Radio Front Desk
Radio Front Desk is a podcast that talks to real people in real clinics about what it takes to build a health and wellness business.
Host Denzil Ford, Editor-in-Chief of Front Desk magazine, digs into the inspiring stories of folks building their practices from the ground up — including what works, what hasn’t, and everything in between.
Created by the team at Jane App, this podcast is your source for discovering fresh ideas and proven strategies for clinic life. Join us on this journey of building a practice you love.
Radio Front Desk
How a former NFL athlete built a successful healthcare business | David Bruton of Between The Lines
David Bruton Jr is no stranger to adversity. After eight seasons in the NFL and a long list of football-related injuries, he’s using the skills he learned playing professional sports to forge a new kind of physical therapy practice: one with the good vibes of an NFL locker room.
The physical space is just one way David is doing things differently. In this episode, he tells Denzil about some unexpected choices he’s made, the failures he’s faced, and how his experimentation resulted in something incredible.
To check out more stories like David's, head to frontdesk.jane.app.
As a former NFL veteran, David spent eight years on the gridiron, with seven of those years dedicated to the Denver Broncos, culminating in a thrilling Super Bowl 50 Championship victory. His journey began at the University of Notre Dame, where he honed his skills both on the field and in the classroom, laying the foundation for his future endeavours.
After David’s NFL career, he pursued higher education with the same determination, earning a Doctorate in Physical Therapy from the University of Colorado in 2021. But his commitment to making a difference didn't end there. He founded Bruton's Books in 2015, a literacy foundation aimed at supporting young readers in the Denver Public Schools system, channelling his passion for education into meaningful community impact.
Off the field, David finds joy in cycling, relishing the freedom of the open road. And when he’s not on two wheels, you can often find him lost in the pages of a good book, fuelling his curiosity and expanding his horizons. But above all, his greatest joy comes from spending time with his family, cherishing every moment they share together.
- Between the Lines Physical Therapy
- Bruton’s Books
- David Bruton Jr on Instagram
- David Bruton Jr on X (formerly Twitter)
This podcast is for informational purposes only and should not be considered as professional medical, legal, or financial advice. The views and opinions expressed in this podcast are those of the guests and do not necessarily reflect the official policy or position of Jane or Front Desk magazine. Listener discretion is advised. This episode contains mature content and language that may not be suitable for all audiences.
And I have my special teams coach, comes and sits next to me and he's like hey, brute, I want you to know we're probably going to go with the other safety, we're going to cut you. And he's like, unless you do something special, you aren't going to be on the team. So, with that being said, something about that about that kind of motivated me and pushed me with my back against the wall and I would go out there and block two punts and it kind of catapulted me to stay on the team as well as be seen as a special teams ace throughout the NFL.
Speaker 2:All right, david Bruton. This guy is no stranger to adversity. After eight seasons in the NFL and a long list of football related injuries, he's using the skills he learned playing professional sports to forge a new kind of physical therapy practice, one with good vibes of his experience as an athlete. For David, the worst part of his injury was being sidelined from his teammates. That's why his clinic Between the Lines brings patients back into a space that feels just like the sport, full of energy and camaraderie. Stepping inside, you'll hear conversation flowing and the music pumping. The physical space is just one way David is doing things differently. He's tried a lot of things, faced some failures, but the result of his experimentation is a flourishing practice in the suburbs of Denver. We chat about all of this in today's episode and I'm excited for you to hear it.
Speaker 2:Welcome to Radio Front Desk, a show that surfaces what real people in real clinics are doing to open, run and grow successful health and wellness businesses. I'm your host, denzel Ford, editor-in-chief of Front Desk Magazine by JNAP. Here we have powerful conversations with health and wellness professionals on the business side of clinic life. We hear their stories and discover what works and how to do it, and we also talk about what doesn't work. If you want to check out more stories like this, head to frontdeskjaneapp. Well, let's start off by I just like to hear your story and like get to know you a little bit. So I wonder if you'd tell me a little bit about yourself, your early life, your early career and how you came here to have this conversation with me today.
Speaker 1:Kind of started playing football when I was in seventh grade. Football was never truly my first passion. I loved the track so I always dreamt of running the Olympics. Obviously that never came to fruition. But with that being said, I was first exposed to physical therapy during my seventh grade football season. So I you know that was my first taste of it and pretty much fell in love with the profession ever since.
Speaker 1:So, where I had multiple PTs that I still have relationships with even today, I'm throwing my time in middle school, high school, college and, professionally, freshman year. I'm on the team and I don't play a single snap. I'm on the bench, I don't play a single snap. So I get talked into playing football my sophomore year, like I don't want to play. I'm so dejected, I don't have any desire to go out there and play and not, you know, see any time on the field.
Speaker 1:I'm dealing with that adversity as a young man. And then, come sophomore year, I play A freshman, dealing with that adversity as a young man. And then, come sophomore year, I play A freshman's brought up ahead of me to play. And in junior year everything starts clicking and it's something about the years. The third year that's something special for me, like something about the third year throughout my career playing football. That's just, I don't know. I'm able to triumph and overcome any adversity. So fast forward. I go to the University of Notre Dame, I have my oldest kid during my freshman season at Notre Dame, so I'm a pre-med major with a full-time football job, and then my oldest son is born. So let's talk, talk about. There's a lot thrown at me, right?
Speaker 2:so yeah, that's a lot.
Speaker 1:So I'm over here saying, yeah, seeing counselors talking to teammates, talking to coaches. What's the best decision? I'm not entirely sure what's the best decision. Do I drop out, go back to ohio or do I stay at school? And ultimately, obviously I stayed in school and it worked out for the best, honestly. But again, I wasn't. I didn't have football professionally in my mind, I was just there to play. I was fortunate enough to get a scholarship, because if I didn't, would I have gone to Notre Dame? No, no, I don't even know if I would have gone to college. We weren't financially stable in that sense when I was growing up.
Speaker 1:So fast forward to that third year, third year, it's just like things start clicking and now I'm getting NFL attraction. This is a possibility for me, which was never even possibly a dream. It's now more so a reality for me that I could play at the next level. So we have our junior year, senior year. I graduated from Notre Dame with two degrees political science and sociology and a minor in Africana studies and I'm drafted by the Denver Broncos in the fourth round in 2009.
Speaker 1:Very fortunate, very blessed. Love this organization. It was very, very much so a blessing and um, that never was really a true dream of mine and never was on the on the radar for me. Um, and then let's fast forward to that third year as far as far as adversity. Um, so we have pre-game meals, right, so you're eating your food. Um, before the game, I'm watching phineas and Ferb and eating my food Again. I had my son at the time. He's six, seven at the time. That's what we did. We watched cartoons all the time. My special teams coach comes and sits next to me and he's like hey, Bru, I want you to know, we're probably going to go with the other safety. We're going to cut you, he's like, unless you do something special you aren't going to be on the team and this is what four hours before the game wow, third preseason game of yeah
Speaker 1:talking about, yeah, talking about some adversity and like, okay, well, how the heck am I supposed to shake that off? Pretty much got told that I'm going to get fired before I have to go out there and play um. So, with that being said, something about that about that kind of motivated me and pushed me with my back against the wall and I'll go out there and block two punts. And it kind of catapulted me to stay on the team as well as um be seen as a special teams ace throughout the NFL One that guys have the game plan against, coaches have the game plan against and kind of helped me have an eight-year career and throughout all that time I saw countless PTs and kind of reinvented or reestablished my love for the profession of reinvented or re-established my love for the profession. Um, they are what kept or athletic trainers, pts and some doctors are what kept me on the field.
Speaker 1:You know I have a binder about this big of like all my injuries from college and the pros um that I had to overcome, had to deal with and uh, and it was through. My experience on the table is what kind of drove me to after I retired. Let's go back into school, let's do our prereqs, that we didn't finish at Notre Dame let's do our, then let's do the two and a half years of the doctoral program. So kind of that's how, in a roundabout way. That's kind of how I got here outside the traditional student way.
Speaker 2:Yeah, I love it. What I love about your story is how you say that like it wasn't like a hard intention that you were pushing for. For instance, since adolescence, my kids play hockey and there's definitely an environment of like these kids at seven, eight years old are like trying to push them, or their parents are trying to push them so hard that they have a chance at the NHL, right, and so I love your story because it's just like the road's almost rolling out behind you or something like that.
Speaker 1:And.
Speaker 2:I find that inspirational because there's so much of life where you're going to hit a fork and you got to choose a different path, and so I think there's so much of that in your story absolutely, and I mean I think that fork comes at any point in time.
Speaker 1:Right, like you could be done playing sports at high school, you can be done college you can be done one year in the league, three years, eight years, 15 years, like at some point in time, sports comes to an end yeah, totally that's if that's your, if that's your, your reason. At some point in time you have to choose. Either the game's going to force you or you're going to choose to get out of there.
Speaker 2:Yeah, yeah, yeah. I have a little anecdote to tell you that I just realized yesterday. So we've been prepping for this interview for a while, but I was telling somebody that I'm interviewing you and it just hit me in the middle of the conversation. I was like wait, the Denver Broncos are the team that my family was like obsessed with when I was a kid. They were just like so into football, and it was the Broncos. And I was like, wait, what? Yeah, that's just so funny. It was a long time ago, though, but still like, I thought, wow, I can't believe I didn't realize that until yesterday.
Speaker 2:So I like to get into see if we can talk a little bit about the mentality that you're, that you have brought to this next phase of your life of like. You've mentioned a few things, like one performing in the in the face of great adversity, and also just like the I'm imagining cause I don't really know, I've never been a professional athlete, but I met. I imagine the mental part of that is really intense, and I'm I'm less asking you to talk about it as an athlete, but just like what? What is that mental space where you're really performing at as hard as you can, and how does that apply to your life today, if it does at all?
Speaker 1:um, yeah, I think. I think mentally. Um, it's what's your self-motivation? Um, because you're constantly under the pressure of being tired. You're never 100 healthy when you're playing, like never. And and some they're always looking to replace you, like the nfl stands for, not for long yeah, right so.
Speaker 1:And every year there's 200 plus players who are drafted to come in and essentially take your job. So there's all this pressure. So how do you manage that? How do you manage that stress? How do you separate work from home and home from work Like you can't bring home into work and that's going to affect your play and vice versa, it's going to affect how you, you know, interact with your family or heck, just how you interact in society in general.
Speaker 1:So that mentality just comes from, I think, a lot of growth as far as experience wise, along with having you know great mentors. We talk about mentors in the physical therapy space or the medical space, but you also have mentors in the athletic space as well, and I was very fortunate enough to have these vets when I was drafted, and two of them, two of which are hall of famers and Brian Dawkins and champ champ Bailey, who taught me how to be a pro, taught me how to manage this, taught me how to study film, taught me essentially how to become more, more irreplaceable. Taught me essentially how to become more irreplaceable because I'm able to do multiple jobs, so I brought more value versus just I'm essentially just stealing money from the organization, so to speak. And then also to that point where I mentioned like you're never healthy. So, taking that mentality to the physical therapy practice, do I have a freshman sophomore in high school or junior senior in high school and that's going to change my treatment path? It's going to change like, okay, freshman sophomore, I have a lot more time. I have more time to get them healthy, versus a junior senior who's trying to get a scholarship and to play college ball or swim or what.
Speaker 1:What have you so understanding? Like? Sometimes the protocol or the clinical practice guideline has to be thrown out the window, and that's what I experienced as a professional athlete, as a collegiate athlete, to be able to still play. Is 80 still good enough? Is 70 still good enough? Is 70% still good enough? Right, as long as there's nothing being detrimental to the body, to the injury, anything's not getting worse, then let's get you back onto the field, because I know this is your livelihood.
Speaker 2:Yeah, yeah, I love that. So let's get into the environment in which you're doing that now, in your clinic. Between the lines, if you could just intro to me, introduce me to your clinic, what it's about and like what's kind of the vibe when you step into there.
Speaker 1:Oh, so the vibe is like to work. You know, honestly, that's the culture we try to set forth, like if you, if you are, you like to work, you like to get better of set forth, like if you, if you are, you like to work, you like to get better. Yeah, you know, you like to have fun. That's that's kind of the culture that we have here. I make it so. It's kind of mimics a NFL locker room which what I've had, like the music's playing, it's not just you know, taylor Swift radio, good lord, I mean she's great, but I am not a Taylor Swift fan, so I'm playing like I'm playing 90s and 2000s hip hop.
Speaker 2:Oh, right on.
Speaker 1:Yeah, you know you're playing, playing Lil Jon Radio or Lil Wayne, like the vibe is is a little different than the typical office space. So we have an office space where we can treat concussions and things that nature, but we have a gym. That is where we do most of our treatment. Um, or there there's racks and weights and BFR and four stacks and med balls, literally trying to tap into that mental space. Cause, when you're hurt and this is what's for me, it's like when I was put on IR you're essentially separated from the team. You're not in meetings.
Speaker 1:Your treatment times are different. You are removed from the team to a certain extent. Yes, you still are a roster spot or whatever, but IR is like well, it's the next man up.
Speaker 2:in that sense, and what does that stand for? Ir? What is that acronym?
Speaker 1:Injured Reserve.
Speaker 2:Oh, okay, yeah, sorry Thanks.
Speaker 1:No, no problem. So tapping into that space, like because a lot of people they go once they get hurt high schoolers or whatnot they're in a training room where you're not seeing the gym, or you're going to a PT space that doesn't necessarily have weights and racks and things. So if you're in an environment that embraces, you know, strength training and power training, things that you are used to, like, we're positively tapping into that mental space like okay, even though you're hurt, you're still an athlete, we're still going to get you there. We're still going to tap into that. That uh uh, that psychological aspect of rehab.
Speaker 2:Oh, I love that. My follow-up question to that is where did you, where did you get the confidence that that would work Like in a, in a in a business perspective, because I think that you have a very personal understanding of why that environment would feel good. But where did you get the confidence that that would work for a clinic? To set up your clinic like that, to play that kind of music and to really set that environment?
Speaker 1:I think I had a multitude of different influences, right? So like what does my 18-year-old son like to listen to, like?
Speaker 2:what did he?
Speaker 1:listen to during his time in high school, kind of, what are the kids listening to now?
Speaker 1:And then, you know, I had my, one of my clinical experiences. It was a baseball focused clinic and they worked out of a gym sometimes too. So just seeing that it could work in an actual gym setting, even though they weren't there all the time, the three or four hours that they were there they were seeing people on the high schoolers on the table and they were enjoying it and buying. So just the different exposures to it, um, and then you know, ultimately I think it's just what would I have liked to be treated in you know.
Speaker 1:You know, if I didn't play football, what would I like to be treated in? But I want to be in a room, you know where. You know you're hearing elevator music or today's hip-hop and R&B or something that more so pertains to me, pertains to my energy or what I used to experience in the locker room. So, yeah, there comes a fear every now and then. Some people are like can you change the music? I'm not comfortable hearing the N-word in certain songs, yada, yada. So yeah, I'll appease them and I'll change the music Again. Am I going to go Taylor Swift radio? No, we'll go clean hip hop and R&B. We will make a shift. I love it.
Speaker 1:We just try to have a good time and have energy, and I'm always dancing, even while I'm treating, and singing and rapping, whatever the case may be, and that's just the culture that I love to work in and I embrace.
Speaker 2:Yeah, I love that. I'm just thinking of my own PT environment. It's a little more clinical than that and I'm like, oh, this would be so fun, because some of the treatments don't necessarily feel perfectly comfortable, right?
Speaker 1:And so I'm like if someone was like dancing.
Speaker 2:I'd take my mind off of it a little bit.
Speaker 1:Yeah.
Speaker 2:Yeah, would you talk to me about your brand and how you came up with the name? Between the Lines, I have something in my head that I think it might refer to. But and just talk about how you created that. How did you create the brand overall, the name, the logo, the choices that you've made in design in your clinic and setup and all of that?
Speaker 1:Yeah, final clinical rotation. While prepping for boards and, you know, putting the finishing touches on the program, I just started throwing out a list of names, that kind of you know how I would want to name the clinic. So I've always wanted to own a clinic Since I got into PT school. This is something that I thought I could do, that I think I was going to do it right out the gate. No, I thought I was going to go let's get some clinical experience route, let's have a mentor at another clinic.
Speaker 1:I thought I was going to possibly jump on my last clinical instructor, but ultimately kind of settled on the name between the lines because it's just an adage that's always used, that I've always heard throughout my time playing. You know there's always between the whistle, make sure the plays are done between the whistle, nothing after the whistle. The game is played between the lines, right? And you think about every sport. What sport doesn't require you require lines, right. There's a start line, finish line in trail running and cycling. There's lines on track, there's lines at the bottom of the pool, there's lines in football, like, every sport has some type of line somewhere. So what we're trying to do is make you better between those lines, you know, and the work you do outside of those lines is going to translate to between those lines and how your performance is, into that sport mentality where it's not just isolated to rehabilitation. We're rehabbing to sports performance. So we're always trying to push you to jump higher, run faster, feel more powerful, feel more confident by the time you leave rehab. I don't want you to just ACL surgery. Okay, you can walk and now you can do all your strength training yourself. Well, why the heck did you do teri ACL in the first place? What were these factors? Okay, let's strengthen the core, let's strengthen your glutes, let's bring in the cognitive aspect, let's have you walk and run through a play mentally while you're still doing these exercises, just tapping into those different aspects. I feel that's kind of hard to do it without the gym. So, like I said my last clinical instructor, they worked out of a gym, sometimes as well. So I said, okay, I want to have a gym, I want to have a gym lines as far as. Does it have a gym? Does it have an office space? Is it big enough to kind of facilitate what we want to do in the clinic? And we landed on this space in Centennial.
Speaker 1:And you know, you go through your whole business acumen. What's the SWOT analysis? So what's my strengths, my weaknesses, my opponents, my threats? You know what's the demographic like. Are we in an affluent area? What are my goals once this clinic's thriving day in and day out, on repeat? Okay, well, in order to provide no charge service once or twice a month in an underprivileged area in Denver, we have to be in an affluent area. Okay, how many high schools are around me? I think there's 10 high schools within 20 minutes of where my clinic is. So just there's a. There was a lot of a lot of moving pieces as far as why we landed in this place, why the name and kind of why. Why that set up with the gym?
Speaker 2:here because there's so much of like knowing your audience in these choices that you're making, in the thought process behind the decisions that you're making. So I think that, um, I think that will help a lot of people to hear how you achieved all of this. Um, my next question is do you do any marketing and how do you? How do you manage kind of tapping into those 10 high schools and getting people in the door?
Speaker 1:So we I have done radio marketing one time and that was a crash and burn. You know it was 15, 20 grand. That did absolutely nothing. Not one referral from it.
Speaker 1:So there's been a bigger push to be a little more present on social media. I hate social media. It's tough, it's the bane of my existence. To stay on top of it, to change my algorithm, I'm gonna have to hire somebody. But but most of our, most of our marketing is coming from word of mouth.
Speaker 1:Like we will go and do talks at like a track team I even had, I had my cousin who's Tyson Gay, who's the fastest American in the 100. Speak to the track team, you know to tap into the athletic components, like, okay, this is what it's like to get to the next level he's talking about. He did PT, he was always practicing, even outside of practice. He did strength training and then doing movement assessments at these high school football teams. Trying to tap into that football aspect and football is very tough because you're trying to break that old adage throw some dirt on it. Uh, you know, you know, pain is weakness. Uh, leaving the body, yada, yada, yada. Right, there's all these old sayings with football and I feel like football, is the one sport that doesn't do a lot of preventative care um outside of, like your strength training. There's no, there's not a lot of mobility, extra mobility work. There's not a lot of okay, I'm gonna do this before the season starts.
Speaker 1:I'm only going to do it when I when I get hurt versus like baseball. I think baseball is probably the most preventative sport that I've seen, especially pitchers, right, they're always doing arm care, they're always doing hip mobility stuff.
Speaker 1:They're always working on rotation, excuse me. So that's so trying to break into that, break that old, those old sayings, those old adages, those that old school mentality. Um has been been tough, but our biggest bang for buck is just word of mouth. Our work speaks for itself. You know, we I've been pushing google reviews. People are loving like avoiding surgery and getting stronger, or yeah or pr or they're somebody's got.
Speaker 1:Some of these individuals are getting scholarships and I'm like and I'm not taking anything from because they're the ones doing the work from the field um, but to get them back onto the field to perform, to keep that scholarship things of nature, is something that we're very proud of here yeah, that's awesome.
Speaker 2:Uh, what, what is your? You're kind of talking about it right now, but I wonder if there's any anything more in there, and how you approach patients and how you, um, how you think of that is like your approach, and then not just yours as a practitioner, but everyone in your clinic. How is there like a unified approach that you're going for with how you interact with patients in your clinic?
Speaker 1:No, I think kind of what I set forth is like treat your own way, you know. Right, we'll have huddles, you know. But how I treat might not necessarily be how Linda treats or how Mac treats. But how I treat might not necessarily be how Linda treats or how Mac treats. We all have different backgrounds and different upbringings and have had different experiences. I like to dance and I like to sing and I like to shoot the crap with patients and their parents or whomever, just having an actual conversation. Linda's a little more professional as far as how she carries herself in, her acumen and how she talks and explains to patients. Mac has a military background. So there's just these different flavors here in the clinic. But ultimately what our consensus is and what our goal is is not to just rehab, it's to make sure they are performing better. So now, like we've had these huddles, we've had these discussions, we've had these talks, let's utilize the blaze pods, let's utilize the soccer nets that we have, let's utilize all this extra equipment here to help them be the best version of themselves, whether that's dance or whether that's soccer, whether that's football, basketball, track, whatever that case may be.
Speaker 1:For me personally, my flavor is like kind of how I'm talking to you now. Right, it's like I'm very chill, very laid back. Well, you know, I'm one of those PTs where I don't avoid cussing, like if I want to cuss, like it's okay, I'm not cussing at you, like, let's say, it's sentence enhancers. So sometimes I enhance my sentence a little bit like that. But people relate to it. I think there's even been a study like PTs who are practitioners who cuss around their patients, there's a more, a greater relatability in that.
Speaker 1:In that sense, yeah, I love that you know, yeah, so it's like I've been able to build relationships with these patients, these individuals. Where, you know, I have a couple that I go golfing with, there's a couple that I've gone cycling with, we've gone to baseball, track meets, swim meets all this in the community. So I don't try to handcuff how they treat Like everybody has their different experience and one size doesn't necessarily fit all right. So we work as a team and if something that I do is not working, I have no problem passing the Mac or passing the Linda and so on and so forth. But we try to keep that continuity of care as close to consistent as possible.
Speaker 2:Yeah, I love that. I love that you kind of also just letting people excel at their own way of being as a practitioner. I think that's awesome One thing. Just to jump back to the business side, one thing we know that our community is struggling with is just how to actually do the nuts and bolts of their business and also kind of getting ahead of the unknown if they were going to open their own clinic. And so I wonder if there's anything that you could identify that surprised you when you opened your clinic or the process of running it or growing it. And there's a lot of little nitty gritty details like when do you hire somebody, or what's it like to negotiate a lease, or do you sell inventory? Like, is there anything like that that popped in your mind that you were surprised by, or that didn't work and crashed and burned like radio advertising or anything like that?
Speaker 1:Yeah, yeah, no, negotiating the lease was probably the tough part, right, because a lot of. So I ran into a couple of issues. One where they would upcharge because they found out what I used to do. There was a space that was similar size to here and they were trying to charge an extra $1,500. After he quoted me a certain amount Once, I told him okay, sent all my financials, yada, yada, yada to prove that I can afford the lease or whatnot. Oh, actually the price is there. So I've ran into that a couple of times. And then then there was a whole.
Speaker 1:I haven't had a job in five years, so I did two and a half years of prereqs, two and a half years of the doctoral program. Well, I still, I still have the financials for it. But since I didn't have a job for five years, it was frowned upon. So a lot of there was a lot of a lot of fear as far as taking that chance, even though, had you know, you had your collateral, you had things that could, essentially, if the business failed, like it was covered. So that that was always the tough part. And then trying to what the big thing is that? One of the nitty gritties and nuts and bolts that, you realize, is like how much it costs to like make it look your way right so like contracting out anything.
Speaker 1:So I remember getting quotes for how to make this office space and the walls and everything like that. It was about 25 30 grand just in the actual office space. Um. So, fortunately for me, I had a buddy who he did pretty much does all his house stuff. I had another buddy who's done floor stuff. So we kind of did it all ourselves in the front office and it was just the supplies and it costs us. You know, cost me $2,500 beer and pizza. Pretty much that's all it costs, right?
Speaker 1:So just finding ways to save especially as when you're new, right, you're trying to save money because it takes a while for you to make money there's always some type of new overhead that you're not worried about. There's always hidden costs. Like, if the toilet goes down, is that in your lease? If the HVAC goes down, is that in your lease or is that something you got to take care of yourself? So there's all these things that you kind of have to worry about. Make sure you're looking at that. So a big bit of advice is just make sure you have a lawyer, make sure you have a business lawyer to look over the contract, make sure you're not getting screwed over To make sure, like things are copacetic and this is normal, because every now and then they might try to sneak something in Can your cam stay the same year in and year out? Or are you getting a kickback? There's all types of things, as far as a business owner that you're constantly worrying about. I still worry about things today, and I'm going on three years.
Speaker 1:And then to your question as far as when to hire somebody. It's, it's, it's difficult with uh, with a cash-based clinic, right, cause you're not always, it's not always you know 18, 20 referrals a day from insurance, right? So referrals are coming from that word, that word of mouth. So when? When was I confident enough to hire somebody? I hired Linda almost a year ago, a little more than a year ago last year, and she was ready for a change. She was at a cash-based clinic before, but the rates were low, she wasn't getting paid as much, so on and so forth. So what ultimately came down, what made my decision, is, as a business owner, I need to hire somebody, because everything that I'm bringing in it's going back to the clinic, yeah, yeah. So that's not ideally what you want to do. You kind of want, you want, you know some to go to the clinic, but you want to also be able to pay yourself. So essentially I wasn't paying myself, I was just paying the clinic to keep lights on doors, open equipment, yada, yada, yada. So that was kind of where that looked like.
Speaker 1:But also a big thing is like how to talk to your employees when you're a cash-based clinic, because you have to build trust. You have to build trust in that community. Everybody trusts insurance, Everybody trusts wherever they're referred to. How do you build trust and how do you build your caseload? So it takes a few months to build your caseload in a cash-based clinic, especially a new one. Right, it's not like I had patients on deck for you, but my thing is like I try to push you know patients to them as much as myself when they call or if we go to meeting or go to pop-ups or things of that nature. Okay, mac, linda, y'all got it. Everybody who signs up, make sure you put them on your schedule, you know, and I'll take a seat back, cause I would love to have time to just do admin stuff or you know what else do I need to do?
Speaker 1:Okay, we're short on this, short on this. Okay, yada, yada, so on and so forth. Um, or do the social media part? So? Um, there's just, there's just a lot of hidden things in business and you'll get your bumps and bruises along the way, right? That's kind of the flow of being a business owner, like you got to roll with those punches sometimes.
Speaker 2:Yeah, you've mentioned Cashbase Clinic a few times. Could you just talk a little bit? So our listeners are going to be somewhat based in Canada, somewhat based in the United States, but I wonder if you could just talk about your decision to be a cash-based PT clinic and just what you know about the insurance side of it all, how you made that decision. I think that's really what I'm curious about is how you made that decision.
Speaker 1:Well, I made that decision because I have kids and seeing 18 to 20 people a day and then having to do those notes at home kind of, would just negate my time as a father right. Like, my kids are in gymnastics, swimming, soccer, want to play golf. You know football. My oldest is in Ohio so I got to fly out there, right. So there's a lot. There's a lot of moving pieces there. So what would give me the best opportunity to remain a dad Right and not just be drowning in all this excessive paperwork and insurance and having to fight for all these visits?
Speaker 1:Secondly is what would I prefer as a patient? Would I prefer 20 minutes on the table and then I do a couple of exercises here and I'm out? Or would I want the 30 minutes, 40 minutes on the table? Then we use the last 20, 30 to do exercises strengthening, reinforce, kind of what we did. And then, thirdly, reimbursement rates. Reimbursement rates are terrible, especially out here in Colorado. I know Virginia is a lot better than here, but in Colorado reimbursement I think on average is between 40, 50 bucks for a 30-minute session, right, and then premiums have gone up. Reimbursement continues to go down. So now I would have to see more patients. So doing my analysis and my spreadsheet as far as what it would look like to break even in a clinic that's cash-based, with an average of $45 roughly versus an average of $172 per patient, I'd have to see 13, 14 patients a day in a 19-day working month to break even versus to break even. To pay myself everything overhead, I have to average four a day at the $172.
Speaker 2:Right, that's a big difference.
Speaker 1:That is a huge difference, right. That's four hours of treatment, or seven hours, roughly every 30 minutes.
Speaker 2:Yeah.
Speaker 1:At 14 people. Yeah, it's a huge difference to try to find that work-life balance and not be bombarded by notes and, yeah, ultimately, that's's why those are the three reasons why I decided to go go to cash base route, and it's scary for a lot of people that they think that right, but go out there and not have these constant referrals coming through. Yeah, but there's so much value and when people when people understand and see and experience the value of going to a cash-based model, not just as a business owner but as a patient, that's okay, cool, this is great. I'm actually getting better, faster and paying less than what I would if I did the traditional route.
Speaker 2:Right.
Speaker 1:Right, and there's so much education We're're constantly doing education with patients like super bills. How does that work? All we are seen as an out of network provider. What does it look like? They should be able to reimburse you not reimburse, but maybe put it towards your deductible or out of pocket max or something along those lines. Like there is a way for you to get get your money back, or something along those lines. Like there is a way for you to get your money back. But who wants to read those 20, 30 pages of insurance jargon that you get when you sign up for?
Speaker 1:your insurance right. There's so many little nuances that unless you're there going through it or you're a healthcare professional, you're not going to understand.
Speaker 2:Yeah, long ago I worked in a couple of clinics and one of them my job was actually to handle this process of billing insurance when they don't pay. That clinic hired a person full time to just like go in, and this was before it was all online, so it was on the phone basically all day talking to the insurance companies like so what do you think about this? And a lot of times it would just be like the code was wrong or something, and so it was just like such an administrative hassle but a whole human full time just to get that percentage paid.
Speaker 2:Yeah, yep, yeah. So tell me more about what you're doing to educate patients on the insurance. Is this just a conversation that happens at the front desk, or how do you actually pass that information to them in an effective way?
Speaker 1:So I'm hoping to do a little, hoping to do a forum at some point in time to any patients to jump on Zoom, kind of educate them about Jane and insurance and how to navigate that space, understanding what to look at, why they should reimburse you, all these different things. But there's a lot of education that happens on the phone. There's a lot of education that happens when I'm selling packages, right? So the big thing for a lot of people is like okay, well, that is a lot right.
Speaker 2:Yeah.
Speaker 1:Say, our 10-pack, that's 10-pack and an eval is almost two grand. Right, but the education piece of it it kind of circulates around. Okay, we can provide you super bills, so you should get 70, 80% of that back towards your deductible or out-of-pocket max or, if you met it post-surgery, all of it back to your pocket. But also the fact that we're not trying to burn through your visits, so like we kind of set up a plan where, okay, you get a 10-pack, I'll see you twice this week, twice next week. Oh, you're doing better, your pain's at a two, three versus that six, seven. Okay, let's go once a week. For the next two, okay, it's still sticking, all right, let's face the other one two weeks. All right, let's face the last one a month.
Speaker 1:So now a 10 pack is roughly four months, the startup, the beginning of the fourth month. So kind of try not to burn through those visits unless they absolutely need it. I'm not, I'm not here, just like, let's just burn, burn, burn, burn, burn, burn, cause then it just seems like we're just taking away the reason why we're doing it. We're doing it to get them better, we're not doing it just to bring in as much money as possible. If that was the case, then we'd go to that insurance-based model.
Speaker 2:Yeah, yeah, interesting, so fascinating. Is there anything that you would advice that you'd give to a clinic owner who's trying to make this decision for themselves?
Speaker 1:I mean my, my advice, especially a clinic owner who's trying to make like, educate your patients, that you're you might be making that shift Right. Educate your patients if you're dropping their insurance, maybe you're not dropping all of it, maybe you're dropping some but also making sure, like you can do the insurance in the cash-based model and just making sure it's like, hey, do you want to fight at the end of your 20 visits for an ACL and possibly get denied for those extra visits? Or you can go the cash-based route and I can give you a discounted rate per visit and we can possibly even do longer visits now that we're not dealing with insurance. So, just being confident and comfortable with that educational piece with these patients, because it is scary. It's scary.
Speaker 1:It's like, oh, wow, I'm paying two grand here, but in that same breath breath especially depending on what area you are like is it very sports driven? Because you know some of these leagues they're paying five thousand dollars for the league you know, just for the spring ball or whatever, uh, spring baseball or all these camps that they're going to or to be on this national club team. Like there's so much money going into that it's like some of them probably won't have a problem paying it for health care, as long as you justify why, why they need it. It's always one in that. Why? What can you do as a pt that may be different than what the coach is doing, or the strength conditioning performance coach like, what can you do? That's that sets yourself apart I love that.
Speaker 2:You just said that it really aligns with another. Um, we wrote this article for a print magazine how to raise your fees, and it's it's all about like feeling confident in in that act of charging people money for health care and that people actually want to give it to you because they want the healing, or I don't know if I'm saying this correctly, but there's a mentality there of like of feeling confident in that, and I think that it's it can apply to different segments of this conversation, like raising your fees or even just like, how do you set up your, your revenue model for your clinic? So, yeah, that's super helpful yeah, absolutely.
Speaker 1:I think, just doing some research too about what's going on around there, like everybody's talking about, like my price. Some people say, oh, your prices are high, lend this clinic. Compared to mine, yeah, my prices are almost two times as much as what they were charging there, but there's a clinic down the maybe 10-15 minutes away. That's actually. They were charging there, but there's a clinic down the maybe 10, 15 minutes away. That's actually. They're charging essentially $50 more than every follow-up visit. That I am right.
Speaker 1:It just all depends on kind of the area you're in and kind of what are your goals and what allows you to feel comfortable to treat for 45 minutes or an hour, like what's? How allows you to feel comfortable to, you know, treat for 45 minutes or an hour, like what's? How do you value yourself? Like we all have school debt. You know. Like everybody in the health care space has school debt. What's going to help you pay that you know. And what's going to put food on your table and take your kids to all these activities, and I feel like that's kind of the norm.
Speaker 1:We undervalue ourselves and I don't know why, as PTs, we undervalue ourselves so much. Is it because we're still seen as a service here in the States and not seen as a doctor in the insurance world. That's why they keep cutting and cutting, cutting prices, even though we have to get a doctorate now, yeah. Or is it because we're so driven to, you know, be kind and friendly and provide the best care possible, and like we want to help our people, but we, we sacrifice ourselves for it, whether that's time or money. I feel like it's just a norm that we constantly deal with or that I constantly hear from other PTs.
Speaker 2:Yeah, yeah, that's so interesting. I think that applies across all of the disciplines that we come across at Jane as well, so I appreciate you saying that so much. I also want to talk about some things that you do outside of your clinic. So would you mind going through your charity a little bit and telling everyone what you do there, and one what it is, how you came to have that and then how it relates to your underlying ethos as a person who's interested in health care?
Speaker 1:Yeah, absolutely so. My foundation is called Bruton's Books and it's geared towards childhood literacy, k-3, third grade here in the Denver public school system. We've been founded since 2015. So we were very active in 2015-16, kind of got a little slow during my time in school and kind of slowed with COVID, but revamped back up. We came up with the name Bruton's Books because of alliteration and obviously it's literacy, so we thought that was pretty clever.
Speaker 1:But ultimately what our mission is is to address accessibility in the DPS area. So I'm in a very affluent area. It's Cherry Creek School District. Every kid's one-to-one as far as iPads, google Chromes and the libraries are ginormous. They have all these books, yada, yada, yada.
Speaker 1:But in DPS, in the Denver Public School System, there's been a big shift as far as cultural influences, demographics, people moving in and now staying. So what we are trying to do is address that accessibility as far as culturally enriched books, like that relatability piece to what you're reading, because that's going to be a motivating factor. Right, and I seen it when I would go talk to the schools. Or sometimes when I go talk to these underserved and underprivileged schools, like, oh, it's a black man who played football but also went back into education and he's a doctor, and he's a doctor, right. So like that is a motivating piece, instead of having somebody who doesn't look like you come up there and talk, say, hey, you can do it, you can do this, you can do that. You know, there's a look and I'm not saying there's nothing wrong with it. I think if you can get up in front of somebody and try to motivate them by all means, but there's something to say with that relatability piece, that goes a long way and it's the same. It's the same with the book.
Speaker 1:You know, if you're reading uh, junie B Jones, right, and it's, it's a young white girl in a book and you're a young black girl. Like, are you going to be relating to that? Right, you got to find something else that that may most more so pertains to you and your culture and things of that nature. So, ultimately, what we do every year is we the last three years is we do a golf outing where we raise funds to purchase iPads, to purchase books and purchase two years of supplemental programming on these iPads so kids can learn as well as parents can have access to it via their computer or something along those lines, whatever they have at home to keep track of what their kids are doing.
Speaker 1:So, dps, I don't know how familiar you are with our prison sizes and things like that, but based on our third grade reading levels, is what our prison sizes and things that, things like that, but based on our third grade reading levels, is what bit is what our prison sizes are based off of really? So, whatever you're reading at there, yes, so we did. There was a research done by maha united way that prison rates, prison sizes, are based on third grade reading levels whoa Whoa.
Speaker 2:No, I did not know that.
Speaker 1:Yeah, so that's kind of why we focused on K through third grade. So kindergarten through second, we're learning to read. Third grade is huge. Now we're getting to the point where we read to learn. So there's definitely a shift as far as what the purpose of our education is.
Speaker 2:This one was David Bruton, and I love talking to him so much because, I mean, obviously it's fun to talk to somebody who has had a professional sports career. What I loved about it, though, was that we didn't really dwell on that too much. We're able to really get into how he's building his business and maybe how that previous life and experience informs how he approaches his clinic. That was really fun, and one of the things that I caught was how the clinic culture is really important to him, and, in particular, he's trying to create this vibe of the positivity that he experienced in a professional sports locker room, and he's trying to provide that for his patients and clients now, who are athletes who are working really hard to be great at what they do, so that was really fun to hear. Another aspect of that was almost veering into his approach to the treatment outcomes, but it was really a comment on how he puts his patients first, and I think what he was trying to say is that, if you go by the book, you kind of were trying to get patients to like 100%, but in practice, especially with athletes who are pushing really hard, that the goal is really to get them good enough so they can get back out there, and I thought that was just a really fascinating part of his business model.
Speaker 2:The other piece that was, I think, really helpful to a lot of listeners out there was his choice around having a cash-based model, and for him it allows him to have a much shorter workday, sometimes like a four-hour workday, I think he said, which gives him so much more time, one to focus on the business as an owner and then also, of course, more time with his kids.
Speaker 2:So that was really cool. And then I really pushed to ask him about how he educates his patients on the benefits of how that cash-based model works, because sometimes they need to go and then send the insurance documents to the insurance themselves. So that was a really interesting part too, that the education of his patients about his business model is so important. And then I really loved hearing about his charity Bruton's Books. Loved hearing about his um, his charity Bruton's Books, and if you if that's not going to make it into the final cut, you can go look that up called Bruton's Books and it's how he's focusing on improving third grade reading averages in the Denver region and such a great little um thing that he's doing there and trying to make a real difference in people's lives and how they can grow up and make a difference themselves. So hopefully this was a good episode. Chat soon.