How a 45 Year PT Practice Handles 500+ Referrals Without Selling Out

In the early 90s, private physical therapy practices across the country were being bought out. Four companies showed up to buy this practice & They said no.
 
While many owners took the check, Dave Damon and his team chose a different path protecting their independence, their people, and the future of their practice.
 
In this episode, Michael Yablonowitz and Nathan Bush sit down with Dave Damon, President & CEO of Kitsap Physical Therapy, who spent nearly 45 years helping build one of the most respected PT practices in Washington State.
 
If you're a healthcare owner navigating growth, partnership, and long-term vision, this episode is a masterclass in building something that lasts.

About Snapscale
At Snapscale, we help healthcare practices scale their operations with HIPAA-compliant virtual assistants trained specifically for healthcare workflows.
 
Learn more:
https://www.snapscale.com 
 
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In this episode, you’ll learn:
• Why saying no to 4 corporate buyouts in 1992 changed everything
• How to grow a private practice without losing independence
• The power of collective partnerships to compete with corporate giants
• What it takes to build a legacy practice over decades
• Why virtual assistants became the key to handling 500+ referrals without burning out the front desk
 
Connect with David Damon: https://www.linkedin.com/in/david-damon-00a4511b/ 

Chapters: 
00:00 - Introduction
06:20 - Facing Corporate Buyouts & Choosing Independence
15:30 - From 2 Clinics to 9 Locations: Building Without Selling Out
23:10 - Referral Overload & The Front Desk Burnout Crisis
27:15 - How Virtual Assistants Changed Everything
36:00 - Legacy, Retirement & What 45 Years Taught Him

#PrivatePractice #PhysicalTherapy #PracticeGrowth

Transcript

Introduction

SPEAKER_00 0:00

In 1992, four companies showed up to buy this practice. They said no. Most people didn't. And most of those practices don't exist anymore.

SPEAKER_03 0:14

Welcome to the Snap Scale Show, hosted by Mike Jablanovitz and Nathan Bush. In every episode, we explore the real challenges and breakthroughs happening in modern healthcare operations.

SPEAKER_00 0:56

In the early 90s, physical therapy started to corporatize, as some would like to say. Private practices across the country are getting rolled up, patient bases, staff, independence, all of it. A lot of owners took the check. Today's guest didn't. Dave Damon is the president and CEO of KitSap Physical Therapy and has spent nearly 45 years building one of the most durable physical therapy practices in all of Washington State. Nine locations, 25 partners, and nearly 100 providers, and a model that actually absorbs the administrative burden most clinics are drowning in today. He retires this August after 40 years as a partner, and he agreed to come on and tell the story. This is that conversation. Dave, it's it's great to have you here.

SPEAKER_01 1:51

Thanks for having me. And um uh it's good to be here and with you. And I would right out the gate would like to first of all give credit to our founder. Um, uh it wasn't just me building this practice, our founder is a brilliant man, uh, Mike Danford, and um he was generous in bringing me in when I was quite young as a as his first partner. We did things together for I guess the next 12 years before we moved into sort of a group model and brought on others.

SPEAKER_00 2:26

So wow, it's amazing. That's awesome. And and again, uh we're here with Nathan Bush, who's the head of growth at Snap Scale, and he will be leading the conversation because if I did it, it would probably wind up rambling. Um so Nathan, pleasure to have you here. Let's get us going.

SPEAKER_04 2:44

Yeah, thanks, Mike. And Dave, thanks for being a part of our show today. Appreciate it.

SPEAKER_00 2:48

Absolutely.

SPEAKER_04 2:49

Dave, you know, you joined the practice back, I think it was 1986 that you told me in your original story. And you were your plan was to stay there at one, maybe two years, but you stayed there and you're still there. Let's start there. Tell me a little bit about that.

SPEAKER_01 3:05

Okay. Well, I I grew up in Northern California, um, kind of the wine country, not Napa, but Mendocino County, and it was a great little town. Uh I loved it, beautiful area. And uh, but I did six years of college in uh Washington State, uh Whitworth College in Spokane, and then University of Puget Sound for physical therapy. Saw this job posting in little uh uh Paulsbo, Washington, and I didn't know where that was. I drove out, met our founder. Uh the two clinics he had were the clinics themselves were nothing impressive. They were pretty small and humble, but he was pretty impressive, a very progressive guy, and uh he offered an awful lot. I thought this would be a great place to get mentored. I I'm an athletic trainer and physical therapist, and he was all about sports therapy, orthopedics in general, a very skilled manual therapist, and doing things that uh others weren't doing, doing pre-employment screenings on firefighters and fitness exams, and um teaching high school kids basic first aid and taping. And I thought this would be a great place to come, uh, get mentored for one or two years, and then I'd move back home to Northern California where I I had a standing partnership offer with some really skilled therapists uh back in Ukaya. But um here I am and uh met my wife and she's a local gal, although she would have I always say she would have been more than happy to have moved to California. She she liked the idea of getting to a little more sunshine, but um the opportunities were here with Mike, and I should give credit to his wife, Barb, who's also a physical therapist, a pediatric focused therapist. Uh they were great, great to me, and and so so here I am, and and I have um now, you know, we've had a f some partners uh retire and and or move for family reasons. Uh and uh so we currently I think have 23 partners, but we're soon to have 24 again.

SPEAKER_04 5:36

Incredible. Take me back, Dave, to 1992. You uh you're one year into being a partner, I believe. Yeah, I believe you said you had two little girls at home.

unknown 5:46

Yeah.

SPEAKER_04 5:47

Corporate comp uh, you know, four corporate companies show up telling you that they're gonna basically put you out of business. What was that emotional state really like when that happened?

SPEAKER_01 5:59

It was scary. Um it was uh yeah, that whole thing seemed to happen. I remember the Clintons being in the White House talking about universal health care and managed care and those kinds of things, and just that discussion on the national stage is what seemed

Facing Corporate Buyouts & Choosing Independence

SPEAKER_01 6:20

to kind of start. It was like the catalyst for the corporatization of healthcare, hospitals merging, and and in the therapy world, you started seeing the precursors to modern day Select, ATI, those kinds of very large companies. They started back then, as far as I know, and and they started back east and in the Midwest and moved out, and it really seemed pretty sudden that four of them were in the state of Washington buying the majority of private practices, and they came to Little Kittsap County, and there were a couple other small private practices. They bought them, they came to Mike and I, and um it was the their approach was pretty intimidating. They basically said, when we said we weren't interested in selling, they said, Well, you might want to reconsider because we have the economy of scale. We are doing outcome studies, and I didn't even know what an outcome study was back then, and it was just sounded scary. And they said, and we've got full-time executives meeting with the CEOs of large payers, you know, Blue Cross, Aetna, etc., and we're getting exclusive contracts, so it won't really matter if the docs and nurses and such, the medical community thinks you guys are just fantastic. That has nothing to do with it. The the patients are gonna have to come to our clinics, which we're gonna put all around you, because we'll have the uh exclusive contracts. And I I just thought, you know, Mike, I said to Mike, we we I think we need to do this. I don't I don't see any options. And I was very young, and he was uh a little more seasoned and and not so scared off, and he said, Well, let's make some phone calls. And so we contacted uh a number of other private practices in the state, and um, and we we were in the founding uh network or co-op. Uh I can't remember the original name of it, but it at one point it was Rehab Alliance, now it's Northwest Rehab Alliance, and it started with maybe 40, 50 or so clinics that were wanting to be independent, and and now we're maybe 400 clinics, but uh of course they helped us. We collectively paid for the administrative folks to help us with compliance standards and um uh most importantly with contracting with insurance so that we could stay in the fight. Um so but uh yeah, I it was scary because it just seemed like there was nothing we could do until we kind of got together. A group called therapeutic associates is sort of the backbone of that network, and um they were uh a group of private therapists much larger than us. They had, I think, just six offices though in Washington. Most most of their clinics were Oregon and California, and they were all physical therapy owned, but they were a group, and they helped us with that running that network, and uh so that's what helped us uh stay in the fight.

SPEAKER_04 9:51

Yeah, I mean that took real courage, Dave. That's incredible.

SPEAKER_01 9:55

I'm not sure how much courage I had at the time, but I um I stepped up along with Mike.

SPEAKER_04 10:04

Yeah. You know, for me, I'm sure all of the numbers look good on paper and everything looked great, like you probably should sell at the time, and they probably made a really compelling case. You and your partner said no when everyone around you was saying yes at that time. All these physical therapy practices were rolling up. What actually was the basis of that? Not the paper. What was the basis of that decision?

SPEAKER_01 10:33

Well, we kind of hated the idea of the death of private practice. We also Mike called some of his private practice friends on the East Coast that had sold, and you know, the stories were kind of yeah, it's nice you get a pot of money, but then it's terrible. That was their opinion. That the folks come in and they look at your patient to staff ratios and they start making you lay people off, and and it's just not so fun. And and our sense was um it it might be nice to have a you know a chunk of money for a while, but we really believed we had a great thing going and it could get better, and and we liked we didn't like the idea of having to change our whole model, of having to change, you know, maybe the the one-to-one nature or the the duration with patients and having those things dictated by somebody else. Um it's kind of nice to be able to do things how you see fit.

SPEAKER_00 11:41

Yeah, and a lot of what we hear, Dave, too, is that like is I I don't I use PE loosely, but anybody looking to buy out practices are bearing the lead, so to speak, and not telling these practice owners that really a lot of them aren't really that true business people. They're great practices. They do great with patient care, they're great with people, and they don't get the business part of it. And again, not everybody. There's some good P copies out there and that sort of stuff, but the the stuff that we hear is more like we just weren't told everything. So they get into the they get into into bed, everything's great, they do get a pot of money, sometimes not enough to retire off of too. You don't think it is because there's a lot of strings at the end. And then what they're not told is the shifts that they're gonna have to make in order to satisfy the requirement of the company buying them, right? You talk about layoffs. Um, you know, they don't think about that, and they don't think as a peak company or the so they get so they start losing that zust because they're like, well, I just had to lay off Sally who's been with me for five, six years, and they don't understand why. And it ruins, and and it also comes out it ruins the patient care too, which is what we're all about. So uh the communication winds up not being the way the way it was supposed to happen. And the practitioner starts feeling, and I've heard this from I can think of three people off my head, they feel like they did such a bad thing, which isn't which isn't true, right? Back when you dealt with it, right? There was again, I'm not but now the pressures are are even harder, like with the amount of payouts, that payouts are the wrong term, but the c what you get paid per visit are even lower, and it's getting harder and harder to make a living. The stories are just are just dreadful. I mean and that's all I just want to share is that it's uh it's just not always uh what uh it's portrayed or the whole thing isn't portrayed. So that's kind of what I want to also share too.

SPEAKER_04 14:04

Yeah, Mike is uh we we look at private practices, uh we identify different areas that uh organizations can utilize support. That's our entire business model. And Dave, when we look at your practice, one of the conversations we had was around the 400 plus referrals you get each month. What is the physical sequence of events, the best that you know, from the time a fax arrives until that patient is scheduled? I mean, that's 400 referrals to coordinate monthly.

SPEAKER_01 14:44

Well, I'm not sure where our where the communication is much more than 400. That we have at just one of our eight locations, we get several hundred, uh, maybe 400, sometimes as many as 500 referrals at just one of our largest clinics in one month. So we don't necessarily get all those 500 in because of the shortage. I mean, there's a huge demand, and um you know, we are as it is, we're employing a fair number of travel contract therapists to help meet the demand, but we get uh um I should know the number right off the top of my head, but it's uh well over a

From 2 Clinics to 9 Locations: Building Without Selling Out

SPEAKER_01 15:30

thousand uh uh referrals in a month. Um new new patients encounters, actual ones we get on the schedule, well over a thousand. Um it uh where were we going with that?

SPEAKER_04 15:48

Yeah, so walk me through how you manage how do you manage that kind of volume.

SPEAKER_01 15:53

Uh well we have we have a great team. We you know we've evolved over a lot of years, so you kind of have things in place. We have divided up some of the roles, we've got uh a fair amount of what we call care coordinators or receptionists, frontline people. Um, but then we have um uh also we've added to having a clinic director who's a clinician, we've added an administrative assistant to help the clinic director oversee the support teams, the technicians and the front office, um, and then we've some of the behind-the-scenes insurance kinds of work. We uh we have what we call a central authorization team, and one of the things, of course, that uh you're probably gonna ask me in a bit, but I'll just offer now is that we've been hearing increasingly about you know virtual uh care coordinators and this sort of thing, and and and you know, we kind of listened and looked for uh probably several years, and then as the margins in our industry have just gotten worse and worse, margins of profitability and being able to just be a healthy uh practice, we had to take a serious look at some of these things. And we initially tried the uh the model of adding, you know, if we lost a care coordinator just through attrition, um there's a moderate turnover with front office teams because you know we can't pay them tremendous salaries, and um and it's a hard job. I mean, it's a busy, busy job. You're taking in phone calls and trying to stay a very um servant-oriented, kind, you know, helpful person while you're dealing with the details of getting the insurance numbers right, all that's going on. So, as we might lose a care coordinator, we tried the model of a virtual care coordinator with the monitor that would greet the patient. And um for us, uh invariably the a lot of the times the patients would come in and they'd want to speak to the live person. Some of them in a couple of cases literally wanted to talk to the virtual person, but not nearly the percentage. Um they maybe were of the same uh ethnicity or culture or whatever, and they would gravitate towards the virtual. Um but where we really found benefit was having these very skilled, very helpful uh virtual assistants just helping offload our in-person present front desk people so that they weren't so highly stressed, so that they could be a kind face greeting a patient walking in the door. Um and and and they um almost every one of them, every one of our in-person care coordinators is very grateful for the virtual assistance that we now have that we've gradually added to every one of our sites. And some of our sites have two virtual assistants doing a lot of the backroom stuff. Uh referral management, these thousands of referrals coming in, they're prioritizing them, they're uh highlighting, you know, putting in all the information, the patient's phone number, so they're so an other team members can look at this spreadsheet and and um know which ones are post-op, which ones are specialty pelvic health or lymphedema or whatever it might be, and and has that information all right in front of their faces, and they know which which patients should go to which therapists and that sort of thing. So they're doing a lot of that, that juggling of the information coming in, as well as taking the phone calls and greeting patients and scheduling them and just offloading the volume of calls we get.

SPEAKER_04 20:28

Yeah, offloading calls is a a major, a major thing. You missed calls or or missed revenue, right? That's essentially as I can put it. And when you have all of these referrals coming in, you have phone calls coming in, and then you also have a patient that's walking in the front door.

unknown 20:51

Right.

SPEAKER_04 20:51

Just describe to me the feeling that your staff was having before you implemented the virtual assistance. How did it feel in the office? What did you guys what were you noticing?

SPEAKER_01 21:03

Well, I'm not gonna say this is entirely gone away because they'll still have they would call me out and say, we still have feelings of overwhelm at times, but it's much less, much less overwhelm. Um you want me to read a quote or two from our care coordinators?

SPEAKER_04 21:22

I mean, that would be tremendous if you if you could.

SPEAKER_01 21:24

Yep, absolutely. Um, yeah, so I I asked our team, just share with me some of the things that um the ways that having a virtual assistants, now that you've had them around a while, how do you guys feel about it? Just be honest and tell me what how they've uh how they've been helpful. And so uh here's one from uh Gal Nicole from our Bainbridge Island office, sent me just this morning, and it says Christelle. Who is the virtual assistant? She says, Christelle is an absolute gem. She is always eager to jump in with any project and helps us feel so supported at the front desk. She is always kind and ready to assist patients on the phone, and she's very organized and proactive when it comes to tracking to-do items and recurring tasks. She goes out of her way to see if there's anything she can aid with. And her generous, warm personality shines through in chats where she excels at balancing clear professional communication with fun, lighthearted messages, and encouragement and humor. We are very lucky to have her on the team, and we definitely feel her absence on the rare days she is out. Our office would not run as smoothly as it does without her contributions, which allow the in-clinic administrative staff to devote extra care and attention to patients as they walk in the door. So that was that's one. I should

Referral Overload & The Front Desk Burnout Crisis

SPEAKER_01 23:10

say we have another Nicole at our Bremerton office who really kind of started us down the path of working more effectively with the virtual assistants. She just what she did was rather than the monitor facing the patient, she took a laptop and just had it open with their VA, um Phil, who they would, she would just, as she was doing her job along with another couple of care coordinators, uh Nicole, who's one of the administrative assistants, she would have the VA, Phil, facing her throughout the day, and and just in communication, it was great for training, and it was great for just sharing load, sharing projects. And and um Phil uh really uh grew to Phil uh as a part of the team. It wasn't he was just kind of off in you know, not in any visual uh contact with anybody. They're very much in visual contact now with our team members at most of our sites, and that model has been great. He'll pick up and see when Nicole's looking, maybe like she's dealing with uh a lot of things, and so he'll be more apt when the phone rings to answer the phone instead of you know somebody else getting it first because he can see that the that the in-person team is kind of swamped, and so he'll take his attention away from a lesser priority thing, like filling out the fact spreadsheet or whatever, and he'll jump in and take care of the things that are at hand.

SPEAKER_04 25:04

That's incredible. Bringing the monitor up and having that available so that you're having like an in-office environment, but a virtual in-office environment, Dave. Yeah, that was a genius idea. I have not heard that before.

SPEAKER_01 25:18

Yeah, they that's been really effective. I think they were doing that at our Bainbridge clinic right off the bat, too, um, for their training, and then they were doing that to in the the you know, Snap Scale does their in-house training with the our a bit of our EMR and that sort of stuff, but then we have to do our own training for the kinds of specific things we want, and so they would do that to get to know the person, but then it just seemed a natural thing to just keep that presence during the workday, and it it afforded a lot better communication instead of everything just being through typing uh teams or whatnot. It was just you know a lot more personal. They even just you know have they can have conversations about the weather and stuff like that, and not just be isolated in their cubicle in the Philippines or wherever.

SPEAKER_00 26:21

There's I was just gonna say there's no, and we see it's all there's no magic pill, right? It's it takes you know, it it takes everybody to make it work, right? We can we have a good foundation, SnapScale is a good foundation to find the right people, communicating, getting things set up. But at the end of the day, if you have a partner that embraces this uh new augmentation for lack of a better term, uh then it works great because like you said, they leaned into the idea, right? You're so they're coming up with different ways to communicate with the staff while we are. So that's when things are fantastic. And what I was talking about before is that you know, we spend time uh with new practices uh that don't uh explaining to them how you know we're here to kind of help, we're here to help augment, we're not here to replace,

How Virtual Assistants Changed Everything

SPEAKER_00 27:15

we're here to finally get to the help that you need. So with with you guys, it was it was a good on-ramp. And you gotta, and again, you got it, we work together, and that's why it's successful. It's not you know, some people think that that outsourcing is just a magic pillow saying again, oh there's a person, you guys disappear, we got this, and it's uh it's not that way. It's it's uh uh you know, you hire someone in in your in your office, Dave. You still have to train them, you gotta deal with it. It's not like uh a cyborg or something, these are real people. And the fact that they're overseas just makes the complexity even greater. So it takes everybody working together to get that foundation set up. And what it is, right, it's it's not rinse and repeat of real people, but it gets easier and easier because everybody's uh you know working from the same guide, you know. And I think that's a big thing to share because uh that's why we have such a good relationship within with KitSap, is because uh we work well together. If we didn't, and they're practice managers and stuff, we're fighting tooth and nail. Oh, we don't want to do it that way, that's not the right way to do it. We're gonna try this way. And there was interfighting, it would have never worked well. And that's like a big thing that when people are looking to you know outsource, they have to get their entire staff to buy in and and and communicate internally before you can even have this relationship, or else we've seen it. They could be disasters.

SPEAKER_02 28:45

Yeah.

SPEAKER_01 28:45

You know, I mean it's it's it's I just wonder we kind of floundered um initially, not not exactly knowing what we wanted them to do. Um, we just knew we needed some help, and we knew that gosh, we couldn't, we couldn't afford, we just literally couldn't afford more full-time, fully benefited staff. And we we needed help though. And so now as we've uh got a little bit of time under our belt, and we have a team now of multiple ones, and what we really appreciate is that they're not all off isolated in their own spot, they actually work in an office together in the same area, and and so they actually are supporting of one another. We were we started to identify things that we really wanted all of our um virtual assistants to do for a while there. One office was using them a certain way, another another way, and there still is some uniqueness of the utilization, but we've we're identifying some things that we want all of them to do, and so now we can have kind of a standard operating procedure and a standard way we we were standardizing how we want our referral management to be done at each site, um, so that they all are filling out their spreadsheet the exact same way with the same color coding, and that way what's really nice about the them being in office if one of them is ill, uh we have some offices that are smaller, significantly smaller volume, and then they can kind of pick up for one another. They can they they can work on another site's uh projects and phone answering and that sort of thing. So it's it's a it's becoming increasingly effective. Um, and we can have them as we gain as we add new people. My vision for this would be they don't have to do all their training with us here on the mainland, uh, you know, in person. They can do a lot of their training right there with the team that is uh our team uh offsite. And the more we do things the same amongst that group of virtual assistants, the more that will be efficient and effective.

SPEAKER_04 31:32

This will be real helpful for a lot of private practices out there. How did you what is your guys' process that you I that you were able to identify that referral consistency that you wanted done in all of your your practices? As a practical takeaway for the audience, what do you guys do? What did you do to identify it and set that up?

SPEAKER_01 31:53

Well, um ultimately um and I I don't think this is super unique. I I think most practices do some form of this, and certainly there are systems within EMRs for uh organizing some of this. We just for us at this point it's pretty efficient to just do take the take the information as it comes in and um put it on a spreadsheet. And what we we try to identify is there are priority patients. We have some referrals that come from the emergency room. We have a relationship with the ER docs for spine care. Um somebody with low back, instead of the emergency room doc sending them home with a muscle relaxant and painkiller and telling them to rest, they will send them for therapy. Um that's a high priority. Those are ones we get in within two days, two business days. That's just an arrangement we have. We have that, uh, we have high priority referrals like that for injured workers. We have um uh the same thing. Uh we kind of have tiered them. It's just what we do. We we um have a tiering of post-operative is sort of our priority level two and specialty patients, whether it be pelvic health, lymphedema, TMJ, the we have uh sub-specialists within our organization. So we we have to prioritize because a more chronic condition, it's not as urgent for them to get in in two days or whatever. It's and we're busy to the point that some of those referrals unfortunately are delayed much longer than I'd like, uh than we'd like, but that's the nature of our industry with the uh um uh with the shortage of therapists available. Um, because we could we could bring in several, uh quite a few more.

SPEAKER_04 34:05

Uh yeah, I mean let's let's talk about that for a quick second. In in 2020, during COVID, didn't something like 23,000 physical therapists left the industry for good? Yeah, and some were virtual and left for different trades. So the economics have changed with physical therapy. Yeah. What is the industry doing now, and what are some of the different models that the industry is doing right now, Dave, to support this reduction in physical therapists?

SPEAKER_01 34:38

Well, um they're struggling. Uh we they we've opened a number of new uh physical therapy programs across the country. Um, but that was a huge hit that that uh loss around COVID. So many people were going through the the psychological funk of it all, and um people becoming disenchanted with this challenges in our field, and like you said, going out for completely different careers or things they could do from home because everybody got used to doing more stuff uh on computers at home and finding you know, people finding ways to work from home, whether some of our industry uh therapists might have left to become our auditors or you know, whatever. Um but so we're uh I know uh APTA and and schools are working hard to expand and open other campuses. Uh it isn't meeting the demand, and and a part of that is also economics related. Everybody now, you know, when I graduated in 1986, it was a six-year Bachelor of Science

Legacy, Retirement & What 45 Years Taught Him

SPEAKER_01 36:00

degree, and um I've since gotten my doctorate um years ago, but now everybody, the entry level is a doctorate, so that means expensive grad school, and people are graduating, even though we're graduating now, about 12 or so thousand new therapists a year. Um they graduate with this heavy school debt, and the industry really doesn't support the kind of wage that they all anticipate or would like to get because of their hundred, two hundred thousand dollars in school debt. It's crazy. And um, so many of them, many of them, a high pretty significant percent go into contract work and travel, and they can you know do short stints all over the country and get paid at a higher wage than other you know places can afford for a permanent staff. So um that is the challenge, and for us, we're trying to meet uh you know work against the odds by becoming more of a teaching institute. And and we went from having six students a few years ago to 17 students to this last year 30 students. Um, we've just developed a really good relationship with a lot of a lot of schools, and they they like that we um offer so many specialty programs to give exposure to students, and that is probably gonna be our our best hope with uh landing some good young clinicians. Um that uh we've had some fairly good success with that, with them. What you know, how many people have heard of Kittsap County, Washington? Not not too many, but when they're here and they see the beauty, kind of like some of those photos back there, um, and they see the culture that we've built in our organization. Um we've been very intentional about building a really great culture, you know, um very professional, yet a place that's kind of fun, it's not too stuffy, and um, we do a lot of outside the office things together with our with our teams that uh you know, whether it's um going on a hike or uh you know different offices are doing different things all the time, or or it might be a one office challenging another office in a bowling night or something, you know, just various things. And so when they when they come and they're a part of that and they see what it's like here, that we're having more success with that, but it's still um not keeping up for us quite.

SPEAKER_04 39:08

Yeah, I did some research too, and walk me through this Mike Danford School of Uh to Work Scholarship that you guys have.

SPEAKER_01 39:17

And we've done that for we've got a lot of our therapists and uh multiple partners. I bet we've got maybe at least eight of our partners are our kids that grew up in Kit Sap County that um might have even you know come in and done some volunteer hours while they were in high school, just interested in seeing what physical therapy was about. They get really interested and excited about it, they go off to undergrad, go up, come back home on in the summers and work as a support tech person to help greet patients and you know clean the rooms and do the laundry and all that stuff, and and uh um and then they they you know finish their undergrad, they go off to PT school, and when they're heading off to PT school and and they already are showing that we've gotten to know these people, and we already know they're you know, if they're a great person, great personality, great work ethic, and we say, you know what, if you come, if you want to come back, we're gonna, you know, we'd be love to offer you this scholarship, and it's not we're not paying hundreds of thousands, you know, we're paying them a couple of thousand a month towards their schooling. Um, I shouldn't even say per month, I'm sorry. It it it uh well, I don't want to reveal our trade secret entirely, but you know, we give them uh uh you know something that might be like could be viewed as a uh a pre-employment healthy sign-on bonus. Um and and they you know come back and they have to work with us for at least three years, but many of them are with us their whole career, and as I said, are partners now. And um so yeah, it's in honor of our founder, Mike. Um we call it the Mike Danford uh uh work school of work um scholarship.

SPEAKER_04 41:24

I love that, Dave. I appreciate you sharing some of that because maybe there's somebody out there that does need additional assistance right now, and that would be a good program for them to look into. Um, but that's the beginning. Let's talk about the end. That's where you're at. Ready for retirement. You know, 40 years of the day, you build something that you can hand off without it falling apart. What does that feel like from where you're sitting right now?

SPEAKER_01 41:49

Oh, I'm really, really grateful for the good people. Um boy, I I I wouldn't want to be in the industry alone. It'd be a challenging, scary thing to do it independently. Um, having good people with you on your team has been uh comforting and helpful. Uh and you know, we I announced this a couple of years ago, um, my planned timing, and it just so happened that August 14th of 2026 is a Friday, and it is to the day my 40th anniversary with Kitsapp Physical Therapy. So I thought that's fortuitous, that's that's a good day to to end things, and um and so we have a really great team that we will be handing stuff off. We have uh uh our next CEO, uh young man Gerald Backe, who's great. His wife has been with us longer than he has because he started at the at the hospital his first 10 years of his career. Um, and then we have uh two additional folks. We're adding depth to our administrative team now. Um we've just gotten bigger over time, and so we have a long time partner over 20 years, Scott Richards. He was the clinic director of our um Bremerton office, and he will be a COO or regional director for kind of Central and South Clinics. Um, and then uh Haley is uh our wonderful clinic director at our Bainbridge Island office, and she uh will be the counterpart COO or regional director for the Central North Clinics. So we we have nine locations now. Um we have a lot of really great opportunity. We've worked with our two native tribes, main tribes in our area, the Squalum and the Suquamish. We've been privileged to help design the little therapy clinic in the Squalam tribes, state of the art health and wellness center, and we do we support them with contract therapy a couple of days a week. That's been wonderful. The Suquamish, we've been in, they've expressed that they'd like us to help them as well. We just are wanting to operate from a position of strength and not spread any buddy too thin. So we want to add some more good quality clinicians, and there's just a ton of opportunity for us. And and good people that are going to keep it going. So I'm I feel good about my timing of ending that we're in great hands, and they uh will keep things going with our our core values for KPT, which is kindness, professionalism, and teamwork. And and uh I think they'll keep that going quite well.

SPEAKER_00 45:17

And I know we're very I know we're uh coming up on time, and I know this is gonna sound like a lewd question, Dave. So you can say, I don't want to answer it, I didn't tell you this beforehand. But after 40 years, uh the state of the physical therapy specialty. How do you feel how do you feel the best way to to stay competitive to make a living? To kind of adapt. How about that? How to adapt. And I know it's a loaded question. I just it's always the question. I know you don't know everything, but you've been in this movie for about 40 years. Maybe you can give a little bit of a tidbit of some other people that are just trying to kind of figure it out, right?

SPEAKER_01 46:13

Yeah. Well, um, yeah, it's a loaded question. I think the the obvious things are, you know, when I started, as long as you were reasonably busy, had a reasonable volume of patients, you didn't uh it was pretty straightforward. You you know, it it the the pay was reasonable, the overhead wasn't crazy. Now with uh cost of operations just going up and up, and and and and everything else kind of moving at no better than flat if not down, um you have to do things smarter. You you have to do things, you still want to do things ethically and effectively and uh true to your values, but you do have to be wiser in this cutthroat world of the insurance world. You have to code effectively, you have to code smarter, so you have to teach your people, you know, to don't call everything therapeutic exercise. That's considered by insurance uh industry kind of a lower skill, so they reimburse differently. You have to differentiate your coding. Um you have to find ways to be efficient, you have to be nimble, and and and nowadays you gotta look for other value-added things for patient care that truly adds value, but the insurance world may not recognize it or support it, but um those who have discretionary income can do some cash services that are helpful. And you know, we're a little slow to that ourselves coming into that era uh and arena, but things like Shockwave or uh, we don't we haven't really been utilizing laser, but that being open to those kinds of things, and you've got to look for ways to help counter your biggest cost of operations is your labor force. I don't, you know, wanna, you know, these are our team members, you know. I want them to have a reasonable, reasonably good um uh wage and living uh quality of life, but if our industry only allows so much, you have to find ways really to help uh to help you afford being able to offer some uh pay increases and benefit increases to your permanent in-person staff. And one of those big uh ways of uh attacking that is using some outsourced help, like we're talking about here. Snap scale virtual assistants uh that um are uh not the cost of your in-person team, especially when you throw in benefits. And if they can be very helpful and you don't have to add that one more full-time benefited staff, that's one of the pieces of the puzzle of uh combating this economy and and the way things are. So I think being you know, and looking into things, uh AI support, we're not trying, we're never gonna uh do away with our in-person teams with AI, but if it can make us more efficient in certain areas and we don't have to hire on more and more people um for certain tasks, then you know we gotta be open-minded to that, even when you're maybe a little gun shy of AI.

SPEAKER_00 50:11

Good information. That was that was some really interesting information. It's funny, someone told told me that you know, you alluded to this, but I'll maybe be bluntly that like no one told you how to sell when you're going through physical therapy school, and now with the shot, and it's there's nothing wrong with it, but you have to be more creative in order to make a certain amount of money, which is yeah, it's interesting.

SPEAKER_04 50:36

But yeah, well, Dave, I I can't tell you thank you enough for being a part of our show today, too. Um the fact that KitSApp is one of our clients, I feel incredibly blessed that you guys chose to do business with us. Um, and with that said, any final words for the guests or people watching about your legacy, your practice, or virtual assistance that you want to share?

SPEAKER_01 51:02

Well, a lot of this talk about the economy and and our industry, I just want to say it is such an awesome field though. And I think ultimately, I'm optimistic that we're gonna be able to figure out you know whether it's governmental changes and and uh putting it to some of the insurance companies to be more reasonable with reimbursements and making them come to the table and negotiate fair contracts and um not just uh showing uh record profitability to their shareholders, you know, letting the providers have a reasonable uh reimbursement. I I think there's gonna be pressures because in the insurance world needs to have happy members too, and a third of practices in Washington State are going out of business because of the economy. If members can't get good quality care because the economics isn't working out, well, the insurance companies are gonna have people unhappy with them, and their members are gonna shop around. So I'm optimistic that ultimately it's gonna kind of work itself out, and people can uh carry on in this really awesome field where you get to change lives, you get to really make people uh help people back to the quality of life that they miss and uh are so grateful for. So you talk about a rewarding field where people are thanking you and bringing you cookies and lumpia and whatever it might be just because they're they're grateful and you build relationships over time. You're spending 40 plus minutes with them in a session and multiple sessions, so you get to know these people and you get to see them through this journey of recovery and back to great health, and and it's it's been a great, great uh career and journey that I've appreciated so much. And it's great. I think it's gonna carry on.

SPEAKER_04 53:27

Yeah, Dave, thanks for letting us capture your story.

SPEAKER_01 53:30

Very welcome. It's great to be with you.

SPEAKER_04 53:33

All right, Mike, just a couple recap here. I mean, it was an incredible conversation with Dave Damon from Kitsapp and talking about somebody that didn't sell out all the way to the incredible idea to put the monitor up on the desk and have the staff inside the office. What an amazing guy and journey, isn't it?

SPEAKER_00 53:54

It is. And and like I said before, it's always it takes two at Tango, right? Like they were open to the international staffing. They were open to it. They had their staff buy in. That's why the relationship is so wonderful. There's only so much that we can do. We need the buy-in from the client. And what they came up with is is great. And that's what a lot of our clients uh do because we work together to make things perfect perfect wrong term, to make things the way that everybody expects. And it's a lot of hard work in the beginning. Like setting up the foundation of a of a uh of a new engagement, a new client is not easy. Uh but if you don't set it up right the first time, and that's not just metrics and KPIs, that's about uh the whole thing about uh selling what we do to the practice, to the members of the practice, to the practice, so everybody understands what we're here to do and it helped. It never gets hope it does. So a lot, but with that work and building that relationship, and we said that a lot, we have a real relationship with this client, which we have with, I would say, I mean all, and I won't say that, that's a lie, but but for a great majority of them, because that's why we get so many referrals, is we are part of their practice, and these agents that we put in there are part of their practice, and we work together to get them to what they were looking for, which is uh to reduce the burnout of themselves and their staff, right? But to maintain the level of quality that they want, right? So that is so his example is just one of the many examples that you know we get you know from our clients, because remember, we learn a lot of our stuff, a lot of our cool things from our clients. Remember, we learn and we can take those things and help others with it. So it's it's it's it's wild. It's it's just a wild partnership if done properly. And if not, it's it's uh it can be difficult if everybody's not bought in. But his story is is remarkable to itself. I mean, really is.

SPEAKER_04 56:17

Incredible story. Incredible story. All right, guys, thank you for joining us on the Snap Scale show. We will catch you next time. Uh subscribe to the podcast, head over to snapscale.com slash podcast, get more information and to uh participate in wonderful episodes just like this in the future.