Ep #58 - You Asked, We Answered: Real Q&A on Positioning, Operations, Hiring, and Growing Your Clinic

You've been sending in questions — and this time, we're answering them.

In this Special Edition episode, host Jody Layne is joined by her longtime business partner Patrick Dermody for a rapid-fire Q&A covering the questions that have been flooding in from hormone clinic owners and providers just like you. Patrick served as general manager at the clinic in Orlando that Jody has referenced throughout the show — the one that grew from 200 to over 1,000 patients — and together they bring a combined perspective that's equal parts strategic and practical.

This episode covers the full POWER framework: Positioning, Operations, Workforce, Experience, and Revenue — and the questions are real, pulled directly from listeners who are in the thick of building their businesses right now.

Topics covered:

• The biggest positioning mistake new hormone clinics make in year one

• How to find your true unique value proposition when every clinic says the same things

• Building systems and SOPs so the clinic doesn't fall apart when you step away

• Managing high call volume without defaulting to automation (and when automation goes wrong)

• How to hire for culture fit — and the multi-stage interview approach that actually works

• Keeping your team accountable to patient follow-up without micromanaging

• Tackling no-shows and last-minute cancellations with real policies, not just reminders

• Increasing patient lifetime value — and why it has nothing to do with upselling

• Realistic revenue targets for year one, two, and three

Whether you're just starting out or already running a busy clinic, this conversation will give you frameworks, real stories, and honest advice you can put to work immediately.

Learn more about Accelerated Medical Practices and The Accelerator: accelerator.acceleratedmedicalpractices.com

This podcast is powered by Accelerated Medical Practices, where we believe hormone and wellness care should be both life-changing and profitable.  If you own or run a clinic and are interested in being a guest on the show, please complete the form here and let's connect!  Or email Jody at Jody@AcceleratedMedicalPractices.com.

 🚀 Grow your clinic with proven systems at AcceleratedMedicalPractices.com

For more Insights and Tips on Growing Your Hormone Clinic, subscribe to THE AMP Report sent every other Thursday and follow us on social media for "almost" daily tips! 

Get The AMP Report

Instagram

Facebook

LinkedIn

YouTube

Last BUT DEFINITELY NOT LEAST, is your looking for the fast track to growing your clinic, check out The AMP Accelerator - A free membership site filled with on demand course content to allow you to learn what you need, when yo...

Transcript

SPEAKER_02 0:14

Welcome to Beyond Hormones, the Business of Wellness, the podcast for hormone and functional medicine providers who want a thriving, predictably profitable practice, and maybe a little less stress along the way. Hi, I'm your host, Jody Lane, and I've worked with lots of clinics in marketing, sales, and business development. And I have seen what works and what doesn't. And here's what I believe hormone and wellness care should be available to everyone who wants it. And while providers know the medicine, many struggle with the business side of their cash practice. And that's where I come in. See, this podcast is here to share real strategies, real stories, things you can implement in your practice right away. So I am so glad you're here. Come on, let's go. Hey there, welcome back to the Beyond Hormones, the Business of Wellness podcast. I'm your host, Jody, and I am very excited about this episode because it is something completely different that I've done since I started this podcast. This is a special edition, and I know you wanted it because over the past several months, you've been sending in questions, real, specific. I'm dealing with this right now in my clinic kind of questions. And so I sat down with Patrick Derby, who is my friend and my business partner and my former office roommate. He's the guy who helped us grow that clinic in Orlando from 200 patients to over a thousand. And we thought, what are better way to give back than to just sit down and answer them? Now, if you don't know who Patrick is, do me a favor, go back all the way to episode one of this podcast and go enjoy listening to us chat. But if you do know him, then you are in for a treat because we went deep. We talked about the number one positioning mistake that many new clinics are making, and it's not what you think. We got into building systems that actually hold up when you're not standing over your staff. And we tackled things like hiring and no-shows and patient lifetime value and what a realistic revenue target even looks like in year one, year two, and year three. Now, there are no perfect answers here. Just our experience. Two people who have lived it, we've made the mistakes, and we figured out what actually works. So this episode is for you. If you are dealing with trial and error and you're tired of it, you're ready to learn from people like us who've already been through it. And I really hope that you enjoyed this. And do me a favor, if you're enjoying this episode, go ahead and leave us a message because we will do this again if you love it and you are enjoying the questions. And if you've got a question, by all means, send it to me. My email address is simple. It's Jodi J-O-D-Y at accelerated medical practices.com. And uh, once we get enough questions, we'll go ahead and do this again. All right, thank you so much for being here. I hope you enjoy the episode. Don't forget to subscribe. And uh here we go. Welcome everybody back to the Beyond Hormones, the Business of Wellness podcast. I am Jodi Lane, your host, and today I with my partner, Patrick Dermine. Patrick, say hello.

SPEAKER_00 3:24

Hello, everybody. Thank you for joining us.

SPEAKER_02 3:27

If you don't know who Patrick is, then I think you should stop listening right now. Go back to the very first episode of the podcast because Patrick was my first guest, and we spend an hour giving our backstory, how we met, how we worked together at the clinic in Orlando that I talk about all the time. So you don't know who Patrick is, definitely go do that. But if you do know, then we're going to continue on because we've been doing the podcast now for about seven months, and it's been amazing. We've gotten an incredible response. And one of the things that's been happening is that providers are sending in questions. And so Patrick and I were talking yesterday, and we thought, wouldn't it be a good idea for us to hop on and answer some of those questions? Right.

SPEAKER_00 4:12

Right, right, right. We have we have a ton of questions too. I was uh rather impressed at how many came in.

SPEAKER_02 4:21

So that just tells you that there's a lot of inquiry out there. Providers are committed to their businesses, they want to succeed, and they don't want to do it by trial and error, which is what we always say that you know, get get your questions answered so that you learn from people who've done it before you. So if uh if you're ready, we should just go ahead and dive in.

SPEAKER_00 4:42

Yeah, let's do it.

SPEAKER_02 4:43

All right, cool. So we're gonna go back and forth. We've kind of like identified who's gonna answer what question. So you want to start? I'll ask you a question. Sure. Okay. So um we talk about positioning a lot. And for those of you who are maybe are new to the podcast, positioning is when you think about your message, your target audience, your unique value proposition, your pricing, your goals. That's all part of positioning. And so this question must have listened, uh, come from the positioning podcast that we did. What's the biggest positioning mistake that you see new hormone clinics make in their first year?

SPEAKER_00 5:22

I think that's actually really easy to answer. Um and this mistake is maybe even something that is just part of the process that you, you know, some people just have to go through because I think the biggest thing is not knowing who they are. And when they don't know who they are as a business, they don't know who they're supposed to be treating or selling to or looking to bring into their practice. Um, you know, I see people just reaching for every service possible. And so they're uh hormone clinic slash med spa slash chiropractor slash gym. And they don't really do anything very well, but they're trying out all these little things because they're fun and cool and new, or they heard about it at a conference and it seemed really cool in the moment, and it was $500 off if you move now. So they got the device or bought the bundle of tests or whatever it was, and then they go back to their clinic and they're stuck trying to weave these new services into their their pitch or their consultations and just trying to make all of it work. And what inevitably ends up happening, you know, a year, two years, three years down the road, they just get frustrated of having all this miscellaneous stuff that doesn't truly resonate with what they want to do. And then they end up throwing it away, losing money on it, selling it for you know, 10% of what they purchased it at, um, to really get back down to the core services and what they really wanted to do. And so, you know, what I would say is to anybody who is kind of in this phase or about to start a clinic, just sit down, take a day and sit down and really think about what you want to do now and what do you want to provide to those patients that are coming into your clinic? Because I I can tell you from experience, when you're in those big rooms at conferences and when you're being sold, you're I mean you're heavily being sold at these conferences, all these cool gadgets and everything, it's easy to be swept up in those emotions and just that sci-fi feeling that you're at the cutting edge. And if you don't go into those things with a plan or you don't know what you want to do from the get-go, you'll be swept away. So sit down and create a plan.

SPEAKER_02 7:48

What was our rule at the clinic?

SPEAKER_00 7:50

Never purchase anything at the conference unless we went to the conference looking for it.

SPEAKER_02 7:57

Well, people think that at conferences, the conference deal is gonna go away. And I'm telling you, there is not a device or a pharmaceutical sales rep out there that won't honor the conference price when you get back if they know they're gonna make a sale. So don't get like freaked out about that. And if I could just add something to that, you said, you know, I love that you know you want them to think about what they want to do, and that is primary. Like that is the most important because you have to show up every day, you've got to be passionate and excited about it. But once you've identified what that thing is, then you have to figure out how you're going to make money from it. And that feels a little uncomfortable because you're probably choosing this treatment or this service because it does good for your patient and for their health and their wellness. But the reality is, is that if you don't figure out how you're going to charge for it, how you're going to get in in front of people, what your net profit's going to be and what it's going to distract from your other services, it could pull your profitability down, which could hurt your clinic in the end, which ends up with what you said, which is two or three years down the line, you realize you've got all these diverse services and you're just your cash flow is crappy. So great advice.

SPEAKER_00 9:12

Exactly, exactly. Um, let's see, let's pick one of these out for you, Jody. Yeah, yeah. And I'm gonna stick with the positioning kind of frame because we had a few that came in from that episode, I believe. So how do you actually differentiate a hormone clinic when you are in a saturated market? And you want to do this without just competing on price. So, how do you stand out?

SPEAKER_02 9:41

That's a that's a hard thing to do, I'm not gonna lie. So, in business, uh, and I'm sure most people have heard this term before, there's this concept called the unique value proposition. Basically, what it means is why you have to be able to articulate why somebody chooses your business over your competitor. That's all it is. And it's one of the most difficult things to do. And we do our workshop, right? And then we've, you know, done this workshop with tons and tons of providers, and we ask that question as part of our workshop. And inevitably, the answer is I listen to my patients, I really care, my appointments are long, I'm committed to the result, I'm very well trained. These are the top reasons why somebody should come to your clinic over somebody else. I'm here to tell you guys everybody has those answers. Therefore, what is it not? It's not unique. Unfortunately, we've reached a point in our industry, like maybe eight years ago, that was unique, but it's not unique any longer. And I interviewed a guy yesterday uh uh for the podcast that his episode will come out after this. His name is Chad Singer, and we talked about this, and I'm gonna totally steal his thunder and tell you what he said because it was brilliant. He said that the first step that you should do to pick your unique value proposition is go out and look at your competitors and see what they're saying and look for what they're missing so that you can fill in the gap. So, and and it's kind of like multiple pieces to the puzzle. So, first, it's like from your heart of hearts, why do you think that you're unique? Second, is what is your market missing that you can put in? And third, it's getting specific about something. Like your unique value proposition could literally be the number of touch points you have throughout the year that is different than others. Your unique value proposition could be your price, you're more expensive, and the reason you're more expensive is because you have more touch points during the year and you take on less patience so that you have the time and the ability to have more personalized care. Like what you really got to come down to something that nobody else is saying and that resonates with your target audience. So I'm not gonna lie, it's very, very tough. We find it tough for ourselves as well. Like we ask ourselves this question, you know, all the time to make sure that we're standing out as well as you know, uh in our in our industry as a consultant. So um don't don't don't not do it because it's hard. Like really, and if you've got to bring in reinforcements, you know, bring in your staff, make it into like an exercise, you know. They always say when you're trying to come up with a hard answer, you want to get all the crappy answers out first. So, you know, bring in lunch one day, bring everybody into a room, have a big whiteboard or a big post-it noteboard, and put out all the answers and then just start crossing out the ones that every other clinic could have.

SPEAKER_00 12:50

I love that. You know, I haven't heard this podcast yet because it was just recorded yesterday. So I I love that advice that he had. And I've I've I heard something, I forget that I think this was at one of our conferences that we went to. Um, it was, it might have been a big Australian guy. I'm pretty sure he was from Australia, big business guru was on stage, and he had something similar. He said, Look for the best people in your market and find out what not what they're doing great, but what they do poorly.

SPEAKER_02 13:18

Oh, yeah. Oh, I remember that. Yes.

SPEAKER_00 13:21

Yeah, and then that's that becomes your kind of unique value proposition. So it's really along the same lines. Like what's missing that other people aren't doing? What are the best people in your neighborhood doing? And then what is it that they are missing, and capitalize on that? And you know, one other thing, go ahead, Jody.

SPEAKER_02 13:39

No, no, no, go ahead. I'm not too.

SPEAKER_00 13:41

I was gonna say one other thing is you have your neat unique value proposition. You know, you have to figure out what it is that makes you different than everybody else, and that's exactly what Jody just went through. And then the other thing that I think is timeless that'll help you differentiate from other your clinics or your competitors, is just being there when they need you. It is crazy, no matter what industry. If you want service, you pick up call the company, and nobody picks up, nobody gets back to you. This isn't a UVP, like this isn't something you can't go out and tell people, we respond when you call. Like that's pretty weak. At the same time, nobody does it. And so if you're there when they need you, leaps and bounds ahead of your competitors.

unknown 14:28

Yeah.

SPEAKER_02 14:29

No, that's that's awesome. What I was gonna say when I was so rudely about to interrupt you was that once you know what your unique value proposition is, you've got to tell people. Like, I know that it's hard to boast about yourself. It feels egotistical. It feels like you're, you know, I don't know. Can't think of the word. It feels like you're yeah. People don't like to be braggadocious. There you go. Braggadocious. That's a fantastic word. You win for for scores on scra on scrabble. Um, yeah, so it doesn't feel comfortable to go out and brag about yourself, but you've got to. If you come up with what your beautiful, unique value proposition is and nobody fuck friggin' knows it, oops, nobody freaking knows it except for your own staff, it's not gonna do you any good. So define it, share it, be it.

SPEAKER_00 15:24

Beautiful, beautiful, beautiful. Great answer, Jody. Great answer, as always. And we're only getting started. We have 54 more.

SPEAKER_02 15:33

No, we don't. Don't scare people. Okay, let's see. Let me pick one. So, you know, we we sort of organize the first set of questions in our power pillar because that's what we talk about all the time. If this is the first time you're listening to the podcast, then let me explain the power pillar, it is our framework as to how we uh coach and consult clinics to grow strategically to get predictable profitability and ease of operations. And so those pillars are positioning, operations, workforce, experience, and revenue. And uh I have a series of every other Monday, we're going through all of the pillars and has a podcast dedicated to each pillar. So that will be that that's already out. So if you're listening to this and you have don't powers, you can go back and listen to those as well. So let's just stick with that. So we're gonna go into operations. So my question for you is and you are the master of operations, you are our general manager, you know your stuff. So I'm gonna try to stub you. How do you build systems so that the clinic runs when you're not there? And I'm sure this is coming from a provider who is tired and wants a vacation and doesn't feel like they can take it.

SPEAKER_00 16:52

It's it's a lot of work. I think that's the hardest part of scaling up any business is figuring out what are your processes, what are the tools that you're using, what are the roles or defining the roles inside of your practice so that everybody knows what they're doing, how they're doing it, and where they're doing it. Um, and this is something that never ends either. Like you'll always be looking at how we can improve the systems that we have in our practice today. But let's just say you're starting out, everything's a mess, and you come into your day ready to take on anything that's thrown at you, but you're not sure what is being thrown at you. So, number one is being organized. And this is very basic stuff here, but actually just being organized everywhere in your business, you know, you should have uh like files, folders, somewhere where you're saving all of the documents for your business tucked away over in one spot using Dropbox, Google Drive. I don't care, I'm agnostic. Um, your schedule, knowing what is your schedule. You can do blocks, you don't have to do blocks, but just getting your schedule organized, when are you seeing people, um, having all of that laid out, and that's all pretty foundational stuff. Then once you have that, I will look at what tools are you using. Um I it's 2026, and somehow we still work with people who are on paper charts. That that's that's crazy, guys. That's ludicrous. I think in some states it's actually mandatory that you use an EMR. Uh, definitely use some kind of actual digital system so that you can keep things organized. It's gonna make your life a hundred times easier. And then we kind of just keep taking it up one level, one level, and looking at what tools we can add on. You don't want to be overcomplicated in the in the beginning, but as you scale, as you get more patients, you're going to need help from some kind of platform. And you know, the two big ones are your EMR, and then another one is called a CRM. It's a customer relationship management tool. Uh, and this is a platform or software that you can use to help keep organized all of your potential patients, all of your current patients. It's extremely helpful with all of your marketing, and it can automate a lot of things that you have to do inside of your business. It helps automate your marketing efforts, which you know, I think we'll talk about a little bit later on in here. Um, you know, we've built out a platform inside of a CRM directly for hormone clinics that helps automate uh lead information or trying to attract new patients, current patients activating old patients, meaning somebody who used to come to you and now they don't, want to pull them back in. So we have this platform that automates a lot of this. Um and beyond that, I would also say that the systems, if you try to build systems for everything in your business, you're gonna become overwhelmed and exhausted and just burned out. And so, what is that saying? How you eat an elephant one bite at a time, even though that's a crazy saying. Um, you just need to take it one step at a time. If you look at your practice and everything feels chaotic, just focus on one item. If you're finding that you're not sure what patients are coming in for, along with a hundred other things, just focus on getting more organized about getting the information on why a patient is coming in. Where do where do we collect this information? Where does it get saved? How do you find it easily? Find those locations, write it all down so it's documented. Even if you work by yourself, write it down because there's going to be a day where somebody, you're going to hire somebody and you want to hand this off to them. And so just start there, start with the small things, document it, save it in a little folder, put it in your drop box area where you have it SOPs, put it in that folder, and then just save it for that that first hire. You know, that was kind of very roundabout.

SPEAKER_02 21:09

No, no, no, that was fantastic. And and as I'm listening to you, I'm thinking of myself, as a provider, that sounds like a lot. So I want to highlight one thing you said, which is probably the most important way to get started. And that is to document. And you mentioned if you're by yourself, this is the perfect time to do it. If you're by yourself, because it's as you grow that things get messier. But if you're not by yourself and you already have a bunch of staff, then enroll everybody in this activity for one week, just one week. Write down every single thing that happens in each area of the practice. One where, you know, like the lead comes in, the whole sales process, one where the patient checks in. And how they sign up for a new program, how the follow-ups, how your refills get done, like really, like just brainstorm all the different functions of the of the practice and then have everybody write down, get together, refine it. I see so many people jump to technology first before they know what they need the technology to do. And that is where it's very confusing. So write it all down. And even if you don't do anything with it for a while, even if it's like, okay, I'm gonna add the technology a little bit later on because you don't really have the money or you don't have the time to set it all up. If you document the process and things start to break apart, like refills don't go out on time, patients are complaining about something, you can go back to the written document and make sure that there is not a gap there and keep refining that document.

SPEAKER_00 22:56

Absolutely. And that's it. I mean, that's the name of the game. Just always refinement. You're just always looking at what are we doing and what little things are falling through the cracks and how can we make that stop.

SPEAKER_02 23:07

And you know, I always have something else to say. So this last thing I'm gonna say, I heard uh uh I listen to a lot of podcasts, guys. I'm a podcast like junkie, but I heard on a podcast once from a business person, uh uh, I think it was Alex Hermozzi, who's one of my faves, and he said, the difference between a successful entrepreneur and an unsuccessful entrepreneur is the willingness to be uncomfortable.

SPEAKER_01 23:32

Yeah.

SPEAKER_02 23:33

And sitting down for that week and documenting that those those steps is the uncomfortable part. And it's hard. I mean, Patrick, that's how you started. You started by saying this is this is not easy, this is hard to do. But the hard is short term, and then the comfortable part is long term. So if you're willing to be uncomfortable for a short period of time to do the work that is necessary, that I know we don't even have to tell them this. They know the answer to this question. Most people are just looking for a shortcut. Be uncomfortable for a short period of time so that you set yourself up for ease and comfort later.

SPEAKER_00 24:12

Well said, Judy. Well said. Ah, let's see. Okay, well, let me throw one your way. Okay, I think this is something that a lot of people are dealing with. How do you handle high call volume without adding another front desk person?

SPEAKER_01 24:31

Ooh.

SPEAKER_02 24:34

I'll tell you what you don't do. You don't use an automated system. And so I'll tell you a story. Yeah, I'm gonna tell you a story. So Patrick and I started at this clinic around the same time, about a month apart, and we were both very, very adamant that we did no automation. We wanted human beings answering the phone. Fast forward about four and a half, five years later, we had jumped from about 200 patients to about a thousand patients. And we had two people at the front desk, and the phone calls were overwhelming. And we gave we caved. We said, we have no choice, we have to get a phone tree, you know. Thank you for calling the clinic. Press one if you want to speak to blah blah blah, like that kind of thing. And it was a disaster. It was a disaster because we had our UVP, our unique value proposition was personalized care. And the very first thing that they got when they called in for this personalized care clinic that was a luxury clinic was a voiceover, like an automation. It was it was awful. So that's what I would recommend you don't do is you don't immediately go to automation. However, there's a couple of things you can do. The first one is train your patients to use the portal. And I, you know, I'm just gonna say that I'm sure you have more to add to that because we went through painstaking effort to tell patients when they would call to submit a refill, I am very sorry our policy has changed. We no longer accept refills over the phone. And it was uncomfortable for a bit because patients were like, Well, I don't have time to go to my computer, I can't figure out the portal, like all the excuses. But we got through the uncomfortableness, kind of forced people to do it, and it drastically reduced the number of phone calls. And it allowed us to be more efficient and more secure because everything was documented. So, you know, it wasn't like someone calling the front desk and there was a call for like a refill of progesterone and they wrote out a post-it note and they brought it to the MA's desk and put the post-it note and it flew away. And you know, like that kind of stuff happens all the time. The second thing is if you do want to diversify the phone calls, get a phone system where each person has an extension so that instead of it being like, and I don't mean like an extension, like you call one main number and it like, you know, like it actually automatically ports over to that person. Okay, there is like those automated when they call and you ask, like, press in the extension, but you can actually uh use a phone system where everybody has their own like direct dial extension. And of course, they're a little bit more money. Um, so that's something you have to take into consideration. But oftentimes patients will know who they want to speak to. And so if you can direct the calls to that place, that could make it a little bit easier to have human interaction without using automation. But that has, you know, that has everything has its issues. So you know then you have like more voicemails because usually people are patient-facing and they're running around the clinic. So um, you know, gotta choose your battles. Choose your battles.

SPEAKER_00 27:49

Yeah, yeah, definitely. And I I'll just one thing to add on with with the portal. Um, when we first did it, you know, texting was being integrated, but I think texting is definitely far smoother now within EMRs. Yeah, and so utilizing the form that most people use to communicate these days, text can also do uh a big number on bringing down those numbers in terms of people calling you. If you just again train your patients from the get-go, because it's very painful to do it, one, two, three, five years in. But hey, if you have a refill or small question, text this line. As long as you're making it clear this is not a 911 line, right? Right. We don't text emergencies.

SPEAKER_01 28:37

Right.

SPEAKER_00 28:37

Um, but but those little phone calls, little touches, utilize the portal, utilize the text line, bring those people away from those phones that tie up the people in that moment, and so that we can give them the space to take care of it in between patients or in between the the other tasks that the staff is doing.

SPEAKER_02 28:56

And don't tell the patient it's because you're too busy. Like the patient doesn't really care how busy you are.

SPEAKER_00 29:04

When you share their response is hire somebody.

SPEAKER_02 29:07

Yeah, exactly. Exactly. And your staff is probably gonna say the same thing. Just hire somebody. Like they don't understand the business from that high-level perspective. So when you share whatever process you're gonna put in and you're sharing it with your staff or you're sharing it with your patients, you know, explain a why that makes sense for them. Like I had mentioned when we reverted to refills only being accepted during through the portal. We didn't say it was because you know mistakes were being made when people were writing it on post-it notes and you know the call volume was too high. We said we're we're trying to protect you. We want to make sure that we know exactly what it is that you're requesting. And if we're we refilling from your written request, there is no no issue, there's no miscommunication, there's uh there's uh documentation. So if by some chance we do make a mistake and we don't get the refill in on time, we know exactly the date that you submitted the refill. Like make the why a benefit for them, and that makes you the hero versus an annoying role that you're doing so that you don't have to hire somebody.

SPEAKER_00 30:10

Right. Exactly, exactly.

SPEAKER_02 30:13

Uh let's move on. So, looking over here at the list of questions, we're gonna stick with our pillars. So we're up to workforce. Workforce is all about staff, creating a culture, and we talk about it a lot. So, and you know, this is a good one for you, Patrick, because you did a lot of the hiring at the clinic. So, this question was how do you hire and more importantly, retain good clinical staff in this very competitive market?

SPEAKER_00 30:47

Oh, I think this is one of the biggest challenges, again, of any business is staffing because your staff can you know launch your clinic success and it can tank your clinic success. The staffing is everything, and so if there's one thing that I want you to spend an egregious amount of time on, it's making sure you have the right people. All right. Um, and how do you this this is a really big question? Um, how do you hire and then how do you retain? Two completely different things. So when when you're hiring, it falls back on do you know who you are? Do you know what type of clinic you want to be? More than just what your services are, but who do you want to be inside of your clinic? Who do you want standing next to you, working beside you in your clinic? Like what type of person, what type of patient do you want? You know, these are questions that you want to ask. And we actually go through this exercise with our clients that we work with. Um, but we go through and we figure out what are your core values? You know, do you want somebody who's loyal? Do you want somebody who's compassionate? Do you want somebody who's thoughtful, creative, exciting, fun? Like, what kind of people do you want? And then also, what is your focus? Like, what is it that you're interested in? Do you want people who are health focused? Do you want people who are data-driven? Do you want people who just want to make people feel good? Like there's different personalities that work well in different clinics, and so you want to figure out what you mesh with and what you want to be surrounded by. And when you start your interviewing process from that point, it's much easier to sift through the people. Now, interviewing is still a bit of a BS game, right? Like everybody's showing up to an interview with a little bit of a mask on. And when you are going through your interviews, you want to keep these culture values in the back of your mind and actually ask questions that directly speak to those values inside of your interviews and don't just stop with their first answer. I always tell people two things when when I'm like coaching people through interviews, is one, always ask probing questions. So what you know, one of our uh values would be like integrity. And so I would ask, we can either ask a positive or a negative. So positive would be like, in the past, where do you feel that you had to show up in integrity in a position where it was difficult? Or you could ask the opposite of it in the past, were you in a situation when you fell out of integrity and how'd you handle it? Or somebody you worked with fell out of integrity and how did you handle it in that situation? And sometimes you get a quick response. Um, a lot of times you'll throw people and you know, it might take them a little second. That's fine. Give them space to think, give them space to respond, and then they'll give you like a little short answer most of the time. And then just ask questions that came up that you thought about when they're giving you that story. Make them give you details, peel back the layers of it. Because if they're lying, you're going to find out. And if it's truthful, then you're just gonna get more information. And then the other thing I always tell people is don't be afraid of silence. A lot of times in an interview, they'll give you the short answer, and then it gets a little awkward, and so they just kind of start talking, or you start talking, just sit there, let it be awkward, you know. Interviews aren't always the most comfortable. It also puts a little pressure on them, see how they respond to it and see what other information they come up with. Um, and that's that's kind of my first approach to the interview. But then the other thing that I want to share with that interview process is do multiple stages, whether it's for uh uh office manager, a new provider, or your front desk. I want you to interview multiple stages. I do three generally. If it's a high level, it might be four or five. But for my entry levels, I'm doing three interviews. I'm doing a phone screening and I actually like to surprise people. I'll just call them up because nobody responds to the indeed emails anyway. So I just immediately dial them up and I hey, I'm responding to your to your resume. Um, and I give them the option to do a quick 15-20 minute conversation on the spot, or we can schedule it. You know, I understand people have a life, but I want to hear how they sound unprepared. Right? I I want to know are they eloquent? Do they do they sound good on the phone? Do they answer rudely? Do they answer nice? Can you feel the bubbly energy? Um, and so I kind of put them on the spot there. And then if they pass my screening call, I'll bring them into the office. Maybe if you're a telemedicine clinic, you just do like a Zoom call. But I like to do things in person, so I'll bring them in person and interview them myself, maybe with one other person. Jody and I often would do uh interviews together. And then if they still pass everything, we still like them, I'll bring them in one more time to actually shadow the role. And you know, I'll pay them for four or six hours, whatever it is, and just let them sit in with the team. How do they mesh with the team? Because the thing I hated dealing with the most was just the personal squabbles amongst staff. Like it happens, but when you do a good job picking people that work well together, very, very limited. And so by allowing them this, we call them shadow days up front, you can really see how they work well with your team or not. Um, you can also see are they asking questions? Are they engaging? Are they just sitting there quietly? All of those things are really important. Um, and that's only half of this question. Good lord, you know, and then let's look the other side. Once we bring staff on, how do we retain them? You know, the golden rule I think does so much lifting in everybody's life everywhere. Treat people how you would want to be treated. And that doesn't necessarily mean you want to make X number of dollars, then you pay them X number of dollars. That's not how business works, right? So when it comes to pay, I think you should pay fairly. Look at your market, what's competitive, and just remember you get what you pay for. So I always look to be on the upper half of the market average. You know, I always try to be like actually top 25%. Um, pay on the upper end, look for the people that are a little bit more experienced, a little bit more professional, and fit your brand. And then beyond that, um, beyond like the benefits and stuff, like as you grow, I understand in the beginning you can't offer a ton of benefits. That's okay. As a small business, as a solo entrepreneur, you're often much more flexible and can offer benefits outside of your health insurance and all that jazz. You can be flexible with time, you can uh treat your staff uh for free, not necessarily pay for their medications, but you know, be their doctor. You know, when they need advice, be there for free. They need appointments, let them have an appointment, treat them. Not only is that good for them, but it's also good for your sales. If your staff is on hormones themselves and they feel so much better, they're gonna tell all of those potential patients all about it.

SPEAKER_02 38:42

Absolutely.

SPEAKER_00 38:43

Um, I feel like I we could do an entire episode on this, so I'm just gonna stop there because that we we could definitely spend 30 minutes on this question and going into all of the different tactics, but it always boils down to treat people the way that you want to be treated, treat them with respect. Um, and okay, one last thing. Make sure they know what the heck they're supposed to be doing. That's a big one that often leads to headbutting, uh, people becoming disgruntled, and then you firing them. And then you're like telling yourself, I can't find anybody good. I always have to fire these people. And then we look at what the training program is, and it doesn't exist. And no time was spent in the beginning showing them how their job's supposed to be done or providing once special fees. Yeah. More than more than once.

SPEAKER_02 39:32

Showing something something showing somebody 17 things in one day, one time, and then expecting them to get it is not training.

SPEAKER_00 39:40

Yeah. So definitely make sure you think through how you are going to train somebody before you bring them on. A smooth onboarding is a long life.

SPEAKER_02 39:51

I think it boils down to the word privilege. When you're hiring somebody, you come from the perspective of it is a privilege for them to work in your clinic. You've created this amazing business and you want to find the right person because it is a privilege for them to have the opportunity to work for you. Once you hire somebody, it is a privilege that they have chosen to work for you. And if you operate from those two privilege perspectives, you'll you'll find somebody, like you want to find somebody that appreciates that privilege of being in your in your sphere. And then once you've got them, every everything you do should be about making sure they're well taken care of. You know, most small clinics don't have advancement opportunities. And so you'll lose great people if you don't help them advance themselves personally. They don't necessarily need to have a better title for them to have more training or have more personal development or make more money. Like there's always opportunity for advancement. It doesn't have to be just another title.

SPEAKER_00 40:59

So true. And when you do get to a point where it is time to say goodbye, because you know, this happens a lot with students, nursing students, and things like that, which I love to hire, hire nursing students, hire wannabe med students or whatever, you know, somebody who's early on in that process, hire them. It's okay that they're going to leave you. Don't hold on to the best hires. Yeah, yeah, they they really are. They're the ones that are most excited to learn. Yeah, they're the ones that are going to show up. They're they want to see all the different parts of medicine and everything. Train them, teach them, tell them everything you have. It is a privilege to be able to do that. It's not a burden. And when they leave, it's okay. Send them off with a hug and a letter of recommendation.

SPEAKER_02 41:50

All right. What else we got?

SPEAKER_00 41:52

Okay. Let's see, let's see, let's see. Um, we're I'm gonna stick with workforce as well because this is your favorite.

SPEAKER_02 42:00

It is my favorite. Let's well, they're all my favorite.

SPEAKER_00 42:02

Yeah, I know.

SPEAKER_02 42:02

I say that every time.

SPEAKER_00 42:05

Oh, this is this is uh a specialty of yours. How do you keep your team accountable to patient follow-up without being a micromanager?

SPEAKER_02 42:18

Well, I'm gonna start with an answer you probably don't expect. Because I know you think I'm gonna talk about automation, right? And and I am in a second. But before you get there, I want you to think about this, Patrick. What in your life that is super important to you do you forget to do?

SPEAKER_01 42:40

Maybe I should have a question.

SPEAKER_02 42:42

Maybe I should ask somebody else a question. No, I mean, like, think about it. Like the things in your life that are most important to you are the ones you're more likely to remember. And so you've got to treat the uh patient follow-up and all the touch points in your clinic in that same regard because your staff most likely, especially after they've been there for a bit and now it's this is a job, right? And and there's chaos and there's more work than they could possibly do in a day, and there's a lot on their plate, it becomes very much a production workhorse. I just gotta I just check the boxes, check the boxes, check the boxes. And it's very easy to forget why you are doing the things that you're checking the boxes. In other words, when, you know, and I'm just gonna go from the medical assistant perspective, you know, why are you spending the time to draw blood and build the relationship at that time? Well, it's a great opportunity to ask questions that you get a little bit deeper about what's going on in their life. Why is it important to respond back to somebody who is having a side effect or a symptom that most likely is not hormones, but they're terrified because it calms those people down and it makes them understand what's going on. It, you know, it takes that fear away. There's a why behind just about every single task that you do. And When you see your staff uh tasks falling through the cracks, most of the time it's because they're no longer connected or they never were connected to the Y. And so if you can bring that back front and center, and you know, how do you do that? So I'm a big proponent, and we both are a big proponent of staff meetings. Um, a meeting once a week for one hour that never is it's non-negotiable, it's never uh dismissed because of patients. Like it always happens, and you do what you have to do to make that happen. And there's usually not that much to go over in an hour. Like, I mean, how many things do you really have to go over? So, this is your opportunity to bring in these kinds of activities. You know, you can talk about something that you've seen happen in the clinic that is not going well, like maybe um staff being late consistently, or uh, you know, tasks uh in the EMR that are four days old and haven't been touched. These are things that are unworkable. And so if you see these things, you can bring everyone together and don't call people out and say you're not doing this, because they know they're not doing it. They know they're late. Like you don't need to tell them that. But you can talk about why this is hurting the clinic, why this is hurting the culture, why this is affecting the patients and allow them to get the why and then choose on their own to start to fix it. So I would start there so that everybody's coming from the same desire to be good and to do all the tasks. Now, then there's just, you know, there are so many hours in the day. So you can have everybody 100% gung-ho and excited and want to work as fast as possible to make take care of everybody and still patient follow-up gets gets missed. That's when it's time to look at automations. Look at how you can either use technology to streamline more efficient processes, use more of a cross-training approach so that if one department, and you know, you could have one person as an MA and one person in the front desk, and I would call those two departments. If one department is overwhelmed, somebody else could pick up the Slack and they can share. Cross-training is so important. Now, obviously, you know, your front desk manager is not going to draw blood. I mean, there's a like a limit to that, but there are definitely things that I mean, I I when I started at the clinic back in 2017, I did everything except for draw blood. I was the front desk, I assisted Doc in uh pellet uh appointments and handed him the trolls, and I did follow-up phone calls. Like there's nothing that a non-medical person can't do for the most part. So cross-train so that everybody feels supported. And don't ignore it. I think that's like the final, you know, advice that I have. It's very easy. And I I suffer from this because I often will lead based on how I feel about the person versus what's good for the clinic because I'm a people person. So if I know somebody is working really, really hard, sometimes I may not call them out on what they're not doing because I feel bad for them, right? Like they're coming from a good perspective, they have the right mindset, they're all that. But that doesn't work. Like, don't be me. Look because to a degree. At the end of the day, it's hurting the patients, and the patients are why we show up every single day. So don't ignore when something's not going well, but you also don't have to be a micromanager about it. You can pull the team together and you can talk about, okay, guys, this is what's going on. Let's brainstorm some of the things that are happening on a day-to-day basis. Maybe you're the problem. I mean, there's a number of times that the provider was the one calling out the issues, and it was the provider that was causing the friction. And it wasn't intentional, but it was just missed. And so when you get together as a team and discuss what's going on, you look at the problem from every single person's perspective, and oftentimes you'll find the solution. And back to the whole like the right person in the right seat and hiring the right person. If you have somebody in your business practice that doesn't want to participate in that conversation, they're probably not a good fit. Because especially if you're a small clinic, when I say small, I mean like 30 people or below. That's to me is a small clinic. If you have 30 people or below, and not everybody is interested in the practice doing well, and they're only interested in coming in and doing their part and leaving, that's going to be a problem at some point. So you want to fill your business with what I call entrepreneurs, people that show up every day acting as if they own the business because they care. I think I went a little beyond the question. I apologize.

SPEAKER_00 49:07

A little bit, but I mean, I think that's okay. I think this just shows that, you know, we often break out these little topics or these little sections of business, and it's like a string. You just keep pulling it, and more and more comes out. Like everything is connected, and these little decisions that you make over here are going to impact over here. There's always a ripple effect. And if you just pull that string long enough, you can see a lot of the foundational decisions that you make. Who are you hiring? How are you hiring? Are going to make or break you much later on or create all these headaches or get rid of these headaches for you. Um, it's just something that, you know, as a business owner, you will learn, you'll come to understand, or you'll listen to people and look out for it before disaster hits your business. Yeah.

SPEAKER_02 49:57

Yeah, for sure. And and I just want to throw this in real quick. It doesn't fit any of these questions, but if you're a provider right now listening and you have dreams of a multi-million dollar clinic, you want either multi-million dollars, you want over a thousand patients, you want multiple locations. If you want a big clinic like that, take my advice. Hire a really strong business development manager. Not an office manager. An office manager in a medical clinic is somebody who does inventory, does the scheduling, like manages the day-to-day administration. And I'm not saying that's not an important role, it is, but if you really want to grow, you need somebody who is not seeing patients, who understands these business concepts, who's always looking at the business from the very highest level to look for how it can improve in minute ways like this. And that is how a clinic really succeeds. Now, if you don't want that, that's totally fine. You can still learn these principles, but you, as the founding physician or provider is going to be the one that has to implement these things, which is totally fine too. We we work with most practices. That's what we work with. We're like the the little fractional, you know, business development person and the the provider is the leader. So it's very doable. But if you're listening to this and you're having visions of, you know, like the clinic we always talk about, that four million plus clinic, invest yourself in a really good, whatever you want to call it. I was the COO, you call it management. Business management, yeah.

SPEAKER_00 51:37

Lots of different names out there, but definitely more than office manager. Yeah. And yeah, yeah. Excellent, excellent advice, Jody. Excellent advice.

SPEAKER_02 51:48

So it's your turn, right?

SPEAKER_00 51:52

Yes. Yes, yeah. What do you have for me?

SPEAKER_02 51:55

Okay, so um we're on E. So power, patient experience, patient experience. We all want the patient to have a great experience, but not a lot of people spend time really thinking about intentionally how do I create these little wow moments? And I want to tell you something, guys. If you do that, a lot of the other stuff that patients complain about, they're gone because it's crazy.

SPEAKER_00 52:25

And it's just like little surprises. Yeah. I think this is not a clinic thing at all. And this is an unintentional shout-out to one of my favorite companies, LMNT Element. It's a salt company, right? So I was a subscriber, and that just meant like I was auto-shipped a box like every three months or something like that. And with one of my shipments, I got a t-shirt. I wasn't expecting it, but I thought it was the coolest thing. And then the next shipment, I got a hat. And then the next shipment, I got a bottle. Like they just randomly would ship me little things, and it was it cost them eight dollars. Like, I mean, it wasn't much, and you know, they're they're not cheap. I guess they're not they're not that expensive, but whatever. So they just dropped these little wow moments into my the experience that I had, and they're they're just a salt company, they're just an electrolyte company, like it's nothing. I'm the biggest fan of them. And if I see somebody drinking like a Gatorade, I'm like, shouldn't be drinking Gatorade here, have a packet, you know?

SPEAKER_02 53:30

You're more than a so many of us in the clinic also using LMD. And then eventually we had a clinic. Right, we carried it and we and we gave it to our weight loss patients as part of their yeah. So all off a hat. You don't even wear hats.

SPEAKER_00 53:50

I know.

SPEAKER_02 53:52

All right, let me ask you this question. This one came in from one of our providers, and I know this was one provider who asked this question, but I'm gonna guess that most people have this question in their mind because this one works how you reproduce no shows and last minute cancellations systematically, and you know, I I don't know, systematically let's also can I add to that question without a lot of pain.

SPEAKER_00 54:21

Yeah.

SPEAKER_02 54:22

Because everyone ignores it because they don't want to rock the boat, right? But it's killing your business revenue-wise. Okay, I'm gonna show okay.

SPEAKER_00 54:30

Yeah. You there's I think it actually depends on what kind of no-shows are occurring. Because I see this in two different buckets. You have your new patient no-shows, and then you have follow-up no-shows, right? And they are two very different problems. Um so let me speak to like the the new patients first. When we work with a clinic that has a high no-show rate, and high no-show rates, like 30% no-show is high. And I, you know, I've seen some people with 50, 60 no-shows. So it can get pretty crazy. Um, and if you're having that problem, then it's probably a qualifying issue. What I mean by that is the work being done ahead of the appointment is very, very small. The barrier to come into your practice is non-existent, and so they aren't invested. Maybe that means that there isn't a conversation up front. If they can just book online, it's your new patient, right? Yeah, new patients. If they can just book a visit with you online without speaking to anybody, they're not very invested. This was a whim, uh, you know, on the moment decision kind of thing. Um if they if you offer free initial consults, I'm gonna say that's a no-no as well. Because again, there's there's no commitment. And if this one might be just a preference of mine, if you're not getting blood work before that initial consult, again, they don't, they haven't bought into your practice. So if they show up, they might get something. If they don't show up, they aren't really losing very much. So I will look at what your new patient process is in the beginning. One, have them speak to somebody in your practice and qualify them. Do they make sense to be a patient? Like, are they having symptoms that would reasonably allow them to be on hormones or whatever the treatment you want to offer? Can they afford it? Yes, share what your pricing is. Okay. You don't have to necessarily give them exactly this is what you're going to pay. Give them a range. I understand that treatment modalities might be different. Uh, how many appointments somebody might need depending on the case might be different. The scope of their treatment can be different. So you don't have to say when you come in, it's gonna be $1,800. But what you can say is, well, you know, obviously it depends on what you're looking for, what ailments come up and what the modality is that uh works best for your lifestyle. But our plans start at, you know, $2,200 a year up to $2,800, or if you do monthly, which I love doing monthly, um, you know, they're they start at $199 and go up to $279. You know, now you've given people an idea or understanding what the ballpark is, and we're gonna lose some people on that call, and that's okay because they would have been a waste of time anyway. And then the people that are still moving forward are a little bit more committed, they understand what it's gonna take to move forward. So when they show up, you're gonna have a higher conversion anyway. Um, and then what else? What else did I say?

SPEAKER_02 57:54

Was the before you move to the follow-up snow shows? Can I just add one thing? Yes, because I I agree with you a thousand percent. However, if the person is calling the front desk, if a new patient, a prospective patient's calling the front desk and they say, How much is your treatment? Yeah, it's not a great idea to then say, well, our plan started $1,800 to go up $200. Because now the person is just price shopping. I 100% agree with Patrick that sharing your pricing is an important thing to do before they come in. If they ask, don't offer it. If they don't ask, don't offer the information. But it really should be a part of a bigger conversation where the person on the phone with them and and we talk about patient liaisons as the person who talks to a prospective patient. We try to get all of our clients to have patient liaisons when they can afford them. Um, you're talking about symptoms first, you're talking about quality of life, you're talking about the result that you're going to get from hormones, and then you can talk about the pricing. Or if they ask the price first, you're telling them, but then you're keeping them on the phone to really talk about the value. Because otherwise, it does become a commodity. If I call a massage therapy place and I say, How much is your 60-minute massage appointment? It's a very different question than what is the cost of my hormones every year for the rest of my life. I just wanted to throw that.

unknown 59:16

Yeah.

SPEAKER_00 59:17

It's it's really true. Um, and as you get larger and larger in your practice, you'll find that that's a conversation that doesn't work well at the front desk and you have to move it behind the scenes. We call that role a patient liaison. Strongly recommend if you are looking to really have some serious growth. But um, it just goes back to qualifying that initial visit for those people. Um, now let's talk about our follow-ups. If you're having patients just not show up, then we they have been trained that that's okay. And we need to untrain that behavior and put some uh guardrails in place so that it doesn't continue. The easiest thing to do is initiate a no-show fee. You know, if you go to uh a yoga class, they have no-show fees, right? If this isn't a weird thing, don't feel weird about it. Put it in place. Um, you know, a $50 no-show fee. Well we are working with a clinic right now that actually has a hundred and I think it was $150 or maybe $189 or a weird number like that. Yeah, I mean, it was a significant uh no-show fee. Like $50 is, you know, I mean, that's it's it's lunch for two these days. Like it's not a little amount, but almost $200 for not showing up for an appointment. People are going to notice. People are going to see that. Uh and then the other thing, automation. What are we doing? How are we reminding people? I'm the worst at it. I just walked out of the doctor's office yesterday and I didn't put my next visits into my calendar until I got back to my car. My wife was like, Oh, did you put those in your calendar? Like, oh, no, thanks for reminding me. Because 10 minutes as soon as I leave the office, whoop, I forget about it. So, what are you doing to help people remember? Um, this typically is built into your EMR where you can send an email out, you can send a text, uh, and bug them. You know, sometimes you have limitations where you can only send one. But if you can send multiple, send multiple, you know, send it, you know, five days out because people are planning their weeks. So send it five days out, say, hey, this is the week of your appointment, and then send it a day out and then send it day off. It's okay, it's just a text. People get hundreds of texts these days. And if they if they don't like it, they can block it. But for the most part, I think people find that helpful. So just making sure that you have some of those automations in place, and then again, protect yourself, put some policies in place, and make sure your patents know about it. Like put a little sign at the front desk, make a little warning box when they're booking an appointment online or like some message. Uh, make them sign. Is it part of your initial agreements that there is a no-show fee? Don't try to be weird and hide this. Um, make it clear so that people understand. Yeah.

SPEAKER_02 1:02:22

Matt, I'm gonna add to it because I always have to add. Well, because we've been in a clinic a long time. And so, you know, one of the reasons we started this company was because we wanted people to learn from all the mistakes that we made. And I think one of the mistakes that we made with the no-show fee was that we allowed, or I don't even think we allowed, it just sort of happened where different people in the practice would choose to waive the no-show fee because they were the one that answered the phone and the person was like, oh my God, you know, I had a meeting and then I got stuck in traffic, and you know, and it became a giant mess. So I'm not saying that you should be like every single person gets a no-show fee, no matter what the issue is, because there are definitely reasons why people don't show up and they're very valid, and you want to be a human about it. But make one person in the office the one responsible for saying I will waive that fee. And all the rest of the staff has to do is I understand what's going on. I just need to go get that way, that no-show fee waived by my manager and I will let you know. Because what will inevitably end up happening is, well, from the team perspective, there'll be friction because the manager might override you if you said it was okay and then you said it wasn't, now you look bad, and that's a terrible position to be in. Or your patients often know each other. So why was one person, you know, given a no-show fee and the other person wasn't? If that happens because of an of a circumstance and the somebody called, you can bring it back to that one person. So if the one person is responsible, the one person can also manage all the mess. So just you know, learn from that mistake that you don't want everybody in the office kind of being able to kind of wave it because they're you know, they heard the horror story.

SPEAKER_00 1:04:18

Yeah, yeah, yeah. That's absolutely true. That's that's your office manager right there. Yeah, that's the perfect thing for them. Yes. And uh yeah, excellent advice. As always.

SPEAKER_02 1:04:30

Yeah, if you don't have an office manager and you do have a patient liaison, let it be that person. Uh it hopefully is somebody who's not super medical. Like some of these administrative things, it's really great when the non-medical person is the one making the decisions because then you're not collapsing the care with the admin. If there's nobody in your office that is non-medical, other than maybe your front desk, and that person is, you know, not someone you want to give the responsibility to, then it's you. It's you as the provider.

SPEAKER_00 1:05:00

Yep. And that's just, you know, that's just how it goes in the beginning. Yeah. A lot of things fall on the founder's plate.

SPEAKER_02 1:05:06

Yeah.

SPEAKER_00 1:05:07

Absolutely. Yeah. Uh all right. Well, why don't you say let's finish this off? We have last one, our R, so revenue.

SPEAKER_02 1:05:16

All right.

SPEAKER_00 1:05:16

Uh let's see. A good question for you. How do you increase patient lifetime value by doing it without feeling like you're upselling everybody?

SPEAKER_02 1:05:31

Well, first we need to define what lifetime value is because lifetime value is not about upselling. So I think this question might have collapsed a little bit. So, lifetime value of a customer is literally the average length of time that that person is with you. And so, we are lucky in our industry because the lifetime value of a patient is longer than most other businesses, because once you reach the point where you need to be on. Hormones, you're not ever getting off of them unless you choose the patient chooses to get off of them, right? So it's not like you suddenly get better, or you suddenly get results. I don't better better say about the wrong word. Anyway, you get my point. So we have found that the average lifetime value of a patient is between three to five years. Now, the goal should be more like seven to ten years, but the average is three to five. And the reason why that is, is because, well, one thing is patients will uh not be able to afford it any longer. That's probably the number one reason you lose a patient. The second is the patient no longer jives with your clinic. And that often happens as the clinic grows, more providers come in, um, and there's just a different feeling. So that could happen. Sometimes it happens because the patient moves away, right? And if you are not a telehealth clinic and they move, that could become a problem. Um, and the last reason is because their friends go someplace else and they want to try a different location. So those are the reasons why you would lose somebody. It has nothing to do with upselling. Now that you know that, now that you know the four major reasons why you lose people, you want to look at what you can do to ensure that you don't lose people. You cannot fix if somebody moves. If you're a pellet provider and somebody moves to another state or they move to a place that you don't have a license, all you can do is give them their records, you know, wish them luck, tell them they ever come back for a vacation, they should visit, and that's nothing you could really do about that. If it's financial, I'm gonna break this into two different parts. Okay. If it's that the person just doesn't want to pay anymore, like I just, I nothing's changed in my personal life, and I just don't want to pay your prices any longer. I'm gonna go someplace that's cheaper. Obviously, you know, you can try to salvage the patient by sharing the value that you bring to the table, but you may not win that battle. But if it's because they lost their job or they had a significant life change, I think it's worth it to work with that patient and say, you know what? You know, what we're gonna do is for the next six months, we're going to give you this significant discount of like, I don't know, whatever, whatever you can give them that doesn't cost you money, especially if this is a patient that you've had for a few years and they all of a sudden like they had a $150,000 a year job and money was on an issue and they lost their job and now they need to go find a new one. You know, for the next six months, we're gonna bring your price down to this. We're it's gonna be a break-even for us, but we want to keep you on hormones, keep you, keep your treatment going. And the end of six months, you know, we're gonna have to bring you back to the regular price. And unfortunately, if you aren't able to do that, then we're gonna have to part ways, but we give them that time. I gotta tell you that that will go so far. You will lose no money, you won't make any money, but you will absolutely have a patient for life. We did that quite a bit during COVID. Okay. I mean, we we did very well during COVID because we were fast to react to uh altering our processes and our operations, and we we worked with people who lost their job. The other reason that you have uh your clinic has grown and the culture has changed and the atmosphere has changed and the patient no longer jives with you. Um, that's that's important. That's important to know. Now, I wouldn't say that you can fix every one of those, but it's definitely worth sitting down with the patient and honestly getting their feedback. Ask them, like, look, I'm not stopping you from going, but I would really love it if you could sit down with me and have a transparent conversation and share all the things that you're noticing that you feel no longer are consistent with what you had when you started. Because that person may save your ass. You may lose that person and they will be gone, but they may tell you things that you never knew about what was going on in your clinic that you can now go back and fix and alter and improve that will save the next 10 patients you are going to leave. Absolutely. And if you feel that you can do that, then by all means, call that patient back and be like, you know, thank you for, you know, you don't have to make any promises in the moment, but let them walk out the door, synthesize it, think about it, you know, maybe discuss it with, you know, like some of your teammates teammates. And if there's some things you're gonna do to change, give the patient a call and be like, you know, thank you for being so honest and sharing with me and here are the things we're changing. And I would love to have you back. And, you know, if you're willing to give us another try and we're gonna reevaluate in three months, and you come tell me whether the things we did worked.

SPEAKER_00 1:10:42

I mean, that's that's that's something that nobody does.

SPEAKER_02 1:10:45

Yeah.

SPEAKER_00 1:10:46

You know, if if oh I know we did it, but yeah, we you you show that kind of vulnerability to the patients and willingness to actually make a change. Very, very few businesses do that.

SPEAKER_02 1:11:02

Yeah, this old adage that you know the customer's always right, you know, that kind of thing, that no longer exists. The I I I've seen this a lot with providers. Um, and I'm gonna say this is gonna sound harsh, and then I'm gonna kind of back up and explain why. So I I I hear this a lot. I'm firing that patient. They don't appreciate what I do for them. Well, that's that may be true. It may be true they don't appreciate what you do for them. They may be a jerk and maybe they are the right the patient you should fight you should fire because there are people out there that take advantage. I'm not saying that every, you know, every story deserves a conversation. But if if you somebody is really upset with you about some or your your business, that that feedback is invaluable. And you just may have gotten to a point where you feel like you've given too much. This could be an indication that your pricing's too low. You know, maybe you're giving more of your time, more of your knowledge, and you're keeping your pricing too low, and there's like this resentment building up. And maybe that's how it's manifesting is in this kind of anger toward a patient that's expecting a certain level of concierge treatment they're not receiving. And they, their expectation of the price is different than your expectation of the price. Like there's value, is my point is there's value in all information. And so just being annoyed that somebody is going to leave over a dispute with a staff member. Um, I always want you to come to the staff member's um defense first because you don't know the story. And at the end of the day, it's the staff member is your team. But definitely sit down with the patient. Um, what was the last one?

SPEAKER_00 1:12:45

Let me get it.

SPEAKER_02 1:12:46

Oh, they just want to push shop. Yeah. So, you know, this happens all the time, especially these days. You know, when we started in 2015, I started it with uh with uh Dr. Carazella in 2015 as his marketer, there were so few options in the entire Central Florida area. We could do anything, like we could make them wait three hours if we wanted to. They weren't going anywhere. But now that's not the case. Not only are there probably, you know, seven hormone clinics within a walking distance from where you are, there's also online options and that the telehealth and it's all over. So if somebody is determined to leave you because they want to go try something that their friend is doing or they want to see if something cheaper is better, sit them down and wish them well. Remind them of the quality of care that they've received at your clinic and invite them to come back whenever they want if they don't feel they're getting the same care, the same results, and the same experience.

SPEAKER_00 1:13:45

With their friend.

SPEAKER_02 1:13:47

With their friend. Exactly. I am astonished at the number of patients that we exited amicably in that way that came back. And I the number of people we've worked with that get pissed off and like, see ya, and that's it, because there's so many other choices. Why were they going to circle back? But how many businesses when you leave, especially if you have a membership program, that they say, I look send me who you're going to, let me look them up for you and make sure that they're properly trained. Like help them make their choice better. And at the end of the day, if you really are providing that extraordinary care, they're coming back.

SPEAKER_00 1:14:30

They're coming back. I can think of specifically two different patients, well, a couple and one other patient who stopped coming to us after like six years, seven years coming. And it was because we were, they were in like Winter Haven, you know. That's like over an hour drive each way for them to come into the clinic. And we did just that. We we knew we knew somebody down there, and so we said, okay, this is the clinic that you should go to. You know, these are your prescriptions. Obviously, you have to give them their charts and everything, but um, don't make it hard, give it to them. And it was within the year they came back because the experience is just it was so dramatically different in our practice than anybody else in our area was providing that they said, you know what, it's okay, it's worth the drive. And they came back. So be helpful, look at how you can always be there for your patients without expecting a return. And I'm a believer in karma. It'll come back to you. Maybe not through them, maybe it'll be through referrals that they told their friends that were closer to town. And uh, you'll see the benefits down the road at some point in time.

SPEAKER_02 1:15:42

I gotta tell you that the the indirect benefit that happens from being that incredible with your patients is that your staff respect you. Your staff is like, I never want to leave this place because I work for a company that is full of integrity, that is really committed to people and the patient outcome. And um, I would say the first like six years of our clinic, I we had very little turnover. As you know, as we got bigger, the turnover was bigger. It just it's inevitable as your business grows, you have more problems. But when we were smaller, like 12 employees and below, and everybody knew what was going on with all the patients. That was definitely something that people would say. It's like I never want to leave here, even though I can make more money if I go someplace else, because this company has their their ethics and their morals in place. Yeah.

SPEAKER_00 1:16:40

Yeah. Uh the good old days, good old days. You know, those small teens were really fun. That's a really fun stage to be in.

SPEAKER_02 1:16:48

Yeah, agreed. Agreed. All right, let's do one more. One more question to finish out our power pillar. We have a lot more questions, but I think what we'll do is we'll gotta close this out and then we'll come back and do this again because we've some really amazing questions from people. So we could, but it's really over an hour. Okay, here we go. What is a realistic revenue target for a clinic in year one, two, and three? That's a that's a tough question to answer without a lot of context.

SPEAKER_00 1:17:26

No, I don't know. It depends. What do you want it to be? You know? I wouldn't I wouldn't venture to guess that you're gonna make ten million dollars in your first year. You know, you would have to have some serious backing. Maybe Tony, if Tony Robbins uh comes in and he's he's your financier, he might make ten million dollars your first year. But you know, this really depends on so many factors that are specific to you when you're opening a practice. Number one, how much do you want to make? Because in your first year, you can absolutely make half a million or more, but there's a lot of work and there's a lot of capital required to make that happen. So if you're going into this adventure with uh a fully flushed out plan with a team with money to invest, then you're gonna be able to scale much quicker. But if you're coming at this as a side job, like you're still working in the hospital, that's what we see 50% of the people we work with. They're inside of the hospital and they're doing this on nights, weekends, and whenever they can. Uh that's gonna look very different for you. And, you know, to put some actual numbers down, I've seen solo entrepreneurs uh launch their practice and in the first year they make $150,000. And, you know, that's gross. Like that's the the full amount that was brought into the business. And I would say that's a success. Because what you're doing in that first year is you're figuring out so many things. You're a lot of times you're fresh out of your training, and so you're learning how to actually practice this medicine. You're figuring out your process, you're figuring out your pitch. You know, how are you speaking to the patients? How are you uh directing that first consult? You're like you're figuring out so many little things about your business. And so if you stay in the black, that's success. That's how I view it. The first year is so often um fumbling around, kind of trial and error when you're doing it by yourself. And then in year two and year three, without pegging like an actual number to it, those should be your some of your biggest growth years. Because when you're small, it's easier to make huge jumps, right? It's easier to go from 100,000 to 600,000 than it is to go from 600,000 to a million. As you as your your clinic grows and you bring in more revenue, growing that revenue is going to be harder and harder and harder. So years one, two, and three should be some of your fastest growing years so long as you have the time and dedication to make that happen. I think that's really I know this is very vague and obtuse answer here, but that's really what it comes down to. Are you 100% in? Are you 50% in? Did you save up money to invest into this practice? Or do you have access to capital that that you can throw at this practice? And if you do, I would expect significant growth in those those first few years, you know, doubling or tripling your revenue. Um, again, given that that you have the capacity for it. But also it just comes back down to what you want. We work with people who only want to be open two or three days a week. They only want to see patients for a total of 12 hours that week, and that's it. And so your your revenue might become stagnant in year two because you're a capacity, and that's the way you want to live your life, and that's beautiful, that's perfect. There's no reason to change if that's the way you want to live your life, because you know, your business is not a separate part of your life, it is your life as a founder, and so this uh you know, work-life balance, it's all one thing. You have to make it fit in your day, you have to make sure that you have time for your patients, time for your family, time for your admin stuff, and just make it flow, whether that be on a Friday, a Sunday, a Tuesday, doesn't matter. You work, make your life the way you want it to look like, and then the growth will come either naturally or with a little help.

SPEAKER_02 1:21:53

From your friends. You know, everything you said is I think the first step to sit down and document, write all that out, like journal it out, talk it out with your spouse, get all that out of your head. The second step is using one of these. So if you're not on YouTube and you can't see what I'm holding and you're listening to it on, you know, Apple, it's a calculator. And I know it's kind of an old-fashioned tool, but probably the easiest way to determine how much money you're going to make at the end of year one, year two, year three is by figuring out what that number is. So we're going to use Patrick's model, 150,000. How much are is a year of treatment worth to a patient? $1,200, $1,500, $2,800. Multiply that number by how much you want to make, that's how many patients you need to bring in.

SPEAKER_01 1:22:54

Divide.

SPEAKER_02 1:22:55

I'm sorry, divide. We all know that I'm without the calculator, I can't do anything. So, because there's a very big difference between I want to get to $150,000, the way I'm going to do that is I'm going to market, I'm going to get my my friends and family, I need an MMA. Like those are all details. But at the end of the day, if you don't have what it takes to bring in 10 patients, if it's going to take 10 patients a month to get to 150,000, and so that is 120 patients, I get that right. And you don't and you don't have tactics in place to get 120 patients, you will not get 150,000. I don't care whether you work two days a week, three days a week, I don't, it doesn't matter. It's getting getting in front of the numbers because there's a variety of ways you could get 10 patients a month. You don't necessarily have to invest six grand a month in marketing if you don't want to, although that is the fastest way to do it, right? Is to invest in putting yourself in front of people who don't know you. Um, but you have to have a plan. And I we, you know, I we talk about dollars all the time when we're on podcasts and when we're, you know, you know, doing videos and all that stuff. But when we're working with clinic owners, we're talking about number of patients more than dollars, because that is a graspable, graspable, is that a word? It's a graspable thing. Because number of patients equals dollar amount, number of patients equals how much time you need to devote in the clinic, number of patients equals what tools and technology you need in order to streamline your process, number of patients equals the number of staff you need to hire. So do what Patrick said. Sit down, think about your life, how many days do you want to work, what do you want to be at? I wouldn't even do two and three. If you're still, if you're just starting out and you're really thinking about year one, just start with year one. Just do this work for year one and then work backwards and figure out the number of patients. Now, how are you gonna find those people?

SPEAKER_00 1:25:10

That's the big question. If people don't know who you are or can't find you, you don't have a business.

SPEAKER_02 1:25:17

Absolutely. And you know, I'm a marketer by trade. That's what I've done since the early 90s. But you don't have to spend traditional marketing dollars to grow your business in the first year. As long as you're willing to go slow. You don't. But you need to be intentional about it. You know, there's a there's a a ancient term called grassroots marketing. I'm sure everybody knows what that is, but grassroots marketing is doing things out in the community in order to get your your your find you find five people. Those five people you get each those five people to bring in somebody else, and you start to get this ripple effect. So there's ways to do it. You don't have the time for that, then you have to go for digital ads. But I'm I I'm saying it over and over again because it's so important. It's so important to get to the end, what the end number is, how much you're making per patient, and then figure out how many new ones you need to bring in to get to that number. And if you are years two, three, four, five, six, seven, eight, nine, it doesn't matter. You take you carry over what the recurring revenue is from the past year, and then where do you want to be at? The difference is the number of patients you need to bring in. It's that simple, guys.

SPEAKER_00 1:26:28

Yep. And if you need help, AMP is always here to help you out.

SPEAKER_02 1:26:33

Yes, we are. So that's where our workshop came from. I mean, for those of you that know the story, I uh I owned a digital marketing agency and I picked up a hormone client. And after working with him for two years, I really loved this industry and I'd never worked in the medical field before. And I said, hire me, I'll come grow your clinic. Um, and the before I even started, we spent a weekend whiteboarding out what we wanted the clinic to look like. And it didn't look like it did, by the way, when we when I left. We we wanted something different. We evolved along the way. We wanted multiple locations and we didn't end up doing that, but we still got to the dollar amount. But it we did just that. We figured out our core values, like Patrick talked about. We figured out our core focus so that we stayed focused on the right treatments. We knew where we wanted to be at the end of the year. We figured out our pricing, then we worked backwards the number of patients, then we came up with a plan to get those patients. And uh we still teach that to this day. Because it's it's it's a predictably, it's a predictable way to grow a clinic without failure. Because if you know all these metrics, then as you are living life and taking doing the actions you need to take in order to make those metrics happen, and you don't, you're not succeeding for whatever reason, you stop and you do something different.

SPEAKER_00 1:27:53

Very well put, Jody. Very well put. You always break down these things very, very well. You're great. You're a great explainer and orator. Thank you. This has been so much fun. Yeah, I'm glad we finally uh put this on our schedule. We talk to each other literally every day. We pushed this off. So I'm glad we finally sat down to do this.

SPEAKER_02 1:28:15

Me too. So you know, you there's no reason that anyone would know this, but Patrick and I, when we worked at the clinic, we actually shared an office. We we our office grew so fast that we didn't have enough space. And I had this giant, gorgeous office. And so Patrick moved in with me. We were roommates for like a year and a half. So, you know, we just would talk all day long. So it's nice to do it over video because we're not in the same space any longer.

SPEAKER_00 1:28:41

I know. I know.

SPEAKER_02 1:28:42

Sucks.

SPEAKER_00 1:28:43

Little blast from the past today.

SPEAKER_02 1:28:46

Well, if you're still listening to this, an hour and a half. Thank you so much for giving us your time and attention. We really do appreciate it. And we're definitely going to do more of these. Um, we we separate our questions out. We have another series of questions that are just from providers that have clinics that are already doing well and are ready to go to the next level. So that's what we didn't get to today. So we'll we'll do that on our next our next show.

SPEAKER_00 1:29:12

I love it. All right. Well, Jody, thank you so much for having me today.

SPEAKER_02 1:29:16

Thank you for all of you.

SPEAKER_00 1:29:16

I'm looking forward to our next awkward silence.

SPEAKER_02 1:29:20

It's just like in the interview process. All right, thank you.

SPEAKER_00 1:29:27

Alrighty. Bye, everybody. Thanks for listening.

unknown 1:29:30

Bye.

SPEAKER_02 1:29:32

Thank you for listening to Beyond Hormones, the business of wellness. I hope that you're walking away with fresh ideas and real strategies you can use to grow your practice with profit and purpose. If you enjoyed today's episode, be sure to follow the show so you never miss a conversation. And if something you heard today resonated with you, do me a favor, share this episode with a friend or colleague. It's one of the best ways you can support the show, and it might be exactly what they need to hear right now. If you want even more tools and support, go ahead and head over to accelerated medical practices.com. Until next time, keep doing the work that matters. Your patients need you, and I am cheering you along every step of the way.