Nitin Chhoda:     Hi everyone. This is Nitin Chhoda. I am a physical therapist in private practice from and I have on the phone with me, Tannus Quatre. Tannus is a physical therapist and pretty uniquely qualified physical therapist. He is not just a PT, he is also an MBA and expert in marketing, physical therapy business consultant and a principal of vantage clinical solutions, also on the web at Tannus and I are doing a presentation together later this year at the private practice session of the APTA November ’09. Tannus has a lot of outstanding ideas on how physical therapists in private practice should market themselves in fact he is a consultant as I mentioned earlier. Tannus has also presented at the recent Baltimore Annual Convention at the APTA and will also be speaking at CSM next year. I can’t wait to go there and see if we can speak with him, cheer for him and maybe even distract him while I am sitting in the audience just for fun. Again, thanks for being on the call today. I appreciate it.

Tannus Quatre:    It’s my pleasure.

Nitin Chhoda:    Let us go ahead and give some outstanding content to our listeners and our readers on both my blog and as well as your blog for a physical therapist in private practice who is on a budget. Starting out new with few or no relationships with physicians, with perhaps 20 or 30 good contacts in the local community, what are some of the things that he or she should do to start generating referrals and start getting a name going in the local community?

tannusTannus Quatre:     It is really common question. A lot of people that are starting practices or are trying to market existing practices like marketing in a fairly haphazard dollar expense and really the case what I tell my clients is that marketing is really you taking the marketing word out of it.  Focus on the word relationship that is really what it is all about and relationships. Take time but they don’t have to take a lot of money. The first thing that I emphasize is focus on relationship lingering meaningful relationship which potentially could be referral sources so business relationships as well those will be getting your practice that would be patient or client relationships. Secondly, just be involved, there is not always by being involved in the community. A lot of times you will come across opportunities otherwise, you will not have any ability to tap into, so being involved in the community not even related to physical therapy, something involved in the chambers, being involved with sporting events in organization, anything that gets you involved in the community and puts you face to face with people in the community that might at some point in time might want to learn about your services or might refer to your services is a great way to initiate the marketing effort at minimal to no cost at all.

Nitin Chhoda:    That is actually a great point, Tannus. Now, when you talked about the chamber, if I am physical therapist trying to build a relationship should I focus on more on the chambers? Should I try and participate in the fund raiser with a local sports team, how would I? What are the best ways to start making connections in the local community?

Tannus Quatre:    Well, the first thing I would say, is ask around and find out what other practices are doing, other colleagues of yours are doing in the area that are successful with that. I would say, don’t even be exclusive just to physical therapy or healthcare even. Know what other small businesses are doing to get involved. Find out what they are doing and emulate that there are many people out there that have found excellent methods for networking, communicating and marketing, that we should be trying to model after and expand upon that will be my advice, in that regards.

Nitin Chhoda:    I found that when I became a member of the local chamber of commerce, they gave me a list of names, phone numbers, and addresses of contacts of over 400 local businesses. Some chambers might give you a similar list of 150 businesses, maybe even 1,000 businesses depending on where the chamber is located. If I get a list like this from the chamber, any strategies on how you can network with a cold list of potential businesses that can become good referral sources?

Tannus Quatre:    Yes, definitely especially if it is an issue and you get the time and know how to put a little bit of thought into it. You have absolutely convinced us to your advantage. A lot of people will take less and they will just build one big database and send out information either by standard mail or by email with fairly generic information and that can get you somewhere but really the best thing to do, is to find the things that are unique to this list and then make your communication in choosing those lists very relevant. An example might be that if you have access to a chamber list, will be to get the new members of the chamber that are filling each month. You should have access to that information as a chamber member, then send out information to those new members and make it specific to the fact that you have a relationship with every commonality. You go to the chamber of commerce. You are welcoming them and as a new chamber member you might offer something specific to them and by communicating and connecting at a much more specific and personal level where you have some common ground. You can find that people are much more receptive to hearing what you have to say rather than what you have blanket message that you know applies to everyone equally and so you are saying it is important to segment your list. Provide them with relevant communication as opposed to singing the same tune with everybody. Absolutely by segmenting, you have much higher chance of success for having your message heard because people are inundated with marketing material and advertising each and every day. They become desensitized and put up huge barriers to information coming across to them. So if you can find a way to personalize what you have done through segmentation, you have much more to get through some of those barriers to be heard by that kind of market.

Nitin Chhoda:    Okay, so let’s say that if you have list and you are trying to communicate with them when you balance time versus money, what are the best ways to communicate with the list to try and build referral relationships, email, phone snail mail or actual personal one on one contact? And how do you know which to use where?

Tannus Quatre:    It depends on the resources you have, it is going to be a function of resources you have so time resources which are most at a premium especially for cremations at physical therapists are going to be very difficult. To be used effectively and or efficiently, I should say do things like sending out or making phone calls, sending out personalized hand written letters, those things can be very effective because they are very personal and anything with face to face meetings as you can easily see. You are going to have to take away from other revenue opportunities by either not seeing patients or clients because you have to be focusing on these personal relationships. Those are very important because they have to be used at the right time and to be used when you have the resources to do that. Just some of the other means in terms of how you can still do it on a shoe string budget or be able to communicate with a lot of people on a limited budget, you do want to have systems in place and be very efficient with how you send out the information you are going to be communicating. Whether that is email or it is snail mail or perhaps it is even communicating through educational events and so forth where you can have a lot of people at the same time hearing the same message. Those messages can be much more efficient although they do lack in some ways, some of the personal benefits you get from one on one meeting at over time and over talk. You have to figure out the resources you have and you have to figure out the benefits of generating that we are building upon that relationship to make the decision to what the best channel is to achieve; that if I am trying to initiate contact with the physician who does know me, will give me the time of the day. Any strategies on how I can put myself in front of them. Well, that is a tough nut to crack lots of times and I think the biggest barrier is not that you can’t get there and you can’t get that face to face. The biggest thing is intimidation that people feel trying to get there, what I recommend a lot of times is the front path of least resistance to a referral source that might be very intimidating or it might be very difficult to access a busy prominent referral source whether that’s likely, we have with those physician or friends or perhaps a surgeon in the market, it might be nearly possible to get a face to face on first try. But by developing relationships with others in the office of that referral source, that has to be the first receptionist, so you could be the office manager or referral coordinator perhaps a physician assistant or a nurse. By building relationships with those people and then having them put you in front of that referral source, you have much more ability to actually get there and it can be done in a way that they can help to mitigate some of that intimidation that you might try to do. Setup one on one meeting with a physician who probably did not have a whole lot of time, additionally did not know what you have to offer them. So by taking some of these more indirect rounds a lot of times, you can get the results you are looking for but it does take little bit of time and a little bit of work to get there.

Nitin Chhoda:    What you are saying essentially is that the relationship should be built with a gatekeeper a whole lot easier than trying to go to the physician direct, correct?

Tannus Quatre:    Yes, absolutely.

Nitin Chhoda:    What if a gatekeeper does not have the time or inclination to speak with me? Is there a way that I can get their attention if I am a private practice owner who is a little nervous about contacting them, any strategies on initiating a conversation with the gatekeeper?  A lot of times I feel like the physical therapists in general have the sense that they need to go and sell their services, sell what they have to offer and I would like to spin it a little bit and ask to think in terms of value that you are providing to them, to the referral sources, to the gatekeeper. What value do you have to offer them by looking at it in that way it changes the dynamic of the entire conversation goes from less than one that is on the same level as they are?

Tannus Quatre:    Auto sales or retail sales to one or more by trying to collaborate with you as a professional and as a clinician and by approaching it that way, the referral sources is much more absent to view the conversation as much as a sales effort and more of a collaborative professional engagement or relationship that the physical therapist is trying to achieve with them not that I am very effective.

Nitin Chhoda:    That is interesting. Building these relationships helps a lot more than just throwing money at advertising or spending X amount of dollars a month not knowing whether it is going to work for you. I think the strength of your practice is only as strong as the depth of your relationships. Would you agree?

Tannus Quatre:    Absolutely, 100% agree. It is all relationships, what we are talking about is marketing in terms of these tactics that are used whether it is advertising, sponsorships or mailing whatever, those are all just tactics that at the end, do not create a relationship. They will not be successful.

Nitin Chhoda:    Speaking of money and advertising, are you against the idea of physical therapists advertising their services in newspapers via postcards, via mass mailings or you think that has a role to play in the overall scheme of advertising? If so, what kind of a budget should a physical therapist allot? Obviously a physical therapist can allot, obviously several thousand dollars a month to advertising. So what role do you think if all consumer advertising plays for a small physical therapy private practice?
Tannus Quatre:    It definitely has a role, you name a marketing tactic and I think there is going to be an argument for using it for most of the good ones in the circumstances. What I find is that small practices still kind of hand the hat on the tactics that were probably more effective years ago when the competition was less and when costs of advertising were less and when there were less options in terms of how to advertise or market oneself. I say in some circumstances, advertising makes sense. I ask the private practice owner that I am working with how we are going to measure the return on this advertising investment. Immediately, that poses a question that can be really hard for us to justify so we are going to put in an advertisement in the newspaper that is going to cost $175 per run. I already know that we are actually going to get the $175 back in that investment. It is very difficult to do because it is hard to track. You have heard the ways it can be done. It requires a level of sophistication and a level of administration that a lot of time a small practice has a hard time forming together. So,yes, advertising can work and it does make sense but I do not recommend it as one of core pieces of the marketing campaign or the overall marketing plan that a practitioner should be applying.

Nitin Chhoda:    Do you think you should form a small section of the overall plan?

Tannus Quatre:    It is not so much the size or the weight of advertising, it is more of the specific time you would use it. There are specific times that you are going to make sense if there is an upcoming event and you are sponsoring this event and this event has brought a lot of attention to your practice. Then throwing significant dollars at that makes sense because that is how you attach yourself to that event or sponsorship; the practices that I see that run ongoing advertisement in newspapers. The newspapers can be very difficult to advertise. They get very small real estate on the actual pages itself and just knowing the distribution of certain publications and the likelihood of actually resulting in actual conversion to the bottom line of the practice knowing that that number is so low it is very hard for me to justify that as a big piece of the marketing plan.

Nitin Chhoda:    I see, in terms of the broader picture, looking forward to the next few years, do you think physical therapists should be focusing more on marketing directly to patients and relatively less on marketing to doctors there is a place obviously for marketing to physicians and it is a big place? What is the trend of physical therapy to patient direct marketing, in your opinion?

Tannus Quatre:    It is definitely shifting in that direction. It is a direction that our profession is moving to and our professionals are moving in terms of the direct access model of care. There is much benefit to have there. What my caution is this, though that the transition has to occur at same speed as the transition with which we are getting that message out and we are a direct access provider. So for example a private practice that wants to put all of their dollars towards the direct access in this market, going right after to the community and not spending their time developing relationship for referral sources, I think, is not a good idea. We are not quite there yet I don’t know if we will ever be completely there during that time. I will argue we will never be at that point that we won’t rely on referral sources for a significant part of our business but this moving towards the direct access market, I see more and more reason to be shifting some of those traditionally spent referral source marketing dollars towards the direct access market, but it has to be done very slowly and very thoughtfully and cognitively. The communities that we live in are quite there with the message that we should consider preferred provider for neural muscular skeletal dysfunction. Lot of those dollars can fall on deaf ears if the market has not got the message.

Nitin Chhoda:    Tannus, as you are getting towards the end of the call a lot of physical therapists are concerned about the impact that physician owned private practices have on their business. For a physical therapist who is concerned about this, what advice would you give him if he has a competing practice staring at him across the street? Well there is a lot of talk about physician owned physical therapy practices and I understand the issues and I believe in them but what I would argue is better be different. Be a provider that provides a unique value in your market. You will find the following now. Will you find the following from that physician that owns the physical therapy practice?  I would say probably not. It is very difficult in rare circumstances where you have a certain specialty or something because there is an economic benefit to owning your own physical therapy practice as a physician. It is very well understood that is the case but that is just one provider in the market. There are numerous other providers likely in the market. There is community at large and there is the direct access market that can understand the unique benefit you have to offer. It should be communicated in such a way that they can understand why, you should be their preferred provider and not the physician private practice. I think it is more an issue for me of PTs versus physician practices. It is more of an issue of differentiating the service of the offer and making yourself recognized as a preferred provider based on some value proposition so I do get a little bit of passion and this issue with traditional practices because I really feel as a physical therapist the onus is on us to go out there and communicate the difference in the practice, the real versus the competitor, whether or not physician owned competitor, whether it is a chiropractor, whether it is trainer or massage therapist or a gym or a traditional owned PT practice. We have the ability to communicate that and we have to take charge of that. Physical therapists in your opinion should for lack of a better word. Stop making excuses. Just step up to the plate, just market better and be better and be focused more on our strengths rather than wasting too much time complaining about the bad state of affairs or finding faults in the way the system is that,  is pretty much what you are saying. That is the way I feel frankly.

Tannus Quatre:    I would say put your energy into what you believe in, not in what you can change. You know and some would argue we can’t change this through legislation. And that is the truth, but is that going to make a difference for your practice today and tomorrow? It is not. Today and tomorrow is what is going to make a difference. Putting your energy towards what you believe in and if you believe in it, do you really feel like you are the best provider in your market to provide the services that you offer? Then the onus is on you to get out there and tell people about it. Nobody else is going to do that for you.

Nitin Chhoda:    Tannus, my final question, patients and their relationships with their physicians. When that patient comes into your practice, are there certain strategies that you can use as a private practice owner to have that patient provide positive feedback to the physician then provides more referrals back to you? Any strategies that can be used to leverage your relationships with patients which will lead to more referrals not just from their physicians point but perhaps from their families and friends?

Tannus Quatre:    Yes, definitely. It is a very important part of the marketing strategy and we classify this as internal marketing versus external marketing. Internal marketing is by far where you want to spend a lot of your efforts because you have got people in your practice who understand you who have come to know you, who understand the benefits so you really want to put focus on making sure they become ambassadors for your practice and no better way than you have them be an ambassador for you in the presence of the referral source that is sent to you in the first place. Again, going back to the fact that this is all about relationships, I am very comfortable for my clients to have open discussions with their plans and with their patients about what communication is important back to the referral source so letting your patients know.

We have made some great progress here I have formed a great relationship with you and I think we have got a good thing going. I would love to work with others. Do you know of anybody else who has elements that we can benefit? Please send them here and we believe in what we are doing and we want to help people. Let the patient know that so they are going to have the green light to go out there essentially market for you. Just by being an ambassador practice it is really important because patients are not thinking that they don’t know what really helps out a practice. The same thing with a physician if they are going to go back and they have got there follow up appointment with a physician of a referral source let them know. Hey, I have got my records there and you are going to be meeting with doctor so and Wednesday let them know how you are doing. I want to make sure that the physician and myself are communicating and were both from the same stage let them know about what we are doing here and you can provide them with materials or educational handouts that you have been receiving. There is an ongoing communication back to the referral source, the value that you are providing their patients through your practice that interaction or interplay of the communication between you as a provider and patient and the referral source and all of their networking people is very critical for that internal marketing we really got to practice. And that is well said and what I have found is that patients need to be conditioned to refer. It is not that they don’t want to refer they just need to be conditioned and once they start referring, it makes a big impact in your practice they just need to be reminded it is not at the top of the agenda also when patients start to recommend us or sing as physicians, that has even more powerful impact. Would you say that is a good way to put it together? Much more powerful than anything that chiropractic owners could ever say and do is what their patients are trying to say about them.

Nitin Chhoda: Absolutely this has been an outstanding interview and I have learned a lot from you in this interview and I am sure so will our listeners.  Do you have any closing comments as we wrap up this interview and any suggestions you would like to give to private practice owners, you know, with regards to marketing?

Tannus Quatre:    Remember that it is about relationships. It is not about sales, it is about building relationships, communicating your value to others or how you can help others and that is about it. Believe in yourself and believing you will do very well with the marketing phase.

Nitin Chhoda:    That is well said, Tannus.  I appreciate you taking the time out speaking with us and we would love to have you back on the blog. We are perhaps, doing a guest post or we are doing a series to the interview so we can benefit from your advice and I would love to be able to contribute to your blog in any way if you think I am going to be. Thank you so much for your time in this phone call.

Tannus Quatre:    Absolutely. Thank you for having me, Nitin.

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