The Best Therapy Experience

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In the first of upcoming series on Book Reviews, below is an interview John Vacovec, a seasoned physical therapist who founded and owns Physical Therapy and Sports Rehab in Massachusetts since 1983.  He published his first book, The Best Therapy Experience, in 2014 and I am pleased to review his book and offer my readers an inside look on why providing value and lifelong relationships is key to success.  There are some hot topics in the interview (including relationship of us to dentists, why doctorate degree isn’t needed, why APTA has it wrong & how PT is like pizza shops), so read in entirety !

ITT Blog: John, thank you for the opportunity to read your book, The Best Therapy Experience and interview you on my blog.  You have been in practice for over 35 years and I am assuming many of the ideas in the book reflect your vast experience.  Why did you choose to write a book now?

John: Harrison, thank you for this opportunity to speak with you and share my thoughts with you and hopefully others. I feel everyone has a lot of meaningful information to share. You can either let it stay there and die with it or put it on paper and share with others.

ITT Blog: In your Foreword, you state quite frankly, “we (physical therapists) are a fragmented bunch of professionals with an identity crisis”. You mention this is a strong statement and this is a really a testament to the rest of the book.  What made you choose these words?

John: They are true words. No one knows what we do until they need our services. Ask any therapist what they do and ask them to answer it in less than 30 words. They can’t do it. And the answers are all different. So if we can’t succinctly state it and we are in the profession, the general consumer can’t possibly know what we do.

If you actually ask the consumer, and I have many times….. do you know what a physical therapist does?… you will be amazed at the answers you get.

Are you like a chiropractor? Aren’t you kind of like a massage therapist? Heck, one person said to me, do you actually have to go to school for this? We have not told the consumer what we really do. That’s what I mean by “identity crisis”.

Everyone knows if your teeth are bothering you, you call a dentist. If you are having a water problem, you call a plumber. If you are in pain, no one thinks of calling a PT because we have not branded ourselves like other industries. And please do not blame it on the insurance carriers. We need to take responsibility for ourselves.

ITT Blog:  A major theme of the book is for physical therapy to have a consistent, recognizable brand that will quickly convey to consumers across the country what we do and what we do best.  In a short statement, what do you think should come to mind in regards to physical therapy for all consumers/patients?

John: For the consumer … Physical therapists are experts in treating PAIN. Right?! What WE should be saying…..We are experts in combining hands on treatment techniques and exercise (and education) to relieve pain, restore motion and strength so you can return to whatever you want to do.

ITT Blog: How does that differ from what comes to mind now?

John: Harrison, no different. 90 % of our referrals come from a doctor telling a client they need to have some therapy to get better. They aren’t walking through our door on their own. When we receive a new client, we should be asking every one of them…… Do you know what a physical therapist does?

This is our precious opportunity to brand ourselves …. we are experts in combining hands on treatment techniques and exercise (and education) to relieve pain, restore motion and strength so you can return to whatever you want to do. This should be our consistent message and we should be taking every opportunity to tell the consumer.

ITT Blog: You mention the following throughout the book, “we all provide our products and services differently”, therefore we do not have a consistent brand to present to the consumer.  What is your opinion on the best way to address this as a profession and what can be found in your book to help clinic owners to improve its systematic brand?

John: That’s right. Product + Service = Commodity. We are all a commodity. In my book I also mention that we are like pizza shops. Often more than one in every town and all with a different product and service…. It’s a commodity. Think of Domino’s, Pizza Hut, Papa john’s…. they have an identity that the consumer recognizes and prefers. In chapters 6 and 7, I talk about a unique process only found at our company and The Complete Client Package and how it works. It makes us less of a commodity because someone cannot get this if they go somewhere else.

Consumers are different today than years ago. Most actively explore and research their options and choices. They want to know what value they are getting for their precious time and money. It’s clear the consumer wants large branded commodities. (Apple, Starbucks, Dunkin Donuts, McDonalds, Panera Bread) The M & A going on in our industry today is huge. Out patient practices must have a process in place that provides a consistent experience regardless of therapist or location otherwise the consumer will choose something that is recognizable and consistent, no question in my mind… and the corporate guys know that we are fragmented.

ITT Blog: You bring up the message of communication and language quite often.  This seems to be a central theme and you have interviews with physicians describing their complaints about our messages.  You mention that “standardization, consistency, clarity and confidence” in conveying the same message in a clinic is necessary.  What was the final event or “wake up period” that led you to challenge what you said to patients and how they listened to your message?

John: Wake up moment was when some doctors (friends of mine) would call me and say “ John, what is your therapist saying to my patient”!!!! I only want you to see my patients from now on…..You know what really bothers all the doctors I interviewed and I don’t blame them. They hate when a therapist tells their referred client … I think you need an MRI, or I think you have a rotator cuff tear in your shoulder, or I don’t think you have a knee problem, its your ankle. It often times may be true because we are amazing at what we do but I don’t have to tell you what that does to the doctor/client/therapist relationship. That client is going back to the doctor saying “the therapist told me I have a ______ problem!!!!

Seriously, if we want to be considered a peer, we should act like one and contact the physician before splitting the clients confidence in the referring doctor. Most people are not taught what proper language is.

Receptionist, client managers, therapist need to learn what to say to the consumer on the phone, at the front desk, in the back of the clinic while treating someone.

It’s all part of someone having The Best Therapy Experience. Many therapist think because they are good that that is what matters. Show me a therapist that doesn’t think they are the best!

But lets talk about language in a different way…Therapist do not know the difference between Therapeutic Exercise and Therapeutic Activity. They don’t name it correctly nor do they bill for what they do correctly. I think that’s crazy. Shame on our profession and educational system for PT’s not having clarity for something so basic.

Are therapist taught what to say in school? I’m not sure. If a school is aware that this is what’s going on in our profession, wouldn’t we want to be teaching students what to say and WHAT NOT TO SAY. Also, with all the different EMR’s, doctors can’t siffer through the entire document to know how their client is progressing. It’s a waste of their time. They prefer a 2-3 line note that tells them quickly how their client is doing.

Unfortunately most therapist do not keep it short and sweet so many doctors don’t ever read our notes, they don’t have time and can get the answer they want by asking their patient directly. By passing us. That does not build our credibility.

2 simple things most of them want to know:

1.) Is my client happy. Worst thing is a complaining client.

2.) Are they getting better.

I consider this all part of “standardization, consistency, clarity and confidence. Can you imagine if we all knew this and we all approached these situations similiarly. We would be branded very quickly. That would be so powerful.

ITT Blog: Do you think a recognized, professional and systematic brand within the field of physical therapy is through the assessment (such as SFMA), mostly treatment (such as Dip. Osteopractic, McKenzie), within each individual company in its language and communication or simply that we should be considered the pain specialists within musculoskeletal field?

John: No, I wouldn’t want to take away everyone’s creativity when treating someone based upon the therapists unique therapeutic skills they have learned along the way. Branding is a process, a look, words, language, sending the same message, the same feeling you get every time. People like feeling they are the most important person in the world but we have to know what they want by asking them and than giving it to them. Look, they have a lot of other options out there to choose for relieving their pain.

Therapist therapeutic skills are not the issue. What therapist are missing is that the consumer doesn’t care about that. They assume you are well trained. If they get 100% better, great. If not 100%, no big deal. If you are using the 3 components (Chapter 4 in my book) of building a life long relationship, they will come back to you because of their experience with you. They remember, how you made them feel and if you meet their expectations. But if you never honestly asked them what their expectations are, than you are treating them blindly… (not good for the the drop off list, no show/ cancels and not finishing a full course of treatment metrics)

ITT Blog: Briefly, what would you say to a new DPT student just coming out of school to be able to promote themselves and position themselves as the pain and musculoskeletal expert?  Do you think, as a private practice owner, that this type of knowledge for an applicant provide more superiority in regards to hiring them as an employee?

John: We just hired a new grad Kellie, amazing, she is so upbeat and the clients love her. Her skill set is nowhere near our other therapists but she gets it. She knows how to zero in on a client and make it all about them. So, my suggestion to new grads is this. When it comes to the interview I would be telling the interviewer this (and of course some might have to practice this and it will eventually become part of you)

Very simple and powerful:

When working with clients:

When you greet someone, smile, make eye contact, use their name 3 times.

Tell them who you are.

Tell them what you do.

Tell them what you would like to do with them and always ask permission.

Keep it simple and don’t use big words. People who use big words are only impressing themselves.

Employer Side:

Be humble in that you don’t know everything.

Be open to listen and learn.

Bring positive energy to work.

Take your client on time

Charge appropriately

Say please and thank you

(DPT’s- be careful about wanting to be called doctor. I know you have worked really hard but it is confusing and misleading to the general consumer and to the rest of the medical community, unless you are working in an academic setting)

ITT Blog: In your book, you mention the limitations behind Direct Access in the United States for Physical Therapists and how the APTA is not going to provide us with 2nd and 3rd tier customers. Will this help us strive towards being recognized earlier in the healthcare process?  Can you elaborate on it?

John: If someone googles ie low back pain, … physical therapist, physical therapy doesn’t pop up. Try googling “pain”. You will be surprised what comes up. If the general consumer doesn’t know what you do they will never choose you directly? Majority of states allow direct access so the door is open for us. I don’t understand why the APTA isn’t doing something about PT having a consistent presence on the internet, across the country. BTW, everyone is brainwashed that you need to go see your doctor first in order to see a therapist. The APTA should be sending out other messages to the consumer to increase their awareness.

***Side note–Didn’t I write about this a few years ago…The Image of Physical Therapy***

ITT Blog: In Chapter 5, you discuss the patient’s “D.O.S.” (D=Dangers, O=Opportunities, S=Strengths).  You make a good point in that what you (as therapist) may be important is not important for the patient.  I have lots of patients who come in and their main goal is to get out of pain and not necessarily improve function, as they don’t have limitations besides just having pain; meaning, they work through the pain.  Therefore, a functional outcome score is not very applicable to them or to their success; however, this is being pushed more by insurance and the PT movement construct of “stop chasing pain and improve function”.  How do you think it is best for new graduates and seasoned therapists to bridge the gap between understanding what is critical for the success of the patient while minding overall goals of the profession by improving function?

John: Harrison,

The “PT movement” has it wrong.

95 % of people come to us because they have pain and they want it to stop quickly. Chiropractors are highly successful at doing that. If there was no pain, we would be out of business. People don’t come to our office saying “I’d like to improve my function”.

Really!!! It’s always about the client and meeting their expectations. If you were treating your mother or your brother, sister, friend… all you would be doing is helping them get out of pain and meeting their expectations and educating them how to prevent it from returning. You can always navigate the other demands of insurance, APTA, EMR. The industry will try to control how you practice. That won’t change. Part of the game everyone is navigating. Corporate will always try to compromise your values… but don’t let them. They are doing their job. We need to do ours and not compromise either.

Regarding function, most people that are in pain obviously want to eliminate it but if we are doing our job and digging deep, we will find a way to identify the cause of the pain and how we can help them with more functional activities to prevent the reoccurance. Digging deep into the functional component.

Understanding someone’s D.O.S. is so important. In my book (Chapter 5) I give examples of what someone’s true Dangers are before we can move to building on their Opportunities. Maybe someone does just want to get out of pain and cares of nothing else but you need to know that the very 1st visit so your overall game plan matches the client expectations. But what if someone really needs to get back to work because they are afraid of losing their job, than that game plan will clearly be different. I think most everything we do with clients should weigh towards the functional component with every visit (when possible). That is what we do really well and get paid the most for doing by insurance carriers. Therapeutic Activities!!!!

ITT Blog: A common theme of the book is to provide unexpected expertise that exceeds the client’s expectations.  You offer many options under “The Best Therapy Experience” Game Plan, but do not mention any specific therapeutic interventions, such as exercise or manual therapy.  From your experience, do you think that elevated clinical skills in manual therapy or pain-relieving exercise prescription is a key component that goes above and beyond what is offered through your program to add value to the physical therapist (versus a massage therapist, chiropractor, etc).

John: Honestly, I see 2 components to that questions:

First goes back to knowing what the clients expectations are. Understanding their D.O.S. Without that knowledge you will be truly unsuccessful in completing a full course of treatment. Clients will drop off and seek other forms of treatment.

Second, I think the best therapists are not always the most skilled. They just have a way about them. People feel good with them. They trust them. They like them and they request them when therapy is needed again. What do they have that others don’t. They naturally or through learning implement the 3 critical components of Building Lifelong Relationships

– Leadership, Relationship, and Creativity.

The consumer wants to feel like they are the only one in the room. Isn’t that how you want to feel when you go out to eat, or getting your car fixed, or at someone’s office. We all want to feel special and we are in the prime spot to do that. Therapist are in the unique situation of being one of the few healthcare professionals to spend 30-45 minutes each session and see clients multiple times a week over a period of time. What better opportunity to understand what someone values and provide The Best Therapy Experience. Add elevated clinical skills and you are often sought out by the consumer. We all know therapist like that.

ITT Blog:  I really like how you interviewed physicians to get their honest opinion on several components of physical therapy that they liked or did not like.  One that jumped to mind and I continue to struggle with through our current software system is the doctor report, or you refer to it as “The 30 Day Report”.  Can you elaborate on what physician want to read, how much to read and best ways for the therapist to get their point across about progression without going overboard?

John:  Harrison, Doctors are busy.

Let’s make their life easy. We write lengthy detailed descriptions of ROM, strength values, function, pain scale etc. They don’t want that.

They want 2-3 lines of handwritten or typed lines of very simple information. Is my patient happy with therapy?

Is my patient getting better? Period. Nothing more than that. As I said earlier though, be careful what you write as you don’t want the client to question someone’s level of skill and confidence in their provider. In those cases, which aren’t many, call, fax, call again until you get your concerns across to the doctor but never ever do that in front of the client. They appreciate that and it’s a great opportunity to build bonds with them. (My research is that we do a terrible job at that as many therapist are “want to be Doctors”)

ITT Blog: In your chapter on the Product, you mention PT is a commodity that consumers can be found everywhere (i.e. reducing pain, restoring motion/strength and improving function).  You mention that focusing on a process rather than on your product and service will begin to separate you from the pack.  Can you elaborate on why this is the reason a consumer will choose your office over someone else?

John: Everyone offers the same exercises, modalities, equipment. Therapist use many different treatment techniques to get someone better. That’s OK. So what makes the consumer experience different from one place to another?

A unique process will differentiate yourself in an appealing way that focuses on a process that creates value for the client.

The minute you answer the phone, the words you use, the first encounter and the therapist encounter are critical at the 1st visit to the very last visit and beyond. Companies are most vulnerable with the part time employee. They are least exposed to the company culture vs your FTE’s. They really need a process to follow. Following a consistent process throughout your entire organization, regardless of employee, therapist or location promotes a consistency that the consumer recognizes and trusts. They like that. Everyone likes that.

We give every client The Best Therapy Experience program packet specific to their body area we are treating. We systemize the collection of copays, surveys, next doctors appointment, understanding someone’s expectations, are you happy with your therapist, with your progress etc. Providing them The Therapist Snapshot as to whether we think their expectations are reachable provides clarity and confidence. And then giving them The Treatment Formula as to what we are going to do to get them better. There are other components to the program packet that requires the client to bring it in with them each visit.

Clients love it and say they have never received anything like this before. And they haven’t. It’s perceived value. Everyone likes clarity and confidence . Its very powerful.

ITT Blog: You reference 3 tiers in your book, 1st Tier (Your Market), 2nd Tier (“Maybe” Customers) and 3rd Tier (Non-Customers) under the realm of Blue Ocean Strategies.  What do you think the best way is for outpatient therapists to create a Blue Ocean and find the market for the 3rd Tier customers, who are considered the untapped demand waiting to find us?

John: Harrison, I am really impressed with your questions. You are a good reader. I bet you were an“A” student? (laughing) **Harrison—not at all ***. People come to see us because they are referred to us, have experienced therapy before or literally know someone who’s a therapist. That’s the 1st Tier and that is getting smaller because of all the healthcare options now available to the consumer. The 2nd and 3rd Tier customer has no idea what we do and since we don’t tell them, they will not search us out. People rely on the internet, family or friend referrals.

The difficult area is that depending where the consumer goes for their therapy, they will have a totally different experience of which some may not be so positive. Therefore they will drop out, no show, not finish a full course of treatment and shift to another service to take care of their problem. That is what they think physical therapy is. We have lost them.

We need to get to the 2nd Tier of people who don’t know us and or might need us in the future. We need to inform them that we are the only profession who are experts in combining hands on treatment techniques and exercise to relieve pain, restore motion and strength………. etc.

Guaranteeing them The Best Therapy Experience….. but that would require all of us to adapt a similar unique process, branding, consistency.

ITT Blog: Since your book has gone into print, what would be 1 thing you would add to it that could make a significant impact on a young clinician’s future?

John: Remember being in school and all we wanted to do was take a course that wasn’t medically related. We get tunnel vision in our structured programs so we don’t necessarily see the whole picture. My book adds a bit of clarity to what is going on in our profession. I would love to have everyone read it so that we can continue looking at making more aggressive changes to our profession.

ITT Blog: Any closing remarks?

John: Harrison, honestly, this was a lot of work answering your questions but I loved it. I liked being able to you go back and make changes to more succinctly share my thoughts. Thank you for giving me this opportunity.

What’s the point in having DPT’s. We are not getting paid more for the advanced degrees nor for our services. The PT degree requires more years and is more expensive. The schools are the only financial beneficiaries and there are way to many schools out there. We are clearly truly the best in treating musculoskeletal issues and we have to start telling the world that we are. If we can’t get together and brand ourselves the reality is that we will always be a bit frustrated in reaching our place in the system as the 1st Choice in treating pain and musculoskeletal issues. We are the only provider that spends 30-40 minutes, 2-3x wk with someone. We are the best positioned to be the 1st to see someone with musculoskeletal issues and become a referral to other specialties. Now that’s a good reason to be a DPT.

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Closing Remarks by Harrison: Thank you John for the opportunity to pick your brain and get some answers to someone who has had a very successful career and private practice.  As much as PTs can argue over most evidenced-based interventions with quoting all types of evidence, the type of information that is provided in this interview is KEY to being successful, no matter what your psychomotor and literature knowledge skills are.

I have been fortunate to have a great mentor myself, Dr. David Love, who instilled many of these values and approaches from the start of my career.  I have been able to add to this foundation over the years, but this foundation has stayed rooted no matter what is added to the branches.  To all new PTs & students out there, find a mentor to lean on (as stated previously in my 5 L’s).  Adding this book will definitely not hurt either.  I have passed it on to my colleagues.

If you want more information or talk to John himself, contact him through his LinkedIn Account and of course, can leave comments below.

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