In this week’s podcast with Francisco Maia from K9PT, Francisco shares some of the many reasons and advantages, from a business, outcome, patient and client perspective, of minimising the number of modalities one works with in a practice, and how this has turned out to be one of their greatest strengths.

Minimising modalities and focusing on developing and growing manual therapy skills can significantly improve patient outcomes, develop strong and lasting client relationships, improve compliance and lead to a simpler, more profitable business model.

Below, I share some of the highlights from Francisco’s and Megan’s conversation with you.

Our hands are our greatest tool – how have you applied this to your practice?

My history forms an important part of the answer to that question! I graduated as a physiotherapist from the University of Pittsburg, which runs a very manual therapy-based PT programme. So as a graduate, this was my skillset and focus. For the first few years, I worked with young, active adults, and exercise progression was a skill that I strongly developed.

For the first few years after transitioning to working on canines, I worked at a vet clinic that was very modality focused, including underwater treadmill and laser. With 30-minute sessions, manual therapy and exercise progression was rarely incorporated.

I then opened my own mobile practice. Travelling all around Chicago, I had to re-invent myself as a canine PT, as my only modality was a class 3B laser. Going back to my roots and focusing again on manual therapy and exercise progression, I noticed that my patients were doing very well – better than they had been doing when I was using the underwater treadmill.

When I then opened a brick and mortar practice, I didn’t even think twice – the results were there without the bells and whistles, and I didn’t feel that we needed them.

 

We always question ourselves when we go into practice, thinking we need all ‘the bells and whistles’. How did your outcomes compare to when you were in the vet practice?

It is an anecdotal approach, but I was seeing that a lot of my post-op TPLO patients were stronger and experiencing fewer setbacks post operatively. We were also able to create a home programme that owners could maintain and keep up with at home. This aspect is really important to us.

I find that if we rely too much on modalities, something has to give, and that is often the compliance from the owner with the home exercise programme.

Because of our philosophy, our owners tend to really want to learn about what they can do with their dogs, and to be very compliant with their home programme, even when we start to taper PT or discontinue PT completely.

For a long time, I still thought that neurological patients needed the underwater treadmill for gait retraining, but then I started learning from other PTs with a human neuro rehab focus, especially neurodevelopmental rehabilitation. As I started applying their approach to my canine patients, I realised that these patients were also progressing better.

I think that this improvement is also due to the education we give owners and the home programme that they continue with on a day-to-day basis, which is far more valuable than the once-a-week PT session that patients often receive when there is a strong modality focus.

 

How long are your consults?

Our initial evaluations are between an hour and an hour and a half. We book a full two hours for evaluation, which allows us also to get the documentation ready for each patient.

Another transition that was quite difficult for me when working at the vet practice was that during the initial consult, we performed only the evaluation and gave no treatment. For me as a PT this was really tough to adapt to. As a human PT, I would always treat the primary problem in that initial session. When I then started to do my own thing, I went back to that approach of performing the evaluation and the first treatment, as well as teaching a few home interventions in that first session.

This way I can help the patient to feel better from the first session.

 

Is a large portion of your consultation focused on doing the exercises and teaching owners how to do them?

Yes, absolutely, as well as having the owner perform the exercises in the clinic with us. We know that much of how well the exercises are performed is dependant on the handler. We often make the exercises look easy, since we do them every day, but for the owner, the more challenging exercises can be difficult to manage and learn. So empowering the client in this way is really important to us and is central to our philosophy.

 

You must have a very specific kind of client. How do you find clients that match your philosophy?

Very often, clients self-select or opt out of being our clients. For example, because of our philosophy, we did not want to allow clients to do drop-offs. So when a client calls us and asks about our services, and we explain how we do things and what our philosophy is, they will either connect with it and feel this is exactly what they want, or they may feel that they won’t benefit from our service. For example, they might be super busy and not have time for this – they just want to bring the dog, drop it off, and let us do our thing.

This was a mindset I needed to get around; that the second scenario client was not our ideal client, and I needed to be fine with that. I needed to accept that we were going to attract the kind of client that would benefit from and resonate with the service that we actually offer.  

 

Do you have any modalities that complement your hands?

Yes, we use class 3B laser all day, every day. This was the biggest investment I made when I started my mobile business. We also use PEMF, either the loop or a bed, and this is great because it doesn’t take any additional time in our sessions.

We also have the small portable TENS/NMES units, which we rarely use. In cases where NMES will be very beneficial to the patient, we tend to get the client to purchase a unit and use it at home on a regular basis. We programme the settings for them and show them how to use the unit safely.

Again, with this modality, NMES needs to be used three or more times a week at home for it to be really effective. We can then focus on other things in the clinic instead of using this modality in sessions.

So you are really using the pet owner as a part of the team.

That’s a great way to look at it – they are absolutely a part of the team! If the owner is not acting as a part of the team, your outcome will always be a little bit capped, both in the short and the long term.

Clients love this, especially as they end the rehabilitation programme. They really feel that they have the tools to look after their pet for years to come. For me, they have to be a part of the team.

What are the advantages of minimising your practice?

There are a few different ways to look at it from a true business perspective, as a business owner. You end up running a more streamlined practice, keeping your expenses lower and making the practice more efficient in the long run.

If you’re looking for a commercial space to lease, you also have many more options available when you are not looking for a space that can take a pool or an underwater treadmill. There is also a great advantage in terms of networking, as you can refer out to hydrotherapy or acupuncture to complement your treatment sessions. This helps to build partnerships in the industry.

It helps to keep things simpler, keep our message clearer and simpler, and helps us to empower the owner to manage things in the long run with their pet, keeping them healthier for longer.

We all have something that we are really good at. Sometimes, especially in our profession, we try to be a Jack of all trades. I feel that more and more we need to specialise in what we want to do or are good at doing. This allows us to become known for one particular thing, which is what people want. They want the best for their pet, and that means a specialist in a particular area.

 

What are the disadvantages of having too many modalities?

One of the biggest challenges is how you schedule the appointments to ensure that the equipment is available to the patients that need them.

Another is how fees are structured, which can be very confusing for the client. They can get so caught up on the financial side of things, that they lose sight of what is most important, and that is how you can actually help their pet. The home programme can also get lost in this kind of set-up, leading to less compliance from the owner.

The marketing component can also suffer. When we spend a great deal of money on a modality, we feel we need to market this modality to our clients. This leads us to see equipment as a commodity, and to step into direct competition with practices in our area that use the same modality. This prevents us from standing out in the market.

Ultimately, people don’t care about the pieces of equipment we have; they care about the value we can bring and the results we get. Everything else is a nuance, if we can communicate to them the value we are able to bring to their pets.

 

There seems to be a perception from clients that the gadgets are what is valuable. How do you deal with this? 

It all boils down to communication. Effective communication is an art, and something we all need to get better at. Once we take the time to learn this skill, this becomes your best asset as a human being, and not only as a practitioner. Once we effectively communicate with potential clients what we can offer their pets, they are excited to be working with us, despite the fact that we don’t have the things they initially thought they wanted.

 

Have you ever felt that not having certain equipment has limited your outcome for certain cases?

No, I really have not. This is a little different from what we are used to. Up until recently, there were some neurological cases that I thought could benefit from the underwater treadmill, and after referring them, some of the patients either did not improve or actually got worse. After taking a break from the UWT and focusing on neurodevelopmental sequencing, the patients started to improve again.

There was one patient where the surgeon felt the dog had a 1% chance of ever walking again; this patient has improved drastically and can now walk with support, without the use of the UWT.  That was the final thing that convinced me we really don’t need the UWT in order to be effective.

When I have someone who would benefit from acupuncture, or a client who would like to add that for their pet, I have places where I can refer them.

I am not saying that using these modalities is right or wrong, and we don’t deny them to our patients; we just explain that this is how we do things, and how we feel get the best results. There has been some recent research into the use of UWT in neuro patients, which does not support its use as being beneficial for them. They showed that there was no real difference between the group that used the UWT and the group that was on an exercise protocol. It's not only UWT – a lot of the modalities we use, even in human PT, are just not supported by a body of evidence. 

 

What advice would you give a Vetrehabber starting their own practice?

This is one of the things I am quite passionate about! The first thing is to keep things simple, and to keep as overheads as low as possible.

If you can, start mobile. It’s a great way to build a clientele while keeping overheads low. If you are coming into a new practice with an existing clientele, then starting mobile might not be the best option.

Then, master the basics, both from a clinical perspective and from an operations and marketing perspective.

Don’t compare yourself to other practices; run your own race and focus on yourself.

Imitate before innovating – find someone who is doing what you want to do, and learn from them. Use what works and learn from their mistakes. Instead of trying to do new things, find the few things that work and be consistent in them until you get the results you want. Once you are there, you can start to change things and find what else works for you.

Lastly, get comfortable being uncomfortable. Growing a business is painful, but nothing is as painful as just staying stuck where we are. Embrace chaos – eliminate the thought process of ‘When I achieve this, I will do that …’ Get comfortable starting different things at the same time.

Understand that being a business owner is a privilege and a responsibility that ultimately will set you free. The only way that we achieve more freedom is by taking the pressure and the responsibility that comes along with it. We need to take the liability, the stress, the ups and downs, and at the end of the day we will also take the benefits and reap the rewards.

 

Please tell us about the K9PT Business Accelerator

A few years ago I started the K9PT Academy, which has become a big focus for me now. Showing people how to get their business off the ground and to be more profitable and successful is the focus of the business accelerator programme. It is a six-week programme focused on the business. We’re just wrapping up the first six weeks of this course, and it has been incredible to see these guys hit the ground running.

I’m really teaching people how I have done things, and how they can replicate the same results for themselves and their practices.

We have shared the recording of the first part of this course for free. Please sign up to our free area if you are not an Onlinepethealth member to access this training. 
How to Leverage the Customer Cycle to Grow and Scale a Successful and Profitable Business in Veterinary Rehabilitation.

 

Conclusion

Focus on your strengths, don’t overthink things too much, don’t doubt yourself and your abilities, look at what is evidence based and effective, and become an excellent communicator – those are the things that I am taking away from this conversation.

Keeping it simple can be a powerful strategy to boost success with each of our patients, as well as with our business.

Please share your thoughts with us, as you read, listen to and process the conversation between Meg and Francisco Maia.

 

Resources

If you are not an Onlinepethealth member and would like to access the training How to Leverage the Customer Cycle to Grow and Scale a Successful and Profitable Business in Veterinary Rehabilitation, please sign up to our free area, head into the business section and enjoy the training!

If you are an Onlinepethealth member, you can find this training in your Business Basics section in the members’ portal.

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