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Why MSK Clinics Sink: A Former Physio’s Breakdown of Bad Advice and Bad Decisions · No Appointment Necessary

• 0:00
  Michael: Welcome to the latest installment of No Appointment Necessary.
• 0:04
  Michael: We are today talking to a very special guest, Mark Reed, who is our or one of our resident physios.
• 0:10
  Michael: Mark joined us from Choose Health and Physiomatters.
• 0:15
  Michael: We nabbed him.
• 0:16
  Michael: And it's actually a really interesting conversation today because we have someone who part-owned a clinic, was was in the physio world, and decided to leave the clinical space and move into marketing.
• 0:27
  Michael: So I think having someone that really understands what it's like running a business and then seeing everything from the other side is going to be quite enlightening.
• 0:34
  Michael: So welcome, Mark.
• 0:36
  Michael: Do you want to just very briefly give us a background of your physio experience?
• 0:41
  SPEAKER_01: Yeah, I would uh don't want to bore everyone with a CV.
• 0:44
  SPEAKER_01: I I graduated as a physio in 2012, went straight into work at any NHS, moved into private practice, then moved about here, there and everywhere, sports, or health, um private practice again, and then eventually set up choose health practice with Jack in uh 2019.
• 1:04
  SPEAKER_01: Terrible time to open a clinic.
• 1:06
  SPEAKER_01: If we knew what was coming in 2020, we wouldn't have bothered.
• 1:09
  SPEAKER_01: So opened the clinic, grew the clinic, COVID cancelled the clinic.
• 1:12
  SPEAKER_01: Then we grew the clinic again, probably like three times in three years, four years.
• 1:16
  SPEAKER_01: Eventually, yeah, I'd I uh I needed a a change and a break, and that was when I got the call from you to see if I wanted to come work at HMDG.
• 1:28
  Michael: Little admission, Mark was actually my physio at one point as well, and I've gotta say, without making him blush, probably one of the best physios I've ever met.
• 1:35
  Michael: Um now, of course, I ask him anything and he tells me to fuck off.
• 1:38
  Michael: I'm not a physio anymore, which is which is annoying.
• 1:41
  Michael: Um but there you go.
• 1:42
  Michael: Uh so and it's interesting because we met back when you were at Choose Health and uh we were doing marketing for Jack.
• 1:48
  Michael: We'd obviously then moved into doing more stuff on physio matters and therapy live and so on, but at the time we were doing marketing at Choose Health, and I do remember we won't mention the the company you're using, but you're using a company.
• 2:00
  Michael: I remember Jack saying to me, you know, we do use a company, and you know, it might be interesting to use you.
• 2:06
  Michael: And we looked at it, and I think he'd spent about 12 grand or something and never tracked or measured anything.
• 2:12
  Michael: So I was like, Yeah, maybe we can uh we can improve something.
• 2:15
  Michael: But um, that's all old history.
• 2:17
  Michael: So let's talk about HMDG and where you are now.
• 2:19
  Michael: So you're involved with HMDG, you've turned into a bit of a marketing consultant in some ways, talking to clinic owners, not necessarily just about marketing, because a lot of what we do is around strategy and advice, whether that's technical advice or or commercial advice and so on.
• 2:34
  Michael: But I wanted to get into some sort of interesting and maybe some controversial topics.
• 2:39
  Michael: One of the things I wanted to focus on was now that you are at HMDG, what surprised you most in the world of clinic marketing?
• 2:48
  SPEAKER_01: I think there's quite a lot of parallels I could draw with the therapy world, the physio world really, and that was quite surprising because a lot of the irritations that I had with physiotherapy as a profession sort of followed me into the world of marketing.
• 3:05
  SPEAKER_01: So, you know, I had a particular bug bear where I, you know, far too guru-led, not enough people have a a grasp of the evidence base independently themselves, and therefore follow everything a guru says.
• 3:20
  SPEAKER_01: And of course, that brings with it just a whole load of uh nonsense, right?
• 3:25
  SPEAKER_01: Um gurus frequently peddling absolute bullshit.
• 3:28
  SPEAKER_01: And I suppose naively I thought that was something that was unique to healthcare and and to physiotherapy in particular, because not all healthcare is like that, and all healthcare can be a bit like that.
• 3:38
  SPEAKER_01: Of the medical professions, physiotherapy is particularly prone to that problem.
• 3:42
  SPEAKER_01: Uh and then I come into the world of marketing and you've got you've got the same thing.
• 3:47
  SPEAKER_01: You've got marketing guru pushing uh quick fix for marketing, just like you've got nonsense peddlers uh in healthcare uh peddling quick fixes for your 30 years of backpit.
• 3:59
  SPEAKER_01: Like, no, that orthotic is not going to fix your back pain that you've had for 30 years, but also neither is this stupid lead funnel strategy going to fill your clinic for the next two years.
• 4:15
  SPEAKER_01: It's just it's it was surprising to me that it's riddled with the same problems, but it absolutely was.
• 4:21
  Michael: I think a lot of industries actually, and and where you see it is where people want to make things really complex, complicate things so they can then generate revenue, whether that is off a patient or gurus in in the industry, you know, uh again, don't want to mention too many names, but you know, um blowing up balloons to fix your leg or whatever it might be.
• 4:41
  Michael: Uh, I always use the analogy of because we see this in marketing, I always use that analogy of you see a slightly overweight person in the gym and the personal trainer's got them standing on a bosu ball with a cattle on one hand and the theraband in the other tied to their ankle, and you're like, what the fuck are you doing?
• 4:54
  Michael: This is this is not how we lose weight.
• 4:56
  Michael: It's pretty simple, right?
• 4:57
  Michael: Eat less pies, quite honestly, that's probably all you need to do.
• 5:00
  Michael: But eat less pies, compound weights, get your knee to do your steps, that's it.
• 5:04
  Michael: We don't need to overcomplicate things.
• 5:06
  Michael: But when you do overcomplicate things, whether that's in marketing or whether that's in in physio, where you need to use this cool new machine and then this new machine, you can then generate significantly more money out of it.
• 5:17
  Michael: And when you stick to the basics and the foundational stuff, it's actually harder to make money, right?
• 5:22
  Michael: If you are, as a physio, talking to a client, uh to a patient and say, right, this is what's wrong with you.
• 5:28
  Michael: We're gonna need a few appointments.
• 5:30
  Michael: A lot of this is gonna be rehab based, and we're gonna work on a strength conditioning plan with you.
• 5:35
  Michael: And quite honestly, in the next three or four sessions, you could go and do this yourself.
• 5:39
  Michael: Well, that's very different to the the model of you need 25 appointments and you need a massage, you need a whatever it might be.
• 5:46
  Michael: And again, you see that in marketing, right?
• 5:49
  Michael: You you sign up with the marketing guru, you have your phase one, and then magically the next masterclass appears to take you to the next level.
• 5:56
  Michael: And what's interesting is that you've done your 15 masterclasses, paid 20 grand, and your clinic still hasn't grown.
• 6:03
  Michael: Um, and it then becomes, you know, as I've heard say, sunken costs for fallacy.
• 6:09
  Michael: Um, and people just keep paying it.
• 6:12
  Michael: But it's it's really interesting that that whether it's in physiotherapy or in in marketing, and I think you've been across all the industry, by the way.
• 6:18
  Michael: You overcomplicate things, you make more money.
• 6:20
  SPEAKER_01: But it it's a that's another parallel as well, because uh choose health because of the clinic that we set up, and in in part because of the way that we did it, we would get uh second opinions quite commonly, right?
• 6:32
  SPEAKER_01: Uh people will come to us for second opinions on complicated stuff, sometimes on simple stuff that had just been managed badly.
• 6:38
  SPEAKER_01: Um and we would see it's just a lot of you know, you just have your head in your hands.
• 6:42
  SPEAKER_01: You've got a patient who's just spent£3,000 in three months with a chiropractic getting an adjustment every week, and they're 0% better at actually what they needed was an MRI and a surgeon.
• 6:52
  SPEAKER_01: You know, and it's it's just stuff like that would happen all the time.
• 6:56
  SPEAKER_01: But then now I I speak to clinics about marketing all day and the marketing that they're doing, and you know, that I've spent£20,000 on this website, and I'm looking at it going, Jesus, that's that's rough.
• 7:08
  SPEAKER_01: Like I felt bad for patients when they'd spent thousands of pounds, got zero percent better, and then they're coming to me for a second opinion.
• 7:15
  SPEAKER_01: We weren't cheap for a second opinion, right?
• 7:17
  SPEAKER_01: But you come in, you're paying your money.
• 7:18
  SPEAKER_01: I feel bad about how much I'm charging you, and now but at least we can get to a solution.
• 7:23
  SPEAKER_01: And like some of the clinics that the some of the clinic owners that I speak to, and speak about the marketing strategies that they're doing and how much they're spending, what the returns are, etc.
• 7:32
  SPEAKER_01: Sometimes they don't even know.
• 7:33
  SPEAKER_01: And I have the exact same feeling.
• 7:35
  SPEAKER_01: Yeah, the exact same, like I feel I want to help you.
• 7:38
  SPEAKER_01: I wish I I wish I was a charity.
• 7:39
  Michael: I think uh we kind of went through dual education.
• 7:42
  Michael: So back in the day, I was being educated about physiotherapy, and um you guys were being educated about marketing.
• 7:50
  Michael: And it was interesting when I had my cervical ridiculeopathy, I remember basically you guys saying, Yeah, you're fucked for three months, like there's a couple of bits we can do, but you'll be fine in three months.
• 8:00
  Michael: And I was speaking to other physios, I remember this particular this particular incident where I was speaking to someone who said, In fact, I think it was Nost 2 pounds, who said, Oh, no, no, no, don't worry, we've got you covered.
• 8:10
  Michael: Um, we can have you fixed in no time at all.
• 8:12
  Michael: You need IDD, it's gonna cost you£10,000 for no sessions, you're gonna be fine in a week.
• 8:17
  Michael: So, you know, I'm not a stupid guy, but listen, when you're in pain, you will do anything, much like when your clinic isn't doing very well, someone comes along and says, Hey, I can fix it.
• 8:27
  Michael: Here's your silver bullet, you need to pay the bills, right?
• 8:29
  Michael: So, so I kind of went, Oh, I agreed on the phone, I will do your IDD.
• 8:33
  Michael: This sounds fucking fantastic.
• 8:35
  Michael: And then I sent a likely little text to a little WhatsApp group, and I was like, Is IDD a thing?
• 8:38
  Michael: It was like, fuck that.
• 8:40
  Michael: And it was like, oh, okay.
• 8:41
  Michael: But it was interesting because that parallel of when you're a clinic owner and you're struggling, when someone comes along with a promise, it's no different when you are in severe pain and I was rolling around crying like a baby, as you remember.
• 8:54
  Michael: I I would have done anything if you'd have told me to stick licorice up my ass and drink green tea with raspberries in it, I'd have done it, right?
• 9:01
  SPEAKER_01: Yeah, and and and I it's something that I'm always aware of.
• 9:04
  SPEAKER_01: I was always aware of this as a as a clinician, right?
• 9:07
  SPEAKER_01: Um, because I I can always remember taking my car to the mechanic, it was clunking, and I had no idea what was wrong with it, the engine light on, and I've got no idea what it'd safe to drive.
• 9:17
  SPEAKER_01: And I took it in and just thought he could tell me anything, like literally make something up on the spot.
• 9:23
  SPEAKER_01: Because I have zero idea whether the word he's even said is a word, right?
• 9:27
  SPEAKER_01: So I am completely beholden to what he says, and also I'm going to pay whatever he recommends.
• 9:33
  SPEAKER_01: That is the exact same as patients in pain, right?
• 9:36
  SPEAKER_01: You're in loads of pain, you come to me, I'm supposedly the expert, I can tell you anything.
• 9:42
  SPEAKER_01: You've got no idea what the words I'm even using even meaning.
• 9:46
  Michael: Because I want to get into the other stuff, but this does bring us to a very, very interesting topic that we've already seen um having an impact.
• 9:55
  Michael: That was absolutely true five years ago.
• 9:57
  Michael: That is not necessarily true today, because with GPT, with LLMs, with Gemini, when I go in and say, um, my physio tells me that I have a trapped nerve and they need to massage it and use a traction table to untrap the nerve and they'll be fine.
• 10:13
  Michael: It's gonna say find a new physio because there's no such thing as a trapped nerve, and actually your nerves have aggregate aggravated, and the traction table isn't gonna help necessarily, these exercises will be.
• 10:24
  Michael: So I think it becomes, and I don't want to get bogged down this because that will that can certainly be another topic, but I do think a lot of clinics are gonna find it much more difficult to sell nonsense going forwards because patients are just inevitably gonna be more educated.
• 10:38
  Michael: And in fact, the same goes for marketing.
• 10:40
  Michael: Interestingly, um, we have quite a number of clients now who have put their uh marketing stuff through GPT and said, What do you think?
• 10:47
  Michael: And generally it comes out and says, Yeah, it's absolutely brilliant.
• 10:50
  Michael: And you know, yeah, this is exactly what you should be doing.
• 10:52
  Michael: Sometimes it will pick up something and you're like, ah, it's actually not a bad idea, or it will be something where you're like, you just mixed up what a churoppet is a chiropractor is, and so you know.
• 11:01
  Michael: But in any case, I think it is one bit of advice actually would be for people to really think about putting stuff through Chat GPT, especially when it's gurus.
• 11:11
  Michael: So, for example, I had an interesting situation where this guru is a clinic owner and they're like, you know, I make all this money and I've got this incredible clinic.
• 11:18
  Michael: And I just took the company's house through and put it through company's house records and put it through GPT and said, Should I be taking advice off of this clinic owner um paying the money for that advice?
• 11:28
  Michael: And it said, Well, no, because they're not particularly successful.
• 11:32
  Michael: So I think certainly using Chat GPT for stuff is is gonna be whatever I let them use, is gonna be really useful, whether it be for patients or just business and consulting advice.
• 11:42
  Michael: Let's not get way laid on that because I will um entire podcast on its own.
• 11:47
  Michael: Let's go back to what surprised you.
• 11:49
  Michael: So we talked about sort of gurus, what else have you got?
• 11:52
  SPEAKER_01: I think there's a few similar things to do with the clinic owners that come to us that I speak to on a daily basis.
• 12:00
  SPEAKER_01: What's what I think is I I don't know whether surprising is the right one.
• 12:04
  SPEAKER_01: No, I probably was surprised by the the volume of it.
• 12:07
  SPEAKER_01: It's the lack of sort of business awareness that clinic owners naturally have.
• 12:11
  SPEAKER_01: I'm aware of that because I I was in the same boat myself, right?
• 12:14
  SPEAKER_01: What I think what surprises me is that that's basically everyone.
• 12:18
  SPEAKER_01: That's basically every single clinic owner.
• 12:20
  SPEAKER_01: Every single clinic owner has a very similar story.
• 12:23
  SPEAKER_01: I'm a clinician, I love being a clinician, I wanted the freedom to practice however I wanted.
• 12:28
  SPEAKER_01: I set up my own practice, right?
• 12:30
  SPEAKER_01: Now I manage a clinic of five members of staff, and I never, you know, as I never wanted to be a manager, I never wanted to be an employer, I was never an entrepreneur, but now I'm an entrepreneur.
• 12:42
  SPEAKER_01: Like it's it's sort of an accidental pathway into it.
• 12:45
  SPEAKER_01: So with that comes a sort of lack of of uh any formal training qualification in in business or marketing or or anything.
• 12:54
  SPEAKER_01: And a lot of the times they're just a bit rudderless.
• 12:56
  SPEAKER_01: They're they're looking for help, and quite oftentimes we become that help.
• 13:02
  SPEAKER_01: Only sort of external agencies they use is a marketing agency, but then that means that they also want to ask the marketing agency accountancy questions and all sorts of other stuff, which is just like, no, you need other professionals for this.
• 13:15
  Michael: I think that was interesting because for me as well, um, coming from the corporate world, seeing the lack of commercial awareness.
• 13:21
  Michael: Now, why are we as big and successful as we are?
• 13:24
  Michael: Because all you physioclinic owners are all as say MSK clinic owners are all nut on.
• 13:29
  Michael: But that's right, right?
• 13:30
  Michael: You're not supposed to know all this stuff.
• 13:32
  Michael: And what we found quite quickly was that people, as you say, didn't want just advice on marketing, they wanted advice on accounting or on technology or whatever.
• 13:41
  Michael: And and we've we've attempted to help with that.
• 13:44
  Michael: We've got something called HMDG Connect for our customers, which is a really cool membership community, and there's lots of information stuff we put out on all of this, all of these different topics.
• 13:53
  Michael: But I think what surprised me beyond that, because I wasn't really surprised by the lack of commercial awareness.
• 13:59
  Michael: That's I think you get that in many service industries, plumbing, whatever it might be.
• 14:03
  Michael: But it was the lack of credible and quality advice available.
• 14:08
  Michael: So when I started HMDG, I had no idea what I was doing.
• 14:12
  Michael: We pirated 99% of it, but there was always someone I could ask, someone who had built a£25 million agency or who knew what they were doing.
• 14:20
  Michael: It was it was actually really simple to get in touch with them.
• 14:22
  Michael: I remember once LinkedIn's this agency owner who had been cleaning it up to God knows what.
• 14:27
  Michael: And I said, Listen, can I get some advice and a little bit of help?
• 14:30
  Michael: I don't mind paying for it.
• 14:31
  Michael: And he was like, Yeah, absolutely.
• 14:32
  Michael: And then he looks at stuff and you went, Jesus Christ, what are you doing?
• 14:34
  Michael: So he sort of helped to a few bits.
• 14:36
  Michael: That's very difficult to do as a physiotherapist.
• 14:38
  Michael: Or and I keep using the word physiotherapist, but let's say clinic owner, healthcare clinic owner, because there's such a lack of quality people available.
• 14:47
  Michael: I I'm always surprised that the the clinic owners who have been there and done it aren't the ones that are actually business consultants.
• 14:55
  Michael: It seems the ones that are generally, not all, I do want to make this point, but the majority, the vast majority of people who are offering advice are actually people whose businesses you wouldn't want to go near.
• 15:05
  Michael: They're terrible businesses, but they realize that they can't make enough money from their clinic, so then they start selling guru advice and masterclasses and work and whatever else is they're selling.
• 15:14
  Michael: So I think that's one of the things that's really disappointed me is that as a clinic owner, where do you go?
• 15:19
  Michael: And you know, when when all of and the majority of the advice is so poor, they end up then making quite poor decisions.
• 15:26
  Michael: Again, I don't want to get too way laid on on gurus and so on, because there are some really good ones out there, no question, but it's just the vast majority.
• 15:33
  Michael: You look at their business, and I sometimes say to people, obviously ChatGPT, their company's house, but beyond that, is this the kind of business you aspire to owning?
• 15:41
  Michael: And if the answer is not hell yes, then don't pay someone 10 grand to help you build that business.
• 15:47
  Michael: So yeah, I think commercial lack of commercial understanding is quite interesting.
• 15:51
  Michael: But then that leads into stuff that we can help with, right?
• 15:54
  Michael: So for example, we're always getting asked questions on pricing.
• 15:57
  Michael: We're getting asked questions on should we do packages?
• 16:00
  Michael: We're getting asked questions on well, let's take just to pricing and packages, for example.
• 16:04
  Michael: I don't think anyone until we got into this industry and started advising people, I don't think anyone did tiered pricing.
• 16:09
  Michael: So, you know, I am uh just like a hairdresser does with a creative stylist director.
• 16:14
  Michael: I don't know, I don't really need headbuts anymore.
• 16:16
  Michael: But you know, you're you're a creative person at the top, and and Jane, who's just started two weeks ago and can barely work a pair of clippers, you have a pricing difference, differentiation.
• 16:25
  Michael: I never saw that when we when we came into the industry.
• 16:28
  Michael: So we have so much data and we've helped so many people kind of exploit that model that it works incredibly well.
• 16:34
  Michael: Another one is, and I was just discussing this with someone yesterday on Connect, the idea of an initial and follow-up appointment.
• 16:40
  Michael: You have someone who pays hypothetically£70 for an appointment, and then you say to them, for future appointments, don't need to worry about that, we're gonna charge you less.
• 16:49
  Michael: Why?
• 16:50
  Michael: They've already shown that they're willing to pay the 70 quid.
• 16:52
  Michael: And then the argument is, yeah, but we spend a bit more time.
• 16:55
  Michael: Yeah, so does everyone.
• 16:56
  Michael: Like if you get your hair coloured the first time, you spend more time.
• 17:00
  Michael: If you go and see a solicitor, you spend more time.
• 17:02
  Michael: So, and of course, where the real money is, is in the follow-up appointments, right?
• 17:06
  Michael: Follow-ups.
• 17:07
  Michael: People come back five times, three times, ten times, whatever.
• 17:10
  Michael: And so this idea that you have this um initial and follow-up thing, which by the way, I have yet to find another industry that does that.
• 17:18
  Michael: And so when we started tracking and measuring it, we used to see people like go,£70,£45, I want the£45 one.
• 17:26
  SPEAKER_01: Why do I need to patients book follow-ups because it's a cheaper appointment and it's shorter, oh, I only had half an hour, so I only booked that one.
• 17:33
  SPEAKER_01: Or they just drop off.
• 17:34
  Michael: Or they go, Well, actually, I don't want the hour appointment, I want the 20-minute appointment.
• 17:38
  Michael: So it's really interesting.
• 17:39
  Michael: And and these are all things that whether it's private pricing strategy, packaging strategy, which we're vehemently against, but that'll be another episode, I think.
• 17:49
  Michael: But it's measurement of results, right?
• 17:51
  Michael: The the you say to a new client that comes on board, okay, you do marketing, what do you spend?
• 17:56
  Michael: 500 pounds a month.
• 17:57
  Michael: How many patients does that get you?
• 17:59
  Michael: I don't know, but I got 1,300 clicks.
• 18:02
  Michael: I don't really give a shit about 1300 clicks, I can get you 3,000 clicks.
• 18:06
  Michael: I just advertise in Bangladesh, right?
• 18:08
  Michael: For a job, for a video, you get plenty of clicks.
• 18:11
  Michael: We care about patients, and it's it's again really surprising that clinic owners aren't doing proper measurement of I spent this much and this is my return.
• 18:20
  Michael: And you know, following on from that, I would say, what do you think?
• 18:24
  Michael: If you ask 100 clinic owners what their net profit was last year and what it might be this year, how many out of those hundred, what percentage would have the answer?
• 18:32
  Michael: Not a hand.
• 18:33
  SPEAKER_01: Nowhere.
• 18:33
  SPEAKER_01: They they'll have it on a record somewhere.
• 18:35
  SPEAKER_01: Um but it and I think that's the difference with with people who run businesses who are business people, who who who are entrepreneurs, who are trying to create wealth, you know, that they are very aware of the metrics at any given time.
• 18:48
  SPEAKER_01: There are only a few clinical, it tends to be, you know, bigger clinics, etc.
• 18:53
  SPEAKER_01: That that have developed that skill over time.
• 18:56
  SPEAKER_01: But the vast majority have no idea on basic business.
• 18:59
  Michael: But that's what I love actually.
• 19:00
  Michael: Uh and why I am so passionate about the industry, because I never forget this.
• 19:04
  Michael: I remember saying to someone very early on, oh, but if you did this, it will make you much more money.
• 19:09
  Michael: And they said, Yeah, but it won't improve patient outcome.
• 19:11
  SPEAKER_01: I was like, Yeah.
• 19:13
  Michael: It makes more money.
• 19:15
  Michael: And I actually learned like the majority of clinic owners are absolutely fantastic people.
• 19:21
  Michael: They're not particularly educated in commercial stuff, but that's where we can come in.
• 19:26
  Michael: We can help you or we can push you in the right direction, whether that's setting you up with a really good accounting firm or whatever the case may be.
• 19:32
  Michael: But I I don't want it to sound like um we're just being critical of of clinic owners because we're absolutely not.
• 19:38
  Michael: I think they do, the majority do an absolutely fantastic job in a very lonely place because again, the industry is very insular, no one wants to share anything or tell anyone anything, or um, and and they do a really great job in a very lonely place.
• 19:52
  Michael: And I think that what they really need is just a bit of support, whether that's us with marketing or or other agencies, there are other ones out there.
• 19:59
  Michael: Um For accountancy firms or business consultants.
• 20:02
  Michael: But it does all translate back into what we see when clinic owners come to us and they say, uh, I spend all this money, I don't know what results I get, I'm worried about marketing, I don't know if I should even be doing it.
• 20:15
  Michael: Uh and it it it's become quite a strain.
• 20:18
  Michael: Another good one, actually, is I know I really have to put more effort and more time into social media.
• 20:23
  Michael: Do you?
• 20:24
  unknown: Yeah.
• 20:26
  SPEAKER_01: It's probably the number one thing that gets asked, is sort of um, I know I don't do much social media.
• 20:32
  SPEAKER_01: And people breathe a sigh of relief when I'm like, okay.
• 20:34
  SPEAKER_01: You know that I I'm I'm really not that bothered by how much social media that you do, unless it is the one thing that you're not doing.
• 20:43
  SPEAKER_01: It's a glaring hole in your strategy.
• 20:46
  SPEAKER_01: I don't know why that's the number one thing that you mentioned anyway.
• 20:49
  SPEAKER_01: And it is in large part because of the popularity of the gurus in the in the industry and the methods that are out there, as the plug-and-play patient accelerator method for your clinic, 1200 patients in a month.
• 21:02
  SPEAKER_01: Like patient actually's got every red flag word, and it's it's so common that when people are just looking for you know how to market your clinic and and so that you're going to come across that stuff, it's gonna it's gonna sound attractive, but it's also gonna have an effect on your psyche so that you eventually feel guilty for not having done that much social media like that.
• 21:24
  SPEAKER_01: Of all the things you need to worry about in your daily clinic life and as the clinic owner, that is one of the least of your worries.
• 21:32
  SPEAKER_01: If that's Everen entering your headspace, I hope to God all the other things are ticked off, right?
• 21:39
  Michael: It's just crazy.
• 21:41
  Michael: When when people are like, Oh my god, I must do more social media.
• 21:43
  Michael: I was saying, I was asked, Do you follow your doctor or your dentist or your plumber?
• 21:47
  Michael: No, do you think people are gonna follow you?
• 21:48
  Michael: Yeah, but we're a bit different.
• 21:49
  Michael: Okay, tell me the most exciting thing that's happened in the last six months in your clinic.
• 21:53
  Michael: And they're like, I saw this torn ACL.
• 21:55
  Michael: Like, no one gives a crap.
• 21:57
  Michael: It's boring.
• 21:58
  SPEAKER_01: No, no one cares as much about physiotherapy or as physiotherapists or like chiropractic as chiropractors.
• 22:05
  SPEAKER_01: Like it's not you find it interesting.
• 22:08
  SPEAKER_01: You need to understand that you became a clinician because you found it interesting, right?
• 22:15
  SPEAKER_01: The majority of people out there do not care.
• 22:19
  SPEAKER_01: I d I I can remember coming out of uh, you know, I think I finished my master's at the time and and my dad had a uh bad day in and um like my opportunity to show him how much I know about osteoarthritis.
• 22:35
  SPEAKER_01: Like, he's funded by education.
• 22:37
  SPEAKER_01: Here is everything I know about osteoarthritis, dad.
• 22:40
  SPEAKER_01: And he just glazed over.
• 22:42
  SPEAKER_01: He could not give a shit.
• 22:43
  SPEAKER_01: He just cared that his knee hurt he wanted him to get better.
• 22:47
  SPEAKER_01: I'm going, yeah, I don't like you've got a lot of knowledge, and that's kind of impressive, to colleagues, to other professionals, to you.
• 22:56
  SPEAKER_01: You're the one who gives the most of a shit about that, and other professionals.
• 23:00
  SPEAKER_01: Quite honestly, most patients don't care where you went to uni, how many degrees you got, what your letters are after your name, all the CPD courses that you've ever done in the last 20 years.
• 23:10
  SPEAKER_01: No one gives a crap.
• 23:12
  SPEAKER_01: What they care about is can you help?
• 23:14
  SPEAKER_01: Right?
• 23:15
  SPEAKER_01: And they care about getting their problem better, and that's it.
• 23:18
  SPEAKER_01: If you went to the university of nowhere and you got them better, they won't care.
• 23:22
  Michael: And I I would say the majority of the time, you'll probably get more success if you're a nice person with terrible clinical ability than if you've got great clinical ability but you can't communicate it properly.
• 23:34
  SPEAKER_01: Yes.
• 23:34
  Michael: People by people and it's it's always a really interesting.
• 23:37
  Michael: So top tip is stop worrying about social media.
• 23:40
  Michael: Second tip is because we get the same thing about blogs.
• 23:42
  Michael: People are like, oh my god, I've got to do blogs, I've got to write blogs, and you read it.
• 23:46
  Michael: And it's like, I you know, I'm pretty knowledgeable about the industry now, but it's like a PubMed paper on steroids on on the on the websites where they start talking, yeah, anyone who uses muscoskeletal, like no one knows outside of uh physio what that means outside of the industry, but they'll say we are the top muscoskeletal clinic in the country.
• 24:05
  Michael: Well, I don't know what that means, so you could be saying anything.
• 24:08
  Michael: And I think that's that's another interesting point, actually, which is the that you have a lot of knowledge, but if a plumber spoke to you with the knowledge that they have about your heating system, or if we spoke to you about your website and started talking about JS and CSS and um Python and you'd get completely confused and flummoxed.
• 24:26
  Michael: The most important thing when you're communicat communicating with patients digitally is to make it really simple and non-clinical, and we see that a lot as well.
• 24:35
  Michael: Um, like you say, the other thing is no one cares about where you went to uni.
• 24:38
  Michael: When we're putting up a a staff profile and it's like got 14 paragraphs on their expertise, and it's like no one cares.
• 24:47
  Michael: They go, Yeah, they do, because they want to care, they they really need to know about like whether they're okay.
• 24:52
  Michael: Last time we went to the dentist, did you ask if he went to university or did you just assume he's been to univers?
• 24:58
  Michael: Yeah, you kind of assume they've been to university, you kind of assume that they have qualifications, right?
• 25:02
  Michael: Um, and it's it's it's definitely interesting to see, uh, and again, I don't want to take the piss out of clinical owners, um, because it's just not something that they're trained in doing, which is why it is so important not to DIY stuff, and again, whether you use us or anybody else, you can't be DIYing stuff, and you've got to get that outside advice.
• 25:21
  Michael: In the same way, I've got no idea how to even open an Excel spreadsheet and mind do a calculation.
• 25:25
  Michael: I don't touch business accounts, right?
• 25:27
  Michael: I've got an accountant for that.
• 25:29
  Michael: Uh okay, last thing, last one.
• 25:31
  Michael: I know we were talking a little bit about we've talked about this a lot.
• 25:34
  Michael: Number of clinics who are like, I don't do any marketing, but I do have magic words, word of mouth.
• 25:40
  Michael: How often do you hear that?
• 25:41
  SPEAKER_01: Uh well, every day.
• 25:42
  SPEAKER_01: I think there's a there's a few reasons why I don't think it's a bad answer.
• 25:48
  SPEAKER_01: There's a few reasons why it's obviously a bad answer.
• 25:50
  SPEAKER_01: You know, I don't all of our patients come through word of mouth, is the most common common thing.
• 25:55
  SPEAKER_01: And therefore we're successful.
• 25:56
  SPEAKER_01: To which I'm sort of the obvious rebuttal is well, you could still have all those patients through word of mouth, but then also have others.
• 26:04
  SPEAKER_01: That's entirely possible, and you just have a bigger, busier clinic, and importantly, you help more people.
• 26:08
  SPEAKER_01: I don't know, yeah.
• 26:09
  SPEAKER_01: Uh you know, there is a reliance on on word of mouth.
• 26:12
  SPEAKER_01: There's a lot of clinics out there that have existed in their local community for 20, 30 years, right?
• 26:16
  SPEAKER_01: Now, I I want to I want to give a shout out to those guys who have basically run a very successful local business for many, many years, often decades.
• 26:27
  SPEAKER_01: They sweep up the local uh market for anything physiology.
• 26:33
  SPEAKER_01: I come from a town like this, there's one physio clinic in 30 miles, they hoover up everything, right?
• 26:38
  SPEAKER_01: Uh they're not very good, but they they hoover up everything, and that's what they do.
• 26:42
  SPEAKER_01: And you know what?
• 26:42
  SPEAKER_01: They've been running that clinic successfully for 20, 30 years, and they do zero marketing.
• 26:47
  Michael: But I mean that's that's marketing in its own right to some extent.
• 26:51
  Michael: If you can corner a local market, make yourself incredibly present and visible, probably do some community work, community outreach, network with consultants and doctors, that in its own right is um incredible marketing, uh and and you've got to definitely commend those.
• 27:06
  Michael: I think the world's changed a little bit.
• 27:08
  SPEAKER_01: Yeah, it does now.
• 27:09
  Michael: When when people say, Well, listen, I I've always survived on word of mouth.
• 27:12
  Michael: Well, why are you talking to us then?
• 27:13
  SPEAKER_01: Well, yeah, one person used to be.
• 27:16
  Michael: Or I I think I survive on word of mouth, and normally the last words of every business has ever gone bankrupt.
• 27:23
  Michael: Because you've got to have control over your customer acquisition.
• 27:28
  Michael: If you don't have that control, it's actually very worrying.
• 27:30
  Michael: You know, one of the things I think from clinic owners that I've noticed, and and being a and having been a small business owner, you're constantly worried, right?
• 27:37
  Michael: You you get one little thing that goes wrong, you have one day of low revenue, and suddenly your business is falling over.
• 27:43
  Michael: And so you're constantly worried, you're constantly scared.
• 27:45
  Michael: And something that I found that worked incredibly well was to have a marketing strategy where I can just turn the tap on and off.
• 27:52
  Michael: So if August is a bit slow or January is a bit slower, I can just pump up those numbers a little bit.
• 27:57
  Michael: And it's also great for forecasting, right?
• 27:59
  Michael: Um, revenue and forecasting to have more of a flat route line rather than this up and down that you have no control over.
• 28:04
  Michael: So I think even those clinics that do do incredibly well with word of mouth, I think the world is changing a little bit.
• 28:09
  Michael: And beyond that, I think it's really important to have control over the over your numbers.
• 28:15
  SPEAKER_01: There's there's two things from that though.
• 28:17
  SPEAKER_01: Um the first is having diversified referral methods, which you're less at risk, right?
• 28:22
  SPEAKER_01: Um if all of your customers come to you from one consultant and that consultant takes three months off, you're screwed, right?
• 28:31
  SPEAKER_01: But if you have referrals coming in from 30 consultants and one consultant takes three months off, you're not going to see that big of an effect, right?
• 28:39
  SPEAKER_01: So diversified referral methods goes across all screen, all streams.
• 28:42
  SPEAKER_01: You want multiple different professionals referring to you, local clubs, local groups, local networking, social media, if you're doing it, people finding you in Google, organically, paid, like all these different streams, and especially some of them being paid, you can turn them up and down like you just mentioned.
• 28:59
  Michael: Uh, and and that's that's really, really Yeah, and I think that's a really good point.
• 29:03
  Michael: I think um that there was a client many years ago, she owned three clinics in a very small area um in the UK, and she dominated the area, and she came to us and she said, Look, I'm really struggling.
• 29:18
  Michael: Our numbers are down 60% over the last three months.
• 29:21
  Michael: So we were looking at him, we're thinking, what on earth's happened?
• 29:23
  Michael: And basically, it was a little sports therapist bod who was quite young.
• 29:26
  Michael: He bought himself a plinth and a Theragun and had taken all of the business.
• 29:30
  Michael: He knew how to market properly, he knew how to build a great website, he knew all the digital tricks and was very digitally savvy.
• 29:36
  Michael: And it was really interesting to see how quickly someone with those skills could infiltrate an impact, a local community by doing something new and innovative.
• 29:46
  Michael: Now, to be honest, he was not doing anything particularly interesting or clinically excellent, but you throw in a thorough gun, you throw in a few bits and bulbs, suddenly it becomes interesting.
• 29:56
  Michael: So you've got to present yourself as well.
• 29:58
  SPEAKER_01: There's different markets there because there are people that know about you, right?
• 30:01
  SPEAKER_01: But I g I guarantee, no matter the clinic, no matter how many people know about you, there are far, far orders of magnitude more people that don't, right?
• 30:12
  SPEAKER_01: So yeah, you might be the busiest clinic in your town.
• 30:16
  SPEAKER_01: People are still Googling who've never heard of you, right?
• 30:20
  SPEAKER_01: There's still a lot of those.
• 30:22
  SPEAKER_01: When you when you're when you're only, you know, you're you're just relying on word of mouth and and local brand awareness, you're just leaving a potential source of of more patients untapped.
• 30:33
  SPEAKER_01: And I think that's that's that to me makes zero sense.
• 30:37
  SPEAKER_01: A lot a lot of things recently that I've been speaking to clinical about, um, and it goes back to why they got into business.
• 30:43
  SPEAKER_01: You mentioned it before, you speak to them why'd they get into business?
• 30:46
  SPEAKER_01: They didn't do it to make money, otherwise, they'd charge more than they do.
• 30:49
  SPEAKER_01: They'd actually start charging what they're worth, right?
• 30:51
  SPEAKER_01: They did it to help people.
• 30:53
  SPEAKER_01: That's why they got into therapy, therapies in the first place.
• 30:56
  SPEAKER_01: They want to help people in pain.
• 30:58
  SPEAKER_01: And and what I'm constantly speaking to people about now is well, the goal then is to help more people in pain, right?
• 31:06
  SPEAKER_01: That's your goal.
• 31:07
  SPEAKER_01: Your goal is is not to help you get uh 30 new patients a month.
• 31:12
  SPEAKER_01: So you help 30 new people a month.
• 31:14
  SPEAKER_01: I want you to help 50 new people a month, right?
• 31:17
  SPEAKER_01: You're helping more people now.
• 31:19
  SPEAKER_01: Downstream of that, you'll also grow your revenue as a result of that, as a proxy.
• 31:24
  SPEAKER_01: But but realistically, you're also going to be helping more people.
• 31:27
  SPEAKER_01: If there's 30 people a month in your town that currently come to you for help, then I bet there's actually 90 in your town that could come to you for help.
• 31:36
  SPEAKER_01: So, how about we go help those people too?
• 31:38
  SPEAKER_01: And I and I think that works.
• 31:39
  SPEAKER_01: It's something that a lot of clinic owners they have to do this with their clinicians.
• 31:44
  SPEAKER_01: That's that's sort of one of the bits of advice I could give any clinic owner is your clinicians are super important.
• 31:50
  SPEAKER_01: They are the business, they are the product, and they need to be on board.
• 31:53
  SPEAKER_01: But nobody's gonna care about the business metrics, the profit margin, anything.
• 31:58
  SPEAKER_01: Nobody's gonna care about any of that as much as you do.
• 32:01
  SPEAKER_01: You're never gonna get your clinicians to care about that as much as you do because you pay the bills and the wages.
• 32:06
  SPEAKER_01: But you can get them to care as much about how you look after that local community, the care that you deliver, how much you help people.
• 32:14
  SPEAKER_01: That is something that they can all get buy-in for.
• 32:16
  SPEAKER_01: And that is something that if you do that bit properly, they will make you revenue anywhere, right?
• 32:22
  SPEAKER_01: They they they have to, because it we I want you to double the amount of people that you're helping.
• 32:26
  SPEAKER_01: Also means for the clinic owner, you're also going to double you the double the revenue that you bring.
• 32:30
  Michael: Yeah, I mean, I don't think any any staff or team member has ever gone, oh my god, our combined retention rate is only 3.6.
• 32:38
  SPEAKER_01: No one cares.
• 32:39
  Michael: Not a not a single employee will care as much.
• 32:42
  Michael: No one no one gives a shit.
• 32:43
  Michael: Um all right, talking of bits of advice, we've got stop worrying about blogs and social media so much.
• 32:48
  Michael: On social media, we had this idea about it the other day about how what you could do, you could spend a few days creating a really nice grid on, let's say, Instagram, so it looks fantastic, and then just leaving it, leaving it alone, and then maybe do 15 posts, whatever it might be, 18 posts, and then take the bottom three and just in uh put them at the top every quarter or something, so it sort of looks like things happen because no one goes all the way down on a on a on an Instagram basically.
• 33:12
  Michael: So that's one little tip.
• 33:14
  Michael: Um, but yeah, so don't worry about blogs too much, don't worry about social media.
• 33:18
  Michael: What other what other tips are we giving people?
• 33:21
  Michael: What what bits of advice?
• 33:23
  Michael: Well what one of the dates do you see and and so on?
• 33:26
  SPEAKER_01: I think number one number one for me, coming from a marketing perspective, is understand what you're doing and why you're doing it.
• 33:33
  SPEAKER_01: If you're going to do something, there better be a reason for doing it.
• 33:37
  SPEAKER_01: And this this is true of clinical practice, right?
• 33:39
  SPEAKER_01: I'm gonna give the patient this exercise.
• 33:41
  SPEAKER_01: Well, what you are doing is annoying him.
• 33:44
  SPEAKER_01: So there better be a reason why he has to do this thing that he doesn't want to do, right?
• 33:49
  SPEAKER_01: And the reason is, well, it's gonna get you better.
• 33:51
  SPEAKER_01: And so if you're gonna do some marketing, what is the goal?
• 33:54
  SPEAKER_01: Have that in mind, right?
• 33:56
  SPEAKER_01: Have that in mind and then measure against it.
• 33:58
  SPEAKER_01: Because there are two things that I see done all the time in clinics that really annoy me.
• 34:05
  SPEAKER_01: We're doing things and we don't know why.
• 34:07
  SPEAKER_01: We post on social media every day.
• 34:10
  SPEAKER_01: Why?
• 34:10
  SPEAKER_01: What does it bring you?
• 34:11
  SPEAKER_01: We do not know because we think we should.
• 34:14
  SPEAKER_01: So have a reason for doing things, but then measure the amount of people that and it there's not a lot of money in this industry.
• 34:21
  SPEAKER_01: It's not, it's not like um, you know, we're talking to clinical owners, it's not like talking to uh Coca-Cola's marketing director, and they're just like, oh, we'll just drop a few million on the World Cup and off for the best, right?
• 34:32
  SPEAKER_01: That's not the style of marketing that you're doing, and you don't have the revenue to do those things, you don't have the revenue to waste money.
• 34:40
  SPEAKER_01: And yet, when I say what did your marketing get you, and you say, I don't know, that's that's ridiculously dangerous.
• 34:49
  SPEAKER_01: Don't do that.
• 34:50
  Michael: Well, you are incredibly tight as well.
• 34:52
  Michael: So, you know, we'll often get asked, I've done this leaflet drop, or should I do this leaflet drop?
• 34:56
  Michael: It's only a thousand pounds.
• 34:58
  Michael: Okay, after you've paid your clinician, you've 50%, they're 50%, and you paid for consumables and you paid for XYZ, what does that thousand pounds leave you?
• 35:07
  Michael: About 200.
• 35:08
  Michael: Okay, so how many patients do you need to cover?
• 35:11
  Michael: Like, you know, it just doesn't make sense.
• 35:13
  Michael: And and I think it's really important to always measure that and think, okay, if I do this, what is the lifetime value of a patient?
• 35:18
  Michael: How much money does this genuinely bring me in?
• 35:21
  Michael: And my answer to every question always is when someone says, Should I do this?
• 35:26
  Michael: If it costs more than 100 pounds, unless you can measure it, the answer is no.
• 35:30
  Michael: Should I put an advert on the local bus?
• 35:32
  Michael: How much does it cost?
• 35:33
  Michael: A thousand pounds.
• 35:33
  Michael: Um, because you can't measure it, right?
• 35:36
  Michael: Imagine if you were seeing patients and and you couldn't, you were blindfolded and and you couldn't hear them and you just had to treat them.
• 35:43
  Michael: That's essentially what a lot of people are doing with their marketing.
• 35:46
  Michael: They can't see it, they can't hear it, they can't feel it, they don't know if it's working.
• 35:49
  Michael: And and also we get often someone will say, Oh, I I did my own Google Ads, uh, I started them in February, and it was incredible.
• 35:57
  Michael: They worked so well.
• 35:58
  Michael: Then in March and April, they just dropped off a cliff.
• 36:01
  Michael: And it's like, well, maybe February was just a good month, um, really, and the ads had nothing to do with it.
• 36:07
  Michael: And we see that all the time, right?
• 36:08
  Michael: Um, we always see people say, It's it's gone really well, but now it doesn't.
• 36:13
  Michael: Well, that you don't know.
• 36:14
  Michael: You it's cause causation, right?
• 36:16
  Michael: So you should know this just because you did something, because I guarantee you that month maybe people drank more green tea than normal.
• 36:22
  Michael: Was it green tea that impacted it?
• 36:24
  SPEAKER_01: And it's the same thing happens in the clinical world.
• 36:27
  SPEAKER_01: And when you relay it back to clinical pathways, people sort of get it.
• 36:30
  SPEAKER_01: Would you ever you're you're treating someone post-op knee replacement?
• 36:34
  SPEAKER_01: Would you stop measuring how far how much knee flexion they had?
• 36:37
  SPEAKER_01: Of course you wouldn't.
• 36:38
  SPEAKER_01: You would you you would you you're gonna measure that each session.
• 36:41
  SPEAKER_01: This is one of the basic metrics.
• 36:43
  SPEAKER_01: Are they making progress?
• 36:45
  SPEAKER_01: But people will will quite happily throw money away blindly and not track anything, which they would never dream of doing, clearly.
• 36:52
  Michael: Or believe crazy stuff.
• 36:53
  Michael: Like, did you know that um Netflix causes autism?
• 36:56
  Michael: Well, apparently Tylenol does, right?
• 37:00
  Michael: Because you can see autism rates increase, you can do pyllenol.
• 37:04
  Michael: Well, guess what?
• 37:04
  Michael: Netflix follows the same curve.
• 37:06
  Michael: Yeah, yeah, yeah.
• 37:07
  Michael: But it it it is really important that that people are tracking things properly, measuring things properly, because like you say, there isn't endless money, and every 500 pounds you're spending, that's real money to you, right?
• 37:18
  Michael: That's that's money you spend on kids' education or on holidays or at Christmas or whatever.
• 37:23
  Michael: If if you if you're Mercedes and you could drop a million quid without it hurting, not a problem, drop, drop the money, but you're real people, and I think it's often criminal when when I see other businesses within this industry, whatever that business is, it doesn't matter if it's a vendor or supplier, a marketing agency, whatever, those businesses that aren't tracking, they're taking money and they're not saying, okay, you've spent X amount of money, what have you benefited, and how have you benefited?
• 37:47
  Michael: Um, you know, it it's it's like I discovered a brand new business guru in the in the industry.
• 37:54
  Michael: And this guy, saying charging 500, I say only, charging 500 pounds a month.
• 37:58
  Michael: And when I spoke to the person, they'd been doing it for two years, and I said, What was your revenue on day one and what is your revenue today?
• 38:03
  Michael: And he said, Well, the same.
• 38:05
  Michael: I said, Well, why did you hire this person?
• 38:07
  Michael: Because I wanted more revenue.
• 38:08
  SPEAKER_01: Well, then you didn't achieve what you set out to achieve, which is why you need to set the goal at the start.
• 38:13
  Michael: Set the goal, figure out where you want to be and measure it.
• 38:16
  Michael: That's that's super important.
• 38:17
  Michael: What else have we got?
• 38:18
  SPEAKER_01: Um, I I I think a big one for me, and this is at the top of my head because it led to a really interesting.
• 38:25
  SPEAKER_01: I actually really enjoyed the conversation, but it ended up with a a little bit of a debate with a a customer, potential customer, about chasing uh pay perfect patients.
• 38:36
  SPEAKER_01: Um and it's something that comes up all the time, and I have really mixed feelings.
• 38:41
  SPEAKER_01: I do, because it he did make a lot of valid points.
• 38:44
  SPEAKER_01: I think if if you have a clinic that is super busy, this is perfectly true of podiatrists at the moment, my God, right?
• 38:52
  SPEAKER_01: Classic example where the diary is full, but it's full of things that I don't want to see.
• 38:57
  SPEAKER_01: It's routine fuck care, it's cut and come again, because there's so much of that right now in podiatry, there are honestly nowhere near enough podiatrists.
• 39:04
  SPEAKER_01: So, what I want is I want to replace that with the stuff that I do want to see, which is the MSK and the biomechanics and the stuff that really takes tickles my tickles my pickle.
• 39:15
  SPEAKER_01: Right, I get that.
• 39:16
  SPEAKER_01: But what you said was replace, and I'm gonna raise you the idea that you shouldn't replace, you should do it as well as, okay?
• 39:24
  SPEAKER_01: You should have a business that is seeing all that cut and come again, but is also doing the MSK stuff.
• 39:30
  SPEAKER_01: And if your interest is the MSK stuff, you should be giving the cut and come again to other people, and you should be doing the fancy stuff.
• 39:38
  SPEAKER_01: This is what I kind of like.
• 39:39
  Michael: We're gonna have a disagreement.
• 39:40
  Michael: So, um chasing the perfect patient, the patient avatar is a load of bullshit, and the majority of clinics should should be should be nowhere near it.
• 39:51
  Michael: Why?
• 39:51
  Michael: Because you take whatever injury, whatever issue you can get, because you need to get busy.
• 39:57
  Michael: So those people, and I remember one client.
• 40:00
  Michael: She was in Manchester and she said she really wants to treat windsurfers.
• 40:03
  Michael: I don't know how many fucking windsurfers there are in Manchester.
• 40:06
  Michael: Um, but I think it's probably not the right route to go down.
• 40:10
  Michael: And and you'll see it all the time.
• 40:11
  Michael: I had a a call with someone yesterday who um said, I just want to see runners.
• 40:15
  Michael: I only want to see semi-professional, professional runners.
• 40:18
  Michael: Well, I'm sure you do.
• 40:19
  Michael: I'd like to only deal with clinic owners who have got a million quid in their pockets, but that's not necessarily going to happen.
• 40:25
  Michael: So I think the perfect avatar thing and the perfect patient is a nonsense unless you are busy.
• 40:30
  Michael: But where I disagree with you, where I disagree with you is that practically you can't do as well as.
• 40:36
  Michael: So let's say you take your podiatry clinic, it's got five rooms, five podiatrists, and they're doing routine podiatry, and they're all at 75 quid, or if you're a podiatrist now they're charging 300 quid or whatever it is, because you're so busy, but it's all at that price.
• 40:49
  Michael: But you want to bring in a biomechanics or an MSK patient or a nail surgery patient where you know it's going to be three times the revenue, well, then you do replace.
• 40:56
  SPEAKER_01: I in those circumstances I completely agree.
• 40:58
  SPEAKER_01: And and that's a you know, these conversations they most commonly come up with with podiatrists.
• 41:03
  SPEAKER_01: The one where it got into the and I agree with all of that, by the way.
• 41:06
  SPEAKER_01: Where because also the different services that you offer have different levels of profitability.
• 41:11
  SPEAKER_01: There's a limit if you've only got five rooms and those five rooms are full five days a week, or however much you can staff them, you need to start filling them with the most profitable things.
• 41:20
  SPEAKER_01: Like, totally agree.
• 41:22
  SPEAKER_01: Um, this was actually uh a discussion with uh a physiotherapist um who just wants more of his perfect patients, actually.
• 41:30
  SPEAKER_01: Is your diary full?
• 41:31
  SPEAKER_01: No.
• 41:32
  SPEAKER_01: But I would like my diary to be full and full of these particular patients.
• 41:38
  SPEAKER_01: Okay, well, now you've got you've you've narrowed down the amount of people that you're gonna you're gonna help.
• 41:44
  SPEAKER_01: It's like you know, you've got a product that could help so many people, and you could sell as many of them as as you wanted to.
• 41:52
  SPEAKER_01: Let's say you've got a you've got a a frying pan, it's the best frying pan in the world, but aha, I'm only gonna sell my frying pan to left-handed people.
• 42:00
  SPEAKER_01: Why?
• 42:01
  SPEAKER_01: Right?
• 42:02
  SPEAKER_01: You've got a product that right-handed people can use.
• 42:04
  SPEAKER_01: You could sell them to right-handed people too too.
• 42:06
  SPEAKER_01: Why on earth would you limit your market like that?
• 42:09
  SPEAKER_01: It makes no sense.
• 42:10
  SPEAKER_01: You just sell more frying pants.
• 42:11
  Michael: If you're already incredibly profitable, then I don't see it's a problem.
• 42:15
  Michael: But that isn't the case for most clinics.
• 42:17
  Michael: They're teaching on profitability.
• 42:18
  Michael: You know, I'd say the average will know more with the private practice barometer, but I'd imagine the average clinic is making somewhere between 8 and 12% net profit after paying themselves a half decent wage.
• 42:28
  Michael: And I think that there are too many clinics that want to specialise in something, that want to just see this type of perfect patient.
• 42:35
  Michael: And unfortunately, I I very rarely see it work, partly because it's very difficult to become specialist.
• 42:42
  Michael: Two, if you do become a specialist, you need to put your prices up, right?
• 42:46
  Michael: Um, you can't be a specialist and then charge the same thing as everybody else because the cost of acquisition is higher.
• 42:52
  Michael: So if I only want to see post-op knee patients, well, that's fine.
• 42:56
  Michael: We can probably help you do that, but your acquisition cost is gonna be closer to£100 than to£20.
• 43:02
  Michael: Now, what difference does that make?
• 43:04
  Michael: Well, a huge amount of difference.
• 43:05
  Michael: So if you're not charging more money, you're not gonna get anywhere with it, and you're just gonna run at a loss.
• 43:10
  Michael: So I think I really do appreciate that some clinics want to focus on more profitable services.
• 43:17
  Michael: So, you know, that we're really, really busy, and I've just bought a focus shockwave.
• 43:21
  Michael: And oh, this is a terrible example.
• 43:23
  Michael: I just bought a focus shockwave, and I really want to use just the focus shockwave because I can charge more money.
• 43:28
  Michael: Let's not go into that.
• 43:29
  Michael: Anyone buying a focus shockwave?
• 43:31
  Michael: Oh my god.
• 43:31
  Michael: I'm gonna get some some.
• 43:33
  Michael: What are you talking about?
• 43:34
  Michael: What's wrong with my focus shockwave?
• 43:35
  Michael: Nothing as well.
• 43:36
  SPEAKER_01: Um, but it but it's a perfectly fine treatment.
• 43:40
  SPEAKER_01: There just aren't thousands of people looking for it.
• 43:42
  SPEAKER_01: That's all or needing it, let's be honest.
• 43:44
  Michael: Yeah, yeah, yeah.
• 43:45
  Michael: Um but in any case, I think that strategically it makes a lot of sense to choose patients that have a higher um revenue and profit level.
• 43:53
  Michael: An example would be most clinics, they go on about selling their sports massage, and you're like, Well, we're not really interested in marketing a sports massage because 50 quid, that patient might come back twice at most.
• 44:04
  Michael: You're paying 50%, you just made 50 quid.
• 44:06
  Michael: If we go and find you a neuropatient or a or a chronic sciatica patient or whatever it might be, your revenue is 800 pounds.
• 44:14
  Michael: Which one do you want for the same kind of cost?
• 44:16
  Michael: And so it strategically, I think it's important, but yeah, there's a lot of there's a lot of people wanting some weird and while kind of patients that are just I mean, we had one client that said, um, I still got it somewhere, who said, I want people who are a certain age, but they also have a certain outlook on life.
• 44:35
  Michael: We want them to be quite fashionable.
• 44:36
  Michael: We'd like them to have an open view on socioeconomic policies.
• 44:41
  Michael: And I'm like, what?
• 44:42
  Michael: This is worse than the windsurfer in Manchester.
• 44:44
  Michael: You know, let's just get Betty in, and I don't really care what her politics are, whether she likes people in Gaza or wants to let's not get into that, but I don't really care.
• 44:53
  Michael: She's a paying patient, right?
• 44:54
  SPEAKER_01: And I think at different stages of her business life, there can be different perfect patients.
• 44:59
  SPEAKER_01: You might eventually want to develop a niche, the clinic's busy enough, the clinic rooms are full, they're staffed all the time, you can't fit more people in any way, fine.
• 45:07
  SPEAKER_01: But when you're just starting out, your clinical interest may well be really semi-professional runners.
• 45:13
  SPEAKER_01: But it's quite simply, on your way to just doing that, you're gonna have to treat lots of people that you don't want to treat.
• 45:19
  SPEAKER_01: I'm very, very sorry.
• 45:20
  SPEAKER_01: But that it's a numbers game at the end of the day.
• 45:22
  SPEAKER_01: There are far more people that you don't.
• 45:24
  SPEAKER_01: Uh early on in a in a in a in a clinic's lifetime, the perfect patient is someone who pays at the end of the session.
• 45:30
  SPEAKER_01: That's the perfect patient, right?
• 45:32
  SPEAKER_01: If you can fill your diary with people who pay you at the end of the session, you're done, right?
• 45:36
  SPEAKER_01: Yeah, that's it.
• 45:36
  SPEAKER_01: You've grew your clinic well done.
• 45:38
  SPEAKER_01: Right now you can start to think about well, actually, I would like to see a little bit less of this and a little bit more of this, and therefore I'm gonna do this with my branding.
• 45:46
  SPEAKER_01: Good idea, right?
• 45:48
  SPEAKER_01: But for the time being, let's just let's just make it so that you can pay yourself and live a comfortable lifestyle.
• 45:54
  Michael: And on that note, we're we're doing all right.
• 45:55
  Michael: So now if you're a clinic owner with a five million pound plus revenue clinic, loads of money, ideally good looking, give me a shout.
• 46:02
  Michael: But yeah, but and you don't moan much.
• 46:04
  Michael: Uh yeah, you can choose choose clients.
• 46:06
  Michael: We I wish we could choose some clients sometimes.
• 46:09
  SPEAKER_01: Well, we do actually Well, we do we we do to a certain extent, yeah.
• 46:13
  Michael: Well, there was uh there was an interesting one where I'd really be careful.
• 46:17
  Michael: But it wasn't non-identifiable, non-identifiable.
• 46:21
  Michael: We tried making me sign an NDA, and often when someone says, I want you to send an NDA, sign one.
• 46:27
  Michael: I my answer is always no.
• 46:28
  Michael: And they say, Yeah, but you've never seen an idea like this before, and you go, just tell me, and they're like, We're getting a shockwave.
• 46:33
  Michael: Um but this this this one in particular um was doing a course.
• 46:37
  Michael: Don't know if I told you the story, they were doing a course and they were gonna sell it for uh£150, and it was gonna generate 7 million in the first year.
• 46:47
  Michael: So I was like, interesting.
• 46:48
  Michael: How what's your marketing budget?
• 46:50
  Michael: And they said uh oh, it's like£1,500.
• 46:52
  Michael: And I was like, Well, if I could turn£1,500 into£7 million, I probably wouldn't be talking to you.
• 46:57
  Michael: But I asked them what the idea was, and Hannah at the time was sitting uh just to my side, and they said it's a video on teaching parents how to self-adjust their babies' necks.
• 47:07
  Michael: And all I heard from the side was Hannah saying, A cough.
• 47:10
  Michael: And I was like, No, like what's that?
• 47:11
  Michael: I was like, nothing.
• 47:12
  Michael: And my spring to a solicitor, they were like, No, what?
• 47:16
  Michael: Yeah, we we we turn those guys down.
• 47:18
  SPEAKER_01: Yeah.
• 47:19
  Michael: We get a lot of fun, we get a lot of fun kooky stuff.
• 47:22
  Michael: The the Mar and our cancellor.
• 47:24
  Michael: Um that's too identifiable.
• 47:27
  Michael: Yeah, anyway.
• 47:28
  Michael: Right, we are at longer than our normal podcast.
• 47:30
  Michael: We've had a good little chat.
• 47:32
  Michael: I'm sure we'll talk a little bit more on some other topics at some point.
• 47:36
  Michael: Is there anything we want to just finish off with?
• 47:38
  Michael: We got our basic tips.
• 47:39
  Michael: Stop worrying about social media, focus on tracking, make sure you're measuring things, make sure, you know, understand that you're not commercial, just like I am not clinical.
• 47:48
  Michael: I don't rub myself better.
• 47:50
  Michael: You know, go and find professionals who are actual and help you.
• 47:54
  Michael: There is no there is no sun cost in getting a great accountancy firm, for example.
• 47:57
  Michael: Find a good accountant and someone who's proactive for you, find a good marketing agency, whoever that may be, obviously, you know, give us a shout.
• 48:05
  SPEAKER_01: But be be be as commercial as you can and think about where you as the clinic owner need to best spend your time.
• 48:14
  SPEAKER_01: Um, I think is is is is one of the one of the things.
• 48:17
  SPEAKER_01: There are certain things that we've drew on, you know, nobody's gonna care as much about the profit and loss as you will, right?
• 48:23
  SPEAKER_01: So therefore, when someone's looking at the profit and loss, it probably does need to be you.
• 48:27
  SPEAKER_01: However, one of your clinicians will be able to do a really simple social media post as well as you can, therefore, probably let them do it.
• 48:34
  SPEAKER_01: You know, you've only got so much time in your week, prioritize what you want to spend the time on and outsource what you don't, outsource it within the team, outsource it to other agencies, accountancy being a classic example, marketing, whatever it is, but spend your time doing the things that you need to be spending on.
• 48:50
  Michael: That's a really good point, actually, is in sourcing are always clinicians who have an interest in something.
• 48:56
  Michael: And I found that most clinics, when they ask, they find that someone's willing to do something, whether it's putting some graphics together or it could be anything, but definitely think about what your team can do internally because quite often they enjoy it.
• 49:07
  Michael: One point I want to pick up on, which is a big, big one, which is about spending your time wisely.
• 49:13
  Michael: We have seen an increase in the number of clinic owners who have I know what you're gonna say.
• 49:19
  Michael: You have decided that they need to spend more time on their business and less time clinically.
• 49:24
  Michael: That's fine if you do it incredibly strategically, if you really think through the consequences and you have a plan as to how you do it over a six month to a year period.
• 49:37
  Michael: We have had a number of people come to us who have decided to step back from clinical life and focus on strategy and business and so on.
• 49:47
  Michael: It's very rare that when we see that, that they make the same kind of revenue as they did before.
• 49:54
  Michael: And often the reason they're coming to us is our numbers are dropping, our revenue is dropping, I don't know why.
• 50:01
  Michael: Can you help?
• 50:02
  Michael: And when we explore it and we peel the onion a bit, we realise that they were doing 60 or 70% of the clinic's revenue.
• 50:08
  Michael: They have stepped back, hired some new clinicians, normally cheap ones who aren't particularly experienced, and they wonder why the numbers have dropped.
• 50:17
  SPEAKER_01: It's it's something that I think it's really tough because it like I said, nobody cares about the business as much as you care about the business, and therefore it's hard to get anybody else in to run the business.
• 50:28
  SPEAKER_01: But also, the clinic owner is usually the best, most experienced clinician in the team.
• 50:35
  SPEAKER_01: And the highest owner.
• 50:37
  SPEAKER_01: That does the best, the best with the patients, that highest has the highest retention, that has the highest session average, that has the highest profitability.
• 50:44
  Michael: Also, so that has a hundred percent of the revenue versus paying, particularly if they're on uh on contract, rather than 50%.
• 50:52
  Michael: So just think about that.
• 50:53
  Michael: If you're gonna move away, then if you are seeing 100 patients a month, someone else has to see 200 to get even close to what you were generating before.
• 51:02
  Michael: Um, it's something we've seen a lot of, and it's it's something that we've seen damage quite a few clinics um and and cause certain struggles.
• 51:09
  Michael: It's rectified, just go back and do some more clinic work.
• 51:12
  Michael: But that's definitely a another tip.
• 51:14
  Michael: We could probably go on all day about things we see, and um that would make a make a great podcast series, really.
• 51:20
  SPEAKER_01: Things we've seen that sunk the business, you know.
• 51:23
  SPEAKER_01: It's just a whole series of what seem on the surface as rather simple mistakes would have led to a complete collapse of a business.
• 51:30
  SPEAKER_01: Like I know people often too many disasters now, really.
• 51:34
  Michael: People often accuse me of being bulshy and polemic and whatever.
• 51:37
  Michael: I I find it very difficult because I could definitely pick out 20, 30 things I've seen in the last six months, but the problem is I I don't ever want to call people out.
• 51:46
  Michael: I very rarely ever call anyone out by name or or or want to um criticize too much.
• 51:52
  Michael: Um unless it's really egregious.
• 51:54
  Michael: Yeah, that there's a lot we see, but unfortunately, I think we just have to be careful because I don't want to make anyone feel bad.
• 51:59
  Michael: I think what I might do is with some of them invite them on podcasts and have a chat about what their biggest mistake was.
• 52:06
  Michael: That could be interesting if they're yeah, if they're willing to do it.
• 52:09
  Michael: So maybe that's a bit of a series we can do.
• 52:11
  Michael: Right.
• 52:12
  Michael: Listen, thank you very much.
• 52:13
  Michael: Get back to bloody work.
• 52:14
  Michael: It's been it's been kind of interesting.
• 52:16
  Michael: This is work.
• 52:18
  Michael: What are you talking about?
• 52:19
  Michael: If anyone has any questions, Mark, then throw them at mark at hmdg.co.uk.
• 52:24
  Michael: Normally he gets questions like how the fuck did you get out of being a clinician and how can I do it?
• 52:30
  Michael: Uh I can get Michael really drunk and sign a contract.
• 52:34
  Michael: But anyone who does have questions for Mark, throw them at him at Mark at HMDG.
• 52:39
  Michael: Um he's always interesting and interested in having a latter.
• 52:41
  Michael: Otherwise, thank you very much and till next time.