EPISODE 423: The Integrated Practice with Jonathan Saigh DC

Hey, chiropractors. We're ready for another Modern Chiropractic Marketing Show with Dr. Kevin Christie, where we discuss the latest in marketing strategies, contact marketing, direct response marketing, and business development with some of the leading experts in the industry. 

[00:00:00] Alright, Jonathan, really appreciate you, uh, hopping on this podcast today. I'm excited to, to dive into it. We, uh, got to know each other last year in the Mastermind and it was a, it was a pleasure. And then it was cool to see, uh, your team share with us the integrative clinic that you have. But before we dive into that, uh, just tell us a little bit about yourself personally and professionally.

Yeah, thanks for having me on, Kevin. Uh. Like you said, the Mastermind last year was a great time. We really enjoyed it and took a lot away from the group. Um, not a true plug for the Mastermind, but if anyone's on the fence, they can always call me and I will definitely be a, a reference for it. It was a great time, but, uh, yeah.

Jonathan say outta Wisconsin, uh, originally from Michigan. I grew up in a small town with actually one of your other podcast guests that we were texting about Jeff Moore. Uh, he was a little bit older than me, but he's a physical therapist that he just had on a few weeks ago. Uh, so small world, but uh, yeah, that was funny.

Yeah, it was a little crazy. I listened to that one. He's, he's still has much energy as I remember. [00:01:00] Uh, you know, I looked up to him. I was in middle school, he was in high school. He and his brother were good athletes and my brother and I were younger and than, than they were. And, uh, so just kind of small, but I remember he was full of energy all the time.

Jeff was so glad to see he still got it. Definitely. Um, but yeah, went from Michigan, went to University of Michigan, played football. Um, uh, offensive line. So, you know, really learned a lot there, had some challenges, uh, as far as some medical injuries that sidelined me for years. Um, you know, careers never go the way you want, always end before you're ready for them to end.

And that really taught me some life lessons early on when I wasn't ready for life lessons. Yeah. Um, and still use those today, but that's kind of where we are. And then went to Logan University and, uh, met, uh. Good group of people that I'm still, you know, in business with, one being my wife. So she went to school with us.

And then, uh, my other two, uh, best friends, uh, Nick and Emma. So we've got a group of us that you have stayed together for. Coming up on, you know, over a [00:02:00] decade now, which is quite amazing. Yeah. So you don't see that, that's, that's, yeah. That's cool. And, uh, I guess they didn't have a lot of NIL money back when you were playing, so you couldn't retire outta college?

No, it was all illegal. You know, if you were taking a, a free burger or, um, you know, a dinner somewhere, um, it, you know, it happened. I have no. Well, I'm saying it now, but yeah, we would go to pay our check occasionally. This happened to you once or twice in my career, but your check would be paid for and nobody would even be there to like think.

But uh, that was technically illegal. We're supposed to report that to the ncaa and yeah, it's a lot different now. A lot different now, a chuckle, but I would've, uh, I think I a different college experience and would've leveraged. Um, my NIL, you know, like everybody does now. Um, yeah, leverage it for, for long-term gain, but, uh, it's, it's interesting how it's changed.

It is, it's fascinating. So let's, um, let's fast forward a little or rewind a little bit, but graduated from, uh, [00:03:00] chiropractic school. Did you work for anyone before or did you just dive right into practice ownership? You know, it's funny you bring that up. We have a, a joke here. Uh. Nick, uh, he's, he's funny, but, uh, I worked with Nick and, uh, he made a comment one time that, that my GPA was so bad I could only employ myself.

Uh, kind of true with my undergrad GPA, but not my chi. My chiro school was much better, but no, never worked for anybody, knew I couldn't because I had a vision from, uh, before I went to Kyra school. Mm-hmm. Um, my dad, uh, was a primary care physician, family physician, small town, so I always knew that. My practice was gonna be different than a traditional chiropractic office.

It was never gonna be siloed into one service line. And I went into chiro school with that mentality of being open to working with other disciplines. And, um, therefore, I knew I was gonna struggle working with anybody else. I couldn't, you know, couldn't work for somebody with the vision that I had. And because I think mainly a lot of 'em don't [00:04:00] have the vision I had from the beginning.

Um, so yeah, nothing against it, but I just was not right to work for anybody else. So I, I waited, took us a while, we bought our own practice. Mm-hmm. Um, but I think it was nine months after graduation or maybe like 10. And then we purchased a, a practice that kind of did our model, which is similar to, you know, how you practice chiro rehab.

Mm-hmm. And we knew it was gonna be a little easier fit to integrate. Um, and then quickly learned that there's nothing easy. Yes. Uh, so that, you know, if it was easy, everyone would do it. And there's a reason why not many people do it 'cause it is challenging. Mm-hmm. But it was what, what we wanted. And I had envisioned for years, and thankfully my wife and my friends were on board for the ride, so, mm-hmm.

That's cool. And then the practice you bought, what, what did it look like, uh, as far as a service? It did offer, obviously, you know, chiropractic, you mentioned some rehab. Was there, uh, some other entities in that or, you know, what did that look like? Yeah, so it was Cairo Rehab. Um, [00:05:00] I. And it was, it was pretty decent model that it was set up on, but it was all work comp, personal injury, that was it.

Um, okay. No Medicare, no commercial carriers. Um, 70% Spanish speaking, and we're south of Milwaukee, Wisconsin. So that was a little challenging to get into. Uh, the other portion of it, it was, I went in pretty eyes wide open, but. We don't know how, uh, but the revenue was about one third our first year from what we expected it to be based off of the, the previous three years tax returns to back it up.

So we did all our due diligence correctly. Uh, but still, it, it didn't make money. And, uh, you know, we went in and my wife and I didn't take, um, any paychecks outta the practice for 34 months. So lived with her parents and commuted 80 miles a day for three and a half years. Um, but really put the grind on and.

Uh, so that's kinda what it looked like originally and we had to revamp it because it, you know, wasn't profitable. It, you know, broke even that first year. Um, and another thing I did is [00:06:00] two months after we purchased the practice, I brought, um, my good friend Nick over and, and paid him. So he, he got paid his second year, 25%, raise his third year, 25% raise from that new salary.

So really committed to him and to, to building something bigger than just. You know, a one or two person operation. You know, my wife and I, so from day one, I took a lot of heat from a lot of people on paying somebody else without taking a salary myself. But I committed to the growth and the vision that we had and committing to that.

I wish more people had the delayed gratification. Right. Where you really put the work in. And, um, and then ultimately you're gonna, you're gonna see that, and that sometimes as an owner, uh, yeah, you may not be the one making the most money in the clinic mm-hmm. But you're building something that ultimately down the road, uh, will, and then you, you mentioned your vision early on, what's, you know, and, and I just, I wanna frame it as well, uh, Emma, who is also in our.

Mastermind that year. She was, uh, she was kind [00:07:00] enough to share a video that you guys had put together, uh, which was really cool to watch it and see your vision and why, uh, really come to light. But before we dive into where you guys are at now, uh, you know, what was the why of, of building a clinic that was integrated even from when you knew the vision in chiropractic school?

Uh, what was the why behind that? The, the why for me was in chiropractic school, they drilled into our heads, you know, roughly 10% of of people in the United States see a chiropractor and then it's 90 plus percent allopath medicine. And I looked at that stat early on, you know, with my, my, uh, family background that, well, why would I limit myself to that small percentage of, of people, you know, there's so many more people that we can reach.

So my vision was always. Go, go after that additional portion of the population with the conservative mindset and, and really like there's a way to do allopathic medicine that is not just drugs and surgery. [00:08:00] And that's how I went into it and knew that we could reach more people, um, with an expanded model, expanded service lines, offering that allopathic model, but differently.

And, and what really happened when we first got in, we weren't big enough to, we didn't have the finances to do that yet. Um mm-hmm. But you've come, you've come across this. Every, every physician you know has, you refer somebody out and their patient experience is horrible. It may be a good provider, but the patient experience is really bad.

And then the patient comes back to you slightly upset that, well, you sent me here and it was horrible. I didn't get in for two months. I got in. They didn't review my case, they just gave me this. They didn't even talk to me in the room. Why did you send me there? So we realized. We wanted to control that, and then we just had to figure out, work backwards.

Okay, how do we get to this point? How do we get there? How do we control that patient experience? But really put the twist on it of the conservative chiropractic mindset, and not necessarily dictating care of the medical providers, but just, Hey, here's the research. Here's what we can do. We don't [00:09:00] really wanna push this, this, you know, uh, sector of what you legally can do as a, uh, position, mid-level.

Whichever you go with, but you know, really, here's what the services we wanna offer is, that's something you're interested in. And, and once we got into it and our reputation got out there, I mean, people started outta the woodwork, mid-levels, physicians loved it. You know, they wanted to refer to us, they wanted to work for us.

And it just, you gotta get through that delayed gratification period, like you said, and build the reputation and then people will seek you out for it. Yeah. I, I love that. It, it, it really stood out to me where you said kind of allopathic model, but without the drugs and surgery, in a sense, you're kind of putting a twist on it.

And then it is something that we sometimes fail to realize is how bad it is out there in a sense of mm-hmm. The experience that most patients are getting in the medical model. It's just, it's a really bad situation and we can do it from a different angle. 'cause I think we as chiropractors come at it from an angle where we [00:10:00] have to have.

Patient first. We have to have a good experience, uh, because if we don't, we're just gonna die on the vine. And so we, we have to have that and be able to, to marry the two and, and control that patient experience. Uh, yeah. And another thing that with that was I, you know, I knew that there's, there's other services that benefit patients that chiropractors just can't do, right?

Mm-hmm. Physical therapy, uh, sure we had a kind, a rehab model, but then we were limited on, we, you can't do physical therapy to Medicare patients. Okay, well, how do we, how do we. Do this properly. Okay, well, we have to bring on a physical therapy team. Mm-hmm. You know, physical therapists and you hear a lot of, well, PTs and dcs, they don't like each other.

And it, it's really an individual basis if you're running the right operation with the right vision and you can get people on board to buy into it. It's never an issue on the credentialing of the individual provider. Either they're onboard for your, your vision of what you're trying to do to your community, serve your community, or they're not, and.[00:11:00]

We've been in this for nine years now and we've had people who aren't on board and we have people who, who are. So really going through that process, that hiring process, and explaining your vision. Patience first. I think I brought this up in the mastermind to you. You know, my two rules. Number one, is it good for the patient?

Number two, is it good for the business? If it's not, if it doesn't pass, number one, we don't care about number two. Mm-hmm. And you get this all the time, you know, uh, down in Florida that you get a vendor walking in and telling you how much money you can make on this. And we do not care. Like you ju you build a business around how much money and revenue you can make in profit margins.

Patients will sniff that out. Employees will sniff that out. You will not be successful. Uh, so that's really what we built it on is rule number one. Is it good for the patient? Mm-hmm. And that's what I'm always about is going back to my athletic past is, you know, tell me I can't do something or I'm not good at it, and I'll just smile.

I'll walk away and then we'll come back and prove to you that we can in the proper way. And that's what we've done. You know, said, [00:12:00] well, you can't, uh. You can't do this as a chiropractor. Okay, watch, you know, I remember all the instructors back at Logan and, uh, well, you can't do that. Okay, well, let's see how, if we can't do it in 10 years, so.

Quick question. Well, it's been tougher, uh, blocking a player that ended up playing in the NFL for a long time, which I'm sure you did. 'cause you played at Michigan, uh, or some of your business challenges. Oh, business challenges because you get your ass kicked in football, you can, you know, you rub it off, you get back up, then you go back to line to do it again.

Business, it, it can affect not you, but the rest of your people. I mean, we have 45 families now that we. Provide for, for, we're, we're not, uh, you know, three, four employees anymore. So yeah, football. There's a couple. Brandon Graham was a teammate of mine. He just retired from the Eagles, just won his second Super Bowl.

Yeah. Um, some other big names, you know, Lamar Woodley was another defensive player I used to go against all the time. Just, uh, I'll never forget, I one play, you know, in [00:13:00] practice did well against Lamar and he got mad and he said, okay, I got you in the next one. And sure enough, he threw me like a little rag doll and I was 296 pounds.

He threw me in the air like I didn't exist. And he said, I told you I got you. And that was it. He walked back to the huddle and you do it again and. Um, but no, I think business is the more challenging one because there's more on the line, you know, in, in athletics originally it's your ego, um, you know, all the hard work you put in.

But then business, it comes down to there's more riding outta your family, your employees, families, uh, team members. Uh, so there's just more, I think, on the line in business, especially when you get to kind of a level where you're, it's not just you and a and a receptionist, it's you and a full rehab department.

Medical department, uh, you know, billing department, you end up having departments no longer just a few employees. And that's, I think what I, uh, I lose sleep over that, you know, I want to do right by them. Mm-hmm. And not just, just me anymore. And that was a big [00:14:00] shift and I had to shift, make that shift early on, probably a year, two or three where I, okay, we're at 10 plus employees now it's, you're no longer.

Yeah. You can call yourself head honcho, but. No one else cares. It's really can you provide opportunity for them? Can you put a roof over their head? That's what I really strive for. And, and day to day, that's, that's really what keeps me coming to work, uh, nowadays. Yeah. I love it. So let's, uh, let's fast forward.

You mentioned nine years, uh, the business, uh, since you bought it, I assume, and we got kind of the picture of it early on. Now give us the, the, the picture now of what the, the clinic looks like, the, the space and the team. I know it'll be hard to go through all of, but just kind of a, a nice overview of where we've gotten in nine years.

Yeah, the clinic shifted. We were in about 4,900 square feet. It was a great setup for a Cairo rehab office. Um, and we made the medical model work there and we just, we knew we needed more, so we actually just shifted [00:15:00] down about half a mile down the same street, and now we are 11,000 square feet. Uh, 45 employees.

Not everyone's based here. We have mobile teams that kind of travel the state for some of our medical services. So we have a fleet of vehicles. Um, I think on day to day we're probably 35 in office, and then 10 are either remote workers or, uh, medical teams that are traveling. Um, so yeah, it's, it's a juggernaut now.

It used to be 36 people in a week was a busy week. 'cause we were three days a week when we first started. And now, you know, if we don't have 36 by noon, something's wrong. Somebody has, something's gone haywire. So it's completely shifted. You know, it's, we are not a high volume clinic. We just have so many employees that we can handle.

 More volume. So we are not a two minute appointment type. You are doing rehab or physical therapy plus an adjustment, potentially medical visit, depending on what your treatment plan is. patients are here for a while. 45 minutes to an [00:16:00] hour and a half depending on what they're getting.

Mm-hmm. Uh, and we'd really pride ourselves on our waiting room was really small, and when I designed the space, I built it that way. Mm-hmm. We only have maybe 10 chairs, and if there's more than three people in those chairs that are existing patients, not a new patient, something's wrong. We get people in and out, everyone's on time.

We'd run a pretty tight ship. Patients know the expectation, you're on time and they show up and everyone's pretty good within a few minutes. Um, but yeah, we're, we kind of funnel 'em in and lack of better terms. You've heard them like cattle in and out. Mm-hmm. Uh, we have kind of stations, right? They, they go through and we, we've laid out the clinic while that it flows from one end to the other.

They're not backtracking too much when they're here. Um, but. We're kind of unfortunately, or unfortunately, I don't know, with quickly two years now, we're out of space a little bit. We're getting there. So, you know, what do you do? And uh, my head is on the chopping block physically, so yeah, [00:17:00] they're trying to tell me you need to start mentally preparing to move out.

So, uh, did you buy the space? I, I recall. I did. Yep. So we did an SBA 5 0 4 loan, so the building's 33,000 square feet. We have 11 of the physical space, but for the 5 0 4, you get the common area as well to meet the 51% requirement. Uh, pretty cool program if anyone's interested in that. Mm-hmm. A lot of red tape.

So yeah, that's what I, that's what I did. Yep. Yep. Yeah, so you're familiar with, I think we talked about it at one of our events. Um, it, it can be a good program, but the bank does own you afterwards. You just have to be comfortable with that. Mm-hmm. You know, they put a lot of requirements on you. So, um, and, and I will say commercial real estate is not for everybody, especially, you know, I've eight tenants in this building, multiple tenants across other buildings, and it's, it's a different job.

But, um, if you're into it, it can be rewarding. It's just you go in with eyes wide open. It's, it's, uh. It's a different business model, you know? So yeah. Now, [00:18:00] now, um, can you move into some of the other space you have or is it all occupied and it would be hard to, to take over more space within your own building?

Yeah, we're, we're fully occupied, but we do have one that is coming up that we might take over, but yep. We have other locations that I can go to. Mm-hmm. So we do, we do have another office space that we could jump over to, and that's where I was going to go. And, uh, probably we will see what happens through the summer, but that's where I'll end up.

I already have the space, so I prefer to rent this. This is a prime location, a new, uh, supermarket just went in across the street. So it makes sense to rent this one, um, that other space that's coming up, but we'll see what happens. Yeah. Nice. You never know, right? You forecast out and then everything changes and that's the fun part of the Yeah.

You just gotta keep options open.

Yeah.

Um, so tell me, okay, you got, obviously you got some dcs. Uh, do you have medical directory, have, um, any mid-levels? Like what are some of the different types of positions you have within the clinic now? Yeah, so I think we have three, three MD supervisors, [00:19:00] uh mm-hmm. We have five or six mid-levels, um, two PTs, uh, PTAs, athletic trainers, um, we call 'em techs.

So, uh, chiro tech, uh, physical therapy techs. We have both reception care managers, billing liaisons, uh, that these are all onsite people still. Mm-hmm. Um, then from there we have virtual assistants that run some of the backend items. That's, that's awesome. Um, now, you know, I, I think one of the things I wanted to get from this too was that, um, other than just like some of the logistics of having a, a medically integrated clinic, but it's just the idea of, you know, thinking bigger.

You know, like any advice to doctors on, on thinking bigger and strategies of having a, a growth mindset around it. And it doesn't necessarily need to be. An integrated model, but just some of the stuff, uh, you know, whether it's good or bad, but just some advice on, on thinking bigger. 'cause I do think we, uh, maybe [00:20:00] our profession suffers from thinking bigger.

I agree with that. And, and full disclosure, you know, I'm not a chiropractor. I never have been. I. And I went into Cairo school knowing that I knew I was not gonna be a chiropractor. And that's no offense to the pr, to the profession. I love the profession. It's, it's obviously given me everything I have in life, uh, saved me from, we didn't go into that, but my athletic past, that's what saved me.

My roommate's dad was a chiropractor. Mm-hmm. Um, with my injuries, you know, he, he enabled me to stay at, at the university and continue to play. And without him, I, I would've. Given up my career after my freshman year. But, um, with that, you know, I, I don't look at myself as a chiropractor, never have. Um, and I officially stopped practicing, I think about five years ago now.

Um mm-hmm. So I'm a real estate professional. Mm-hmm. Technically, and it, it's bonafide. I mean, I have a dozen properties now and that's what I manage on a day, day-to-day basis. Uh, still involved with the practice, but I manage the managers essentially here. So I'm not adjusting people anymore. Uh, but I think the biggest [00:21:00] thing on the growth mindset is you have to be willing to evolve, right?

We ran into some roadblocks early on, um, and it was about Medicare specifically with pt. We, we knew our patients needed physical therapy, rehab. We can't give away the service for free and we can't bill for it. So what do we do? Do we just refer them out to somebody else, back to the hospital or back to another A TI Athletico where we know they're gonna complain about the service.

They're, the providers aren't gonna listen to our orders, they're gonna disagree with us. There's no collaboration. So they're gonna treat the patient and then we're not gonna find out about it until we request the note three weeks later and it's gonna take them three to four weeks to get us the notes.

So now we're two months into their treatment over there, and we don't know what the heck is going on. So like having that growth mindset of when a problem arises. Not giving up on it, realizing there has to be a way around this. Let's think about it. It might be hard, but what are we gonna do about it?

Mm-hmm. Rule number one, is it good for the patient? We disagreed with it being good for the patient to refer [00:22:00] them out for that. So then we brought it in, okay, how do we do that? Physical therapy specifically? They opened it up with Covid that it could be a telemed position. So we took advantage of that in 2020.

And then when they shut it down, uh, I'm blanking if it was 21, 22, whenever they shut down the telemed, then we offered our physical therapist full time, and she moved from Virginia. Her and her husband relocated from the military. He was getting out, so they came here. And that's just, that's just how we look at it as, as.

That willingness to evolve and, and just not take a, a, a change or a problem, you know, at face value and stop looking into it and stop pushing, pushing the envelope. Um, so that was kind of one of it. And then the other part with that, you know, evolving is you as an individual have to evolve. You are not the same provider.

We've talked about this with Brett, uh, Winchester, Mark King. You know, I've known those two for 15 years now. Both mentors of mine, of mentors of yours, you know? Right. They were at the Mastermind. It's, [00:23:00] you're not that same provider that, that you were when you graduated, when you started practice those same, that you were five years into practice and realizing businesses is like that as well.

You're not the same business owner. That you were when you started. I, I know for a fact you weren't. Right? Like we've had conversations. It's, you, you, it's never a, a, never a linear path. There's going to be ups and downs, and with that experience, that scar tissue, you learn, you evolve, you become better. And that goes back to my original introduction of the athletics.

Mm-hmm. Right. Getting, getting your butt whooped by people who are better than you, pushes you. Mm-hmm. And we really just have that mindset on the business side. And that's what's always been my growth mindset, is I wanted to help more people than were willing to be helped by chiropractic alone. Mm-hmm.

And some people disagree with that, and that's okay. I respect their, their opinion on that. And, uh, we just have that mindset of we want to help as many [00:24:00] people as possible. Um, and, and we, you know, we do other services here. We mm-hmm. We almost give providers the same opportunity that we give patients. We give providers the opportunity to collaborate with other specialties.

Um, you know, we have an anesthesiologist who does pain management and a surgery center here for us, with us, I should say. It's never for us, it's always a team member or with us. Um, you know, we just, Nick just got off the call with a podiatrist today that wants to come in and start collaborating. Mm-hmm.

And, you know, utilizing our hyperbaric oxygen chambers, we have two of those and our surgery center. Oh, great. That's wonderful. You know, just that, that willingness to be open to change. Um, is, is is tough for some people 'cause change is uncomfortable. But we've really leaned into being comfortable when you're uncomfortable.

Lloyd Carr was my college coach, and mm-hmm. He taught us that. Yeah. Um, control what you can control, number one, and then be comfortable with being uncomfortable, number two. So, [00:25:00] uh, that's just kind of where we are in the growth mindset. We're, we're never satisfied with where we are. We do celebrate the wins.

Um. We just know we have more as a team and as, as a company than, than just being satisfied with, with doing what we're currently doing. Um, so not everyone can get on board with that vision. Let me be clear about that. Mm-hmm. We talked in the mastermind quite a bit about, uh, how hard it is to, to find employees that are aligned with your vision and um, you know, it's a constant challenge there, but.

Once you can get people to buy into the growth mindset and what they can actually do and they're capable of, it's amazing when I take a lot of pride in seeing potential in employees that they don't see in themselves. Some people can't handle that and they will quit. But that is probably my biggest, um, um, I think attribute is I push people because I know they're capable of it and they don't think they are.

Yeah, I'm really bad at a lot of [00:26:00] things, but that's one thing I'm pretty good at. Mm-hmm. Um, so yeah, it's, uh, the growth mindset's a topic I think that you see a lot on Instagram and TikTok. Yeah. Right. And, and every guru's got a CA, a course for it. But it really, there's a lot of cliche things that are, are actual true, actually true if you implement them.

And, um, it starts with delayed gratification. I cannot emphasize that enough. Yeah. Nick and I drove the, the two biggest piece of junk cars in our parking lot when we had hourly employees. They had nicer cars than us, but we were dedicated to like what we were doing, not taking the money and mm-hmm. Now people look back or look at us and go, oh, it must be nice.

Must be nice. And I, you and I have talked about that. Yeah. It wasn't nice when I was, you know, getting married and couldn't afford a honeymoon, and I had friends that were golfing every Friday in the summer and I was working 60, 70 hours was a standard week, not even, not even extra time for me. Mm-hmm. You need to take a break.

My mother-in-law love her to death. Right. [00:27:00] But she's like, I think you're working too hard. But that's what you have to do in the beginning. So, um, yeah. And I want to touch on the phrase you said, be comfortable with the uncomfortable. And I do think that's kind of a, a problem we're seeing with a lot of people is once they hit up against that uncomfortableness or discomfort, they um, they back off and say up, I don't want, I don't wanna do that.

Um. You know, I don't wanna get burned out. Like they, there's almost this unhealthy relationship with discomfort now, and that's really hard to grow when you aren't willing to, to do that. And, uh, I think that's, that really sums up what growth mindset is, or just even being in business and, and when you open up a practice, even if you're a full-time treating physician.

You are now a business owner and you're going to, if, if, if you're gonna actually do this thing and make it worthwhile, uh, there's gonna be some discomfort. There always is. And I think, uh, you know, it goes back to kind of a cultural [00:28:00] shift. I, I reference athletics a lot because I think it, it really shapes character.

And I'm a little older for this, it was, it was starting to come on when I was in high school. The younger kids were getting participation trophies and I think there that really set up the expectation that it's just okay existing. Mm-hmm. It's okay to be on the team, but not contributing. It's okay to. To to go out there and perform.

But did you give it your best? No. Well, it's still okay. And that's where being comfortable when things get uncomfortable is very difficult for a lot of people nowadays. And I think that that has. Partly, you know, to do with the cultural shift, but I'm, I agree with you that if it was easy, everyone would do it.

So you have to be prepared as a business owner that it will not be easy. There's a few people that I follow and you do as well. Uh, Hermo is one of 'em and, uh, it, it expect it to take longer and cost more money and mm-hmm. Expect to fail. And, and I. You know, he talks [00:29:00] about all the time he put up a post today actually about how many failures he's had.

Partnerships failed, corporations failed. Um, and I go back and look and, and Nick and I together, uh, 'cause Emma wasn't with us yet in the early stages. Mm-hmm. Um, 'cause she's a stud and she was out doing her thing with the Chicago Bears second female chiropractor and f fell. We'll give her little shout out outs when she listens.

But before her time, you know, Nick and I, we, we can go back to one decision that costs us a million dollars over about three year period. Mm-hmm. Back when we weren't making any money, I wasn't taking a salary. You start talking about, holy cow, that 300,000 in one year when I wasn't taking a salary living in the basement, that could have changed my life at that point.

That wasn't life changing money back then. Um, so it's just you, you gotta be comfortable when, when things aren't going right and you cannot give up. You have to realize, um, that that first. Hurdle is when most people are going to give up. You know, the average, I'd probably call it, 80% of people would [00:30:00] give up that first one.

Then the second one hits, that's gonna be another 10 to 15% are gonna give up. So can you keep pushing through all of that? That's what's gonna separate you as a business owner, as a provider on your skillset as a better husband. A better spouse, anything. I mean, you can relate it to anything. Really when things get tough, what do you do?

 Fight or flight. But the third one is freeze and a lot of people freeze and, and really, uh, you can't, you gotta keep moving, even if it's one foot in front of the other when you think that there is no end in sight. Mm-hmm. Uh, that's what really separates people. So, um. Yeah, it's, it's challenging, but you know, you've been punched in the mouth enough times in your life, you realize it's going to continue to happen.

Yeah. We have a joke, Emma and I have a joke. Uh, we say that all we need is this to happen and then it'll be smooth sailing and we laugh about it now because it's, uh, it's never that way. And there's always going to be another hurdle that you didn't plan for. [00:31:00] Um. Something happens and you lose a provider unexpectedly or, or somebody quits without honoring their, their, uh, you know, six week, uh, termination notice.

They just leave you abruptly and now you're, what do you do?

I had a, a patient, he is a ex Navy seal. He is a very successful business guy now he is in his sixties and uh, he was on the SEAL teams and all that. And he said they had three, like to have the, just the ultimate in leadership.

And when you're in a Navy seal, obviously you gotta have that, that's like the upper echelon. And he had three key things. I'm not gonna say the third one 'cause it was pretty derogatory and funny. It's, but, but, uh, uh, the first two is, it was just communication. And he, and he said it in a way that's just like your communication ashes.

Just to be precise. And it can't be, you can't be just like beating around a bush a little bit. You gotta really communicate. I mean, there's just no way. Uh, you gotta, you really gotta do that. And then he said you have to have a system of problem solving. You have to be able to take every problem [00:32:00] and handle it and have a system around it because, uh, there's gonna be endless amount of problems and you cannot predict what problems they are.

But if you have a system to handle problems, then you can address most of them. Obviously there's gonna be certain things. Has a Navy seal that, uh, maybe it doesn't get solved and that's fatal. Uh, but yes, that, that was like two of the three. And again, I'll leave the third one out and I just, to your point is you gotta get comfortable and have a system around solving problems because they're gonna arise and your problems are gonna always be there, but it's gonna look different.

Like if you don't do shit and you don't try to grow and you go you know, mediocrity and you're 50 years old, like you're gonna have problems. Mm-hmm. Um, if you head, if you take 'em head on and you overcome them. And you're 50 years old, you're gonna have problems still, but you, maybe you're a lot better off in life and you got some comfort and you could provide for your family and other people like that.

And so you gotta get a, uh, comfortable with, with the problem solving. So it, well, you're, you're hating on some stuff too that Yeah. That we didn't really touch on that I, I feel need to touch on is, is I have a team, you know, that's the good thing [00:33:00] is I have two high level people. On a team. And then I have a second tier of people that, I mean, they're, they're committed for life.

Mm-hmm. You know, so I have two tiers of people who are committed. And you go back to that team mentality of, of, back in the beginning, I didn't wanna do this alone. I want, I'm, I'm a PAC individual, I like people around me. And I've said this when I had no money, no title, no staff. I said, I don't want to go to the top alone.

I want people to come with me. I want my friends with me. So. I created this, this business that allowed me to do that to, to bring people with me, uh, in this military athletics business. I think it's the same where, where around people. You have to have those systems. You have to have other people that compliment your failures, what you're not good at.

Everyone within our office knows I'm a visionary. Don't, do not look at me to be a how, well, how do we do that? You know, an operator, COO is not my position. I'm the vision. I can see where we're gonna go. I can kind of navigate how we're gonna get there, but the actual details, that's [00:34:00] Emma. And then to actually hold the line, that's where then Nick comes in and mm-hmm.

That's where the three of us are so different, but we work so well together. Because we leverage the other person's strength. Um, and then it comes down to I'm not selfish and I didn't just take myself to the top. You know, they come with, uh, they're rewarded the same as I am. Uh, but then the other thing is, is we're touching on there or you were with the seals, but you get to choose your hard.

You know, being poor is hard, being rich is hard. Which one do you want? Uh, being happy with your job is hard. Being upset with your job is hard. Mm-hmm. So which one you get to choose. And that's the great thing that we have today, is you get to pick which hard you want to go after. And that's what I think we did here early on was we chose our hard, we knew it was gonna be difficult.

We knew the cards were gonna be stacked against us in every single group at the hospital. It was against us. That was our biggest competitor when we were this little baby of a clinic. Mm-hmm. I never said it was another chiro office or a [00:35:00] PT clinic. And by the way, PT clinics came after us, turned us into the PT board because we had physical therapy on our website instead of physical therapy modality.

So like we had a target on our back from day one, but it was the hospitals I was going after them. Um, and so we picked our heart, you know, they, they have endless resources. We don't, so we have to run the ship better, tighter. Better patient experience. We don't have the ability to mess up and it doesn't matter because we have, you know, 30 orthopedic surgeons behind us to pick up the slack that we missed.

Mm-hmm. One screwed up, one patient experience. Yeah. Um, so I, I really live by that, that no matter what you're gonna do in life, it's going to be hard. So why not pick something that, number one, fill your cup, and number two, you know, is rewarding to, to your family, to other people. And that's how we look at it.

Mm-hmm. So we're. We're excited every day when, when, even when things are going bad, it's, it's not fun to come into work. But what's our other option? We're gonna sit there and choose the hard, uh, that is fighting so. [00:36:00] Love it.

And I'm gonna just one last little quick topic and uh, you know, you could obviously have 10 episodes on this, on an integrated clinic, but if someone wanted to get started with it and right now they don't have anything going on there, uh, what would be your recommendation as a first hire?

Not as like consulting or an attorney, I all that You definitely gotta be doing some of that stuff, but, uh, would it be getting, finding a medical director? Would it be maybe thinking about PT or, uh, what would you say if you're gonna get going with that? Yeah, the first one, obviously you nailed it, right?

You, you gotta get the legal stuff out of the way. Um, so, so after that, you have to replace yourself. You cannot be an owner operator if you're gonna get into the medical integrated space. You have to be able to, I. Separate out from that. You cannot be a key man practice anymore. You have to realize that the company you're building is going to be bigger than you.

Um, you may be the best chiropractor in the world, right? We've had these conversations. We all think we're the [00:37:00] best at what we do, and we may be. On our micro level, and then you meet Brett Winchester and Mark King. I'm lacking a little bit, but, uh, you have to replace yourself. 'cause number one, it's gonna, if you can replace yourself, it shows you have the, the finances to afford it.

You have to, that kind of proves two steps here that you can financially afford to replace yourself. And two, operationally, you're not the key man anymore, and you can step back into that true operational role because again, everything is gonna be harder, longer, more expensive than you think. So. I look at it like that, that that's the first step.

And so, replacing yourself, so what do you do? You may be like, I was, I, we did everything. Mm-hmm. Um, we were the cleaning crew for I think the first three or four years. So we, uh, one of our first steps, believe it or not, was hiring a cleaning crew. Mm-hmm. Um, once a week, back in the day. And, and people may laugh at that, like, oh, that's.

Small, but it, it really was a first mental hurdle for us to, you can't control everything. You can't do everything. You have to get better [00:38:00] at what you do to become more profitable, to be able to spend the money elsewhere. And in the beginning though, you have to do the opposite. You have to not spend money anywhere.

Mm-hmm. So it's really replacing yourself and looking at what roles are you currently doing, and then what do the company finances look like of the roles in that you can replace. And it's, this is a grant card owned thing. You know, I'm gonna pay somebody to mow my lawn because I can make more money by doing something else.

You can't just pay them to mow the lawn and then you sit and watch them mow the lawn. You, you know, you're not there yet. So, uh, I think that's what it was, is replacing, and for me it was. I had to replace so many jobs. I think four or five jobs roughly. Bookkeeping, accounting, cleaning, chiro, uh, rehab tech.

So call it a pt, really? 'cause we, I just wasn't billing Medicare. Um, so, so paying some high level jobs. Um, and that was a big one early on when I still wasn't taking a large salary. I still don't take large salaries. I, we put it back into the, the clinic, but, um. [00:39:00] That was a big step because it's a mental hurdle too.

Mm-hmm. It's hard to let go of the, the business that you've built your baby for X amount of years. So wherever point you are and you're thinking about getting into, uh, integrated practice. You now have to let it go and realize that somebody's not gonna do it a hundred percent the way that you've done it or you want it to be done.

And that goes back to your comment with the Navy Seals. You have to have systems already in place and you have to have, you know, operating handbooks of how you're going to do things. Because if you don't, then you get into it and it is overwhelming. And the other part of integrated is it's expensive.

Mm-hmm. Be ready. The cash, uh, the cash flow out doesn't stop because you are now paying mid-level providers or an MD do surgeons pain management. Um, the, the, the amount of finances that you have to have once you, you're fully running right in the beginning. You can go part-time. We know that you can get strategic about it.[00:40:00]

Uh, but, but you have to be ready that a, a medical practice operates financially at a different level than a sole. Uh, ownership chiropractic office. It, it just becomes a juggernaut and once you turn it on, it's really hard to turn it off. So you have to be, then change your financial safety nets and things like that and just be prepared for that sort of thing.

Um, that I think we've talked. It, it, it comes hard and fast. And then next thing you know, you look back and our expenses right now, uh, per month are just about two times what we made our entire first year. Mm-hmm. So every month it's no matter if we make money or not, that money is going out the door. So what is your six month safety net?

Whatever you determine, six, 12 months, what does that cash flow look like? That cash reserve that you need to have, and it becomes a big number, pretty, pretty quickly. And, um. You just have to be prepared for it. And you get numb to it. You get numb to the numbers. When you know money in, you're like, yeah, but here's all the money [00:41:00] going out, you know?

Yeah, for sure. It changes completely so. Uh, just be prepared for a, a fun ride though. Yeah, well, it's a great answer 'cause it's, um, you know, you gotta start with the, the essentials. And I have another colleague that's, uh, got a few locations that are integrated and he doesn't treat patients anymore. And he's like, I don't know how anybody, like, I just like the stuff I have to deal with all, you know, just create division to make sure it goes out.

He is like meetings and, and doing all that. He is like, we wouldn't be able to do it. And, uh, it's, it's definitely that clinical duplication you're gonna need to start out with. And then, and then kind of go from there. Yeah. And that, and you know, to kind of really answer your question outside of hiring yourself, you know, then you gotta just vet the, the, uh, medical providers really making sure they're on with your vision.

In realizing this as a collaboration, what do it doesn't have to be, you know, you can build your practice the way you want, but our practice is built on collaboration. Um, people have a say in things, not a say in things, but we have meetings and. Medical providers, they [00:42:00] make their own decisions, but we are going to educate them on the information that we have.

And, and with that is conservative care of chiropractic, physical therapy, uh, imaging. You know, a lot of medical providers, um, don't really review imaging and really haven't seen it. They just see the reports all the time. Mm-hmm. So really teaching them, here's, here's the actual x-ray, throw it up in the meeting.

Um, so once you replace yourself, it's I think getting a really good, uh, provider that understands the vision. And, and it's not as hard as you would think because so many people have been in the hospital system for years and they know that that is not the right system. They, they know that it is patient last, everyone's a number.

Uh, it's just not personalized. So it, it is easier to find people than you think, but then getting them to. Operate within your systems and your vision becomes a difficult part. And that's where the training, the systems that you're talking about really come into play. Um, and, and no matter how often you have 'em, you can always have it more often.

We were [00:43:00] doing once a month, and now I think it's every day. So when we have meetings, so team meetings, uh, but it's all about, uh, improving the process so that it's smoother. Well, Jonathan, this has been amazing and, uh, got into some growth mindset stuff that I, uh, really, really appreciate. And I know sometimes it can be cliche, but I thought you brought a lot of great information on that.

And again, however, the person wants to, uh, direct that they, they have to get that vision down and then they have to have a strategy to overcome the obstacles and get there and, and build a practice that's gonna serve you. And it can happen a lot quicker than you expect. And sometimes it can happen a little bit slower, but as long as you're making.

The right decisions are on the right path. You're gonna, you're gonna see through that vision for sure. Absolutely. Yeah. Yeah. Well, I appreciate it, man, and hopefully we, uh, run into each other soon. Yeah, thanks Kevin. Always a pleasure catching up with you.