.
• 48:34
  Michael: That's you you you get my point.
• 48:36
  Michael: Okay, so let's talk technology and software.
• 48:39
  Michael: And by the way, I didn't mention it earlier, but you were talking about, I forgot, you were talking about um a lot of things that you do and and and the processes you have in place.
• 48:48
  Michael: I do wonder, it's a question I suppose as well as a statement.
• 48:51
  Michael: I do wonder how that will change over the next year to two years and how much of these processes, particularly some of the intricate stuff, becomes quite automated.
• 49:00
  Michael: Um, and you get AI doing a lot of those things.
• 49:03
  SPEAKER_00: So, yeah, we've we're dabbling with the different AI sorts of for note taking, and that's just to um improve productivity and reduce burnout, even you know, I've got to write four set four sets of notes and leave in five minutes, you type thing.
• 49:19
  SPEAKER_00: So we're we're definitely working with that, and we are also dabbling with ideas around AI receptionists, when and how to use them.
• 49:28
  SPEAKER_00: Um it's you know, we they're evolving, aren't they?
• 49:31
  SPEAKER_00: So they're getting better and better.
• 49:33
  Michael: They are, and and I think that um in clinics there's a big focus on some very specific things like note-taking, like AI receptionists.
• 49:42
  Michael: Since last week, Claude has had anthropic have done quite a big thing.
• 49:46
  Michael: I was never big a f a big fan of Claude.
• 49:48
  Michael: Holy crap, what you can do now.
• 49:51
  Michael: It it is absolutely fantastic, and I think that one of the unfortunate things as a clinic owner often is you simply don't have the time to be like me to be sat around looking at what's happening in the world of technology and playing around for days on end, kind of figuring out what you can do.
• 50:06
  Michael: But some of the things that I mean, let's put it this way, I can do a thousand hours.
• 50:11
  Michael: Work that did take me a thousand hours last week, today takes me an hour.
• 50:15
  Michael: I mean, I it's it's insane with the match between co-work code and and chat, you know, that the whole vibe thing is is amazing.
• 50:23
  Michael: Uh, I'm probably talking nonsense to lots and lots of people here and don't get what I'm talking about.
• 50:27
  Michael: But um, yeah, I I think that that we'll see over the next year or two a lot of clinics really moving towards more than just call AI call answering with AI and and and and so on.
• 50:38
  Michael: For example, I have no doubt that within about 20 minutes I could build you a a full-on reporting solution across everything that you have within the clinic, spitting you out a report, uh, uh a drill-down report every morning onto your mobile phone.
• 50:53
  Michael: I I think I could probably do that.
• 50:55
  Michael: Maybe it'll take an hour.
• 50:56
  Michael: Uh it's a powerful tool.
• 50:57
  SPEAKER_00: It's and it's still a language model, isn't it?
• 50:59
  SPEAKER_00: You know, we're not we it's not AI yet.
• 51:02
  Michael: Well, it's not it's not general, yeah.
• 51:04
  Michael: So it's it's it's it's not thinking itself yet, but it is it is a language model, and it and and now Claude has made Anthropic has made Claude what's called a vibe model.
• 51:15
  Michael: In other words, you don't need to learn to code or to code with it.
• 51:19
  Michael: I would like X, it will do X.
• 51:22
  Michael: If anyone wants to go on HMDG Instagram, you'll see a nice video.
• 51:25
  Michael: We don't tend to make videos very much.
• 51:27
  Michael: That is a single prompt from Claude saying, here's the survey, make us a nice video, and it created that video.
• 51:33
  Michael: It and that's a very, very low-level level stuff.
• 51:38
  Michael: So anyway, I I think AI is gonna have an interesting point on that.
• 51:41
  Michael: Let's talk technology and software.
• 51:43
  Michael: Holy Trinity, shockwave ultrasound imaging and force plate testing.
• 51:46
  Michael: Um, was that a deliberate strategy or was that like over time you thought I'll get the the force plates, then I'll do the well, I know imaging obviously injections.
• 51:55
  SPEAKER_00: So yeah, it ultrasound and and injections, yeah.
• 51:58
  SPEAKER_00: The ultrasound machine, we actually recently bought a new new machine, an upgrade machine, a better machine.
• 52:03
  SPEAKER_00: Yeah, that that was a no-brainer.
• 52:05
  SPEAKER_00: You know, the the injection and imaging service is was really important, and Matt Proud is leading in this field, and that's only going one way.
• 52:12
  SPEAKER_00: Shockwave therapy, we're really strict on how we use extracorpical and radial shockwave therapy because the literature is it's not for everyone and it's not for everything.
• 52:22
  SPEAKER_00: So persistent lower limb tendinopathy is where we use it.
• 52:25
  SPEAKER_00: And since we brought it in, I remember Kieran saying, right, I'm just making the decision, we're getting it, and we've not looked back.
• 52:30
  SPEAKER_00: You know, it's paid itself off probably a hundred times.
• 52:33
  SPEAKER_00: And as an adjunct, then it's really important that you have that chat and that community that we're going back to that communication with the patient, what it's going to give you, what it's not, you know, you know you might notice some improvements three months after the last treatment.
• 52:44
  SPEAKER_00: This is all what the literature suggests.
• 52:46
  SPEAKER_00: Um, you need to have those chats.
• 52:47
  SPEAKER_00: I've I know clinicians, sports therapists who are using shockwave on people's arms as a massage gun, on backs, and all over the place is just a mess.
• 52:55
  SPEAKER_00: Unfortunately, it's it's not a treatment which leads to regulating.
• 52:59
  SPEAKER_00: So the shockwave is uh an important adjunct to treatments.
• 53:02
  SPEAKER_00: The fourth steck, so we start off with the dynamometry with valve, the handheld dynamometry, mainly because the way physiotherapy training is going is very much rehab-based, fortunately, unfortunately, these days.
• 53:14
  SPEAKER_00: Um our clinicians are really good at that arm of the service, and that's where our our model of care is very much rehab, and that's what we why we have our rehab gym and loads of amazing kit.
• 53:28
  SPEAKER_00: But the dynamometer, we start off with a handheld dynamometer to create a profiling uh session with patients, and then we moved on to the force decks, which just adds you know a plethora of of numbers.
• 53:39
  SPEAKER_00: And you might think, oh, tech, does it, you know, is it just a vanity project?
• 53:42
  SPEAKER_00: Trust me, when you have a an appropriate patient, you say, right, you're coming in next time for your profiling session, here's your here's your blood tests, that's your cholesterol, that's your glucose, your diabetic, your this, which is just an analogy I use.
• 53:55
  SPEAKER_00: Well, we're gonna do this, this, and this based on that interventions.
• 53:59
  SPEAKER_00: Um, we're gonna work on your eutentric quud control because you've got telephemoral pain, and we know actually that's really important because actually the four steps showed you on a counter movement jump, then retest it in three months, and you'll see what percentile they'll move into.
• 54:13
  SPEAKER_00: And then the patients can't wait.
• 54:14
  SPEAKER_00: They can't wait to work hard, they commit to that middle bit.
• 54:18
  SPEAKER_00: Um, so but it's not just, oh, here's the four steps.
• 54:21
  SPEAKER_00: The patient don't, they just look at it as a piece of metal.
• 54:23
  SPEAKER_00: You need to work them and nurture them in that second, third session is the is the important bit.
• 54:28
  Michael: Exactly that.
• 54:28
  Michael: It's telling a story, and and we all know I I I love it.
• 54:31
  Michael: I like the before and afters, right?
• 54:33
  Michael: I you you you are gamifying rehab, you'll bring them in.
• 54:36
  Michael: It's like you you if you've got VO2 max, okay, great, but so what?
• 54:39
  Michael: Well, you're in the tenth percentile of the worst people on on the planet.
• 54:44
  Michael: We need to get you up to 80%, right?
• 54:47
  Michael: And and we're gonna help you and we're gonna measure you.
• 54:49
  Michael: And the same with whether it's horse plates or or any of the kinds of things.
• 54:52
  Michael: I mean, dynamometers are a brilliant example.
• 54:54
  Michael: You know, the amount of times before dynamometers exist, you say how you're feeling, and the patient goes, Yeah, great.
• 55:00
  Michael: Yeah, they may be feeling great at that particular moment in time, but the dynamometers are gonna test a lot more than just feeling great.
• 55:05
  Michael: It'll be some accurate data, right?
• 55:07
  SPEAKER_00: One thing we have learned, and I guess failure needs success, so it's a failure, but we we had it, we did have it as a bit of a vanity project, as a specialist service and things, and we pitched it as this sort of expensive appointment where you're gonna come in and I've got to sell this sort of appointment to you and you're gonna have this profiling.
• 55:22
  SPEAKER_00: Didn't work.
• 55:23
  SPEAKER_00: So we made the decision now to integrate it into all care.
• 55:27
  SPEAKER_00: All types of appointments can get it, you know, depending on your journey.
• 55:31
  SPEAKER_00: And I I don't care if you know you're not spending£100 or you're not buying a the elite care athlete package level four, like some clinics, you know, maybe in London offer, because end of the day, I know that that profiling session is going to nurture your journey and it will aid your journey.
• 55:49
  SPEAKER_00: And it's not about numbers, but that will come in by itself.
• 55:52
  Michael: This is why I like you.
• 55:54
  Michael: Um give everyone some stats.
• 55:56
  Michael: Only 42% of 500k plus clinics have an ultrasound scanner.
• 56:00
  Michael: Force plates uh sit at about sit at 20 to 29%, even amongst larger clinics.
• 56:07
  Michael: Um, basically Ultra Sham Force plates are high trinity um of modern private practice.
• 56:12
  Michael: Now, it also shows because this ties in with your data, because it is about experience, right?
• 56:17
  Michael: If you're giving everything to people, um, they have a much better experience.
• 56:21
  Michael: You know, it's certainly different to going to Bob down the road where you get a little massage.
• 56:26
  Michael: The data shows that tech enabled clinics charge 20 more 20 pounds more on average for an initial consultation and they have a rebooking rate of 82% versus 71%.
• 56:37
  Michael: Let's not go into all the reasons why, because I think you gave most of them uh anyway, but it makes an awful lot of sense.
• 56:43
  Michael: One thing I do want to say, kept saying valve there.
• 56:46
  Michael: I do want to point out the uh this is a little plug for George um and the team at Gate of Motion.
• 56:52
  Michael: You want false plates obviously, valve very, very, very good.
• 56:55
  Michael: Gate of Motion does something very, very, very, very good as well.
• 56:58
  Michael: Um, and at a slightly different price.
• 57:00
  Michael: So if you're uh if you like throwing your money around, then great.
• 57:02
  Michael: But uh there's a good option with with George.
• 57:05
  Michael: He hasn't paid me to say this.
• 57:06
  Michael: I he definitely needs to buy me a beer, but um I did I just hear it from everyone that I talk to, they are very happy with the with the Gate of Motion things.
• 57:16
  Michael: I think we even spoke about it, don't we?
• 57:18
  SPEAKER_00: We were very close to to go with that.
• 57:19
  SPEAKER_00: Yeah, there was a couple of other reasons why we didn't, but um, yeah, I agree.
• 57:23
  SPEAKER_00: They're um they're they're a great team and offer all the all the tech services.
• 57:26
  Michael: Yeah.
• 57:27
  Michael: So if you have if you're tech enabled, you can charge roughly on average 20 pounds more on on your consultations, which is an interesting one because if you just do that the 20 20 pounds more doesn't sound a lot, and people often say this, but when you see 500 patients a month, that extra 20 quid makes a big, big difference.
• 57:45
  Michael: I mean, you are now going into and entering into a different level of business.
• 57:49
  Michael: So 20 pounds more, but the interesting one is the rebooking rate, which is eight, it's an extra 11%, which again, you add an extra 10 11% on your um on your ongoing appointments, because that's where the real money is, right?
• 58:01
  Michael: It's not the first appointment, it's the ongoing appointments.
• 58:03
  Michael: An extra 10% on all of that revenue, that's not bad.
• 58:06
  Michael: And the CapEx, the spend on some of this stuff is actually not as horrific as people might think.
• 58:12
  SPEAKER_00: Yeah, I agree.
• 58:12
  SPEAKER_00: Yeah, it's it's definitely a no-brainer.
• 58:14
  SPEAKER_00: And that patient journey is really important, start to finish.
• 58:17
  Michael: So, do you know what your this is uh do you know acquisition costs?
• 58:21
  Michael: Because people who knew acquisition costs, well, I'll give you the data in a second.
• 58:26
  Michael: Do you know how much it costs you in marketing to bring in one new patient?
• 58:31
  SPEAKER_00: I think I was sits at around I'm pretty sure the latest figures were around£21, which went up, actually went up a bit, but it was 19, but um yeah, around around that, it's it's hovered around that mark.
• 58:43
  SPEAKER_00: I'm quickly, quickly, quickly looking.
• 58:46
  SPEAKER_00: You tell me to tell you what you're doing.
• 58:50
  Michael: Um oh sh I I will it's pr it's probably around that.
• 58:55
  SPEAKER_00: I think yeah, just we got the the report a couple of weeks ago and it it's been hovering around between 19 and 22, 19 and 23.
• 59:04
  Michael: So you are roughly at around everyone listening to the podcast is really enjoying this.
• 59:09
  Michael: I will uh yeah, easily, easily 20.
• 59:13
  Michael: Yeah.
• 59:14
  Michael: So yeah, really important you know those numbers as well.
• 59:17
  Michael: Um because it if if you don't know those numbers, if you're not tracking it, it's very, very difficult um to know whether to even spend on marketing or not.
• 59:26
  Michael: Now, here's the interesting thing on the survey only 25.8% of clinic owners know it.
• 59:32
  Michael: Uh know they're it's CAC, they're CPA.
• 59:34
  Michael: Those who do generate, those who do generate 63% more revenue, which is super interesting.
• 59:40
  Michael: That's 327 versus 200k.
• 59:43
  Michael: So the medium the medium number for acquisition is around 25 pounds.
• 59:48
  Michael: So just something worth worth people thinking about.
• 59:50
  Michael: I think what I will say is I I I don't think that just knowing only your cost of acquisition for patients is the only thing affecting that.
• 1:00:00
  Michael: I think if you know that, you are probably reporting on many other things as well, and you have many other metrics in mind.
• 1:00:07
  Michael: I don't think it's it's purely, and I don't know, but I think it's purely a sort of relation.
• 1:00:11
  Michael: Yeah, but it certainly, certainly, certainly helps something worth worth knowing.
• 1:00:16
  Michael: Um so growth and strategy.
• 1:00:18
  Michael: That's a quick question.
• 1:00:19
  Michael: We got a few more and then maybe we'll have a chat if you want to cover anything that you've seen in the survey because you've had access to it.
• 1:00:25
  Michael: Very quickly, growth and strategy, written business strategy.
• 1:00:27
  Michael: Do you have a written business strategy or growth plan?
• 1:00:30
  SPEAKER_00: I think we do.
• 1:00:30
  SPEAKER_00: It needs updating.
• 1:00:31
  SPEAKER_00: Well, we do no we do, but um, yeah, it's it's something that we probably need to get better at referring to more regularly.
• 1:00:38
  Michael: Do you have vision with Brent?
• 1:00:39
  Michael: So you kind of do actually.
• 1:00:41
  SPEAKER_00: Yeah, we got from that from that perspective, yes, we do.
• 1:00:44
  SPEAKER_00: And um that's we're in we're in the thick of it now, so we're doing it.
• 1:00:49
  Michael: Yeah.
• 1:00:49
  SPEAKER_00: So the vi the the strategy is being implemented, and we're we're implementing things that we're working on and that we want to improve.
• 1:00:56
  SPEAKER_00: So arguably, yes.
• 1:00:57
  Michael: Just for clarity, Brent is our accountant, he does all of my businesses and your business, and he has this thing called vision, which is really useful just to know exactly where you are as a business, being able to plug in data and and so on.
• 1:01:08
  Michael: So numbers.
• 1:01:09
  Michael: 82% of one million plus plus clinics have a written business strategy versus 53% of smaller clinics.
• 1:01:16
  Michael: Um, it's one of the kind of stronger signals, actually, um, in terms of sort of scaling and readiness to scale.
• 1:01:22
  Michael: I think uh it's not necessarily the document, right?
• 1:01:26
  Michael: It's not it's not the got it necessarily that helps, it's the mind and the thinking behind it.
• 1:01:31
  Michael: I think a lot of people muddled into growth.
• 1:01:33
  Michael: I know, I know I certainly did.
• 1:01:35
  Michael: I hear it a lot from clinic owners.
• 1:01:36
  Michael: They sort of go, Oh shit, that happened.
• 1:01:39
  Michael: But if you want predictability, control over that scaling and that growth, then whether it's business metrics or reporting or strategy, those are those are actually really, really important, particularly written, funnily enough.
• 1:01:50
  Michael: I never have done that, but uh certainly for clinics it's an important factor.
• 1:01:54
  SPEAKER_00: And going back to it and saying, Oh, this is what we wrote then, and as actually we've done this in this sense.
• 1:01:59
  SPEAKER_00: And then giving yourself a bit of a pass on the back or a you know, a slap in the face sometimes.
• 1:02:03
  SPEAKER_00: But it's like you said, the readiness to scale is the is you can't scale until you're ready to scale, and you've got to before that, you've got to know if you're ready to scale.
• 1:02:10
  SPEAKER_00: So there's you know, you can't just have it, yeah.
• 1:02:12
  SPEAKER_00: I just want another clinic and another one.
• 1:02:14
  SPEAKER_00: Well, what are the numbers saying?
• 1:02:15
  Michael: Because it's well, or if you want to scale, you may think you do, but you don't necessarily know you do.
• 1:02:21
  Michael: And talking of that, like do we get another clinic?
• 1:02:24
  Michael: Do we go this is where the survey's gonna be brilliant because you are gonna be able to see exactly how much money at what stage most people make when they do go in and get all another clinic space.
• 1:02:34
  Michael: And and I think it's gonna be great for that.
• 1:02:36
  Michael: So definitely, definitely look at that if you are scaling.
• 1:02:38
  Michael: So monthly versus annual accounts, this is a big one, because I think the majority, vast majority of clinic owners I know that are on the smaller end, yeah, smaller size end, it's very much annual.
• 1:02:49
  Michael: They kind of know a bit about their monthly unders.
• 1:02:52
  Michael: How what about you?
• 1:02:53
  Michael: What do you do?
• 1:02:54
  SPEAKER_00: So what was it?
• 1:02:55
  SPEAKER_00: The the topic was monthly versus annual accounts.
• 1:02:58
  Michael: So how often do you review your financial?
• 1:03:00
  SPEAKER_00: I think we get we get monthly reports.
• 1:03:05
  SPEAKER_00: Personally, we're always looking at zero at Brent's reports and things, at Vision, you know, because it's all it's all real time.
• 1:03:11
  SPEAKER_00: You need to know exactly what's going on.
• 1:03:13
  SPEAKER_00: You know, I could tell you who booked in yesterday, I could tell you, you know, what that charge was for, I could tell you what we spend on you know, Amazon per month, you know, all of that with just within two minutes.
• 1:03:23
  SPEAKER_00: And I think some might say, oh, that's just intent, but you you need you need to know that.
• 1:03:26
  SPEAKER_00: You know, Alex Ferguson knew every academy player's mum's brother.
• 1:03:32
  SPEAKER_00: It's a part of leadership.
• 1:03:34
  Michael: It's it's really important to know that stuff.
• 1:03:36
  Michael: And and you could also tell me, which most other people couldn't, uh, what's your capex for the year, what's your net profit, what's the forecast for uh cash in the bank at the end of the year.
• 1:03:45
  Michael: You can tell me that because I know, and you're able to do that with something like Vision and um sound like a bloody sound another bloody advert for my accountant.
• 1:03:54
  Michael: Um you can uh if anyone wants to know outrise uh.co.uk.
• 1:03:58
  Michael: It's not cheap though, go in with 50 quid.
• 1:04:00
  Michael: But you it you've gotta go, you've got to know that stuff.
• 1:04:03
  Michael: For example, if you want to hire a new person, I used to be able to just plug in like we're gonna pay this person 50k and it moves all of your numbers and it figures out whether you are uh how much you need to grow in this model.
• 1:04:13
  Michael: It's really good, isn't it?
• 1:04:14
  SPEAKER_00: It is, it's so good.
• 1:04:15
  SPEAKER_00: And you know, I'm not gonna you know say I can find all that all those figures, it's done by the specialists, and you know, I can only do that because they they offer that service.
• 1:04:23
  SPEAKER_00: And one thing I've learned is if you're in doubt, if you're in doubt about something, you know, get the professionals in to do what you know that that job.
• 1:04:31
  Michael: Yeah, I I've heard, oh, it's fine.
• 1:04:33
  Michael: I've got my brother's sister-in-law's friend's cousin doing it.
• 1:04:36
  Michael: Um if I say, Oh, listen, I've got my friend's brother's sister-in-law's boyfriend doing something to my shoulder because I tore something, you'd have a heart attack.
• 1:04:44
  Michael: You'd be like, What the are you doing?
• 1:04:47
  Michael: Go and see Matt immediately.
• 1:04:49
  Michael: But it does seem like sort of real in-depth knowledge of the numbers are not necessarily the thing that people do.
• 1:04:55
  Michael: Now, in terms of the data from the survey, 59% of the big million plus clinics have been.
• 1:05:01
  SPEAKER_00: Sorry to interrupt, I'm just gonna move location because my daughter's gonna kibosh things.
• 1:05:06
  Michael: Oh no, so 59% of the 1 million plus clinics have accounts prepared monthly versus only 21% of smaller clinics.
• 1:05:17
  Michael: 61% of smaller clinics I only see their numbers once a year.
• 1:05:21
  Michael: Now that's really surprising.
• 1:05:22
  Michael: Only close to 60% of 1 million pounds clinics have accounts prepared monthly.
• 1:05:27
  Michael: That's really surprising.
• 1:05:29
  Michael: I remember getting to a million pounds uh HMDG and it was it oh my god, there was so much going on.
• 1:05:35
  Michael: I needed to to have more data than that hitting a million.
• 1:05:39
  Michael: So that's a really interesting stat.
• 1:05:40
  Michael: But it does show you certainly have a much higher chance.
• 1:05:43
  Michael: So 60% of one million plus clinics have accounts prepared monthly versus 21% of smaller clinics.
• 1:05:49
  Michael: So if you're not doing it, don't feel bad because everyone else is exactly the same.
• 1:05:53
  Michael: And 61% of smaller clinics only see their numbers once a year.
• 1:05:57
  Michael: And I will tell you that that is dangerous for one reason.
• 1:06:00
  Michael: Reason well, no, I'm sure for many reasons, but certainly for this was my reason.
• 1:06:04
  Michael: You cannot tax ban if you see your numbers once a year.
• 1:06:06
  Michael: You cannot tax plan, and you've got to make sure you're you're you know you're a business owner, the government's bad enough as it is with with business owners.
• 1:06:15
  Michael: Um, you need to make sure you're tax efficient, and so that's important.
• 1:06:21
  Michael: Right, last question, last stats.
• 1:06:23
  Michael: Intentions, you don't have to tell us this one.
• 1:06:25
  Michael: Intentions, scale, well, I sort of know, scales or or stay put.
• 1:06:28
  Michael: What do you think?
• 1:06:30
  Michael: Scale.
• 1:06:31
  SPEAKER_00: I think yeah, we're we're at that point where we we're we're just warming up, you know, flex physio burgers here has only been around for two and a half years.
• 1:06:38
  SPEAKER_00: We have been approached um in the past already.
• 1:06:43
  SPEAKER_00: Uh some PE has approached us, but we've not been ready.
• 1:06:47
  SPEAKER_00: Make sure you talk to me first before you do.
• 1:06:49
  Michael: Yeah, I'll tell you some stuff.
• 1:06:51
  Michael: Yeah, I it's it's interesting.
• 1:06:53
  Michael: I think throughout the survey, I think one of the biggest, I think the biggest thing that everybody agreed with across every location, every area, every geography, every every level was scale.
• 1:07:03
  Michael: People want to scale, people want more patients, they want to grow, they want to make more money.
• 1:07:07
  Michael: Yeah, only 12% of clinic owners surveyed plan to sell in the next year.
• 1:07:12
  Michael: I think it was three years, but only 12% of clinic owners plan to sell, which is very, very interesting.
• 1:07:18
  Michael: Given um, I'm sure you've had about 20 emails from companies we all know who have been emailing out saying we want to buy you and pay you loads of money.
• 1:07:25
  Michael: Um, and I think that's why prices have gone actually quite high.
• 1:07:39
  Michael: We have all of that data.
• 1:07:40
  Michael: I believe um I'm brain dead at this point, but I believe the biggest selling group was not the oldies, uh, it was the 45 to 55 or 35 to 45.
• 1:07:51
  SPEAKER_00: I think it was 45 to uh yeah, 45 to 55, I think it was something like that.
• 1:07:55
  Michael: 45 to 45.
• 1:07:56
  Michael: I don't even know the blood data.
• 1:07:57
  Michael: Go and look at it, uh, you can download it all.
• 1:08:00
  Michael: Um so, but the point is that it's very small number of people looking to sell, loaded percentage, which is quite surprising.
• 1:08:06
  Michael: I think that's partly because people loved what they do, and probably a lot of people don't feel like they've finished yet.
• 1:08:11
  Michael: Um, but that small percentage is driving the value and the multiples of clinics up a little bit.
• 1:08:18
  Michael: Um, you know, a clinic that was worth 300k five years ago on the same numbers now, you're probably gonna get an extra 100k for it.
• 1:08:26
  Michael: If not, if not more.
• 1:08:28
  Michael: Maybe at those lower levels, not necessarily more, but certainly 50 to 100k more.
• 1:08:33
  Michael: If you're making a million pounds, um, you're certainly going to get a lot more.
• 1:08:37
  Michael: So I think it's just supply and demand basically.
• 1:08:40
  Michael: There are so many people buying at the moment, but there's certainly been a bit of a shift towards maybe the really small clinics.
• 1:08:45
  Michael: There's that sort of in-between, because the the in-between ones are actually very difficult to grow.
• 1:08:49
  Michael: So I think there's been a bit of a shift towards either the really small ones or the or the much, much bigger ones.
• 1:08:54
  SPEAKER_00: I mean, it's it's you know, if you sell your sell your clinic or your business, it's great.
• 1:08:58
  SPEAKER_00: I think there's a wider concept around that and your your uh I guess your beliefs around sort of gold standard care and you know, even these multi-clinic holdings, what what are they offering?
• 1:09:08
  SPEAKER_00: You know, is it just so I can post it on LinkedIn that we're opening our 13th clinic of the year?
• 1:09:13
  SPEAKER_00: You know, you gotta you gotta see through that.
• 1:09:15
  SPEAKER_00: And I think healthcare isn't just about scaling.
• 1:09:19
  SPEAKER_00: There's business and there's healthcare.
• 1:09:20
  SPEAKER_00: We're we're very much in the in the offering phase, in the in the healthcare phase um at Flex.
• 1:09:25
  Michael: No, I agree, and I think um there's there's all sorts of deals being offered at the moment, and I I think that the majority of people that sell want to sell to de-risk themselves, they want to get out, they they can see that there's money there.
• 1:09:37
  Michael: Yeah, I've heard my my business is my retirement many, many times, or my pension many, many times, and people need to and want to de-risk.
• 1:09:44
  Michael: I think the average there was a date bit of data here actually, which was unhappiness.
• 1:09:48
  Michael: So the well-being score of people looking to sell was 2.3 of five versus three point six who are keeping, which is not particularly interesting or enlightening, but that's you know, that's the way it is.
• 1:10:00
  Michael: If you're unhappy, you're older, sometimes not even older, you want to sell if you're burnt out.
• 1:10:06
  Michael: And and then perhaps some of the other things that were so important to you a few years back legacy, the team, gold standard ownership.
• 1:10:14
  Michael: Someone puts, you know, I I'll put it to you, Alex, and you you know, you know, I think you're a brilliant guy, and I love all of you guys.
• 1:10:21
  Michael: Um, someone sticks five million quid in front of each of your noses.
• 1:10:24
  Michael: I don't think you're gonna give two hoots about gold standard clinical care going forward, so you're gonna take that five million quid, right?
• 1:10:30
  Michael: Each.
• 1:10:31
  Michael: Um, you know, money pays pays for a lot of things.
• 1:10:34
  Michael: So but of course, that's a it's a bit unfair because no one's giving you guys 15 million quid for your clinic.
• 1:10:40
  Michael: Yet, yet they're not.
• 1:10:43
  Michael: But yeah, I think it is quite interesting.
• 1:10:45
  Michael: I I believe podiatry clinics are more likely to sell now, and I think that's partly because their margins tend to be a bit higher and they tend to do a little bit better across the board than than say physiotherapy clinics.
• 1:10:56
  Michael: Yeah.
• 1:10:57
  Michael: Um, chiropractic clinics don't tend to tend to have the model that many people buying businesses want.
• 1:11:04
  SPEAKER_00: Yeah, it's a multidisciplinary interventional, yeah, yeah.
• 1:11:08
  Michael: Yeah, yeah, people want that multidisciplinary approach.
• 1:11:11
  Michael: They want yeah, I'm talking very generally here, but they they don't necessarily want the business model the chiropractors have.
• 1:11:16
  Michael: Not all chiropractors, but but some.
• 1:11:19
  Michael: You see, I've I'm couching my opinions.
• 1:11:21
  Michael: I've got to be careful.
• 1:11:22
  Michael: Um it's um yeah, and they want multiple rooms, they want growth, and they want whatever.
• 1:11:27
  Michael: So I think that's that's quite interesting.
• 1:11:29
  Michael: In terms of data you saw in the survey, because I know you made some notes, I gave it to you a couple of days ago.
• 1:11:33
  Michael: Um, what do you think of it, first of all?
• 1:11:36
  SPEAKER_00: Um, yeah, I think I think it's it's a great um you can see the work that's been put in, you know, over 700 respondents is you know, is high level, you know, sample size.
• 1:11:47
  SPEAKER_00: So I'm just gonna shut this door.
• 1:11:49
  SPEAKER_00: One second.
• 1:11:50
  SPEAKER_00: So it's it's credible data.
• 1:11:52
  SPEAKER_00: Credible data, first of all.
• 1:11:54
  SPEAKER_00: So the the the numbers that come in, you can really I don't think there's been anything like it before.
• 1:11:58
  SPEAKER_00: You know, there might be there might have been some literature done, you know, about this type of stuff, but you know, we've we've well you've done um a great big audit on specific things, which is great.
• 1:12:07
  SPEAKER_00: Um, you know, it's interesting to see things like marketing costs per revenue, stuff like that.
• 1:12:12
  SPEAKER_00: It's quite quite nice to know where where your averages are at because I'm sure you know we've had many chats should I should I reduce my ad spend or should I put more in?
• 1:12:19
  Michael: And it's always been more according to capacity.
• 1:12:24
  Michael: In fact, I bullied you yesterday to pay some more money to us for marketing.
• 1:12:28
  Michael: I'm gonna bully you every day.
• 1:12:30
  SPEAKER_00: I love it off.
• 1:12:31
  Michael: No, that is an interesting style.
• 1:12:32
  Michael: In fact, I wrote an article uh a year or two ago on how much should a clinic spend on marketing, and I actually gave our and my ranges for what we've seen over millions of pounds of ad spend and where people sit, and it was actually close to the survey.
• 1:12:46
  Michael: I think people are possibly unaware of that there is a difference between the business size and how much availability you've got because that impacts things, um, and exactly how much people should be spending as a percentage of their revenue.
• 1:12:58
  Michael: Um, I think most people probably think, you know, uh with a big clinic, you know, a grand or two is enough, and actually it's not necessarily enough, or it could be too much again.
• 1:13:08
  Michael: Uh but I think the majority of clinics in this country, I mean like 95% of them are underspending on their master.
• 1:13:16
  SPEAKER_00: Again, I guess it depends, you know.
• 1:13:17
  SPEAKER_00: We we I'm obviously not a specialist in that field, that's just you guys, but it depends what your um, you know, is it just Google?
• 1:13:24
  SPEAKER_00: Are you looking into Meta?
• 1:13:26
  SPEAKER_00: No, what your advice was don't don't press that boost button, you know, you're not gonna touch the sides of Meta in the right way.
• 1:13:31
  SPEAKER_00: You know, you spend 10 grand and then you you you might be talking a month.
• 1:13:34
  Michael: Yeah.
• 1:13:35
  Michael: I think marketing, I and I suppose I was just talking about digital marketing because that's what we do, and of course I'm gonna say everyone should spend more money.
• 1:13:42
  Michael: I actually don't, and and as can can attest to the fact that I often say don't spend any more fucking money, it's stupid, do this instead.
• 1:13:49
  Michael: So that that isn't that's that's why we are who we are, because we don't just tell people to spend more money.
• 1:13:54
  Michael: But I think there's more than just that digital marketing cost, there's that cost in other marketing that isn't necessarily digital, and and I think people often forget that.
• 1:14:02
  Michael: And I know for a fact that people in the survey have not taken that cost into account when talking about their marketing because we did we we know.
• 1:14:11
  Michael: So I I think uh there are other areas you can spend on marketing, and you yourself, Alex, for example, you spend your own time on marketing.
• 1:14:18
  Michael: Now, I like many clinic owners, they probably don't account for that as part of their marketing cost, but they should.
• 1:14:24
  Michael: This is a the the age-old issue that I have with chiropractors.
• 1:14:27
  Michael: I keep bringing up bloody chiropractors.
• 1:14:28
  Michael: I love most of you, but the age-old issue of I'm going to spend a thousand pounds on my marketing for a free spinal check.
• 1:14:37
  Michael: I'm going to get 100 leads through, and that's cost me£7 a lead, which has cost me, yeah, which has cost me seven pounds a lead, which sounds bloody amazing.
• 1:14:47
  Michael: Seven pounds a lead.
• 1:14:48
  Michael: So you give each of those people 20 minutes in their session.
• 1:14:51
  Michael: It takes you an hour of chasing time to chase those seven people because you've got to WhatsApp and call them, whatever.
• 1:14:58
  Michael: You've got to pay an administrator.
• 1:14:59
  Michael: When you look at that seven quid, it's closer to about 400 pounds because you've got so much time that you have to spend on the admin.
• 1:15:06
  Michael: I know chiropractors, this is absolutely insane.
• 1:15:08
  Michael: With an admin team of eight fucking admin people, what are they doing?
• 1:15:13
  Michael: They are calling leads constantly to bring them in.
• 1:15:16
  Michael: That to me is insane.
• 1:15:17
  Michael: Because you've got your your seven or eight people that pay 200 grand in admin plus.
• 1:15:22
  SPEAKER_00: That's that's that's it needs to be organic, it needs to be organic, and and healthcare needs to be organic.
• 1:15:27
  SPEAKER_00: Yeah, you know, you can't put a square into a circle, put it that way.
• 1:15:30
  SPEAKER_00: And everything comes out in the wash, and uh your Google reviews, it'll be your your rebooking rate, your DNA's, you know, it will all come out in the wash.
• 1:15:38
  SPEAKER_00: How you can't force it.
• 1:15:39
  Michael: Yeah, but agrees.
• 1:15:40
  Michael: I I think if it worked, you know, I've I'd maybe have a different opinion, but people say it works because and it doesn't matter whether it's chiropractor, we've got physios taking nonsense, but they say it works because they get the leads in and they go, Oh, from these ten leads we sold to two people, they never think about how what the work was that brought those two ten people through the calls, the emails, the systems, the go-high levels, probably using that and the admin stuff, and then they never measure the rebook rate from those people because that rebook rate is not six appointments, it's one.
• 1:16:11
  Michael: Maybe you're lucky.
• 1:16:13
  Michael: So I I think when you when you do the mass property, this is why it's so important to know, really know your your your acquisition cost for marketing.
• 1:16:20
  Michael: Um sorry, you sort of geomet in there because this is a bit of a passionate topic of mine, because I think um marketing should be should be about brand and putting yourself forward as a really great business.
• 1:16:31
  Michael: And I and I think that doesn't just include it for me, marketing is actually a paint job on the clinic.
• 1:16:37
  Michael: Marketing is actually buying a shockwave, let's say, or buying some cool vowed kit or get in motion kitchen.
• 1:16:45
  Michael: Get in motion kit.
• 1:16:46
  Michael: Um, I think that's marketing as well, and you've got to always consider that in everything that you do.
• 1:16:50
  Michael: It's probably all well, not probably, it's also how you dress and it's how you you speak to people and the money you put into training your front desk how to do their job.
• 1:16:58
  SPEAKER_00: Everything, body language, you know, your your your your tone.
• 1:17:02
  SPEAKER_00: Yeah, I love all that stuff.
• 1:17:04
  SPEAKER_00: I love that.
• 1:17:05
  SPEAKER_00: I love that.
• 1:17:05
  SPEAKER_00: And end of the day, you need to know your stuff, you need to know your product.
• 1:17:08
  SPEAKER_00: Yeah, that's the most important thing.
• 1:17:10
  SPEAKER_00: But a good marketeer or or uh, you know, can can do lots.
• 1:17:13
  Michael: Yeah, I think anything else from the survey that you saw that was kind of interesting.
• 1:17:19
  SPEAKER_00: The the bit that stood out for me was that point that we you touched on earlier around the sort of the communication uh around re re retention or rebooking, around sort of the communication, the trust.
• 1:17:30
  SPEAKER_00: I think that's massive.
• 1:17:31
  SPEAKER_00: And that's where a lot of our sort of mentoring focuses on, how you sort of look after your staff.
• 1:17:39
  SPEAKER_00: And you know, and I think that then feeds into your turnover of staff and things, you know, what what are you offering them, what what are they learning?
• 1:17:46
  SPEAKER_00: And we not only want to grow great clinicians, but we want to grow, you know, clinical leads and you know, who knows, clinicians who might have a stake in in the business or the our next clinic, you know, show me what you're what you're made of.
• 1:17:57
  SPEAKER_00: You know, this is the opportunity.
• 1:17:58
  SPEAKER_00: Yeah, so those that that stood out.
• 1:18:00
  SPEAKER_00: I did make a couple of things.
• 1:18:01
  Michael: What about the the clinic uh take-home pay?
• 1:18:05
  SPEAKER_00: So yeah, the um some of the figures, I guess, that you shared were quite interesting.
• 1:18:10
  SPEAKER_00: You know, I I expected them to be a bit higher, especially like the clinic owner slash CEO level.
• 1:18:16
  SPEAKER_00: Um yeah, it was quite alarmingly low, I'd say.
• 1:18:20
  SPEAKER_00: And it's maybe my expectations are just a lot higher, but you know, I can see why physiotherapy as a private business isn't like a gold mine in in a in a sense.
• 1:18:33
  SPEAKER_00: You have to really put in the effort, you have to diversify, you might need to get sports docs in, you might need to offer other interventions, not you know, we as you know, we offer a variety of other things, knee bracing, shop, you know, specialist services.
• 1:18:48
  SPEAKER_00: You're not gonna become you know the the renowned clinic just by 50 quid follow-ups.
• 1:18:53
  SPEAKER_00: Um you'll be you'll be a great clinic clinically, but you know, if you want to scale your business and then I find it sometimes quite uncomfortable because some of the you know our our staff even might might listen to this or other physios that know us, or I need to be talking as a clinician sometimes and I need to be talking as a business owner, and finding that middle ground, especially when I'm doing our one-to-ones, is quite tricky because at one point I need I might need to be quite direct with you know a team member or or or an employee, and then I'm your I'm your mate and we're having beers and we're talking about that patient and that case.
• 1:19:23
  SPEAKER_00: So there's two sides to owning a business.
• 1:19:25
  SPEAKER_00: Yeah, it can be quite uncomfortable sometimes talking about the the business side when your background's actually a clinician, but you know, it's it's part of it.
• 1:19:34
  SPEAKER_00: You have to you have to do these things and then you have to be ruthless.
• 1:19:36
  SPEAKER_00: We're not here to we're not a charity at the end of the day.
• 1:19:41
  SPEAKER_00: You know, there are targets with corporate business, and if you if you're not hitting the targets and expectations, then there's difficult discussions.
• 1:19:48
  Michael: You know what Alex, I'd frame it a slightly different way than that.
• 1:19:51
  Michael: You can't treat any patients if you don't have any money.
• 1:19:56
  Michael: And the more money you got, the better treatment you can give, and the more patients you can give it to.
• 1:20:01
  Michael: Because if you are sat around with a retention rate, and I remember clearly it was 1.1 back in the day, and I remember laughing, thinking bloody NHS physios, I don't think you're around at that point.
• 1:20:12
  Michael: But if it's 1.1 and you're not making any money, you're not buying any of the cool kit, you're not doing the things that that patients really need.
• 1:20:20
  SPEAKER_00: It's not it's not even that.
• 1:20:21
  SPEAKER_00: You can't invest in the staff.
• 1:20:23
  SPEAKER_00: You know, I'm I'm far I'd I'd want to invest in the staff more than just a clinic.
• 1:20:27
  SPEAKER_00: You know, here's your growth, this is the next step.
• 1:20:29
  SPEAKER_00: You know, here's a a thousand pounds a year CPD fund for you to do what you want, you know.
• 1:20:34
  SPEAKER_00: Have a duvet day three days a year, you know, not just a sick day.
• 1:20:38
  SPEAKER_00: We we pay for sick days, you know, we offer the same annual leave as NHS, but it all comes at a cost.
• 1:20:42
  SPEAKER_00: You can't have these things if we're not doing the other bits.
• 1:20:45
  Michael: I'm sorry, but so so the the average, because we didn't mention it, the average sort of median pay across the the the surveys in the 50Ks.
• 1:20:54
  Michael: Yeah, uh it does change a little bit for the uh there is a bit of a gender bias there.
• 1:21:00
  Michael: There is also a difference in uh age group service and discipline and so on.
• 1:21:04
  Michael: But I was surprised that the CO owner wasn't at 175 or something turning over all these business matters, but they're they're simply not.
• 1:21:12
  Michael: And I'll tip you before the call, I it always amazes me actually how well you guys all do, no matter what size your business, because you know, your entire job is to turn away patients.
• 1:21:23
  Michael: That's that's your job to get rid of your customers.
• 1:21:26
  Michael: Imagine any other industry.
• 1:21:27
  Michael: If a little alien came down and said this guy opened a business and there's a fella down the road offering all the same services for free, and he wants to charge for it, and he wants to get rid of them as quickly as he possibly can.
• 1:21:38
  Michael: I mean, it's a bit kind of silly, right?
• 1:21:40
  Michael: So I think anyone doing anything at all in this industry is doing really, really well.
• 1:21:44
  Michael: But I think it does account for just can't make them account uh the kind of retention tools available in terms of um what a what a software service does, where you pay him 20 quid every single month.
• 1:21:56
  SPEAKER_00: Well, I mean, I think to that, you know, we're seeing some of the stats you shared, like the utilization rates of 80%.
• 1:22:02
  SPEAKER_00: That's that's that's pretty much where you went where you need to be.
• 1:22:05
  SPEAKER_00: It's it's simply that the cost of the product is just not lucrative enough.
• 1:22:10
  SPEAKER_00: You know, that's just the field we work in, as if you're just churning through physiotherapy patients follow-ups, it's just that's just how it is.
• 1:22:16
  SPEAKER_00: You know, there's a cap.
• 1:22:17
  SPEAKER_00: And to grow, you either need to scale and multiply that or introduce other modalities.
• 1:22:23
  Michael: Well, well, you've got the problem of you know, it costs you money to bring new patients through.
• 1:22:28
  Michael: So, you know, to some extent that that's a that's a limitation, even if you are a capacity of 80-90%, you're still having to spend money to bring new patients through the door in one way or another.
• 1:22:39
  Michael: Um, and then yes, the price.
• 1:22:41
  Michael: And you know, I I am a big believer in putting the price up, and putting the price up, I don't mean two quid or five quid, I mean significantly, um, in a in a strategic way.
• 1:22:50
  Michael: I'm not saying just plump 50 quid on your price tomorrow, but I think that um the clinics that do, uh especially clinics like yours, and you are above the fold, right?
• 1:22:59
  Michael: You are above average uh according to the survey, but the clinics like you who are investing heavily and you know have the right clinic and so on, um, there's no reason you couldn't be charging£50 more than you do at the moment.
• 1:23:09
  Michael: I think I think that people would pay it.
• 1:23:11
  Michael: I know I would certainly pay it.
• 1:23:12
  Michael: Um when I had to get my injection recently for my say recently last year for my spine, I went and found the most expensive bloody person I could.
• 1:23:20
  Michael: On the advice, actually, with some advice from lots of physiologists on you who could push me in the right direction.
• 1:23:25
  Michael: But I can't remember what my console was, like 400 quid or something ridiculous.
• 1:23:28
  Michael: You know what?
• 1:23:29
  Michael: I don't care, I was in pain.
• 1:23:31
  Michael: I think there's a lot of people out there that don't mind paying for high quality health care.
• 1:23:35
  Michael: That podcast last time around with Heather.
• 1:23:37
  Michael: It's if you're delivered the service, you will pay money.
• 1:23:41
  SPEAKER_00: Exactly.
• 1:23:41
  SPEAKER_00: It's delivering the service, and you've got to justify that.
• 1:23:44
  SPEAKER_00: And you know, you need to provide excellent care every appointment.
• 1:23:49
  Michael: Yeah, exactly that.
• 1:23:50
  Michael: And if you do that, people, you know, we all know that we pay more money when we're treated well in in in place, or we come back more when we're treated well.
• 1:23:57
  Michael: Um and if things look great and feel great and you're comfortable and so on.
• 1:24:01
  Michael: Um, that also, by the way, extends to how you talk to patients and all of those cool things.
• 1:24:06
  Michael: So I I think um that's a good place to leave it.
• 1:24:08
  Michael: Unless you've got any other stats that you you found that are super interesting.
• 1:24:12
  SPEAKER_00: Not off the top of my uh head.
• 1:24:14
  Michael: Okay.
• 1:24:15
  SPEAKER_00: It's it's such a plethora of stats.
• 1:24:17
  SPEAKER_00: I think it needs uh a pint and uh a review.
• 1:24:20
  Michael: Take you six months to get through.
• 1:24:22
  Michael: Uh it will genuinely take you six months to get through.
• 1:24:24
  Michael: There's so much data in there.
• 1:24:25
  Michael: We covered uh less than uh 0.1 of a percent of it.
• 1:24:29
  Michael: Um for everybody out there, go and check it out.
• 1:24:31
  Michael: Just go to the HMDG uh website.
• 1:24:33
  Michael: Uh if you go to uh um resources in that sub menu, there's barometer, click on that, and you'll see tons of stuff, the downloads, you see loads of articles contained and so on and so forth.
• 1:24:44
  Michael: There's there's a there's a lot a lot of stuff there.
• 1:24:46
  Michael: I hope you enjoy it.
• 1:24:47
  Michael: Thank you.
• 1:24:47
  Michael: Oh, and if you have questions or thoughts, you can always throw it at um barometer at hmdco.uk.
• 1:24:54
  Michael: We're welcoming all kinds of thoughts and suggestions because we will be doing more going forward.
• 1:24:58
  Michael: So it'd be great to see that data over time and how that changes.
• 1:25:01
  Michael: But otherwise, thank you, Alex.
• 1:25:03
  Michael: Thank you so much.
• 1:25:04
  Michael: Really appreciate you coming on.
• 1:25:05
  Michael: And um, we kind of did this one gung ho by just you know, the survey came out today, so we thought let's go through some numbers.
• 1:25:11
  Michael: So thank you again.
• 1:25:13
  SPEAKER_00: No, thanks for your time, Michael.
• 1:25:14
  SPEAKER_00: Appreciate it.