“Barber Shop Physical Therapy”

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In November, I had the honor of speaking at the annual conference of the Private Practice Section of the APTA. My presentation was focused on how clinical care should drive all business metrics in our profession, and it seems to have struck a chord. Most interestingly, many people have been interested in a concept that I introduced called “Barber Shop Physical Therapy.”

Some private practice owners consider variability in the care provided by their therapists to be a competitive advantage. If one therapist has a Maitland background, another is a Graston expert, and a third uses pilates and yoga with all of their patients, that means that a practice can potentially attract and help an even larger demographic. Right?

This philosophy is very similar to the business model of many barber shops. Each barber has their own station, often rented from the business owner. They each have their own tools, their own methods, their own pricing structure, and their own clientele. As an example, take a look at the picture above; it’s not the best quality picture on earth, but both of those people are special to me. That’s my son, Brendan, and our barber, Tom. Brendan is 5 years old, and Tom is the only barber to ever cut his hair. We would go anywhere Tom goes to get our hair cut, because of the relationship, the experience, and the haircut. He’s practically part of our family. Tom has moved shops over the years, but we move with him, because it’s him that we’re after, not the name on the front of the door.

If we return to our PT practice owner, it’s interesting to me that some of us see this type of set up as advantageous to our businesses, because all I see is risk and confounding data.

The Risk of Dependence

The risk comes whenever a business is reliant upon an individual more than the systems/processes of the business. We all need to help create value in our practices by hiring and training our people in the way to do things the “(Your Business Here!)” way. If one of your referral sources only sends to one PT by name, EVEN IF IT’S YOU, you are at risk of losing all of that business should that PT leave for any reason.

Another glaring example of this dependence is on the business side. If someone were to ask you about billing systems, credentialing process, or follow up on A/R, I sincerely hope that you could have a detailed conversation. Cash is the lifeblood of your business, so answering, “I have a billing manager that handles that,” is unacceptable. If you came in tomorrow to find that this person was no longer sitting at his/her desk, it’s okay to experience some aches and pains due to the loss; it’s not okay to have no idea how, when or how much you’re going to get paid!

Confounding Data

The other ramification of Barber Shop PT is that it produces data that cannot be acted upon. This is true in the areas of daily operations, clinical outcomes and patient satisfaction:

  • Let’s say that you’re a data nerd like me, and you want to generate and monitor weekly reports that analyze operational behaviors like patient visit frequency, length of average appointment, number and type of CPT code billed etc. If you are running a barber shop, can you pool your three therapists’ data and understand about how your business works?
  • Congratulations! You are tracking your outcomes and the data shows that your patients’ clinical outcomes are in the top 10% of PT clinics nationwide. That is unbelievably good and something to be proud of, but if you’re running a barber shop, how do you answer the person that asks you, “Why do your patients get better?”
  • Because of the variability of care, patients are going to get used to one style that isn’t sustainable in the event of employee vacations, illnesses, or separation. The barber shop will produce a lot of this:

Nancy is the best physical therapist around. I had an unbelievable experience and reached all of my goals. My only issue was that I had to see John when Nancy was on vacation, and he made me worse when he changed up my whole program.

So What Do I Do?

In November, I had the honor of speaking at the annual conference of the Private Practice Section of the APTA. My presentation was focused on how clinical care should drive all business metrics in our profession, and it seems to have struck a chord. Most interestingly, many people have been interested in a concept that I introduced called “Barber Shop Physical Therapy.”

Some private practice owners consider variability in the care provided by their therapists to be a competitive advantage. If one therapist has a Maitland background, another is a Graston expert, and a third uses pilates and yoga with all of their patients, that means that a practice can potentially attract and help an even larger demographic. Right?

This philosophy is very similar to the business model of many barber shops. Each barber has their own station, often rented from the business owner. They each have their own tools, their own methods, their own pricing structure, and their own clientele. As an example, take a look at the picture above; it’s not the best quality picture on earth, but both of those people are special to me. That’s my son, Brendan, and our barber, Tom. Brendan is 5 years old, and Tom is the only barber to ever cut his hair. We would go anywhere Tom goes to get our hair cut, because of the relationship, the experience, and the haircut. He’s practically part of our family. Tom has moved shops over the years, but we move with him, because it’s him that we’re after, not the name on the front of the door.

If we return to our PT practice owner, it’s interesting to me that some of us see this type of set up as advantageous to our businesses, because all I see is risk and confounding data.


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