Phil Singleton: Hello, everybody, and welcome to another episode of the Local Business Leaders Podcast. I’m your host, Phil Singleton. Today, we have a special guest with us once again.
David Straight is a doctor of physical therapy, he’s an author, speaker, and a marketing expert.
He’s also the co-owner of e-rehab.com.
…AND the marketing director of a seven-location private practice.
David and his business partner own and operate a digital marketing agency that serves the physical therapy private practice market. He and his company provide websites, email newsletters, SEO, reputation management, video marketing, and social media marketing for over 1,600 locations across North America.
He’s the author of “Booked Solid, the Fast and Easy and Affordable Way to Use the Internet to Drive More Patients in the Door.” He’s presented on multiple, national, state, and local professional conferences as well. His passion is to help people understand that physical therapy is the best first choice for neuromuscular conditions.
David Straight: Yeah, that’s good.
Phil Singleton: All right. We kind of read through your bio at the beginning. Can you give us kind of a quick three-minute overview of those first steps out of college and into the real world and how you got to the agency that you built today?
David Straight: Sure, well, first of all, Phil, thanks for having me on today. As a physical therapist, I graduated back in the early ’90s and love treating patients, helping them out. Found what we do is a specialty and something that really no other profession does. But during the course of treating patients for over 15 years, I found that a lot of people weren’t getting physical therapy. I had numerous people that I spoke with as well as people that came in the door with patients that had problems but never saw a physical therapist. So, I saw that as an opportunity to help educate my community on the value of seeing a physical therapist first.
You don’t have to look very far nowadays in the news to know that there’s all kinds of problems with healthcare costs, while physical therapy costs, 50 to 75% less than the traditional care that … for example, a back pain patient might get in the medical industrial complex. Then of course there’s the opioid epidemic where we have, I think what, last year 63,000 people died. More people died from opioids than cancer, from breast cancer and car accidents. So, we as physical therapists are there to solve problems so people don’t have to take on those types of treatments.
I realized, during the course of my physical therapy career that nobody was really promoting private practice online.
– David Straight
I realized, during the course of my physical therapy career that nobody was really promoting private practice online. I had created my first website for my practice way back in 1995, and then started doing an email newsletter, and … you’ll like this one, I was doing paid ads on the Go To Network, which became Overture and then Yahoo. And then Google, of course, came along, and overtook them. But we were generating two to 3% of our business way back in 2001 from paid ads. One, it was the wild west and the cost per click was less than a dollar. I started e-Rehab in 2003 with some friends of mine in the PT community and then in 2005 sold my interests back to my former partner who I’m now the marketing director for again, and created e-Rehab and found a great partner. We’ve been in the business now … we like to say we’ve been around longer than Facebook and Yelp, which, I think says a lot, as you know. A lot of people that are doing websites and stuff.
Phil Singleton: That’s awesome. I was actually listening to a podcast the other day and I was telling this guy how I basically got a D in computer science and then kind of run my own agency that I make a decent living from. He’s like, yeah, you’re the kind of guy that I wanna learn from. You don’t want to learn from the … and he can use that almost like somebody that diets. You don’t want to learn how to lose weight from the guy that’s had 3% body fat since he was born. You wanna learn from the people that have been in it, have done it, and struggled through it, and that’s what’s interesting about what you said. You came from the other side so you know exactly what some of these guys are going through and then you went kind of the other side and now help them grow their practices, which is really, really awesome, and lends to, I think, to a ton of credibility rather than, like, an outside marketer that really doesn’t know what some of these guys go through.
I’m guessing it’s kind of unique. I’ve to run into a couple of physical therapists over the years. I do know that it just seems like they’ve got slightly different marketing challenges, and even like margins safe to work with I guess maybe than other forms of, say even kind of in the medical practice world. But, can you kind of just start diving into it? If you’ve seen a lot come and go, what kinds of things for a physical therapist are working in terms of, let’s say, lead generation.
In the physical therapy market it’s kind of unique because, for almost 100 years we’ve generally been a referral based business.
– David Straight
David Straight: Sure. As a marketing consultant that it’s really important to have a total online presence. In the physical therapy market it’s kind of unique because, for almost 100 years we’ve generally been a referral based business. Meaning, physicians have referred patients to physical therapy. Over the last 15 to 20 years, lots of clinical research has come out that says, hey patients should go to physical therapy directly. So, it’s a balancing act for private practices. They get most of their business, at least the first time a patient comes in, from referral sources. You certainly need to make sure that you have a referral marketing program in place, but online you need to have a great website so you make that great first impression. 80% of people that go to a PT website go one time. You don’t sell anything on your PT website for the most part so people aren’t gonna come back.
But, what we like to say too, or the second component, is, if you look at web analytics, Google is most PT practices’ home page. It’s the first thing a majority of people see online when it comes to a PT practice. So, having a great Google presence, ranking for physical therapy in your local market, ranking for your business name, of course, and then leveraging all of the great new tools that Google My Business is providing, that’s the second thing we would say. So, first a website. Second would be Google My Business and SEO and search rankings. And then the third thing that we found is reputation marketing. You and I know well with our training and experience with duct tape marketing that lead conversion is something that a lot of people don’t consider. They think of marketing as lead generation only, but really, like we have explored for many years, since about 2009 the idea of lead conversion and using reputation to help people that are considering a practice to actually choose them and not go to another website.
So, making sure that you get good ratings and reviews are social proof and it’s out there on the internet, on Google for example, on your website, on social media, is important. Then a nice email newsletter that goes out month after month. It’s so low cost and so easy to do, is something that we highly recommend because of the time it takes to do it is next to nothing. And the ability to get it out there, the cost is so low. Then there are other things you can do. Social media of course has been the rage for years, but looking at web analytics and also what Google says, 99% of searches are done on Google and Bing and not too much search for physical therapy practices or what we call utilitarian services are done on social media.
So, it’s important to have a Facebook presence, Twitter presence. We’d love you to because video’s a great way to build a like and trust in John’s elegant model, you know, like, trust, try, buy, repeat, refer. Having video can actually show who you are and what your thoughts are and what your expertise is. So, video marketing is something that we really like. And actually say it’s more valuable than Facebook or Twitter, just because of the way people seek out and utilize the web to find PT practices. So, those are-
Phil Singleton: Yeah, you think for a doctor, especially, anything where you can like see or hear the doctor…
David Straight: Yeah, that’s really simply and well put. Absolutely. So, websites, SEO, have a simple email newsletter go out. Build your reputation, lead conversion. It’s really changed a lot of practices. It’s the best investment they say they’ve made if they buy into it. Then, having a social media presence, as much as anything for SEO. Then, using leveraging video is really nice. Nowadays, as you know, we’re doing this awesome podcast, you’re halfway across the country, technology’s available to do video and quality video for a very low price as well. Those are the things that typically work well for that. A referral based utilitarian type of service versus a hedonistic service.
The other way to describe it is nobody wants to see an emergency plumber or a locksmith or endodontist, or an orthopedic surgeon, or of course, a physical therapist. They need those services, and once a need is fulfilled, then they hope they never go back. If you contrast that to, like, a restaurant or a fitness center or a personal trainer, people want those things, you can induce demand for them.
If you understand your market, and those different segments and how they consume your services and what your ideal targets are, then its pretty easy for us, you and I especially, to recommend how to leverage these tactics and these tools
– David Straight
It goes back to what, again, you and I have learned and know well. If you understand your market, and those different segments and how they consume your services and what your ideal targets are, then its pretty easy for us, you and I especially, to recommend how to leverage these tactics and these tools that you and I use and provide for others so well.
Phil Singleton: Yeah. I love the referral marketing thing, I’m sorry, the reputation management. I’m obviously really big on that, too, but it’s like … I don’t even think it’s just for any doctors, right? Just recently, one of my twin son was diagnosed with some kind of mild asthma. Our pediatrician referred us to the allergist that they refer people to, and I think maybe going back 10 years or so ago, I would have just gone because my doctor said go there. Right?
David Straight: Right.
Phil Singleton: But I did what I think pretty much everybody does, is I went and I looked up online this allergist specialist that they referred me to. They had horrible reviews. So, they lost the referral because they weren’t taking care of business on their own. And I would have gone there if it looked even halfway decent ’cause I trust my pediatrician a lot, but, it’s like any referral based thing. Who doesn’t go online to double check what your friend said or what your doctor said, or something like that? And that’s probably especially true for any form of medical thing. It’s just too easy to do a little bit of due diligence and see are these guys a nightmare or not. And these guys were. The other allergist that they sent me to was just, like, it was like terrible reviews, like many. It wasn’t like one or two that they could have explained away or one or two and no other good ones. It was like there were some good ones but the majority of them were bad. I was like, I’m not even gonna waste my time, right?
And of course we ended up going somewhere else because the other people took care of business, you know what I mean? We’re in the business so we know kind of how to look behind the matrix a little bit but still, we’re looking for the same stuff and if you read enough of them you get the gist of it. I think that’s just so huge, but especially for medical. I think a lot of people just don’t realize … yeah, you gotta have the referral thing lined up, because it still works, but if you’re not set up online to capture your own referral demand, you’re not gonna get all your referral leads. You’re gonna lose them, right?
David Straight: Absolutely.
Phil Singleton: And I think that’s huge, huge I think, in your space.
94% of buying decisions are influenced by some sort of online situation.
– David Straight
David Straight: Yeah, absolutely. I couldn’t agree with you more. You mentioned that, what’s a good piece of advice for any type of service based business nowadays. 94% of buying decisions are influenced by some sort of online situation. A great resource for people that might be listening, small businesses is brightlocal.com. They just have all kinds of wonderful statistics about how ratings and reviews and reputation influences buying decisions. So, it should be, between the common sense that you articulated and the data that’s out there, and the cost to implement the program. It’s cheap nowadays to do these things, and there’s no reason why people shouldn’t do it. It does take a change in your processes, but it can really, if you have two, three, four, five hundred visitors a month to your website, wouldn’t it be nice to spend a few hundred bucks and maybe convert two or three more percent of those people into paying customers? It’s, like I say, it’s a no-brainer for me.
Phil Singleton: That’s awesome. Now, I’ve got to give you one example. I love what you’re doing because it’s your niche and I’m trying to get more into that and a couple of spaces nationally for what we do, but here locally, in Kansas City, it’s tough to be in one metro area, I think, and be a niche in something unless that’s big enough. But, we do get, in Kansas City here, at least we get to talk to a lot of different businesses and our portfolio is a diverse business base.
I’ve talked to some physical therapists, I think, over the years, and one I can remember … I’m always trying to figure out, because you talk to other businesses and some of them have different types of marketing budgets, dependent on what the margins are and it goes for any business, especially in medical. But I know in this case, I think we were talking about doing a new website for these guys. For us, it’s maybe like a 7,500-dollar investment for a website and all the SEO and upfront stuff, and I just remember the gentleman that owned the practice was similar to a lot of small businesses, which sets a lot up front. But, I remember him telling me, “Man, that 7,500, that’s more than I spend the entire year on marketing.” This is like a two location, I think, physical therapy practice.
Tell us a little bit about this niche and the things that work for them and what’s kind of reasonable; how big of a plan can they have and what type of investment … not to get in specific dollars but what kind of things can they be doing? This guy in particular, he was really interested in getting involved and rolling up his sleeves and doing some of his own work, which is great when you got a client like that, right? Because they’re willing to do some of it, and you’ll get maybe some of the best content if they’re just not trying to do things 100% passively. It did strike me as, okay, maybe there’s not the budget to work with me or the margins are a little bit thinner.
This is more, I don’t wanna say like a commodity type of a medical service but maybe it’s not like the guys that do cosmetic surgery or, I know some of the guys, like in bariatric surgery their margins are a lot higher so they can dump a lot of money in different places. In this space I don’t really know where these guys are, but what things work? How robust can their plan be? And I guess it probably would depend on, is it a single location, multiple location, how long they’ve been around. But, can you give us a little bit of insight? I was like, what do I tell a guy that’s got a marginal budget but we’re always trying to help people out. What things can they be doing on their own? And then when is it time to, like, maybe contact a guy like David Straight? Say okay, you’ve got enough here where we can actually help you out?
There’s no opportunity to really, to over-treat, or see people for additional visits because that kind of strategy typically ends up backfiring when patients should be done with you but you’re asking them to come in for more. So, the only real strategy for physical therapy private practice is to increase volume.
– David Straight
David Straight: Yeah, absolutely. You’re obviously a super smart marketer and you just nailed a lot of things with knowing very little about the market. First of all, fee for service medicine, which is defined as anybody that takes insurance, to a great degree is a commodity. There’s no opportunity to increase billing. There’s no, for a particular date of visit, because fees are set by insurance companies already. There’s no opportunity to really, to over-treat, or see people for additional visits because that kind of strategy typically ends up backfiring when patients should be done with you but you’re asking them to come in for more.
So, the only real strategy for physical therapy private practice is to increase volume. So, what I tell practices like the one you’re referring to, is to think about when they’re most profitable. And, in a service business their primary costs are their staff and their rent. So, the goal is to book your practice solid or to work to really increase your schedule to capacity, because once your profitable, if you have unused scheduled visits on your calendar there, that’s just purely lost profit. The value in online marketing, even in the referral based business like physical therapy, is to help you get your name out there, which you can do at scale for affordable rates, and then book your practice solid.
Obviously, if you have to bring on more staff, then it’s again, you’re gonna have to save for that and you’re gonna increase costs there. But, gotta book your practice solid, and the internet is … or, those are wonderful tools to convert to get your name out there for people that are comparison shopping, the doctor gave them a list and said pick from the list. You wanna stand out on that list. They found you in the insurance book. Make sure that you’re the best first choice there, especially with reputation. Then, as far as your budget goes, well, once you’re dealing with pass break even, then that’s when you should really step on the gas and spend money on marketing, and then get yourself up to that capacity.
Your budget, I think it’s lazy to say you should spend X percentage of money on marketing. I really think what it is, is you wanna spend as little as possible to get the job done. But, most professionals, to some degree they resent marketing. They go to school, they spend a lot of years becoming a specialist, and when they come out then they realize, “Gosh, I’m in the real world and I have to compete. I don’t wanna spend money on marketing.” So, they look at things from cost-centric standpoint, and they really typically don’t budget enough or at all.
So, Jim Collins, “Good to Great,” he always talks about how small businesses fail primarily because they’re afraid to spend money because they think they’re throwing money away. There’s just too much data out there to say now that’s not the case. You should have a good budget. Work yourself up to capacity, leverage those tools online-
Phil Singleton: I know we’re talking about being lazy about a number … but, just out of curiosity, is there anything that’s in the physical therapy space? Because it’s so tough. Some margins are like, consumer software, let’s say, that are really high, right? I mean, there’s a large affiliate. So, they can like give 20, 30% commissions off of a sale, on top of other marketing and stuff like that. Not just small, other businesses, I mean, is there any kind of a range you would say, that somebody could just do a gut check themselves? You’ve got a lot of locations and a lot of clients in this niche. So, I mean, low end, 5%, 10%, 20, is there anything, any gauge that way? Because, I think some people are like, just looking for any type of idea, like, in the space.
But I know what you’re saying, you can’t really…. especially if you’re not even break even yet then a percentage, even a range, doesn’t even make any sense, whatsoever. But, any kind of a benchmark in there that just would give, would 10% of an established business be anywhere close to it or is it more than that? Just a gut reaction?
I would say if you’re not spending five to 10%, somewhere in there of your revenue or 15, 20%, again, it depends on the size of the practice, your margins, you’re just not gonna survive…
– David Straight
David Straight: When people ask me this question and that’s why the value of having a marketing consultant matters so much, but, I would say if you’re not spending five to 10%, somewhere in there of your revenue or 15, 20%, again, it depends on the size of the practice, your margins, you’re just not gonna survive because-
Phil Singleton: Right, so if somebody came out and says I’m only gonna spend 1% or 5% of me … that’s almost like going fishing without any bait on the hook, to me. It’s like at some point you gotta put something out there.
David Straight: I’d say it’s like going fishing and not having a pole. It’s not gonna happen. Physical therapy is in a unique position as a profession. So, all the data says we provide so much value. So, what we’re seeing is a corporate roll-up in physical therapy. When there’s a corporate roll-up you have an executive level expense there, and so what happens is the quality of care goes down.
Well, physical therapy private practice, the small ones, they think they can’t compete with them, but in the review economy we live in, they have clients that are competing with giant corporations. They’ll never outspend those giant corporations. They don’t even have marketing people, but they can compete with them because they can rank online affordably, and they can stand out as having the best reputation in the community. So, that’ll keep them in a position where just spending that money on that type of strategy can actually keep them afloat, and keep them booked solid, or working at capacity where they’re-
Phil Singleton: I absolutely love that, ’cause I’m thinking right now, I’ve got a couple of dentists on and they … when you focus on and you do the things like you’re talking about, especially on the reputation management, they like crush franchise ones, ’cause the people don’t have the same level as their employees that are not owners, I think to some extent.
David Straight: I would totally agree with that. They’re just not as engaged as an owner, and the big corporations, reputation isn’t even on their radar. And if it is, then it’s a massive changing of course of the ship to get everybody on board. So, smaller businesses have tremendous opportunity just to bake into their culture the simple strategy of asking for ratings and reviews the right service.
Phil Singleton: Yes, and then what you can do is end up stealing some of the demand-creating marketing that people do. Like I was saying, somebody else generates your referral, they don’t take care of business, we’ll steal that when it gets filtered back to the internet because we did take care of business, right? So, you’ll be the hundred-review guy and maybe didn’t have to spend as much on marketing because the other guy did it for you. And you just stole it when it came through the internet. So, that kind of stuff is awesome and it works.
David Straight: Yeah, absolutely. It’s just not difficult. We know this so well. It’s just a tremendous opportunity. I would encourage people to, you know, they’re listening to this and they’re in your communities seek you out. You get it. I mean, have the conversation.
Phil Singleton: It definitely helps …Every business niche is different and you are a true expert in this space. So, anybody that’s a physical therapy space, please reach out to David and make sure you contact him, because he’s the top expert, I think, in the country on what he does and the best of what he does.
I gotta wrap it up with this, but tell people how they can contact you, and anything else that you got going on to promote, or books or eBooks or anything where they find out more about you or get a little taste of your services.
David Straight: Sure. The best thing they can do is go to our website e-rehab.com. If they want to talk to me specifically, set up a time with me, they can even call me, 760-585-9097. I got a second version of my book coming out the second or third quarter this year. It’s in draft right now. If you’re in the physical therapy private practice space and our ideal target market is the five clinics or less, I am certain that we can help you out. If nothing else, giving you some good advice but in most cases providing you with some great services that will help you build your practice.
Phil Singleton: Awesome. Ladies and gentlemen, David Straight, e-rehab.com. Thank you so much for giving us … there’s so much in this episode to consider and think of or enact on, I wanna really appreciate you spending the time with us this morning.
David Straight: Thank you very much, Phil. It’s been a pleasure speaking with you and hopefully this information will help the small business owner out there that’s struggling with bright and shiny objects and just is looking for a strategy to move forward.
Phil Singleton: You heard him, folks. Check it out, e-rehab.com, David Straight.