Latest / The Elite Nurse Practitioner Show / Episode 228 - The Business Questions Every NP Should Ask

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Episode 228 - The Business Questions Every NP Should Ask · The Elite Nurse Practitioner Show

• 0:02
  Greetings. This is Justin Allan, the elite nurse practitioner. Welcome to the Elite Nurse Practitioner Show podcast dedicated to nurse practitioner entrepreneurism and achieving financial freedom, where I talk directly with nurse practitioners who need help. Listen up. Our market is saturated. Jobs can be scarce. are underpaid. We are undervalued. We are taking advantage of by the sharks within the health care system. And frankly, screw that. Sick of it? It's time for a change. And listen, I'm here to help make that happen. We are powerful. We can forge a path, and we are in control of our career and ultimately our financial and personal well-being.
• 0:40
  You do not need to submit to health care administrators and your doctor overlords. You do not have to take the measly salary. You do not have to work 50 to 60 hours a week. There is a different way, and I'm here to show you that path. This podcast is broad, unfiltered. I have not talked with the nurse practitioners of the podcast prior to the call sign of an email exchange to schedule the episode. What you're about to listen to is a consultation session between a nurse practitioner and myself. It is real, it is unscripted, it is unplanned, and I have no idea what we're going to talk about. Anything and everything can happen during our conversation. The nurse practitioners in these episodes are struggling with an issue in their professional or financial life, and they have reached out to me for help. My goal is to help the nurse practitioner with actionable advice that will enhance and improve their professional, business and financial life. My other goal is to hopefully help my practitioner, sisters and brothers build a more productive, powerful and free life. So I hope the content information within these podcast episodes does just that. All right, on to the episode. Everyone. Justin, along with the nurse practitioner, welcome to the Elite AMP show. Today's episode is going to be a solo episode with me. Um, basically just answering some of your questions. So I've asked some folks kind of, you know, what questions they want me to answer. And I've used a few of the frequent questions that have ever been asked to me. And so moving forward, I'm going to be doing one of these episodes every once in a while. So if you have a question for me, you don't want to be on the show, but you just maybe have one question for me. Email me Justin at Elite Comm and I will compile your questions. Once I get to about 8 to 10 questions, I'll do an episode. So if you have a question for me, email me Justin Elite. Com and if you're interested in being on the show, if you need help, email me to Justin. Let's get a episode schedule. So let's go ahead and get into the questions that some of you have asked me. So first question, my practice is doing okay, but I feel like I've hit a ceiling. How do I know what I should focus on next to actually grow?
• 2:48
  Difficult question to answer without knowing some context there, but I'm going to answer it more from a high level, just from a general ality. Okay, so you have to diagnose your bottleneck first.
• 2:59
  Okay. What's preventing you from growing?
• 3:06
  Why are you at a ceiling? Usually there's some kind of identifiable problem in your practice that's preventing you from, you know, reaching past this ceiling from getting past this plateau. It can be a variety of different reasons. Okay. Typically it's going to be patient acquisition.
• 3:25
  Right. You just have low patient volume. You just reach this plateau. Where's you know your turnover rate equals your new acquisition rate. Right. Let's say you have a patient churn rate of 5%. And then you have a new patient volume of 5%, basically an increase of 5% every month. So if you lose five patients but you gain five patients, you're just basically at a standstill, right? Well how do you fix that? Typically there's going to be a marketing thing. Like I've said before in other episodes, Your biggest priority as a practice owner is to ensure your extracting as many warm and hot leads as you possibly can. Okay. You have to ensure that people can find you easily. Go to Google and User and use the keyword Planner. It is a free tool for just use Gemini or ChatGPT. Write and ask what are the most frequent keywords that revolve around your practice's niche being searched for in my area and figure out what people are asking about, and then just ensure that your Google business listing addresses that. Make sure your website addresses that through consistent content, and just make sure people can find you easily. Okay, this is just a general SEO strategy. Having lots of content on your website and just making sure you your, you know, your Google Business listing is completely optimized and dialed in. All right. Um, also another bottleneck, uh, that prevents you from growing. Getting past the ceiling is capacity. Do you have the capacity to see patients? You know, a rule of thumb is that you're booking out 2 to 4 weeks in advance. It's probably time to hire another provider. Okay, you've reached your capacity. People in the cash based niche wellness space. Basically, your patients are looking for solutions. Quick. They don't want to wait. All right, so if you are booking out more than two weeks in advance, then you've reached your capacity. All right. It's time to hire another NTP or put more hours into your business. Okay. And then also just retention. Remember this rule of thumb. With a business, it is always cheaper and easier to keep your already established customers or sell your established customers more things than to acquire new customers. Okay.
• 5:49
  It's always cheaper. It's always more effective. So do what you have to do to increase the lifetime value of every single patient that you have. Sell them on more services and products and do whatever you have to do to. Maintain your patient base. Reduce patient churn.
• 6:08
  Reduce patient turnover. And how do you do that? By being competitively priced, by offering a good experience, by providing good customer service. Right. If a patient wants to leave. Ask them why.
• 6:21
  Why are patients leaving and then address that problem? Um, I think I've said this story before, but like I've had a patient before who, um, was just having some issues at work, he got laid off and he was just in a real financial pinch. And he was a patient with us for 2 or 3 years, maybe even more. And he was just like, I'm gonna have to cancel my subscription. You know, thanks, guys, for helping whatever he was, you know, super kind about it. Super polite and it to me, it was just like, what can you afford, man?
• 6:58
  And he could afford like, it was like 50 bucks a month or something like that. Like, basically it was like covering our cost. And. Okay, fine. If I can keep you as a patient, then it's worth it. It took him about 2 to 3 months to get back on his feet. And guess what?
• 7:15
  Boom! He kept paying us again. The, you know, the normal price. So you have to do little things like that sometimes to retain some of your customers. Okay. Um, and you also need to identify the 20% of services that truly drive your revenue. Okay.
• 7:33
  Stop doing random things. Identify what is going to be a high revenue stream vertical within your business. Okay. What are some where are the higher ticket things? What are the things that are mostly in demand? What are the things that have the highest margin on it? Focus on those things. You do those things right there. You should hopefully get past the ceiling. All right. Okay.
• 7:56
  Number two, it's another question. At what point should I hire another provider instead of just seeing more patients myself? Two week rule. All right. 3 to 4 max. If you are booking out more than 2 to 4 weeks, it is time to hire another provider. All right.
• 8:14
  You've reached your capacity. Essentially, if you are finding yourself doing more busy BS work than actual income generating work, it's time to hire another provider. Okay. Look at the economics of your business. If you are generating, you know, a healthy profit, but yet you're just killing yourself. Invest some of those profits into your business by hiring another provider. Okay. You need to free yourself so you can work on the business versus in the business you want to work on marketing. You want to work on growth. You want to work on increasing patient acquisition. All right. And ultimately you want to hire someone before you're just completely overwhelmed and burned out. If you are burned out, sometimes this will work against you. You're so burned out, you just don't have the energy to hire someone. Or if you do begin hiring someone, you're so burned out, you're so desperate you begin making bad decisions on who you hire, right?
• 9:13
  The quality of the provider that you hire is extremely important. You do not want to hire someone who's going to be a thorn in your side, basically, right? You need to hire someone that aligns with the culture of your business. Someone who you basically vibe with, right? Someone you can shoot this with. Someone that has a general practice philosophy similar to yours. Like I do not hire people who are really goody good, you know?
• 9:44
  Goody good. Follow the guideline kind of providers. I don't hire those kinds of people because they are thorn in my side. They do not make me money. They bitch and complain about everything. Um, they're just not worth it. I'd much rather have someone who's willing take a little bit of a risk.
• 9:59
  Right. Okay. Next question. I feel like I'm constantly busy, but my revenue isn't really increasing. What am I probably doing wrong? So I feel like I'm constantly busy, but my revenue isn't really increasing. What am I probably doing wrong? You are not focusing on income generating activities. That's probably what it is. You are focused more on the busy work nonsense. Always ask yourself this question in your business. Is this an income generating activity?
• 10:37
  Is what I'm getting ready to do or what I'm doing? Is this going to help me generate revenue? Am I working on building a new product? Am I working on integrating a new service line into my practice?
• 10:47
  Am I seeing patients? Am I marketing? Am I doing the things that increases my bottom line? Am I doing the things that increases the revenue in my business? If you are not, you are probably doing busy work. You are stuck in analysis paralysis, overload, paralysis, and you are just focusing on things that truly just don't really matter in your business. All right. That's probably the reason why you feel busy, but you're not making any kind of money, all right. You can get stuck doing busy work in your business. I am guilty of this as well. Right? Uh, I'm working on a new project right now, and I find myself really focusing on too many details.
• 11:33
  Um, I'll let everyone know what this is. You'll probably see it when I. When I begin advertising it, but, um. Yeah, I find myself. I found myself today for almost four hours working on this protocol, and I was just like, dude, it's good enough. Like, it accomplishes the job. Move on to the next protocol. Right. Um, so even I'm guilty of it. Okay. It is one of those things that happens to all entrepreneurs who are detail oriented. But you have to try to push past those impulses, those instincts inside you that tell you to work on these things that truly just don't matter. Right? You want to not be self-employed. You want to be an entrepreneur. The self-employed individual will work their out off while not making any more money. That's not what you want to do, okay? You need to delegate the tasks that are not income generating okay. Delegate as much as you possibly can in your business. Vas, medical assistance, AI automations, whatever. Okay, do a audit on your week. Literally. Just sit down, write it on a piece of paper. Create a note in your phone. Dictate what it is that you're doing. All right.
• 12:55
  Going to ChatGPT. Okay. Here's a here's a suggestion. Go into ChatGPT. Create a new project file and just name it. Why am I wasting time in my business? Okay. That's it. Download the app and explain to it that what I'm doing is I'm trying. I'm trying to do an audit of what I'm wasting time on in my business for one week. I will be dictating and transcribing little notes here or there throughout the day on what I'm doing, and I want you to then tabulate all of these over a period of a week. So that way we can identify what what are the time scenes in my business. Okay. And then for one week just open your phone up, click dictate. And I guess this is what I'm doing. I'm sitting here, uh, charting on this patient, or I'm sitting here fooling around with my website, or I'm sitting here dicking around with templates in my EMR, whatever it is.
• 13:44
  All right. At the end of the week, tabulate them all and see what you're wasting time on. You might be amazed that you're wasting hours of your week just doing just absolute nonsense. All right.
• 13:56
  Okay. Next question. If you were starting a cash pay practice from zero today, what would you spend your first $10,000 on? Well, I used to be able to start a cash based practice for, like, five grand, you know, 3 or 4 years ago. Now it's probably gonna be more closer to ten, possibly even closer to, like, 20. All right. If you want to, like, really invest in it. Um, that's kind of one of the new businesses that I'm getting ready to launch is going to be a practice startup thing that's very low cost.
• 14:35
  Um, but what would I spend $10,000 on if I was starting a cash pay practice from zero today? Number one is the leanest startup, Leanest setup I could possibly get away with. I would utilize AI to build my website out for me to build out my marketing ad assets, to do as much as I possibly could do through AI. Okay, that would say it that right back that right there is going to save a few thousand bucks. Okay. Um, I would then identify what systems I need at the lowest potential cost I could get away with. Um, really depends on what service line I was going to offer. Right. I mean, if I was doing HRT or weight loss or any one of these standard cash, you know, niche based services, um, I realize now that you don't I don't need very many patients to really generate a profit. 50 patients, 100 patients.
• 15:33
  And you're probably doing pretty well, right? So I'd probably completely skip anymore. I'd probably just use Google Docs, and I would just save everything in a Google Drive and just find some little scheduling app or something to schedule patients on and just leave it at that spot. What I would do, Practically free. It would have to be a brick and mortar practice. Tell them it only can be difficult to scale unless you're doing something very high. Ticket. Um, and so I'd probably just find some really cheap office chair, sort of a thing that's 500 to $1000 a month, and I'd probably pop, you know, three months worth of, uh, rent at it. Um, marketing.
• 16:10
  I would not spend a dollar on marketing it at first. I would just launch my Google business listing, make sure my website's solid, make sure the SEO is there. Um, yeah, I think that would probably end up costing me something like 7 or 8000 bucks. I still have a couple thousand dollars left over for just overhead stuff. Um, that's probably why I'd spend the$10,000 on. And that wasn't a very specific answer, because, I mean, there's not one thing I'd spend$10,000 on, right? Uh, I would spend the money, basically, where the return on investment is for both my time and my money, and that is just producing. And that's just utilizing the lowest cost thing that can get away with. Because ultimately, at the end of the day, for a practice to succeed, you need to accomplish two things. Really. I need to generate money and I need to see patients. So what are the things that I need to do to generate money and to see patients? Everything else is noise, right? Um, so yeah, not a very specific answer, but it's kind of hard to say what I spend exactly $10,000 on, but I think that's pretty much what I would do. Yeah.
• 17:20
  Okay. Next question. How much money should I actually be putting back into my practice instead of paying myself? Um, I don't really have a specific answer to that because I don't know where where the growth levers are in your business. But in general, generally speaking, here. Okay, you should be investing roughly 25% of your profits back into your business. Okay. You always need to be investing money back into your business to grow it. And, well, you know, what do I spend that money on? Right. Um.
• 17:57
  Marketing. All right. If you want to expand your reach, do some Google ads, get legit script certified. Do some meta ads. Um, have a billboard. You know, something like that. It's usually worth to give it a shot. Sometimes it works very well. Sometimes it's a complete waste of money. You don't really know. That's the problem with marketing. There's no guarantees. Okay. Um, people systems.
• 18:25
  That's usually a good growth lever. A hiring staff and hiring other providers is usually the largest investment you're going to make into your business. Right. Having the right people in your business will change the trajectory of your business. Having the right people will allow you to focus on what matters in your business, and that's growing in generating income and not doing the busy work. Okay, so putting the appropriate money into other providers. Having a solid office manager, you know, those are usually good investments. Um, and really I guess what it would come down to, you know, how much money should I actually be putting back into my practice that are paying myself? That ultimately comes down to what your personal financial situation is like. You know, I mean, if you're living way above your means, you're just not going to really have a whole lot of money to put back into your business.
• 19:23
  So a good rule of thumb with profit management in your in your business, just in general practice, it doesn't matter what kind of business it is. Um, your profit. Right.
• 19:37
  You know, for most practices your margin is going to be anywhere between 40 to 50%. So if you make$100, you pocket 50, right? This is for simple math here. So you make $100. You make. So if you bring$100 of revenue, you make 50 bucks. That's your profit. Out of that profit, 25% needs to go towards reinvestment back into your business. Okay. So 25% of, uh, a 50 is what, like 12.5, something like that, $12.50. So what you have left over okay is essentially now your actual true net profit. From that. You want to put about 30% to the side for taxes. All right. Just so that way you're not surprised at the end of the year okay. And then whatever's left from there that's actually what you take home. And that's the amount of money that you need to just get used to living off of. Right. That's the easiest, realest way to manage profit in your business. All right. I'm not going to sugarcoat it. That's just that's the easiest way to do it. All right. If you want to grow your business, if you don't want to grow your business, if you don't want to grow your practice, then don't invest a dollar into it. I know plenty of people who just get content with what they're making in their business, and they say, you know, word of mouth is doing pretty good and we're slowly growing month to month. You know, we get five people who turn over every month, but we get like 6 or 7 new patients. So, you know, we're getting 1 or 2 new patients a month. This is fine. I'm not spending a dollar marketing. I'm happy seeing the patients myself. I got one medical assistant in the hill helping me out or whatever.
• 21:20
  I know people like that, and there's literally nothing wrong with that whatsoever. If that's the case, then maybe just save like 5 or 10% for just a rainy day and then just keep the rest. A lot of people do that. Right. Okay. Next question. Everyone says I need multiple revenue streams. Should I keep adding services? It depends.
• 21:45
  Um, is the service complimentary to your overall service line?
• 21:52
  If it's not, no. Okay. Just don't add services to add services that don't even compliment your, you know, your base services. Right. Like, don't offer Suboxone if you're doing a hormone replacement therapy. It just doesn't make any sense. You know doing hormone replacement therapy and you want to do vitamin injections. Sure. That complements it. Right. So the question is, is are the new services or is the new service that I want to integrate into my practice.
• 22:23
  Will there be demand for that service from my established patients? And can I sell them on it? If the answer is yes, even a small percentage. I mean, depending on, you know, what kind of service line it is, if it's a very high ticket, 101 or 2% buy. Okay, cool. It's worthwhile if it's a low ticket one like a bit of an injection or something. Well, 2,530% bite. Cool. It's probably worth it, right? You just have to do a little bit of a cost analysis on it, you know, how much money does it cost you to learn the new skill, to integrate the new service into your practice? Like there's always an investment into a new service, right? You always have to invest some money to integrate a new service into your practice. Typically, um, is there going to be a return on that, that there is then by all means at it. Okay. But complexity does destroy scalability. Okay. You don't want to make your business too complex. The best business is a simple business, right? Um, a cheap business is a business that's cheaply closed. You invest $100,000 in your business. It's going to be pretty hard to close that thing down, right? If you invest ten grand into it, it's not the end of the world. It's not really that big of a deal. Okay, um, But you do want to focus on increasing the lifetime value of every single customer. Okay. Without becoming everything to everyone. We all fall into this trap. I have probably most practice owners have. You begin trying to do too much because you're just grasping at straws, trying to figure out what that one thing is that truly is going to move the dial in your business. Okay. Some things can truly move the dial in your business and other things can't. All right. So, um, so just keep that in mind. Okay. Sometimes it's worthwhile to integrate a new service into your practice that complements it. If it's high ticket, the margin is really high. It's probably worth it, right? If you're just integrating stuff into it, trying to figure out what's working, then you are still you're just doing you're doing too much and there's something else wrong with your business. Basically, you're just trying to offer so many different things to see what hits something is wrong. All right. All right.
• 24:40
  Next question. What's the difference? What's the biggest difference between the practices that stay at 2 to $300,000 a year and the ones that get to seven figures? Number one is owner mentality. Okay. You have to develop a little bit of a thick skin, right? You have to ignore noise.
• 25:06
  Some months are going to be really good. Some months are going to be bad. It's just noise. It's just like investing in the stock market, right? If you look at your portfolio every single day, you're just going to get you're going to go crazy with the noise. Some days you're up 3%, some days you're down 5%. Whatever. Right. So the mentality of the practice owner is where they can ignore the noise and they can focus on their mission and their objective.
• 25:38
  They remain consistent with the business. They're following the rules, right? They're investing 25% back in their business. They're always focused on growing it. They have more of an abundance mindset okay. They realize that they can make as much money as they want if they put the effort and work into it, as long as they're doing it the right way. Okay. Um, you know, they're focused on marketing. They're focused on new patient acquisition at all times. They're focused on increasing the lifetime value of every single customer. They want to retain their customers at all costs. They want to sell as many things as they possibly can to their established customers.
• 26:20
  Right. Recurrent revenue. They're focused on recurrent revenue versus one time, you know, said and done kind of services. That's why I'm such a fan of subscription based pricing. Right.
• 26:32
  Subscriptions, memberships, packages, those sorts of things. Um, I just create a new course about that, too. I just just remembered, I don't know, should be releasing it soon, but you know how to create packages, how to create memberships, how to create, you know, create subscriptions and stuff. You need to understand how to do that for recurrent revenue. Recurrent revenue compounds month after month after month. All right. That's how you slowly grow it. Then you eventually get to an inflection point where it just takes off. It just compounds exponentially. Okay. Um, the people who get passed through $300,000 a year are very rarely a solo provider practice very rarely. They usually have other providers and they usually have staff. Okay, I don't know.
• 27:19
  I don't know if I've ever talked to an NP who who has $1 million business who just does it by themselves. I don't think I have, I think every single one has some staff. They at least have a receptionist in a V. I had a medical assistant or something. Okay. Most of them have other providers seeing patients for them. Okay. They have systems in place, standard operating procedures, those sorts of things. Those those those growth levers, they're willing to reinvest money back into their business. That 25% rule, they had the capacity to see new patients.
• 27:50
  There's no 2 to 3 four week waits. The patient call they can get them in same week typically. All right. And more than anything, the biggest difference between the practices that say, at 2 or$300,000 a year and the ones that get to $1 million. Ultimately, it comes down to just being patient. Really, very few businesses hit $1 million in revenue in the first 2 to 3 years. Very few. Um, unless you just have a unicorn, which happens. It's happening has happened to me. You know, I know people who it's happened to, but it's it's it's rare. All right. So from most of the practices that I've sold and people that I've consulted with who do $1 million plus a year. It usually takes 4 to 5 years to get to that point. They're patient and they just keep grinding and they keep hustling, right?
• 28:46
  That's what it comes down to. And ultimately sprinkle some luck on top of it too. Like you just gotta sprinkle some luck on it too. You're offering the right service at the right time to the right people. You know you're in the right area. So there there is some luck factored into that as well. Okay, but you make your luck. You know, if you're if you're not out there doing it, then you won't get lucky, right? Okay. Last question. Knowing everything you know now, what would you do differently if you had to build your practice all over again?
• 29:22
  That's a good question. So knowing everything you know now, what would you do differently if you had to build your practice all over again? Well, I'm actually getting ready to start Another little, little. Little concierge kind of practice. Um, and I would integrate very high ticket services right from the get go. That's probably what I would focus on. One thing I've realized in the last, probably really about the last 3 or 4 years, one thing I realized, and this might be kind of exclusive to the time that we live in as well, right? So we live in a very K shaped economy, right? Very K shaped. And if you don't know what a k shaped economy means, basically what it means is, is that a k has two prongs to it. Right. The one one's going up and one's going down right. That's what a k is the k on. That's that's the down slope is 50% of the population okay.
• 30:22
  50% of the population are struggling. I mean struggling they don't have shit to their names okay. They have no assets. They are a $500 emergency away from not being able to pay their rent. Okay. I mean, so 50% of the people that you see in your life, 50% of the people driving, around 50% of the people that you see at the grocery store, unless you shop at some, you know, organic store, you know, grocery store, like sprouts or whatever. But like 50% of those people are struggling right now. The upslope of the K, right, the top 50% are doing fairly well. Right. The 75%. The face to face, if you just you know, if you if you're if if you look at that top or the prong of the K right, the first 75% of that of that stick basically, um, they're doing okay. You know, they're able to save 10% or something like that. They're probably a few months away from financial ruin. They're doing okay. That top 25% of that or that. Yeah, top 25% of that prong. So essentially 1,015% of the population is doing amazing, doing amazing. Times have never been better. Okay. They have their assets. They have their money in actual real assets. They have their money in the stock market in appreciating assets. Okay. The price of their house has tripled in the last five years. And they bought a house for $800,000. It's worth 3 million now and just insane shit like that. Okay. Those people are doing very, very well. And that's about 10% of the population, which means there's approximately 35 million people in this country, 35 million who have lots of money, who have a very disposable income. And those are the people I want to target. Okay.
• 32:23
  So knowing everything I know now, what would I do differently if I had to build a practice all over again? That's what I would do. Like that. That's basically what I would do. I would just focus on very high ticket services. Right. Um, and that's kind of the new business I'm getting ready to launch is more of a high ticket concierge thing. Um, and so that's what I would do. Uh, and honestly, two, I would, I would only focus on income generating activities, too. I would also not be so scared to invest money back in the business, and I just would be so anxious about it to a business is going to work or it's not. At the end of the day, I just stop worrying about it. Like, get all your ducks in a row financially, have an emergency fund, make sure you took out some income coming in. So that way, if the business does fail, it's not the end of the world. Right. Okay. Okay.
• 33:15
  Those are eight pretty good questions. So thank you for submitting those. Uh, if you want to submit a question for the next one, please email me just in the elite np.com and I will answer those or message me on Instagram or Facebook. It's just Justin Alan Montgomery on Facebook and Instagram.
• 33:31
  So friend me and just shoot me a message if you want to. You know, if you have a question for me.
• 33:35
  Okay, okay, I will see everyone in Vegas here in a couple of weeks. Yeah. Leading up conference is in, uh, what is it? Yeah, like two and a half weeks, something like that. So if you are going to be there, I look forward to seeing you. Come say, hey, I'm not shy. All right, y'all take care.
• 33:55
  Bye. Thank you for listening to the show. Quick legal disclaimer the content of this podcast has been for informational and entertainment purposes only and should not be used as legal, financial, medical, regulatory, or practice. Specific advice for information pertaining to your specific legal, financial, medical, or practice specific needs. Please be sure to consult with your lawyer, CPA, medical director, and or your state's practice laws and the most up to date clinical guidelines.
• 34:16
  As always, do your due diligence when it comes to any information found online and podcast. The content in this podcast is copyrighted by Galaxy Medical Southwest 2023. It cannot be duplicated, rebroadcast, or reproduced without our written permission.