May 1422 min read

Successfully Leading a Team as a Practice Owner with Michael Silva

Join me on our latest DPT to CEO interview, Michael Silva, PT. Michael is the owner and operator of RUNstrong, a coaching program designed specifically for runners and run coaches. Michael also specializes in business coaching and consulting for practice owners looking to grow. During this interview, we dive into Michael’s journey from staff clinician to multi-clinic practice owner, to now business coach and consultant. He shares the ups and downs of his career, what he’s learned along the way, and gives advice on what will help someone become a successful business owner in the healthcare world.

What we're covering:

*Would you like to tell us your story?

*What fears do you remember having when first starting your practice that were the biggest to overcome?

*Here's what I didn't like about our profession...

*I know you mentioned with your clinic, you always attracted really fun and motivated clients. How do you do that?

*How have you learned to say "no" in things that come up in your business?

*Here's a good segue into leadership stuff...

*What qualities, if you had to name two to three, will make you a successful business owner?

*As a solo business owner, how do you learn to take care of yourself instead of always prioritizing business?

Would you like to tell us your story?

Michael: I was like many of us who got into PT. I was a high school athlete who got hurt way too much, and I spent time in physical therapy. In order to the biggest event in my high school career is, I dislocated my kneecap about a month before my senior football season. Football was my life back then. I was definitely going to be a defensive back in the NFL according to my 18-year-old self, of course, right? I thought my life was over, went to PT, and literally, I was in PT like three to five days a week. They got me strong, got the swelling down, they did all the miracles that PTs can do, and I didn't miss a game that season. I missed a few practices and kind of weaned into it, but I had an amazing season. The team did. It was great. I was like, "Wow, that's kind of cool. I like to work out, I like to not wear a suit, I like to not be in a cubicle. This might seem like a good career." And I like people, I like to talk, so that's what got me into it. I wasn't 100% committed because I ended up going to school as a pharmacy major. Do not know why, still to this day, I'm confused on why I did that because I don't like chemistry.

But then I transferred over to the exercise physiology program at the University of Rhode Island with a track to go into like the pre-up type of program. Took a year off, worked in what I called the glass door between PT and fitness. I ran a post-rehab fitness program at a Wellness Center, did that, worked closely with the PTs, and that really reinforced, "Okay, this is where I'm going." Applied to PT school, thankfully got in, went to UMass for my masters in PT because this was before the DPT. It was a great program. Left there and I got a job for one of the biggest healthcare companies in the world at the time. It's no longer around. I was one of 250,000 employees, and I wasn't overly joyous about being a number in that big team, but it was fine for what it was, but it wasn't great.

So then I left that job after two years and went to a smaller private practice, and it just wasn't a population of patients that I was really enjoying. And at that point, I was really discouraged about my career choices. I'm like, "What am I doing?" You know, I was seeing... I think our cancellation rate at this clinic was like 30% or higher. It was really high, lots of unmotivated, really unhealthy individuals. Some of them wanted to be there, most of them did not want to be there. So I almost left the world of PT and got offered a job for a big medical device company, and I came this close to taking the job. And then I had a long conversation with my wife over a sleepless night and decided, "I'm going to do my own business."

Do you remember the movie Field of Dreams? Did you ever see that movie? So if... If you build it, they will come. Yeah, remember that P.H.? So kind of corny, but that's what I did, and I started my practice as a cash-based practice. And this is back in like 2001, 2002, and cash-based practices really weren't a thing back then. So I started as a cash-based practice going to people's homes, and I was still working part-time for the clinic that I had worked for, and I was slowly taking hours from there and building my business. And I did it in a really professional and ethical way. The owner of the business knew what I was doing. We had a great relationship. He was okay with it and kind of built it, and then realized that I'm on the road a lot, traveling 25-30 miles in between clients, and not being able to really be efficient.

So then I opened my first brick and mortar, and I had all my clients come to me, still cash-based, which was great. We were doing well, was supporting my family. I had my first child right at this point as well. My wife was home. My wife was also a PT. And then I realized I was turning a lot of people away that really didn't want or had the means to pay cash. And I had a friend who owned a PT and network type of practice. So I was sending him lots of people, and I helped him build his practice unknowingly. So then my wife, "Why don't we just go and network or do a hybrid?" Again, we didn't have this terminology back then, like we'll just do both, we'll see what happens. And we did, and then the floodgates opened, in a good way. And you know, I got extremely busy. And at that point too, I was still just all by myself.

So I was a solo... I was the janitor, I was the biller, I was the scheduler, I was the PT, I was the trainer, I was the dog walker, I was the babysitter, I was... I was everything. I started building a team at that point, but I had like someone answering phones and another trainer that was working underneath me. Then when we opened up to accept insurances, then it blew up, and I started recruiting PTs and built the practice up. So I went from in my car as a solo practitioner traveling on a cash-based basis to building. I was about to open my fourth office. I'm really blurring through all of the... the 20 years of the highlights, yeah.

So after 20 years, I was about to open my fourth practice. And so it would be four practices in two states, between Massachusetts and Rhode Island. And I just... there were some... some reasons, life and many reasons, some of them emotional, some of them professional, some of them mental, that I think it was a time for me to... to unload the practice, and it was a good time to sell at that point. So economically it worked out for me, which was nice financially, I should say. Non-economically.

So anyway, I did, I sold the practice, exited successfully, was with the company that bought me for a short time, and then really wanted to get out of patient care and think of other ways that I could, you know, continue to do good things in the therapy space. So I left that practice. I probably should mention I also have an online platform of educational and motivational content for runners that I did called RunStrong. So I kind of built that along while I was building our... or sports medicine practice as well. So I dedicated some time to that. And then I kind of fell into this coaching consulting role, which is what I'm doing now, and trying to help other PTs start or grow their practices. With that, I still do a little work in the running space, and I'm writing a book right now. And that is my life in a five and a half minute story.

What fears do you remember having when first starting your practice that were the biggest to overcome?

Michael: Well, there's definitely fear, there's no lack of that, right? And I see that now, even with some of the older new to owning their own practices. There's just the fear of the unknown. For me, I turned 30, had my first child, and totally went on my own to support my family with this business all in one month, the month of May of 2003. And that was... I remember telling my wife, "If I don't grow up now, it ain't never gonna happen. Like this has to... I've got to make this work." And I think so... I felt that pressure to support the family, and I had the fear of, will I be able to do this, you know? Because the one advantage of being an employee is you get a paycheck. It's a consistent paycheck. Yes, you'll get some bonus structure, maybe get a little more. You've got your job, you've got your benefits, and all of a sudden, all of that is on this guy.

And so the fear of not being able to provide for the family was there, and to be honest, that was there very briefly. And I think that fear is what keeps a lot of people from doing their own thing, not just in PT world, but entrepreneurs in general. I think the people who have that entrepreneurial mindset aren't afraid of a little fear, and they can kind of feed off of that. I think once you realize it's not that hard and it's not that scary, depending not for everyone, you get over that fear, there's always good things on the other side of that fear and anxiety that you're feeling. So that's... that's kind of what I remember, and I can actually feel it in this area of my chest and stomach just thinking about it. It's very... it's very guttural, for lack of a better way to describe it.

Morgan: Yeah, it's like it's a pretty intense feeling, I guess, to feel like your back is kind of up against the wall and it's put up or shut up, like you have to do something and make decisions. And I think that being decisive is really important to being successful as a business owner. Even if not every decision that you make is the right one, you just have to kind of choose something and go.

Learn more about conquering fear as a new practice owner in the blog post here.

Here's what I didn't like about our profession...

Michael: Just how regulated, yeah, just how regulated it is. And I think the best therapists I've ever met are more artists than scientists, you know? There's a lot of intuition in what we do, there's a lot of art to what we do. But there's no ICD-10 codes for some of the things we do and say. And I think it takes the creativity out of our profession. And I think, like the cash-based practice where you're not having to do things a certain way and check certain boxes and follow guidelines, I think amazing outcomes can happen when a good artistically minded therapist is allowed to get creative and do what they need to do for the patient, obviously in a safe, scientific way. But I just think it's too much, too much accountant-like, rigid thinking regulation that takes the fun out of it a little bit, yeah, you know? And what we do is fun and you can make it fun, but you need to have a different mindset.

You don't necessarily have to go cash-based to have it fun, you know? We had a hybrid practice and we attracted really fun, healthy, active clientele who really wanted to be there. So, it was high fives, fist bumps, and hugs with everyone. It was like, you know, good music playing in the background, we weren't in a stuffy office, there were no lab coats, and we had fun. So, we made it fun and I think we kind of overcame the negativity of that regulation and restriction and felt like the weighing down of the insurances. I'm not just going to sit here and bash insurances because they do pay a lot of us money for what we do, but yeah, I think that's fair, you're right. I don't want to be all anti-insurance because they provided a lot of revenue for my business over the years, and without them, who knows what my business would have been like. Just think, in general, we could be a little more allowed a little more creativity space as therapists.

Morgan: I know that for me has always been like the most fun part of working with clients. Like, I see a lot of athletes in the gym, and it's just like thinking creatively about what can we do in our session so that all of our treatments and exercises and everything are very sports-specific and specific to what the athlete wants to do, you know? Rather than making my treatment whatever somebody else was telling me needs to be in my treatment and everything, which is a whole other fun aspect. But yeah, I mean, like, and that's what makes all the sessions fun, is doing things with patients and like treating the way that you want to treat.

I know you mentioned with your clinic, you always attracted really fun and motivated clients. How do you do that?

Michael: I happened to stumble upon the running world early on when I started my practice. I had started doing triathlons at that time. My wife was a really intense triathlete; she was a collegiate track runner as well. And we just, in our community running triathlons, we just started getting into that. And then I worked with a collegiate runner who worked at a local running store and did a good job with them. He's like, "Hey, I got someone I want to refer to you." Just happened to be a future Olympian for Ireland. So I worked with this person, it went really well. "Hey, I got something I want to refer to you now." He referred me a two-time Olympian from Ireland. It just happened to be in this area. So it just built this momentum in the running world, and thankfully, I was successful.

I loved lower extremity biomechanics. I loved the foot and ankle and the hip. Like, that was probably led me to being successful in that world. But at point moving forward was aimed around that avatar of the runner, not necessarily the Olympic-bound runners, which fortunately I was able to treat about 15 Olympic runners over my career, which was amazing and some of the fastest people on earth. But that was like 3-2% of my business, you know? So everything I did was aimed at just grabbing the age group or the marathoner who's raising money for the Leukemia Lymphoma Society or people barely trying to get to their Boston qualifiers and everything in between from high school to... I had an 88-year-old runner who was still doing half marathons. It was awesome. And I did that by collaborating with running stores and offering free workshops at running stores, hosting events at our clinic. So everything I do between the equipment I brought in, the collaborations that I had, the community events that we did, was revolved around and it started in the running world. So that was our niche. Literally, our practice was a practice that the runner built.

And I know some people get nervous about niching down, and we didn't just see runners, but because we were so runner-focused and runners are tend to be, you know, pretty motivated, pretty type A, pretty stubborn, but in a good way, like they just want to run and get better. Yeah. So with that and they're talking to their friends, and we got plenty of non-runners, but it just... Because of that foundation that we built with that niche, I believe we started attracting... We did a lot of work with CrossFitters. I know that's your world. You, when the CrossFit gyms started opening in Rhode Island, we were getting there. And we would go to some of the CrossFit events and, you know, do injury screens on people. But we just started getting into the active world. So one of the taglines we had on some of our t-shirts that changed over the years was keeping active people active, keeping healthy people healthy, because that's what we were doing, you know? Then we kind of built in the triathlon world, the running world, and it was just like... We never sent fruit baskets to doctors' offices or went to the doctor to just refer to a doctor to refer us all their patients.

What ended up happening is through the events and the networks that we were creating on the patient level, on the ground level, they would go back to their doctors and they... We would refer them to an orthopedic. They would find out about us and what we were doing through the patient, and it was great. So then we had... And one thing I believe in, any of you out there listening who are going to develop relationships with doctors, you don't want to put all your eggs in one basket because if one of... If I was really reliant on one orthopod to send us all of his patients or even just all of his runners, if he picks up and leaves and goes to another state, then a big part of my business is gone. So we... We had... I used to say we don't get a thousand patients from one doctor, we get one patient from a thousand doctors, which worked for us because it was really diverse. Like when you invest your money, you want to have diversity, right? So yeah. So it was really diverse for us, but it was all built around... It started with the runner. And there's these active, really health-forward, fitness-minded patients. And that's what we built.

And I tell you, I don't know if I would have survived in healthcare if I didn't have literally the best patients in the world. And I had staff members come and say the same thing when they started working for us. And some people came to ask for jobs because they knew about the patient clientele we were seeing. They didn't want to see people that had lawyers and workers' comp claims and, you know, what fills a lot of people's schedules. Can I answer your question in there? Because I went off on a little bit of a tangent. Alright. So, on that note, one thing I think when you niche down, again, don't be afraid to niche down because there's these like... Like runner-adjacent people on the outside of that niche that came in and it helped just our overall practice, our overall energy.

But also, when you're dealing with really healthy, active, motivated clients, I would bet a lot of money that we had probably the lowest cancellation rate out of... At least out of any other clinic that I know personally. If we were above 4%, that was a bad month for us. So it was very, very low. And I can't say it's all because of me as the business owner or specifically my therapists because they're all amazing therapists. I think there's a little bit of all that because we had amazing patients. So which... And a lot when I'm talking to practice owners, I really try to focus on like who do you want to work with? You gotta pour 130% of your passion and your energy into attracting those people. And then you're going to have a practice filled with the people you want to work with. You're going to have job satisfaction, your team's going to have job satisfaction, the patients are going to get better, they're going to feel that energy. It's just a win-win-win for everyone if you do that.

Morgan: Yeah, absolutely. Like, I think there's so much to go into with all of that. Niching down can be a scary thing because, you know, we're all trained to be able to help anybody. And, like, in our heart of hearts, we want to be able to help everybody, you know? Because we all care. Especially as a solo practice owner, you can't help everybody because you're only one person, you know? So it definitely is a benefit to niche down in that way. But when you pick a niche and you pick a target market and go all into it, especially if it's something that you yourself are genuinely interested in, just all of that passion and energy really comes across. It delivers a really good patient experience to everybody that you're working with.

And then, you know, all the adjacent folks that you mention, they're going to come to see you anyways, even if they aren't in your niche because they like the vibe and they've heard good things, exactly. You know, and like, by keeping your own energy really high and positive, you can work with whoever you want. And what I always tell people is like when it comes to picking a niche, your niche is just for your marketing. It's not your caseload. You can work with whoever you want now, as long as the vibes are good because you can also say no. You don't have to work with everybody, which is another important thing too, right?

Learn more about niching down and picking the right target audience for you in the blog post here.

How have you learned to say "no" in things that come up in your business?

Michael: Just, I mean, on a real basic level, like people come in to sell different pieces of equipment or certain tools that we didn't need for our practice, we would say no to those things. But I don't think that's where you're getting at, saying no to... You know, I've interviewed a lot of people over the years, and I've interviewed some really good therapists that I did not offer jobs to. It wasn't because they were not amazing people or amazing therapists, it's because their passion and their skill set did not align with ours. And it was always a good conversation, but still saying no to those people is never a fun thing to do. But when I explained it and explained why I think it would be best that they looked at another practice that maybe, you know, if someone came in and they wanted... They had a specialty in pediatrics or hands, you know, we didn't do hands, we wouldn't really do pediatrics, per definition. We had younger kids, but we didn't do pediatric PT. And if that was their passion and that was their niche, although I was honored that they came and wanted a job with us, I would say no.

Morgan: I think that makes sense, you know, like figuring out whether somebody or like a certain opportunity is going to truly be a good fit, you know, and making a decision based on that. And like what's going to be best for you and your business but also best for them long-term, you know? Like, you wouldn't want to, I guess, mis-serve them or underserve them by inviting them into the practice, but it's not really a fit.

Michael: 100%. And, nothing in the long run, nothing positive would come out of that. There would be some sort of negative energy surrounded by that decision, even though it was two yeses with me and the therapist. Um, yeah, you've got to... You've got to know, which kind of goes into team building, like you've got to know who you want on your team. And building a good team is hard, and I made the mistake many times of hiring someone for their resume and then realizing that their personality, their energy, their values didn't fit. But they had an amazing resume. Then I learned, like, you can teach skills, you can't teach personality and values. So, there's more to hiring than, you know, where you went to school and where did you do your internships and where did you work, you know? Especially in a field like ours where it's so personal, it's so high-touch. Saying no to the perfect resumes was hard sometimes, but you had to do it. It's another... It's another no you have to learn how to say when you run a business.

Here's a good segue into leadership stuff...

Michael: So as soon as I started the business and realized it wasn't all about me, you know, I'll be totally transparent. When I was starting the business and I started working with these Olympic runners, and you know, business was going well, I was making money, I was becoming the man in the area to see, yeah, I felt good. This is my business. Then I realized I can't see every patient, I can't do everything. I'm getting really tired. I need to build a team. And then I totally had a mindset shift and more about the practice and the mission of the practice. And it's not about Michael. And over the years, I slowly started to step back and bring on more leadership roles. Obviously, when I opened another office, I would have a manager. So when I sold, we had a practice manager at every office. And through weekly meetings with them, helping mentor them to become good leaders and kind of imparting the stuff that I've learned, self-educated through... I can't tell you if I... I can show you my bookshelf, it's one self-help leadership book after the next and entrepreneurship. We probably share a similar library.

But also, I took part in the Goldman Sachs 10,000 Small Business program. I don't know if you know about that or did it have it where you are, West? Uh, I'm not sure. I know about it from the last time we talked, though. Yeah, something to look into. It was an amazing experience. It was for anyone listening, Goldman Sachs took on this mission to train 10,000 small business owners in our country. You apply for it. It's basically a scholarship because you get people who have MBAs are not going to like me saying this, but it's almost like a mini MBA. It's all about business. It's all about growing you as a leader, growing you in your business, learning your metrics, learning communication skills, learning negotiation skills. One of the top experiences I had, besides hiring my own consultant when I first started the business as well. So I had a business coach and consultant who helped me get out of the 'It's not about Mike' mindset, yeah, it's about your team. And then going through that experience and then all the self-education I did, in the books I've read, and how to become a better leader and build a team and build confidence in people. It took a long time to do that. If you don't, then I don't think you're going to have a very successful practice.

You might be so success depends on how you define success. Like, I could... I know there were months in my business where our metrics were great, the numbers were high, our cancellation rate was low, but employees who weren't happy. So was that successful? Not in my book, you know? Success to me is when the passion of our staff, myself, our staff is rising, our metrics are rising, everything's going up. But if our metrics are rising and our stress levels from the staff and their passion and their enjoyment is going down, and those two lines are going in opposite directions, that's not success for me. Even if it's switched, if, yeah, I got a great, happy team, here's my metrics going back down. This, that. So they kind of have to flow together to be successful. So going back to that, like, being a really good leader, being able to mentor your staff, give people some leadership roles if they want them, and also tie into what they're passionate about is a big part about, you know, building the team. You know, we were built on the runner, like I said. I had an amazing therapist who ran one of my offices who was a D1 tennis player, and she's like, 'What if we started some overhead athlete programs? What if we do it? Let's do it,' you know? Yeah, and she wanted to do that. We had two former gymnasts, and they're like, 'What if we reach out to gymnast schools? Like, can we host an event? Let's do it,' right?

So allowing them to take on a little project they're passionate about, they're kind of in control of it. They would come and tell me what it is. Again, it's not about Mike. So I was able to step back and let them do their thing, and it was great. Yeah. And I really hope that they enjoyed those opportunities as team members, and I'm sure they did, but it's doing things like that to keep your staff motivated and on board. And know if they're not motivated and on board, then the whole mission of the company is not going to go in the right direction.

Morgan: I think that makes a lot of sense, and I think you bring up a really good point about determining what success means to you. I feel like I see, you know, tons of advertising about growing your practice and being successful, and just in general, it's so interesting because I think a lot of times it's implied that success is about revenue, like it's about how much money you make, and for some people, that does mean success, but it doesn't have to be, you know? So, like, it might be more important to you, like I've worked with some people where they're just like, 'I just want to make some money, I don't really care how much, you know? Like, $1,000 a month would be great, I just want my time back and that's it,' and like, to have, like, the flexibility and everything like that is my primary priority. For, you know, like you had mentioned, like, with your clinics, like, yes, of course, we want all of our money metrics and numbers and stuff to look good, but you also want your staff happiness levels or like satisfaction levels to be good as well, and right, it's only success if both of those are going up. And I think that's something important to consider when you're getting into your own thing and like to keep reevaluating as you go.

If you'd like to learn more about developing a leadership mindset, check out the blog post here.

What qualities, if you had to name two to three, will make you a successful business owner?

Michael: I was going to say something about the word fear. It's not about being fearless; it's about not being controlled by fear and knowing that fear usually comes from the unknown and being able to move forward with that. And that's in every aspect of the business: from 'Should I hire this person?' to 'Should I fire this person?' to 'Should I open another clinic?' to 'Should I do this program?' to 'Should I even open the office?' So being okay with fear and knowing that a good thing is coming on the other side is a huge quality.

And then communication—I've learned that too late in life, I think. When I was younger, I wish I had more communication skills. I wish they taught it to us. My wife is also a health coach, and she's done a lot of extensive training in communication. It has taught me a lot—between active listening and appreciative inquiry and all these different things. Communication is the foundation of all human interactions, and within communication, it's being a better listener than talker.

As a solo business owner, how do you learn to take care of yourself instead of always prioritizing business?

Michael: Well, for me, I am married to a physical therapist and health coach. Your business will only be as good as you are healthy. You absolutely have to, and I'm kind of being a hypocrite because early on in my career, I used to wear two hours of sleep as a badge of honor because I was up late doing things and up early getting my workouts. You just need to prioritize yourself. I don't know if that answers the how, but I sacrificed my body and my health many times over the years for my business. Would I do it again? I think I would have taken better care of myself when I was a young PT, especially being such a manual-focused PT because my hands are really beat to snot. Is that an official medical term? No, it isn't. I've got a lot of instabilities in my hands because I mobilized way too many talus bones and way too many hips and released way too many psoas muscles with my fist and fingertips.

You need to take care of yourself. You just have to make it a priority, put it in your schedule. The return on investment in yourself will be much better than squeezing in an extra patient and missing your own workout or staying up too late trying to create another social media ad. Like, get your rest, save your body. You only get one.

Morgan: I think that's just something to remember, to keep in mind. And like, there are going to be points where maybe you do kind of prioritize the business a little bit more, but in general, making sure to prioritize yourself and your own health is obviously super important because without you, there is no business.

Michael: And we in this profession should know better, right? We're preaching this to our clients, and if we're not doing it, we are hypocrites. Yeah, well, so practice what we preach.