0:00:02 - Mark Henderson Leary

Well, Michael, welcome to the show. How are you? Thank you, Mark. 

0:00:06 - Dr. Michael Nula

Yeah, doing good, Mark. Thanks for having me. 

0:00:10 - Mark Henderson Leary

So I'm curious where we're going to go with this conversation. I think one thing to start with just feels like the right thing to say we share a passion for winning Right, so what do you like to win at? 

0:00:27 - Dr. Michael Nula

who like to win at games. That I get my mindset on, you know, and it's funny. It could be something as simple as playing a game with my daughters at home. Uh to then, you know, setting games when it comes to like business, um, and strategy, you know, get my mindset on something and want to win on it, you know, and I love doing it with others. Sharing that win, you know it's a lot. 

0:00:50 - Mark Henderson Leary

It's enjoyable to celebrate that with other people because, kind of what resonated with me, I was just, you know, I read through your bio and just there was like a little section in there about purpose and then I saw that the whole, like you know, really want to you're, as an nba enthusiast and I want to, you know, really want to be an enthusiast and want to, you know, want to playing zone defense, want to help teams win, and you know, my theme is about winning and I think there's so much to the feeling of not winning that it gets frustrating and can be massively erosive, corrosive to morale of a culture Eventually. So I think there's a dynamic in leadership of any business and in any kind of practice, where the founder, entrepreneur, is ready for war, ready for a long slog. There's a passion, a purpose, a massive investment in education and other things. It says we're ready to go along on this and I can take a lot of days that don't quite win and still have the belief. But then in the culture there they may not have that sort of tolerance. 

You know, you hire some people and they're like, hey, this kid, this, this is, this sucks. And so I think that all of that kind of combines to when people come to me. Oftentimes they're. They're worn out. They still have a spark of belief, but they're like man. I thought we'd be winning by now. I was a winner in school. I'm a winner in life. I'm a competitive player, you know. Did you have any your career, any times where you thought, man, I'm, I'm, I'm tired of not winning Like I want to, or maybe even feel like I'm losing and I believe I can win? Is there anything in your, your history like that? 

0:02:39 - Dr. Michael Nula

Man, that's, that's. Uh, you know we've all gotten there, right. I mean it's up and down, so there's times where we feel like we're winning. There's times where we feel like we're better than where we're at and where we may even be losing. We lose sight of progress, you know. We lose sight of what is the game we're even playing. Do we even have a vision? Like, where are we going? What are we doing? Right? Those moments of feeling, feeling stagnant, stuck, going through the motions. So absolutely, I've lived that. And um, it's in those times where you know you get glad that you're surrounding yourself, around the right people, are connecting with the right person that can sort of pull you out of that Um and or that you do it collaboratively and talk through it. But, um, I think that's part of the ups and downs of life and business, you know. I think you know to think one can be on on a winning streak all the time, every time, always high, I, you know that's that's perfection, that's that's impo, that's impossible. 

0:03:34 - Mark Henderson Leary

we can get excellence, but perfection, that's that's unattainable, you know yeah, winston churchill's quote if I get right, somebody will correct me if I'm wrong. Something about success is going from failure to failure with no loss of enthusiasm. 

0:03:52 - Dr. Michael Nula

Right. 

0:03:55 - Mark Henderson Leary

You know, I was watching the Olympics, like so many people. It looks like these people are just successful, successful all the time. And then I watched a video. I don't even know where I ran across this video. It might have been some reel that was totally unrelated and it was a gymnast learning to do. 

She was on the uneven parallel bars where they like get to the top of the bar. She's standing on the bar and then how do I describe this? So it's in an audio terms. She's basically jumping backwards and grabbing the pole, the bar with her hands and swinging. So she's basically jumping backwards and grabbing the pole, the bar with her hands and swinging. 

So she's learning to kind of swing around, stand up on it and jump and then catch this thing and it shows like 30 spectacular falls in a row where it's just like she misses the bar completely, not even close, and smack, yeah, right, and eventually it's like her fingers on there and then it just rips right off and eventually she gets it and like her fingers on there and then it just rips right off and then eventually she gets it and hangs on and flips around and lands back on the top of the bar and it's like amazing, and that is the part of winning that we don't see. And then, when we experience it, I think we're like I didn't know it was going to be like that Right on. 

0:05:03 - Dr. Michael Nula

Yeah, the journey right. So many of us tend to keep that private and those perceived losses or failures, yeah, we're kind of tucking that down somewhere. But I mean that's pretty neat that you watch someone actually share the journey and share the victory and what they identify as the win. You know. 

0:05:18 - Mark Henderson Leary

Yeah, well, I love the kind of connection. I wasn't really trying to be super cute, but, but I was with the whole winning thing. But you know, physical therapy is a background. There's got to be a lot of connection to people with injuries and you can't compete if you're not performing. And in fact I kind of looked at your bio and I thought the way you described it, passionate about creating positive impact in people's businesses and lives so they move better and enjoy active lifestyles, pain-free. And then down there this winning thing, I thought, well, it's, I think it's, I guess, the winning thing too, you know, like helping people remove the pain from their life physically and emotionally, so they can go win and get back on the field right. And and so you know what? What inspired you to get into physical therapy in the first place? 

0:06:01 - Dr. Michael Nula

yeah. So back in high, my last year of high school, I had a bad knee injury, a patella tendon tear, so it's that tendon that runs along the front of your knee. I went and tore that and so I found myself in physical therapy. The rest of the year had to forfeit my last season of playing basketball, but fell in love with the profession pretty quickly. I was that dude that always liked science, health, being active, always loved people, and so this idea of being able to work with people, help them get back on track, get a piece of their life back, was really exciting to me. So it's one of those things where one door closes, another opens. 

18 years old racing home one day, kind of like, hey, my dad, I know what I want to do. I want to be a physical therapist one day and I want to own my own practice. And then that was the neat thing was day and I want to own my own practice. And then that was the neat thing was having that experience in a hospital setting. I thought like, while it was good there, there seemed like there could be better. Uh, that could be great. And I was like started getting on a quest to go discover what that meant. I got limited results, even though I had a nice experience, and it wasn't until I got to college and had a great experience and great care that I ultimately got, you know, full athletic return to sport ability back and it was like, okay, not all physical therapy is the same, you know, and I'm interested in learning more about that, and I think the way I can stay in that space is someday owning my own practice. 

0:07:20 - Mark Henderson Leary

Yeah, I think there's a lot in that and it's a very similar story. I think, especially in anything sports related, it seems like there's very in that and it's a very similar story. I think, especially in anything sports related it seems like there's very, very common. I had this happen to me. Something really helped me get back there and I thought this is magic and I I would love to be able to learn how to do this for other people and I think it's really an understated passion and driver and I think an industry that gets kind of commoditized fast a lot of personal trainers, a lot of like Kairos and a lot of things where it's just kind of run in the middle industry, just a kind of factory type of mindset. But the stories of the people who I talk to they're like no, this is really important and I take this very seriously and it's really really powerful purpose built into it. 

0:08:03 - Dr. Michael Nula

Yeah, and I always carried that sensitivity Like I knew how much that really it broke me for a little while. You know there's a there's a psychological component to healing and overcoming a painful condition at a time where you have no prediction. You know, am I going to ever get better? Is this going to hurt all the time? You know, all I want to do is be better yesterday. So I'm really sensitive to that, that experience and you know kind of what goes on in one's mind and then that desire to just have someone so attentive to your needs, that's in it to win it, to help you over that finish line. So I always carried that through practice and that became kind of a standard piece of philosophy of how we approach care. It's taking care of people one at a time, really individualized, taking that time to really connect with them, figure out what's making them tick, what do they want to get back to, and being attentive in the fullest manner, being present. You know, no matter what's going on in our own lives, you know. 

0:08:56 - Mark Henderson Leary

Yeah for sure. Another part of your story that I think is worth kind of drawing attention to is the entrepreneurial side of it, and because I hear a lot of people in all forms of healthcare. You know it's not what it used to be. We're not graduating as many doctors or healthcare providers as we need and you know it's just scary and sad and all that and it's not motivating that. You know who wants to run a practice anymore? Because it's the old way is dying, and what I find is two things. One is that I think the old way is dying, but the new way is also coming to life, so there's a lot of amazing opportunity and new forms to be very entrepreneurial. And the other side of it is like in terms of motivation. I think health care providers and doctors are made out of the same thing Humans. They make them out of humans and humans are born with many of them, especially in this country, in my opinion. 

I think the United States is particularly well suited to manufacturing humans made out of the entrepreneurial substance and they come out with this sort of pre-wired I'm gonna do this myself, and we don't even necessarily know what this is when they first say that, but they're gonna. I'm gonna do something myself, I'm gonna take some risk and we're gonna do this better, whatever it is. And I kind of heard that in you. It's like what you were probably pre-wired to go do something better and handle it and do it and own it. And that showed up as like well, this is my calling, this is. I know what this means and let's go to work on this. Is that is that far? 

0:10:22 - Dr. Michael Nula

off 100. You know, and probably that entrepreneurial spirit started really early. I'm that kid that knocks on doors, you know, hey, mister, can I mow your lawn, rake your leave, shovel snow? You know, um always getting after being my own boss and creating work, and uh, always with that helping vibe too, you know. So it was inside of me and then you know really what cemented it fast forward. Um worked for a large healthcare organization and uh, had this idea yeah, I'll go work for a few years and then, when I get enough experience, I'll break off and start my own practice, whatever that means, right, yeah, and after one year it's cemented. I was like, okay, I know exactly what, how not to do things. It's go time. Now it's time, let's just start this now. 

0:11:01 - Mark Henderson Leary

I've got enough, you know enough in the tank to go get after it and do what I think we need to do here well, that's a good pivot in the conversation too, because I have a lot of strong opinions around the learning what not to do, because they do create a lot of motivation and there is a lot there. We do learn some things from, from things that don't go well and major mistakes, but usually those are pattern, interrupt changes, like we have bad behaviors or behaviors we think work and we, we learn in times of extreme pain how to modify that behavior, and so this in the way trauma and other things change, change our personality, because personalities don't change except for under extreme conditions. I do think that that once you've got that sort of motivation to do it right uh, health care in particular, I mean I've never met a doctor who doesn't I mean truly I've never met a doctor who doesn't say something that sounds like I know more about my craft than I ever thought I would need to know. I know so much I've been schooled to death and I can tell you exactly how much you know about running a practice or running a business that I learned from school and it's exactly zero, and so that's sort of the inspiration of like, well, I know there's something I need to learn, but what is then the challenge when do you go find that? Where do you and especially in an industry that's a 100-year-old fledgling industry? 

My definition is never. Healthcare is never. There are subspecialties and things that are understanding how capitalism works very well Dentistry and optometry are very good at that but other aspects no idea how to go to market, no idea how to do these kinds of things. So where did you start finding how to do it? And I particularly want to be. I want to dig into who. Who was it that helped you get down this path from? There's got to be a better way to. Oh, there's a better way yeah, yeah. 

0:12:48 - Dr. Michael Nula

So, probably like most practice owners early on, you know, we go in thinking I'm going to start a practice and we're not thinking it's also a business, right? And um, we had a good problem. We took off the first. After 18 months. I look around and all of a sudden I had, uh, 17 members. So um, realized pretty quickly you know, this is a bona fide business and organization. I need to learn how to run the show. Who am I as an owner? And if I'm the coach of this team, who am I as a coach? What kind of coach do I want to be? And then what is this organization, this team, this business stand for? What's our identity and how are we going to do this? But I'm also pretty fortunate. 

My father's a 40-year-plus HR guru. I call him the Yoda of human resources really and so he was super helpful, helping me kind of focus and say you know, listen, you might want to start to go and get some training in business management. Very helpful with business planning early on and being a soundboard for ideas and creating some early on structure. And then I've got my mother, who was a long time high school Spanish teacher, so her influence really helped me see that I'm a teacher at heart. So, taking those two things there, I went on a journey and just started taking courses. 

I would attend workshops, read books, anything I could get my hands on, really to start to learn the business side of things. And it seemed like the more that I learned, the more certainty and confidence started to cycle in and then clearer I was on where we're going as an organization, as a business, and started doubling down on the things that work. And then that opened the door to this idea of like hey, we could go open another location. And then you do that and you do that well, and we could go open another location. We started getting invitations and it was sort of organically growing and scaling and it wasn't ever. If I'm really honest about it, that wasn't what I set out to do on day one. 

0:14:42 - Mark Henderson Leary

That's a good point. So you know, I worry sometimes when I talk about the entrepreneurial DNA, where people are sort of self self aware, self select, that, like you know, I'm going to run something, whatever it is. But a lot of health care founders, I think like a lot of entrepreneurs in general, kind of find themselves there accidentally maybe not necessarily accidentally, it's not maybe the right word unexpectedly, uh, maybe with some desire. But, like you know, here we are and like I didn't realize I was going to be this person and I got to make some choices. And so I do think that there's very often a fear, skepticism, of like I just want to see if I can survive. I, I would like to provide, I would not, I'd like to not kill anybody this year. I'd like to make sure the very vast majority of my patients are better off leaving my hands than they came in. 

The idea of having four or five practices seems absolutely insane to me right now. And then there is sort of like well, you know, actually I'm quite good at this, really like what I do here and maybe I could teach some people and and maybe there is a greater impact to be had if I, if I taught more than I did. That's right, which is a way to disorder sort of describe that. And I think it's sort of fair to reserve, if you're listening to this, thinking like hey, I'm just kind of getting this cold, start off the ground. The idea of 10 locations, that scares me to death. You know, like did you kind of have that same kind of mindset like 100? 

0:16:16 - Dr. Michael Nula

welcome to the club. I remember when I first started the practice it was, like you know, getting an idea of what was in the state and looking at like even a few practices and thinking, oh wow, look at this practice here, six locations. I could never think about six locations. You you know that sounds like unbelievable. 

0:16:30 - Mark Henderson Leary

If I can get one person to answer the phone properly. 

0:16:33 - Dr. Michael Nula

Man, right, you know, but it's like to go back to what you were saying earlier about winning and games and sports. I mean, like you play to win, which means you're going to take the court, the field, and you're going to put your best out there and you're going to get after it. You know, and ideally you're going to be so good to the game that the game will be good to you and you'll find a flow. And I, you know, I was always so obsessed with just hearing so much about patients and them getting a piece of their life back, feeling like they got high quality physical therapy, attentive, I guess, the way. I wish I got it early on out the gates and maybe had I had that approach, I could have gotten back to basketball sooner. 

So that was always kind of sitting there and continues today. So it was always like how do we, you know, share a philosophy, expand a philosophy? That is just we care so much about helping them get to the finish line, identify what that finish line is and do everything in our power to work together collaboratively, like really engage that patient. And that's empowering to the providers that we worked with through the years. That's something. Now that I'm, I find I'm working with practice owners across the country trying to install that and inspire that among their teams. You really be thinking about these outcomes that we want, not so much the minutiae details of how to get there. Just get them excited about like what's, what do we want to create here? 

0:17:51 - Mark Henderson Leary

So a hundred percent. So like when I and this goes to mindset a little bit I talked to almost well, I talk about this a lot and it is as an individual healer. That's a role and it's an important role and I'm not diminishing it, especially in the degree of commitment varies widely across specialty. If you're an anesthesiologist at some point you might be totally fine, never having to put anybody under again. You learn the craft and you're moving on. If you're a plastic surgeon, you might feel like, no, I spent 20 years becoming the best in the world. I could never totally step away from that. I'm still the very best. But there is a mind shift. That is, you know I'm changing the world in a very powerful way. One patient at a time, care provider or whatever, who are all doing it kind of at this next level capacity and maybe my contribution to that is raising the bar on the whole organization as opposed to raising the bar on myself as this individual craftsperson. And that mindset is sort of. 

I think it's really fair to choose either one. I think some people are better off saying you know, leadership's not my thing. In that way, management's certainly not my thing. I'm really the are better off saying you know, leadership's not my thing. In that way, management's certainly not my thing. I'm really the creator, the designer, and I really try to teach my leaders to esteem their other providers, that if that's their jam, you've got to praise them for it, because these individual contributor crafts people, artists, surgeons, whatever they're magical and they're the people whose names we remember for inventions and research and things like that. 

And so it's a different way of being magical and if that's, you go for it. But if you're more like well, I'd like to create a group and mentor all those things, then that's certainly where this conversation lights up. And so, with that in mind, what do you tell the people you coach about how to change their mindset, to get other people, especially the non-licensed folks, right? How do you get these everybody in the organization to be now lit up with that passion to get people back on the court, to get them back into winning shape? What do you tell them? What do you? Do you get really specific here? 

0:20:14 - Dr. Michael Nula

yeah, I, I love first connecting with, like, just getting to the basics of man. There was a time where you didn't know any of this stuff, like isn't it conceivable that, like, others can learn this too? And how cool if you could be the teacher for that, because you've also now had time to synthesize this, you know, and you could get this like distilled in a way that, like is really precise to that honors your vision for this or philosophy on this and um, and be to your point, be the teacher. I mean, then, now we're exponentially reaching with a way that we feel is the right way. You know, because you got a lot of these people that think, like their way is the way, um, the way I do, it is the way people want it and I'm the best at what I do, and but you know, it's, it's a greater gift if we can try to pack, package that and share that. 

It's so unselfish of us really to think it could start and live and die with us all by ourselves would be unselfish. How do we, how do we share that? I know it sounds kind of cheesy, but there's a teacher in all of us. Um, yeah, and it's so rewarding to to then you get to inspire and influence someone else. Watch them kind of pay forward what you've, you've sort of learned and applied and think like man, look at what I'm doing here now they're going to go teach someone else and just the impact of that. 

So it's just finding a pathway that gets one looking more at how can I teach more rather than do all the doing. And if this is like a team, like, how do you share the ball, swing the ball, pass the ball, make the extra pass, um, and in those moments of pause, talk about what's going on on the court, on the field or, in this case, in the practice, like review the film, so to speak. Um, have those little touch point timeouts and do it in a compassionate way rather than point fingers, but like lean in kind of like in a helping way, so, or it's a wee thing yeah that's. 

that's where I find our conversations start to go, and because usually there's a lot of attention on how to effectively delegate, how to get others to get things done. And, man, well, I feel like I do pass the ball, and then they drop the ball, yeah, and then I have to go follow up with them, and then they don't even have the ball anymore. It's like, well, okay. 

0:22:14 - Mark Henderson Leary

Yeah, so, when it could be, on the metaphor, so like, I've worked with a lot of clients who have that exact same experience and specifically they'll say hey, you know, dr So-and-so just doesn't have the hustle. You know they seem more concerned with getting out of here on time. You know they're not really. You know we're trying to develop a specialty with this kind of thing. They don't seem to care about that specialty. Or, you know, don't they understand that if they see two more patients a day, it changes the, the measurables on and the impact, or a few more minutes with it, depending on what you value. Right, so it's this? Do they get it? Do they really understand that? And that's like the associates, or oftentimes at the partner, a little less at the partner level. You got other problems yeah but certainly the associate level. 

And then there's like down the front desk. You're like you know the person, you know these people, I get this, these people, they just don't care, they don't show up. They say they're going to show, they don't show up, they don't care and like how am I supposed to get my core values? And don't they understand. They're helping people you know live better lives and they're just like they're just phoning it in. What do you tell these leaders about how they have to transform? Or what do you tell them when that happens? 

0:23:22 - Dr. Michael Nula

Yeah, that's usually where I try to go and explore, like, is there any infrastructure for communication, any cadence of any weekly meetings, weekly Huddle something? Because how let's engage them and start to help this team feel like they're all contributing to build something together? And um, and then when you have those moments where you start running a narrative in your mind, how about just to ask them straight up like, hey, just curious, you know where's your head at on this, that or the other? Um, because I, you know, it's just my I found my mind wandering a little bit and, uh, I didn't want to start making something up that doesn't exist. So, you know, what's your view on this, what's your opinion on this? You know, what would you? Is there something you do a little different or something that you'd want to throw your, your sauce in there? Like we can make one great sauce together here? Um, doesn't have to just be my way and no way. So I mean, the more we can I don't know be a little vulnerable and invite the group to share. 

I think, that engagement goes a long way, and I think that's what today's workforce wants. So they wanna feel like they have a little voice, they matter, they're valued. I mean, how do we show our teams that they're valued? What kind of structure do we put in so it's like couples do date night or families do like we come together for a family dinner night? What are we doing in our practices to bring everybody together to share and have some voice? It's not just one voice doing all the talking and everyone else doing the listening. 

0:24:46 - Mark Henderson Leary

Yeah, that's exactly right, and I think one of the things I'm trying to not trying to I say that always trying to find the words because the formula is straightforward you got the right people in the culture, you take care of the people in the culture, you're gonna have great stuff. Obviously, there's more tools in the toolbox. You gotta get crystal clear on what outcomes need to look like, what numbers and metrics things are. The jobs have to be doable and winning has to be possible, and then we got a reward when it happens. But I do think it's pretty simple that if you you talk about that, this want to win as a value for you, if you're going to bring somebody on your team, one of your first questions before you let them work is has to be do you believe, as the hiring manager, that this person shares your passion for winning? 

Because if they don't, everything you do is going to irritate them and everything they do is going to irritate you and I think it's really important to say that at all income levels, at all education levels, there are people who want to win this, for example. That may not be your value, but you have to. You have to approach it with that assumption and you have to approach it. Approach it with that criticality of did you let somebody in who acts, who was wired to row in the opposite direction of you? That is not their fault, that's right. 

0:26:08 - Dr. Michael Nula

I love that you're bringing this up. I mean because that, yeah, that's one of our senior responsibilities. Like, yeah, to go back even further, it's like how, who are we letting on this, this team, who are we letting on the bus, so to speak? Do we have a qualification process? Is there any system to how we go ahead and qualify? If these are right, fit people right? Are we just hiring the first person that has a nice resume and seem like we had a nice conversation, but is there some, some more substance to it? To unpack to your point Like are they going to want to row in my direction? Do they get excited about the things I get excited about? Do they view you, know, pro, like showing up to work the same way I do? Like that this isn't just a job. There's something bigger going on here. 

0:26:45 - Mark Henderson Leary

Yeah. 

Um yeah, I think one of the kind of litmus tests on that is how much effort do you think you need to put into taking care of patients? Like, is it an extreme amount of effort that you were like we got leader that to take care of the patients? Don't worry about the patients, take care of employees. Does that make you want to throw up in your mouth or just run for the hills or run for the office and try to protect your patients from them? Because if you have people with the wrong values and the wrong things in the mind and you give them more fuel, you're just feeding the garden full of weeds. You are not going to get the fruits and you give them more fuel, you're just feeding the garden full of weeds. You are not going to get the fruits and vegetables you want. 

If, however, you have weeded well and you have planted proper seeds that can grow in those conditions, you take care of the conditions and that comes the bumper crop. So your people are the same thing, they share the core values, they share the purpose, then you just give them the love and they're right there, right they. You don't have to go find that your patients are like at home, right and so they're hard to find. Your staff are right there. You go, take care of them and show them the love, and because they're wired in alignment with where you're going, they just start doing all the work. And those people come in and they get this great experience and they leave and they tell their friends about it and just kind of. 

0:28:08 - Dr. Michael Nula

And that's how it works yes, yeah, that's exactly how it works. And then you got to have organic growth and you know you find a flow where it almost feels like, wow, we're getting busier, we're getting bigger, but it doesn't feel like it's harder work. You know there is like is it conceivable that, as we get bigger, can actually get a little easier because we've got more people that are sharing in the rowing and in the work and taking initiative and doing the things that we all believe in that are important For sure, and so I think my next question was going to be and I think it's a great, great cue at 15 locations what's different? 

0:28:44 - Mark Henderson Leary

You're doing the same outcomes, all that, people wise, leadership wise. What are we doing differently in a specific way? 

0:28:54 - Dr. Michael Nula

As the locations start layering in. The only thing that's different is we've got more people in leadership positions, more people having voice. There's no bottleneck where it's just like running at the top with just a few people. So I think, if anything, everything opens up more. You're doubling down on the systems that work. It's fundamentals right. That's what wins championships. You just it's so grooved in that it doesn't matter what location you go to. Everyone's going to enjoy the same experience. It's the same way of feeling received, routed through care and then all the touch points along the way. 

0:29:37 - Mark Henderson Leary

Yeah, I think you nailed it with. The systems are going to have to work at that point because in a small, five-person, total, single practice, you can hear and see everything, you can look at it. You know if it's working right because out of the corner of your eye or ear, you go oh, that didn't go right. Let me get involved. 15 locations. There are people who will be hired and fired that you will never even meet, let alone you overhear the conversation of like what's the what's the tone of their voice. And so you got to have the groundwork in place. The systems and process have to be there, and I my personal opinion, is you have had to create those leaders who can lead like you, lead in the right altitude. Right, I mean, they're not going to lead at the highest level, they're going to be able to lead a branch, lead a location in a way that you would if you were there. 

0:30:30 - Dr. Michael Nula

That's what takes a while to create. 

Yeah, and you start seeing the hats kind of spread out In the early years. Early years, you know one one wears a lot of hats and then maybe they have one or two other people at that senior leadership and it's a lot of multiple hats. You're doing marketing, then you're over here doing administration stuff, Then you're going in and doing the technical service stuff and, um, you know, as you get larger, with more locations, you start to have, you know, people in in areas. That people and knowing who's who and who's doing what, Not that people aren't communicating to know what's happening from division to division or clinic to clinic, but we've got people in places that are taking responsibility at the well-being and the day-to-day success of those areas and owning it to the fullest extent and with pride, glad to own it, glad to be elevated and take more responsibility, to contribute in a bigger way, and excited to teach and influence and share. Right, it's always like teaching, sharing you know what's it, the you know, reaching for new goals and teaching everyone along the way. 

0:31:33 - Mark Henderson Leary

Yeah, I think you're, I think it's right that's. That's the biggest shift as the organization grows. They're just. I mean, especially when you see the high-performance, highly-leveraged healthcare practice where there's only a handful of physicians and maybe hundreds of other people, there's a massive amount of support process, communication, guidance. It's critical to care and we kind of we very much have to have that licensed critical producer the surgeon, the doctor, whatever. Without the dentist, without it just doesn't, it doesn't work. But I think it's important to see how many more ingredients there are in finding and caring for a patient in a way that leaves them with the experience that they want and it matches our vision. You can't just do it with just the one person. There's so much more that goes into it. 

0:32:34 - Dr. Michael Nula

Yeah, and I love that. You mentioned leadership earlier and you know it's picking the right leaders but then it's developing them. You know, are there professional development plans every year. You know much like if we're talking about clinicians, what are we doing to advance our skills clinically, stay relevant, current with the science? I mean, as leaders, what are we doing to professionally develop those competencies that we lean on every day to be effective leaders? We lean on every day to be effective leaders. There are some things that we have innately, but it's that commitment to development. And so I see across the country sometimes that's a missing piece with they're growing or they want to grow or they're feeling stuck, but there's no development in people. 

0:33:15 - Mark Henderson Leary

What kind of things do you see there? Where do you go with that? Where do they go with? 

0:33:18 - Dr. Michael Nula

that, yeah, I see, one of the biggest hang-ups that I see that traps practices is it's communication breakdowns. 

You know, it's one of three things either there's misunderstanding, miscommunication or no communication. Sometimes there's some, sometimes it's all, sometimes it's one. But bottom line that there's these communication breakdowns. There's crucial conversations or clearing conversations that aren't happening and, um, it really starts to break down a practice or a company and and it's sometimes a ruin, it's like it's in the way of attracting talent or retaining talent. You know, and there's a lot of energy and attention and reaching right now about how to attract and retain talent, um, and a piece or an ingredient to that is what are we doing to strengthen communication in the workplace? What are we doing to open those channels of communication, reinforce psychological safety where we're having safe, open, honest, often communication so that we're working our stuff out on the biz, in the biz, right, not trying to figure this out on the weekend with well-intended family and friends, but what are we doing on the inside of the business, together with the people that are connected to the things that keep us up at night? 

0:34:28 - Mark Henderson Leary

yeah, yeah, yeah, I mean I think that's. There's a lot to that and more often than not in a health care practice in my experience we're struggling with, we've got a lot of the wrong people, just truly wrong people Don't believe the right things. We had some people who were affordable and available, and I've seen that all the way, not as commonly in partner, but I'll see it in associates man. I will see like, yeah, we needed somebody to fill the lane and it's like man, they're hard to get rid of, so think that through. But and it's like man they're hard to get rid of, so think that through. But you got to do it and we get there, and so that's a big factor. 

But then I think you flip it around Like if you're the practice founder, you're not the wrong person, you're just probably not to be doing that. So that means one thing you got to grow, we're not going to replace you. So what? You know, how much development do you put in that person to say, hey, I know you think you're conveying high standards of excellence, but I think your staff hears it, as this guy's not nice on any level or he's extremely um, I don't know what's the word I'm looking for, but just not fun to work for and that can happen sometimes. 

0:35:44 - Dr. Michael Nula

I'm hoping they're not thinking that if the practice owner's trying to introduce some professional development to help everybody kind of advance their game and, you know, up their game, it's just how they approach work and having the tools they need to deal with today's complex patients and today's workforce. I mean, it's different times. We're evolving. There's different needs, different motivations, different things people want from work. They want some more flexibility, for example, they want to have more voice, they want to feel like it's more than just a job. What are we doing to, you know, put systems and support in place and people outside of the owner, um, because sometimes there's, there's layers, uh, that one's not willing to let their guard down with. They're dealing with the owner of senior leadership. So what are we doing for this, for lack of better words, like middle leadership, or see um like lead or um, you know uh. Supervisory like lead or you know supervisory type of support. 

0:36:41 - Mark Henderson Leary

So I just had I kind of had a thought, because I pushed the point a couple of times and your response led me to believe that I was kind of off on what you're experiencing. I wonder in physical therapy if there is a little less intensity around I mean just extreme outcomes like there is in the surgical worlds or even in ophthalmology, where there is a higher level of pedestal for surgeons and doctors, where the egos can run away and expectations of that standard of excellence can be kind of out of control. In the PT world do you have a larger? I mean, most of the folks show up kind of humble like hey, how can I be better? 

0:37:21 - Dr. Michael Nula

I'll teach them Great, great point. Yeah, I think there's the same creatures live in physical therapy, yeah, so people that are open and humble. And then there's others that you know, they, you know legends in their own mind, as we like to say you know, and they're kind of know it all and got it all figured out. And yeah, those people live. They're hard to approach, they intimidate others, but I think I can go out on a limb and say all of us in the physical therapy industry care a ton about producing high value outcomes. 

I mean, we didn't get into this field to just go through the motions, so there's definitely a standard of care and we're looking at each other through this industry and knowing who the ballers are that are in the top echelon and then who are the ones that are just going through the motions, and that's whether they're physical therapists or organizations, practices, et cetera. And the high performers want to be connected to the high value places. There's no question and this I'd like to think in every industry there's going to be a small percentage of professionals that aren't in it to win it, but the majority are you know, yeah, yeah, interesting stuff. 

0:38:30 - Mark Henderson Leary

So we covered a lot of ground. What did we miss? Anything you want to add to the conversation before we? 

0:38:34 - Dr. Michael Nula

before we wrap it up, I think we covered a lot today too. I'm feeling good, yeah, thank you. 

0:38:42 - Mark Henderson Leary

Well, I appreciate it. Thinking about healthcare as an entrepreneurial profession, which not everybody does, I do. What's your passionate plea for anybody who is leading a practice, trying to grow a practice? What do you, what do you want for them today? 

0:39:02 - Dr. Michael Nula

you know, we just want people to care so much about helping other people and you know, um being part of building something special together. You know, trying to create impact, trying to create some, some legacy. Um, you know, and just approach it as a pro, not as an amateur. You know, with whatever we commit to doing, you know, put pour all yourself into it. Um, you owe it to yourself and you owe it to others. You know, um, I think it's a special time to be in health care right now. 

I'm, I'm energized, I mean, I'm on this, you know, season mission, whatever you want to call it, to help practices gets. You know, kind of figure out where you're at and where you're trying to go and what can I do to help you get there. I I see a time where collaboration is power, it's strength, in a time of, like, evolution and complexity. And, um, it's a time to join forces and work together and find, maybe, some some creative and new ways, innovative ways of how we approach things, but still honor the fundamentals and the basics of what we do and not forgetting at the root of what all of this is about. I mean, we're in the health business, we're in the service business, we're in, hopefully the healthcare business, not the sick care business. We're in, hopefully the healthcare business, not the sick care business. 

So what more energy can we put into proactive care, empowering today's patients, empowering society to do more for themselves and have the knowledge and the wherewithal how to navigate today's complex health system and reach for resources when they need it, rather than go to the web or well-intended neighbors and sometimes the wrong sources. But start building your resource list, um, and do everything you can to be healthy. You know it's, it's the greatest wealth is health, man. You've it's. It's what better way this society is going to function if we're all healthier, moving better, etc. 

0:40:57 - Mark Henderson Leary

Yeah I can, I couldn't, I couldn't agree more. I mean I'm aligned with everything you said. I mean the massive value. I mean the least valuable healthcare organization I work with is healing people for a living. It's a pretty awesome value. They're something better in their life as a result. 

And the idea of collaboration and there's so much to be done together. And the idea of collaboration and there is so much to be done together. And the idea of there's no competition that's not what this is about at all. There's a massive value chain of helping somebody with what you do and get them to the next person and help them with what they need, and how many millions of people they address the health thing. That's so critical. But they let the other ones sort of sit there because they don't have a better way to deal with them. And creating this collaboration and working together and the power that can come from that, I think, is just so amazing. 

I think we're absolutely I mean I really couldn't be more excited about what is transforming and what's happening, because we just keep getting more and more entrepreneurial leaders into the healthcare space who have more and more realization that the field is wide open, which has a drawback too, because there's a lot of experiments yet to be run that will fail, and so that's the frustrating part when it's wide open like that, there's not as many role models to copy, but there are starting to be some and there's lots of innovation happening. 

And, like I said, this is hundreds of years or 100 or so years of an economy that's never really tried to be capitalized, that we'd never really figured out how to deliver laser-focused value to a well-understood customer at a very valuable price. And people are starting to do that a little more every day and it's transforming how people buy. And there's lots more transformation to be done. But, man, I just love helping and being a part of it because I I think it's going to yield exponential benefits in my lifetime and even more in my kids and grandkids I'm with you. 

Couldn't agree more well said well, so if somebody wants to find you, uh, how do they? And they'll have details in the show notes for any of the hard to clicks, their type stuff. But what's the simplest way? Somebody could just look you up real quick. 

0:42:58 - Dr. Michael Nula

Yep, they can go to my website nulatrainingsystemscom, or they can reach out and email me, mnula at nulatrainingsystemscom. 

0:43:06 - Mark Henderson Leary

Nula N-U-L-A trainingsystemscom. That's right. Yep, well cool. Thanks so much for the time. I love the conversation. Could have done it all day, which is so often. It's one of the gifts of this podcast getting able to talk with people who have that shared passion for entrepreneurial health care and leadership and making a difference. So thank you for taking some time to be with me on this and put this out on the internet for people to listen to us jabber on for 45 minutes. 

0:43:32 - Dr. Michael Nula

Yeah, thank you, mark. I appreciate being here today, so, thank you, awesome, thank you. 

0:43:37 - Mark Henderson Leary

All right. So to the listeners, that's our time for today. If you found this valuable, please give us some feedback on it. If you think someone else would find it valuable, please get it in their hands. 

This stuff does not float around the internet by itself, much to the contrary of what people might think. Same thing for the likes, subscribes, shares and all the comments and feedback. That stuff does not happen without you getting involved and taking the initiative to do it. So we love every single piece of that that comes our way. So don't forget, by the way, that if you are stuck, if you feel like Michael can help you with something, please reach out to him. If you feel like I can help, please reach out to me. If you are stuck in trying to create that practice that is thriving in the sense of a great culture that you love to be a part of, and everybody in the organization loves it, with patients who love it, and it's giving you the life you deserve. If you're stuck, don't stay stuck. You do not have to stay stuck. Reach out, get some time with me at practicefreedomcom slash schedule. Love to hear from you. Other than that, we will see you next time on Practice Freedom with me Mark Henderson Leary. Thank you, sir. 

0:44:46 - Dr. Michael Nula

Thank you, that was fun. 

0:44:50 - Mark Henderson Leary

Thanks for doing that, for sure I had a lot of fun as well.

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