Richard Rose: VP of Operations at PRO-PT

In this episode, Richard Rose III, Vice President of Operations at PRO~PT Physical Therapy, shares his journey from practicing clinician to operational leader in the physical therapy space. He discusses the challenges of growing and leading a provider-owned practice, developing the next generation of clinicians, and how strong leadership and clinical excellence go hand-in-hand in delivering better patient care.

Host: Hersh Solanki

Guest: Richard Rose, VP of Operations at Pro-PT

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Transcript:

Hersh Solanki: Well, Richard, thanks so much for joining us. I appreciate you coming up from Central California. Yeah. Let's take it from the beginning. So maybe talk to us about what got you in this space. I mean, you've been in it for a while now, but we want to hear the origin story.

Richard Rose: Yeah. Well, Hersh, thank you. And thank you to your team. I mean, everybody I've met so far has been fantastic. And they made my ability to get here so easy. I met Caitlin first and then Katrina and Greg and now you. So thank you to the whole team. I mean, you talk about experiences, which is something that's important to us at ProPT. Your guys' experience for me has been fantastic. So thank you to that. But my history started in physical therapy. I graduated from University of the Pacific almost 17 years ago, 2009. And I took a job out of school with a company, Pro-PT, in Visalia, California. And at that time, I had two offices. And I believe I was the seventh PT to be on staff. So our home base office, which was Visalia, opened September 10th, 2001. And so everybody knows what happens on September 11th, 2001. And things change dramatically. So our owners, co-founders, Todd Martin and Ronnie Enod, that was kind of like, they're like, oh, shoot, should we have done this, right? It's kind of an odd start. But they pushed through. 2009, I like to joke with them that in 2009, there was an inflection point. And that's when they hired me. So there was a shared vision on what mattered at that time in physical therapy. It was this idea of, as things have changed dramatically in 17 years, but they had this shared vision. They saw growth and verticality as a problem at that point in physical therapy for folks like myself who were non-owners, right? Who didn't own the clinic, didn't open it themselves, but they saw this idea of verticality as a problem. There weren't opportunities to move up. And at that point, it was kind of this shared idea. they had talked about what their vision was for pro-pt and i was young enough and naive enough to believe in it and so i accepted a job with them as a staff pt at our home base and and just a year and a half after they went and had their first acquisition and they asked me to lead that clinic which was in porterville california so i'm going to show you guys all like the little tiny towns within 30 minutes of Highway 99, that was kind of where we grew up and where we're at, which is where I'm from as well. But I had an opportunity just a year and a half in as a new therapist to lead a clinic that had existed in the community for over 30 years. And again, I like to think I was young enough and I was naive enough to believe I could do it. But what really happened is I had the support of both Ronnie and Todd at that time and the entire network of what we had at ProPT. And that was our third office. And so I led that clinic for just over five years. And the very first PT that I hired there was from Porterville. His name's Abel and just fantastic. And when you talk about being in a leadership position and wanting that first kind of follower, the first person to jump on board and be like, yeah, let's do this thing. That was Abel. And so I knew right from there that at some point, Abel would be in charge of that clinic. And I couldn't have been happier. So part of that was growing Able. And I received another opportunity about five years after being in Porterville to go back to my hometown, which is in Hanford, California, to open up De Novo, a new clinic, which at that time was our seventh office that we had. So I had that opportunity and it was different, right? First one was an acquisition. You're taking over a clientele. You're taking over a culture that existed in the community for over 30 years, but also trying to align it with who we were at ProPT. And then going to Hanford was kind of like going back home. My family has been there for a handful of generations now. So I knew the community. I knew the leaders in the community. And we're trying to create a new culture around physical therapy in Hanford. At this time, I was a little bit older, still pretty naive, but I thought I could make it work and was able to grow a fantastic team there over the next almost six years that I led that clinic in Hanford. And then Ronnie and Todd came to me with this idea of a non-treating role, right? Which I was like, yeah, at this point I was roughly 12 years out of PT school, had now been treating, had been leading for nearly 11 years. And they said, we are opening up a position for vice president of operations that would want you to consider it. And it was a big conversation, especially with my wife. And we have three kids as well. This idea of, could I bring myself away from the team environment, the growth environment of an individual clinic? And what kind of impact can I have on a company at this point? So it was ultimately decided on that, that I would apply for the position and Todd and Ronnie graciously selected me as the as the first VPO I guess of pro PT at this point and since then you know my dedication has been to leadership and I've talked to a couple other people about this and it's like well why go into a role that pulls you out of what you went to school for I went to school to be a physical therapist and now I'm working on leadership business admin all these types of things that I don't go to school for I didn't go to school for. PT school is historically known for not having that as a strong part of their curriculum. But again, I had fantastic leaders in Ronnie and Todd at that time. And still at this time to this day, they're still my leaders and my mentors to learn a lot and to have that support. And we've been fortunate along the way as we've added clinics and I've received so much grace and so much feedback from the directors that I helped support in our now 20 offices and soon to be 21 that has helped me grow as well. And without their forgiveness at times and their ability to say, hey, Rich, we'll let you slide on this one. I've been able to grow and to a leader now that I think is at least salvageable and yet still has a lot of time to grow.

Hersh Solanki: It seems to me, though, doing the acquisition in the DeNovo fart, in many ways, you're running an operations role anyways, before you actually go and take the role itself. How did you think about when that opportunity was presented to you to go full time deep? Did you feel like you had those lived experiences before such that you could jump into the role pretty quickly?

Richard Rose: It's a great question. I certainly believe that I had the awareness to go find the answers to the questions I didn't know. And I think that the smaller scale of being in an office, understanding what it means, because as we grow into leadership, it really is about the management of the culture. If you can manage that, if you can get people on board and kind of inspire your leaders and the folks that you're supporting in your leadership role, I think that those other things kind of manage themselves a little bit. And at least you have the place to go and seek out those answers. And the environment allows for that and it encourages that as well. So the smaller scales certainly created opportunities to understand the larger scales and the holes that I know I still have in my knowledge base.

Hersh Solanki: Right. Maybe talk a little bit about your leadership style, right? Because you said, really, that's the, you impart that on the culture of pro PT or really any business that anyone runs, what are some traits and maybe some things you can give to the listeners on how you lead?

Richard Rose: I think that first and foremost, when you ask that question, what comes to mind is something that my dad used to always say. And one of the things he always said was, always carry a shovel. And it's like, well, you know, what does that mean? And my dad, his history was very minimal college, kind of started as a groundskeeper at a school district and grew to be in charge of maintenance operations and transportation. At some point, he was in charge of a hospital company that had 30 plus locations. And what he said was he'd always carry a shovel. And to his point, what that meant was he was always willing to dig a hole. And because there's nothing just more humbling than digging a hole. Because after you dig a hole, what do you do? You always fill it in. And you almost never see what's happening because most of the work that you're doing is underground. And so if you're able to always be willing to jump in and have the ability and humility, I think, to do that. And so I think back to always carrying a shovel and being willing to jump in and do like just the lowest end. You talked about going back on the smaller scale, the acquisitions, going into de novos. I mean, there were times where I'm cleaning toilets. There's times where I'm vacuuming the floor, cleaning baseboards. And I think to not lose the humility required to understand that those who you're leading are also doing those things. And I don't want to say it's necessarily lead by example because it's not. I don't want to pretend that I'm out there digging holes all day. But it's the willingness and the ability still to do it, I think, which is what rings true. Because somebody knows that if they're down there and they're working, they really need somebody, they can call me. And they know that I'm going to be there. And I'm going to have a shovel in my truck to help them dig out of whatever situation they're in. So I think that outside of having a term, like an affiliative and authoritative and commutative and teammate and kind of pace setter, I think I'm just that idea of always carry a shovel.

Hersh Solanki: It seems to me in the experiences that we've had in running this company, the leaders that get into the weeds that actually do the problem themselves and where they know prom is beneath them. Right. Those are the ones that inspire, right? Yeah. Hey, you know what? If he or she's going to do it, I'm going to do it.

Richard Rose: You nailed it, right? You nailed it, right? You're not above doing what got you there as well. And I think it's also important to do the things that got you there. I think there's a different resonance that rings with the team when you start talking and they know like, hey, he's done that. Hey, he's been there or he's willing to jump in on it right now. You know, I think those are the types of things that go a long way.

Hersh Solanki: And do you miss the patient care side of things? Do you do a little bit still? How do you manage that? Because to your point, you went to school to see patients. It's a newer role for you. Curious how you keep that balance for you internally.

Richard Rose: You know, outside of having an identity crisis, right? Because, you know, you walk around, people are like, oh, what do you do? And I go, well, I'm a physical therapist. And I go, what do you treat? And your answer is, well, I don't treat. I don't treat patients anymore. So to answer that, you know, I might treat 40 hours or 80 hours a year. And it's just on an oddball need to go in, jump in, and be helpful someplace. So there is that identity crisis. Because I do miss it. I think what you get when you're in the clinics is you get more of those immediate hits, almost like those dopamine hits, right? In the sense of you have a patient in front of you that you've developed a relationship with and you've connected with them over time. Initial eval, you get an hour with them to connect, to differentially diagnose, to begin a plan of care, to get buy-in from them that there is an end in sight, that there is a life at the end of the tunnel. And then to be able to show that and develop that with them over the next few weeks, there's nothing that beats that. And everything that comes around that as far as being able to connect with your teammates that are also involved, physical therapist assistants, our aides, our techs, our front office, all of those things growing up in sports, the team environment has always been a place that I've enjoyed. And it feeds off of each other. Some folks will have, you talk about the buckets, right? I can fill up your bucket and somebody fills up my own bucket. I like to think I have a big bucket that I can drop a lot of rocks off into other folks. And I don't need a lot more to fill mine up. There's sort of like this push up from the bottom, which is kind of cool. It just keeps filling up. But you miss that sometimes. There's no doubt about it. But I like to consider with where I'm at this idea of kind of, if you think about like roots of a tree, right? And so, and sometimes roots of the tree is almost backwards because it's going down and really should be like going up. It's like you're kind of supporting this idea of going up. And so the choices that you make and the impact you have is here and it spreads out. So now instead of me seeing 70 patients a week, in some regards, I'm having a small thumbprint on 7,000 or 8,000 people a week. That is certainly humbling, but also with that comes quite a bit of awareness towards the impact that even a small decision can make, whether it be positive or negative. And you got to live with it one way or the other.

Hersh Solanki: What was the most surprising for you? Maybe thing you didn't expect in this transition? And maybe for folks that are considering making this transition, what should they know?

Richard Rose: That is a great question. And I'm not sure that I've considered it in that sense of what didn't I anticipate to happen. I think if I'd have to answer that through not anticipating what I would feel internally when it comes to understanding decisions. And so when decisions are made, there's all kinds of decisions made at any level. I mean, our aides and techs are making decisions every day. Our therapists make decisions. Our directors and CLPs make decisions. And then it works up to like the VPO or COO and you make a decision at that and and what you don't realize at the beginning is as the decisions go up they only make it to my desk when they're closer to 50 50 you know in the sense of if i have 18 or now i have 20 directors that are relying on a decision once it lands on my desk more than likely it's like 11 to 9 or a 12 to 8 split and so there's always going to be somebody on the wrong side that's what they feel like on the wrong side of that decision. And once you make six or eight or ten decisions, at some point, every single one of your directors has been on the wrong side in their minds of one of your decisions. And so if you don't have the established relationship, if you don't have the established emotional equity, I would call it, to be able to make a decision and somebody be like, well, that's not what I thought, and be able to come back the next day and be like, but I trust that it's for our purpose and our mission to provide experiences, create and deliver experiences second to none. They have enough trust built up to say, okay, hey, I trust it and let's move on. And so I think if I didn't anticipate something, that's what I probably anticipated the least.

Hersh Solanki: I feel something very similar in just the leadership roles in general, right? I always can't be a yes person. You can't just say yes to everybody. But if you've had the shovel and you have dug the holes and folks know that you understand the complexity of whatever problem that you're making a decision on it's a little bit easier to yeah to get on board even if you're not on the same page yeah you wish you could agree with everybody in every moment at every time.

Richard Rose: and i think what helps with those decisions at least for us is there's a there's a mission involved right and for us i just mentioned it but it's creating a delivering experience is second to none. And so any decision that we make, especially a decision that's going to be maybe controversial, it has to come back to the root of that. And if the decision's not made based on that, then you're going to get further away from who you are and who we are. And you're going to drive away the trust that you've built up with these folks. And so making those decisions from what we call Start With Why, if you haven't heard of Simon Sinek, he talks about Golden Circle. He's one of these TED Talk guys, and he's amazing. And he talks about starting with why. He has this golden circle concept, and that is deep in our roots on what it is. And so we've defined our why as just that. And so when decisions are made, it starts there. Because it's very easy to say we're a physical therapy company. That's easy to say. So if you make decisions based on being a physical therapy company, you're going to make a lot of really good decisions. don't want to steer you wrong, but if you're thinking about in the sense of the experience of anyone you encounter, who do we encounter in physical therapy? Well, first off, you encounter referral sources, right? What's their experience like? You encounter patients. You encounter patients' loved ones, right? Their parents, their grandparents, their parents, their children are bringing in to see you. You're encountering them. You're encountering the patient. You're encountering your colleagues. You're encountering the community when you go out and serve. And then at the very end of it, typically one of the last people you encounter are the payers, right? And you guys know about revenue cycle management quite a bit here and how much that matters. And it has to feel good when you get feedback from a payer that says, hey, we love working with you guys. Because how many times does a payer even talk about that? You know, and it's because you've made the experience so streamlined and simple for them. That's what they want, right? That's what they're, I want the easiest job possible. I come in to get this done. And so if you can have that and create that, gosh, you know, you're doing fantastic. So that's why we live from our why.

Hersh Solanki: On the clinician side, I'm sure one of the roles and one of the things that you focus on today is how do we prevent burnout, right? Because I think getting talent and keeping talent is probably one of the most foreign parts of your role today, right? How do you think about that? And what have you implemented to make sure that your best talent, you're able to retain and keep really excited to be?

Richard Rose: If you talk to anybody in physical therapy and they're not talking about burnout in some sense, I want to know what they're doing so we can learn. I think what you do is you ask questions first. And our immediate, if you're talking about burnout, you're only talking about providers. You're maintained. So ask questions. And you can rely on, there's national polls out there that talk about. And one thing I'm not good at is quoting specific numbers from polls. But I know that the themes are focused around either I see too many patients. You guys know this one, documentation. If I could just treat my patients and not have to document, how much better would I feel? This concept of work-life balance, and what does that mean to people? And so you ask those questions, and we collected some data on it. And one of the big things, this was a few years ago, was about documentation. And this was prior to anything in the concept of ambient listening tools. And so we said, well, what can our EHR do for us right now? And so we tried to streamline some things, understanding that the experience matters for our providers, yet without sacrificing compliance, the ability to collect money, all those types of things all matter. But the focus of it was our providers. And so we looked at how long are you spending doing documentation? And so we had a parameter that was set. We collected data and we said, we got to reduce this in half. How do we do this? How do we set up a system that allows our providers to do just that document, get done, be happy about where they're at, and at the end of the day, go home, right? Because that's where the work-life balance begins, is when they can leave your clinic and be done and just be able to focus on their family, which is so important for people who are either growing families, they have relationships, regardless if it's not a spouse or children. They have friends that they want to hang out with. They had animals that they want to take on hikes and go to the mountains with and those types of things. And if they had to be stuck on, gosh, what I still have to do at work. Gosh, I have to go in an hour early to get my documentation done. Jeez, I have to stay 45 minutes late to get it done. You're going to run out at some point. Especially if you're just going to slam down production numbers down their throat. Oh, you haven't met your production numbers. Well, it's because I'm documenting an hour after work every day. Well, how do you listen? How can you listen to that and continue to not make changes? And so those were some of the things that we did. We tried to listen. We tried to ask questions and listen and figure out where the true problems were for our specific staff members. And then creating systems that allow for those problems to be solved. Not to oversimplify, but that's really what it comes down to. If you can listen and understand what the needs are or the problems are, then you fix a problem. And if you could do that on some level of a scale and do that over and over and over again, you're going to be working in the right direction.

Hersh Solanki: On the opposite side of that, making sure that you run a clean shop with clean operational metrics is really important. Right. I think margins are tighter than they've probably ever been. Sure. Right. With lowering reimbursement, higher costs to collect, higher costs to serve and treat. What are some of the core operational metrics that you look at on a daily or weekly basis that give you the heartbeat or the rhythm of your work.

Richard Rose: You know, it's interesting when you ask the question, you mentioned reimbursement once and you mentioned cost twice. And I think that that's one of the things that gets overlooked is this idea of how do we control costs? How do you automate procedures within a system to allow it so you don't have to have, you have to have as few touches as possible. If you can limit the touches and automate, then you're controlling cost. Reimbursement is a massive uphill battle and it's one that we are fighting always and we should. We should continue to fight that battle. But I always think, too, control the controllables, right? What is it that I have under our operating roof to be able to manage, and I can do a lot better job in the short term on cost management. And so we'll look at that, right? We'll look at cost per visit. You mentioned it, cost per claim, you know, maybe what it costs to collect a dollar. You know, there's different ways to look at costs, and all of those are probably good as long as you're looking at them with some level of consistency and understanding what story they're telling because that's where you get limited is a metric is not just a metric, it's a story. And then where does that story lead in order to have a positive impact on that metric? Because if you follow something and you understand what it's telling you, you'll have a positive impact on it. And so you can pick, I think you can pick a lot of different measurements. The typical ones are going to be visits, evals, referrals, all those types of things. I think ease of referral of scheduling, which you can measure a number of different ways, whether it be through how long does it take to get somebody scheduled, how long does it take to get them seen. Certainly DSOs, if you're not following DSOs, that's a massive problem. To me, it's not so important about what's the key metric that you choose to follow, but that you follow it and understand the story. And does it support what you're doing? So, you know, some of the things that we're really passionate about is even like our NPS score. There's not a lot of physical therapy companies that have NPS scores. Yep. And that matters to us because we talk about the experience, right? So what better way than a subjective question that goes out to every single patient that we see? We don't cherry pick them. Like, okay, you discharged with X amount of visits. So we're going to send you the NPS score. So we look really good. Every visit we see, every patient we see gets an NPS score, regardless if, unfortunately, they were a self-dropout or they're somebody who complete their clinic care, all the way to the ones that complete 18 to 20 visits with us, right? Post-op shoulders, ACLs, those types of things that have longer plans of care. And we're very passionate about that because it supports our why. And so, again, I hate to sound like a broken record, but those key metrics have to support your mission. And that is our mission. So that's why that's one of the key ones for us that we like to follow.

Hersh Solanki: How do we think one metric that I've been thinking about a lot that we are spending a lot of time building tools to help optimize is schedule utilization. Right. Because to me, you have a series of fixed costs that you need to run your group. Schedule utilization is one of those variable top line drivers that could fundamentally impact margin. How do you think about schedule utilization as a metric or a series of metrics that you look at?

Richard Rose: I guess a follow up question would be those, how would you define schedule utilization? Like, is it defined by how many slots am I leaving open? What's my saturation percentage? How many am I doing on a daily, hourly, weekly? How are you guys defining it?

Hersh Solanki: So we, the way we've done it is we will set provider working hours for every single provider. And then if you can schedule two visits at the same time, right, depending on whatever the compliance guardrails are, right? So Medicare, you can't, but other payers, it may be okay to. So if you take all of that into account, you look at what are the total potential hours that a provider can be scheduled. So that's your theoretical ceiling of how much can you schedule? And then what's your utilization as a percent of that, knowing that, look, our goal isn't to go burn out physicians. But of course, you're running a business at the end of the day as well, right? And so that's the inherent tension. But that's how we think about scheduled utilization.

Richard Rose: Yeah, it's almost like a heat map. Yeah, of sorts, right? Like you look at it and say, hey, I have the ability to schedule X and I actually scheduled Y. How did I do? Yeah. Right? And I think that I love that idea. It matters on, it has to have flexibility in what a company defines as 100% saturation, right? Because you're going to find out, you've probably talked to enough physical therapy companies at this point. Some people will have production standards that will be 45 or 50 visits a week and some will have production standards that are unfortunately 100 plus a week. And so if you, I guess in some sense, you have to have variability if you're gonna build that. But understanding, I think when you mentioned like the Medicare limitations on the schedule, that's probably some of the stronger guidelines. And if you can base it on that, I think is where you would find the most impact. So for example, if I have a therapist and I know in a clinic that is 25% Medicare, and they have 40 hours a week you know what would i anticipate how many of those hours would anticipate them to have medicare now i can start solving right so 25 but that's 10 right easy numbers like easy numbers when i'm doing theoreticals but you can look at say well hey i had this provider at 15 i had this provider at 35 like why am i having the saturation on one person and not the other or you can even look at it at my level i'd be more interested in kind of clinic to clinic like are they taking advantage of those opportunities in order to again that comes down to the experience experience of the patient experience of the therapist the experience of the payer because all those guidelines matter um but some level of i would almost term it a heat map to say hey what's this look like you know you got your reds or your hots and your greens or your colds or however you want to do that right think of a weather map yeah uh i think that would be important to see i think that'd be something it's something that we look at i think we look at it right now on a grosser term, kind of weekly. We haven't gone as granular, I don't think, at the hourly level. We certainly understand the percentage of patients seen, but I don't know that we look at it like, hey, they had 12 hours versus 16 hours scheduled with a particular insurance, right? That would be pretty cool.

Hersh Solanki: Yeah, and I think it's a balance, right? It's not to say, hey, fill every single hour, right?

Richard Rose: Right, sure, but I think it's having that data you can make whatever decisions you think are right.

Hersh Solanki: I think one of the more recent parts that we focused on is a simple feature, which is a cancellation waitlist, right? I should basically say, yes. And I'm sure you guys have some version of this, right? But even that feature alone can be quite complicated to build because there's all these scenarios where you would want to schedule and scenarios where you're like, hey, actually don't schedule. And then, hey, if I have waitlist stacks go out, how many patients should I send it to? I don't want to just flood my entire patient population, you had one slot, right? So you think about this feature, you're like, okay, we should have the idea of the wait lists. Implementing it is actually a lot harder than it seems. It has to be something that folks like yourself will use.

Richard Rose: Well, so dynamic too, right? Because as soon as somebody gets scheduled, they're off that list. And like you mentioned, how is that defined? I have to imagine from an engineering standpoint, setting the rules for something like that. And then also being able to make them somewhat customizable because if i'm in a different setting than somebody else like i'm gonna want something entirely different in outpatient ortho world versus somebody in a skilled nursing facility or even not even that because they're not really scheduling as much but a neuro inpatient or outpatient neuro or pediatrics and like you said well how do i match this patient with this provider at the right time when i can push them in uh i don't envy you for solve a problem like that. But I can tell you that if you get a way to make that customizable, there's gonna be a lot of folks who are pretty happy about it.

Hersh Solanki: Yeah. We think of things as almost of rules engines, right? It's your rule. That's exactly right. How you submit claims. Here's your rule of how you post payments. And now here's a rule of how you can schedule. And you have to set your own rules. Because I think to your point, if you just give an out of the box offering, people will be like, oh, this is like 90% of the way there, but that last 10%. It means I can't use this because it doesn't actually meet every single thing I need. Oh, yeah. And so that's a great point in terms of it has to fit exactly what the provider or maybe you're the clinic manager or for back in the day, you're managing one clinic. For that clinic, you're going to set the card, card rails and guidelines. You can say this is how we're going to operate. This is the culture we're going to set. And then we're going to set up ruling based on that.

Richard Rose: And then the last five or 10 percent is totally key. Right. Because, oh, this is great. This is great. And you got this big butt at the end. Right. but it doesn't have this or doesn't do this like to that point like i've been spending probably the last week or so granted not every hour of every day but small times last week just trying to dial in a specific text message the actual verbiage that we want to go out that matches with what we're trying to accomplish and so 95 of it was done in five minutes right and then the other five percent has been done over 45 minutes to an hour right as far as like kind of going back and forth um with who's helping us develop that and put that in you know because all this html stuff which i don't understand and so i'm like well i just want these words then you know i want to look like this and they're like putting all these you know carrots and whatever other characters they put in there right and i don't know i won't begin to pretend i know what they're talking about but i know what the outcome is and i'm i'm grateful to have folks that are a team who helps me get that outcome which is so important yeah to be able to to verbalize something to somebody and oftentimes very poorly how i verbalize it but they're able to capture it still in some regards at least get the ball rolling on it and they're like hey i think you're thinking something like this i'm like yeah i didn't say that though but that was perfect you know so i'm thankful to have those team members as well.

Hersh Solanki: As we think about moving forward over the next couple years and we think about technology, I think there's, especially with how quickly these language models are getting better, I'm sure you're reading it in the news, and I mean, there's entire companies that are being fully replaced by these language models. What are you the most excited by for the profession over the next couple years that you think will have a material impact?

Richard Rose: I was trying to think of something that was unique, but the reality is at the very surface level, I think at the overarching theme is it gets people doing the things that they were intended to do. And so the simplest example is our therapist or our therapist intended to do to treat people, to help people, help optimize function and form to get back to a prior level of function or patient specific outcome. that's important to that person. That's what they're optimized to do. And a language model can now help support that. But you go to like the front office. What did they have turned into? They've turned into folks who've had to chase down paperwork, who've had to chase down authorizations, have to chase down all these things. What's their intention? Well, to help create an experience and a culture inside of a clinic that people want to come to, right? That's the first person you see. And you don't want them to be like, hang on, I'm on the phone again. Or hang on, I'm sending this fax again, right? I think the overarching theme is getting our people back to doing the things that they were intended to do. Our techs, they're there to support. Not to just be typing in our exercises and sets and reps and all those types of things for us as we're treating patients. And our billers, what's the idea? To get it posted, to get it collected, and to follow up on the nuances. Not the 95%, but the 5%. And so I think that the language models allow us to do that. get people back to the intended job. And I think that's the most important thing. It's easy to say get back in front of patients, which I think is important, but that's the intent of that position. But there are several other positions in physical therapy that have to get back to what they were intended to do. And that's what these, I think these models can provide for us. So that's what I'm excited about is get people back to the jobs that they're intended to do. And I can tell you that their satisfaction will go way through the roof as well.

Hersh Solanki: Yeah. I mean, I think we hear it day, right, if you're doing things that are repeated or really manual, your job satisfaction is going to be lower now, right? Versus if you can be patient facing and really make sure that experience with the patient is an amazing one, right? Your satisfaction will just be higher, right? So I totally resonate with, I think that that point, that point you just made. What about in terms of recruiting therapists? Because I think I'm sure as you continue to expand and scale, you went from from two to 20. And I imagine you guys want to continue to grow. recruiting really good talent is going to be probably one of the hardest things to do well and to keep that quality high. I'm curious how you think about if there is a use of technology or whether it's a culture or whatever it is when it comes to actually recruiting new therapists. I'm going to work with you guys as well.

Richard Rose: Yeah, talent acquisition, right? Like if there is going to be a stick in the mud in order to grow and meet, what I like to say is meet the needs of community right we have you know a such a small percentage of the population in the united states that need physical therapy that go to physical therapy i've heard studies as low as like seven or eight percent the highest studies i've seen are like 15 percent you know even if you even say 20 at the very highest end that means one out of five people that need physical therapy are getting physical therapy so it's not a need issue from a community standpoint the need is can we provide the environment and the people to support and meet that need let the community ask and that's what's important so talent acquisition you know i'll tip my hat to a guy in our company who's in the last year and a half or so has kind of redefined that for us uh rocky cisneros and i call him rampage rocky because this guy is dialed in on the things that you mentioned like what are people looking for well they're looking for a culture and environment to be able to get mentorship and grow. We all started, I think every single PT, at least 90% of my hate to say everyone, but nine out of 10, maybe 95 out of 100 started PT to become a great clinician, right? And so when they're looking, especially at a school, when they're looking for their first job, they're looking for a job that will support that. And so you create things that meet those needs. So we have a written down mentorship program in the sense of it's a year-long mentorship program for every new hire that we get it changes a little bit if you're a new student new grad or if you're somebody who's three or five years out but there still is a mentorship program on kind of who we are you know the the student physical therapist who just came out isn't like how to be a pt right that's gonna be more than mentorship that three to five years and be like well how do i grow into like a provider all of us it sounds silly to say that but how do i grow in that sense somebody who's seven or ten years out or more they might be looking for leadership they might be looking for other things that require mentorship as well so we have developed different things that apply to our culture and since of we have a an accredited residency program that we've had for gosh a dozen years now probably before it became kind of more popular we have a leadership program that we do and so i think it's about listening again listening understanding where the problems are and then and then fixing those needs and getting it so the culture matters tremendously how uh tech plays a role in that uh rocky would probably be answering better better than i could yeah uh i know that there's there's a strong people want to be affiliated with things that that match their morals and their core values and at the top of ours is service and honesty and that resonates with people and you can say those things anybody can say if probably if you look at most companies core values you're gonna have some form of service you're gonna have some form of honesty sure but if you can then show it that like hey this is truly who we are this is what we do i think that's what matters are you living your core values your mission vision of values are you living those and if you do that and you have a good mission you have a good vision you have a good core values people are going to want to be associated and affiliated with you and so if you do those things talent acquisition will happen because then people are going to say oh what happens if you go to a great restaurant right when people say oh what's this place you got to go right you got to go to this place what how how better to have 120 from buyers and say hey we're from pro pt like you gotta work here like you no you gotta come join us we do things differently you know so i think that those things are tremendous it sounds it's it's not really techie in that sense but that's that's what people want to be a part of

Hersh Solanki: yeah no i i agree right people want to work at places that get them out of bed and get them really excited about that they do and i think hats off to your team i mean getting to 100 therapists there's so much that we've learned that goes behind the scenes is being able to scale that infrastructure up to be able to support 100 therapists from an operations perspective IT perspective process and system perspective so it is really a step up to go and get to that scale so so congrats on that last question I have for you is where do you guys see yourselves over the next couple years like what is an ideal next three years look like i'm sure you guys have done some some work on that but what are you guys optimizing for right now

Richard Rose: yeah i think um to give it a shameless plug we i have a podcast as to an podcast that we talk about what we call our pro pt 2.0 and uh that kind of just started this november and december on where we want to go and i think what is at the base of it is we truly believe that what we do matters. And I think that what we do creates opportunities for others that doesn't exist elsewhere. And so if you have that product, why wouldn't you want to share it? And so if we're going to go and share it, we're going to grow. We're anticipating growing and we're going to be regionally based right now. We're tucked in the Central Valley of California. Our goal is to not forget who we are right and and that regional dependency matters but we have an ability now to again go back to kind of i think the very first question i answered about creating verticality that otherwise doesn't exist because you have so many pts now especially that are coming out with you know some of the stats say on average i've heard 75 or 80 000 in school debt 120 plus if you're undergrad how are they going to go and open up their own business with that amount of debt a loaner's going to be like yeah sorry you know good luck come back to me in 15 years after you pay those back and then maybe maybe we can talk so for folks that still have a desire to be a part of something that allows them to treat we want to share that for those people who want to lead and have an ownership of something that they get to invest their time into we want to create that and deliver that so our our focus right now is to grow but in order to grow we have to have our our systems functioning well and also innovate and try to be proactive in the problems that are going to be coming up as we grow right we have a great infrastructure but we don't want to wait to add four or five clinics and realize oh shoot that we're missing something how can we anticipate and yet and we are going to miss things i i don't i don't want to pretend that you're going to be perfect when you do these things but i think the realization of like once you see it then you go fix it and you just have this unrelenting effort and desire to make it better all the time even if it's one percent right that's better and just have that desire don't let it go and so those are the basis of what we're going to do. We anticipate growth. We anticipate providing a service and experience to providers, to communities that aren't currently served by ProPT, to different payers, to different referral sources, all of those things that we're proud of and still recognize that we rely on to do what we do to expand it. And so I certainly think that that's our vision and we're looking for team members. That's going to be the only thing that holds us back because we want pro-PT people. We want people that match, align, that's such a key word, align with our mission, vision, and values. And if you have that, I don't think you can find a better place to grow. That's why I'm still here 17 years later, because I'd had that ability. Had I not had that ability, it's very feasible to think that I would have probably searched for it someplace else. But I've been able to have that over and over and over again with them. And so I'm pretty proud of that. And that's kind of where we're headed with Propity 2.0.

Hersh Solanki: That's awesome. Well, thanks so, so much for that.

Richard Rose: I appreciate it, Hersh. Thank you to your team. I couldn't have had a better experience. So thank you.

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