Next Level Pros - #147: Losing $50,000 Every Month to $23,000 Profit in 60 Days / Increase Profits / Next Level Pros Podcast

Episode Date: May 20, 2025

Welcome to a new episode of Next Level Pros! In this engaging discussion, Chris Lee and Trent Lowenstein share the turnaround story of Amber's podiatry clinics in Portland, Oregon. Designed for medical practitioners struggling with profitability and business owners looking to scale efficiently, this episode provides actionable insights to transform your practice from running in the red to flourishing in the black. Learn how Amber went from a net operating income of negative $144,000 to a positive $23,000 in just a few months by joining the Next Level community, focusing on key metrics, and implementing strategic marketing initiatives. Discover the importance of staff accountability, the power of knowing and tracking key metrics, and how to effectively budget your marketing spend to fill up your practice’s calendar.Highlights:“Previously none of our employees knew what it meant to be successful.”“When you can measure something, you can control it. Before, there was no visibility—now we know our break-even, our gross margin, our average revenue per visit. That’s when it gets fun.”“It’s scary to spend money on marketing when you’ve been in desperation mode. But the opportunity cost of not spending is bigger.”“Nobody loves your business like you do. Everyone else gets paid, and the entrepreneur goes home wondering how they’re going to make payroll. That’s why alignment and incentive structures are so important—so your team starts pushing the wagon with you.”Timestamps:00:00 Introduction02:25 Turning Point: Joining the Community04:40 April's Success and Key Implementations08:50 Clinic Capacity and Staffing Issues14:24 Compensation Structures and Recruitment31:38 Marketing Strategies and Cost of Acquisition37:16 Addressing Marketing Concerns and Repeat Business40:16 Opportunity Cost and Scaling the Business49:44 Improving Front Desk Operations and Employee Incentives59:06 Exploring Marketing Channels and Strategies01:03:20 Conclusion

That sounds scary, Chris. One problem is you do not have visits. You have a cost of marketing, a cost of acquisition that scales, and you have twenty three thousand dollars extra from this last month. The best advice I could give to you is spend twenty three thousand dollars. That sounds scary, Chris. Can I give you a recommendation there? Yes. Are you going to tell me not to do that?

Don't do it. Are we really? Yes. Are you going to tell me not to do that? Don't do it. Oh really? Amber, thanks for joining us today on the show. Yeah, thanks for having me. Excited to have you. So Amber, can you give us a little background? I know you own podiatry clinics and can you give us a little bit more color behind that?

Yes. We own three locations of podiatry clinics in Portland, Oregon. My husband is a podiatrist so he's one of our doctors. We have two other doctors in our other locations, clinic manager, billing manager, and then staff. So you've got a lot of interesting things and I'll just like kind of point them out and then we're gonna dive into them. So like what one up until you join the Next Level Community, you were losing money and we've seen some really cool things and we're gonna talk a little bit about that, how you've been able

to turn that around, make some money. But yeah, so you've got some really, really cool things going on in the business. Can you give us like, give us a little bit more color. So you joined the Next Level community back in, was it February? I think February, yeah. Okay, cool.

And up until February, what was taking place in the business? So it was, it's me and my husband running the business and trying to figure it out without any idea of what we're supposed to be doing. And so it was just, it literally was like fighting fires every day and trying to, I guess, you know,

I listened to like a lot of podcasts and so I thought that I knew kind of what I was talking about, but I really just had no idea. So we weren't profitable, no accountability in place, just like kind of a disaster. Yeah, I'm looking at a P&L from January 1 to March 31st. It looks like you guys had a net income of negative or a net operating income of negative 144,000. Yep, that's about right.

And so obviously that hurt cash quite a bit. Yes. I mean, yeah. Then at that point, it's like desperation mode. You have no room to invest in marketing or anything. Yeah. And so around this time, while you're going through this cash crunch, I believe you had reached out to me or how did we get connected? Yeah. So I heard you talk at a Kyle Mallian event. You didn't pitch anything.

You kind of just talked about basic business principles, life stuff, and I loved your vibe. So I followed you on Instagram. And then, you know, kind of during this, at some point you started talking about the community. I previously didn't even know that you had a community. But it was your AI, you were talking about like AI tools and how to incorporate AI in your business. So I reached out and. Yeah, awesome.

So, so I know that was around around February. And so during the at this point, you're you're negative cash flow. You're you're struggling, you're listening to different podcasts, trying to figure it out on your own. Like, one, why would someone in a position like that even join our community if one you can't even afford to pay your own bills? Why Why would you fork out money to join? And I guess walk us through what you had to overcome to be able to make that jump and what it's looked like since then. Yeah. So I think that we knew that we were going in a bad direction and so we had to do something

drastically different. And education has always kind of proven for me to be what I am. I love educating myself. And so I wanted to be in a community with someone who had been there, done that. You talk a lot about your bankruptcy. And I knew that you were in the hole and you got yourself out of the hole.

And so I was in the hole. And I could either try to figure out how to get out of it myself or speed up the process and follow in your footsteps. So it was really scary. I mean, it was a heavy lift for us. We took money out of our HELOC in order to join the community. We were super negative in the business, but I knew I was going to go down a worse path

if I didn't do anything. Hey guys, it's Chris. Hey, a lot of you leave comments asking for help. Do me a real quick favor. Shoot me a text at 509-374-7554. That's 509-374-7554. Shoot me a text. I'll answer and help you with whatever you need. Don't worry, I got you back. Let's go back to the show, baby. So fast forward. We're sitting here on May 6. How did the month of April close? April was fantastic. We're positive $23,000. Let's go. It's exciting. It's wonderful. So

you go from essentially losing $50,000 a month to positive 23. That's a $73,000 swing. What were some of the main things that you implemented over that time? And then once you answer that, we'll dive into more of like, okay, what can we do now? What is the next big moves that we got to take? But yeah, what were some of those key things that went from negative 50 grand to positive 23? Yeah.

So accountability of our staff members was probably like the biggest driver. So previously, none of our employees knew what it meant to be successful. We didn't have those key metrics in place. That contributed a lot to the chaos of the like day to day in the clinic. We had some AR issues also that we kind of figured out and then marketing. We were doing no marketing and so we started implementing marketing strategies and yeah. Yeah. Awesome.

Awesome. So, you know, one thing I remember from like when you were considering joining the community was just a few questions I had about your business and they were around what we call impact metrics, which are our version of KPIs. And I remember clear as day that you're like, I don't know that. Yeah. You're like, I don't know that.

And like today we're sitting over some metrics that are obviously when you're talking about holding these people accountable, it's really what I mean holding them accountable to these type of productivity, right? Yeah. Yeah, we jumped in hard to the metrics immediately with Trent. I think knowing the numbers was one of the first things that we clarified. So that was huge. Yeah. I mean, I'm looking at some things like, okay, what is your break even, right?

$100,000 a month is kind of what we call the nut that you have to cover to be able to start making money. Understanding like your gross margin of 95%, that your average revenue per visit is $250, what your total visits were last month versus this month, that type of thing. All these metrics are really where it becomes fun to be able to pull the levers

and really just understand the game, understand the rules, understand the logic, understand when I do this, it results in this versus just kind of shooting from the gut or from the head. Yeah, those numbers were non-existent before I started. I mean, we had no idea. I mean, I think even revenue per visit is a brand new number that we just came up with not very long ago. Yeah, that's amazing. We always said like, if you could measure it, then you could control it. So her issue was she couldn't measure it and she couldn't control it. There was no visibility and now that you have your chart of

accounts dialed in, you're in a lot better position. So Trent, when you say chart of accounts, can you explain to the viewers more of what that means? Yeah, so on your profit and loss statement, you have descriptions usually on the left-hand side or almost always on the left-hand side that are the actual items that you are, the descriptions of the items that you're spending. So, like materials, direct labor, your insurance, your rent, your operational expenses, and having a clean chart of accounts where you can clearly identify sections where you should

be spending a certain amount, like marketing as an example, what's the marketing spend, help you gain clarity in your business so that you can protect that 25% net profit of your business. Yeah, so like previously things were not necessarily in the right buckets. We had way more buckets and then there was no consistency as to like this always goes in the marketing bucket and we've even since dialed in deeper and have multiple different types of marketing buckets so that we can really see like, oh, I spend a dollar in this and this is my return. And that's all brand new.

So one thing I'm not seeing on here, and I'm interested to know if you know about your business as far as like capacity, do you know your current like capacity metrics? Yes, we are under utilizing all three of our clinics drastically. So yes, I think we can see, let's see, a full day of- 24 patients. 24 patients. And how many days a week are you open right now?

Yeah, so that's another problem. So depending on the doctor and if they do surgery or not is how many days they're in clinic. So we have one associate who's non-surgical but she's in clinic four days a week. She's spread out throughout the three clinics. But she's only ever in four days a week. Right and that means that one of our locations is, all three of our locations are fully staffed, but like one of them is only open two days a week seeing patients.

One of them is open five days a week seeing patients. When you say fully staffed, are they fully staffed the other three days? Yes. Even though you're only seeing patients two days a week? Yes. So sometimes the medical assistants travel with the doctors, but there are several days where we have a front office and a medical assistant sitting in an empty clinic. Hey guys it's Chris if you're finding value in what you're hearing go

ahead and like and subscribe that way people just like you can find this content for free here on YouTube. Now let's dive back in the show. Right yeah so it's it's interesting so you have the capacity right now, like from a facility standpoint to have 24 visits a day? Per clinic. Per clinic. And if there were more doctors at those locations, could you see more than 24? One of our clinics for sure, we could see 48, maybe three times that. We have enough exam rooms.

The other two clinics, we really only have capacity to see 24 patients a day. Yeah, because I think it's important, you're in the capacity game. What do you have capacity to fill and what percentage of capacity are you hitting? And so when you're talking about that you have like a clinic that you have two different rooms and you could be doing 48 a day, right?

Like the only limiting factor at that point is what? Just volume of getting to the right patients. Volume of patients, but then also a doctor, right? Because you don't have a doctor. Oh, yes. So the first limiting factor would be a doctor and the second limiting factor is like getting to capacity. We have the doctors are sitting and not seeing 24 patients.

So really our problem right now is the patients. So if like what I'm looking at these numbers right now, so you have your three different doctors, your husband, Dr. Menao, which in March did 160, Masuo did 94, and Goff did 153. And then that was in March, and then you look like month over month, you had about the same type of visits from Meneo. Mizzou increased from 94 up to 130, so that was almost a 50% increase. And then Goff was about the same. And so really, if you just take 160, and you said the average clinic's open four days a week? Well, no, they're all open different days a week.

One's open four, one's open five, and one's open two. Okay, let's call it four. I guess the best way to look at it. And so if you're four days a week, right, and you're times 4.3 weeks a month, right, you're 17.2 days essentially a month that you're open. And a full capacity times 24 would be 412. So I think an easy round number would be like max capacity

for one doctor four days a week would be 400 visits. Yeah. And so if you're just comparing the numbers against that, like your top producing doctor is doing 160, right? And you said, Goff, she's full time not doing surgeries, right? Correct. So like her only metric is this, right?

There's no other metric. And so essentially, and if they're seeing 24 a day, are they still able to have breaks and lunch? Is that sustainable really to hit 24? It depends on how much they talk to their patients. For patients, or 24 patients a day, it's 15 minute appointments. And so it would be busy. I mean, in order to see a patient in 15 minutes

and then chart on that patient, the charting is really where it squeezes. And I think that like AI scribes could play a big role. There's a lot of efficiencies that we can pull in there. What's the average time that you expect the doctor to spend with the patient? It depends on the doctor and how much they talk. And it also, it really depends on how complex whatever they're coming to see. So- I like to chit chat with my doctor.

But an average of 15 is doable. 15 minutes is like, that would be more than a lot of doctors spend with their patients. Because my understanding, the doctor isn't the only person seeing this patient, right? Like they have somebody coming in beforehand, checking them in, a nurse type. Yes. So 15 minutes is with the doctor. Right. So it's not the full appointment time.

Yeah. Right. And so, you know, it's interesting because yeah, if you look at, look at Goff, she is essentially running at 40% capacity. Right. And so there's obviously a huge, huge opportunity because, and then how is their compensation structured? They're different. So Mizzou is on salary.

Goff gets a percentage of her collections. Percentage of collections, okay. And what's the percentage of collections there? 28%. 28%, okay. So essentially what you're leaving on the table is 72% because outside of that, you really, do you have any variable costs,

any like with an appointment per patient? Ooh, that's a good question. Not from like a, not really because we don't really have cogs. We sell orthotics and so that would be something, but other than that- That's additional opportunities. That's not from like an appointment. Yeah.

So right now, no, I mean we could see that many. We have the staffing already in place. So it's interesting to look at it, right? So if you increased capacity by 10%, going from 40% to 50%, right? So that would be another 40 visits a month for Goff times $250 times 72%, right? Because she would be getting the other 28. So that would be an additional $7,200 a month

just by increasing. Now if you were able to get them, so that's for every 10%. So to be able to do that times six, because essentially to get her to full capacity, like a full capacity clinic would look like an extra $43,000 a month net. I know, it's crazy. I know these numbers.

Right. So it's interesting to look at just what that is. And then you got somebody like Mizzuo, they're not getting paid for additional production, is that right? Correct. He's motivated though. He would work harder even if he wasn't financially. Why? Why would he be motivated to do that? He is, I don't know how else to. Is there any other incentive plan or production structure? No, but kind of the thing with him was is that in order to get him to come on, he needed a salary because if he was going to be production based, he would start at zero.

And so what's his salary a month? It's 135 a year. Okay. I don't know. Okay, so yeah, 135, but then that's not fully burdened. So probably another 22%. That's like your education fees and all the other stuff. Just everything that goes into it.

Oh, right. So I'd say he's about 165 grand, which puts him. Maybe closer to like 200, because we pay for his malpractice insurance. Okay. So I would say like he costs like 200,000. 200,000, got it. Okay, so which means your break even with him is $16,666.

And so, which means, so is Goff just completely 28% of visits? No salary? Yes, but she is, she's working hard to get additional benefits like her malpractice insurance paid for. And continuing education. Continuing education. So we're, Trent and I are talking about that contract

after this. All right, so no, but this is interesting to look at like, okay, at what point is Mizzou cheaper than golf, right? Right. And so have you calculated this? No. Oh, let's calculate. Okay, let's do it.

Let's do some math. This is good stuff. Okay, so Mizzou is making 28% of 250, right? She's making essentially $70 a patient. Is that right? Golf, yes. That's correct essentially $70 a patient. Is that right? Goff, yes, that's correct. So, sorry, I said Mizzou, I meant Goff. Yep, Goff is making $70 a patient

and if Mizzou was on the same exact structure, visiting, he saw 130 patients, he would have made $9,100. Instead you paid him $16,666. Yes, I'm painfully aware. Okay, so if you were to pay golf fully at 400 patients, right? Like if you got golf completely cranking,

you would pay golf $28,000. Yes. Okay? So essentially your break even a win, golf actually becomes more expensive. So you take his salary divided by 70, is that $238 or 238 appointments a month. Does that make sense?

Oh, totally. Yes. So essentially, Goff will be cheaper all the way up to 238 and then she becomes more expensive. And Mizzou will be more expensive up until they hit 238 and then he becomes cheaper. Right, okay. Makes sense?

Yes. So which, I guess, if you're looking at these compensation structures, which one would you rather have? I would rather have a percent of production. Yeah. Because it limits our liability. Right.

And I think it motivates them as doctors to see more patients, to a certain extent. Exactly, and, but my question would be, And I think it motivates them as doctors to see more patients to a certain extent. Exactly. And, and, uh, but my, my question would be how hard is it to recruit people on just purely a percentage? It's hard to get them stuck. Like he will, Mizzou will switch over to a percentage probably next year after he's established himself a little bit.

It's very difficult for someone to walk in the door and get paid zero dollars for at least 90 days because that's how long it takes to collect money. It's a tough stuff. So is there a better structure than either one of these combined? I was hoping that you would tell me what that was. So I do believe there is a better one. Yeah, I'm sure. I was just wondering what your thoughts are. Trent and I have talked a lot about profit sharing, about percentage of production. I think there's a lot of different ways. I don't know if we need to answer. I mean, from a recruiting standpoint,

like a base salary is always going to be the strongest way to be able to bring in more applicants or more potential people that you can select from, right? And so, I mean, what you're doing with Mizzuo is probably overpaying from a standpoint where you could probably come in and say, hey, look, we will give you a base of, call it $80,000, and then a percentage of production. So I'm just gonna throw this out there, right?

Like if you were to do, because right now you're essentially, if Mizzou continues doing this exact at 160 times $70 times 12, right? You're paying her $135,000 is, and are you giving her anything else besides that or is it just the 28%? Currently it's just 28%, but we, she's asked for-

For additional. She came in as a part-time doctor and that's why we did that percentage and she kind of ramped up since then and she wants to be more considered full-time. So that's why she's renegotiating her contract. Right, which is totally understandable. So I'm looking at something like this.

I'm like, okay, what if I were to provide like $80,000 base, right? And that way I attract more applicants in, and I'm just shooting from the hip. I haven't even studied this right now. Okay, we'll see if the math maps before I write it down. We'll see if this thing maps, right? Like, so if I'm looking at, okay, 80%,

but then I could do maybe a 10% profit share. So then let's see where that would get us. If I was at 160 times $25 times 12, right? So yeah, that would actually put this actually mess a little bit. So that would put us at $128,000 versus $135,000 what you have it currently structured at. And I will say like 160 is a low,

I would say that 200 visits per month is very comfortable and where they should all be at least landing. What is the math at 200? Yeah, so, and that's the beauty of what you have. So if you have 200 times, that would be $25 a visit because you're paying them 10%, you following me? Yep.

Okay, so that would be an additional $5,000, okay, times 12, 60. That would put her at $140,000. Yeah, so there you go. That's, that's easy. Now, but is $140,000 for a doctor as a podiatrist a salary that's desirable? It's not very competitive. It's not very, what's a competitive rate?

So the hospitals are bringing in new doctors at over 200,000. They work them to death. And then when you retire in 30 years, you make $205,000. And so there's like an education piece here of if you want to make more money, you got to produce more but it, but it's not very competitive, just being honest. So I agree, there's a give and take, and I think there's a key thing to be learned here just for anybody that's watching the show is like,

money is only one aspect to the solution. Like they got to be able to make enough money, right? They got to be able to pay their bills and see opportunity and everything like that. But there's a lifestyle aspect, right? If they're working at a hospital, being worked to the bone, how many days a week are they working at a hospital? Five.

Five days guaranteed. Oh, for sure. And here we're talking about like a four day work week at capacity is 400. Yeah, yeah. Right? And so, so like we're not even talking about like, like under this situation of 200 a month, you're still only hitting 50% capacity.

So you're still sitting around, you're still not, you know, like running around crazy and you're working four days a week. Like you've got some benefit there. Yeah. And so like, okay, what is this happy medium of where we can create this structure? And maybe the base needs to be higher. Maybe the base is $100,000 versus like, I mean, essentially, for Missoula,

you have a base of almost 200 grand because you threw in all these extras, right? Right. So if you're at 100,000 with like a 10% profit share, then there's this additional incentive to be able to go and get it, or maybe even lowering the base back to 80 and bumping up the profit share 12%, 13%,

or something along those lines. And that's not even profit share, that's rev share. There's also the opportunity to do profit share, right? And you understand the difference? Yeah. Yeah. You know, profit share would be even more important, right? Because now once you're covering all your basis

and actually making money, if they have the ability to share in that profit of that one clinic or that one facility, like that can be highly motivating. That would be great for us because our big thing is limiting our liabilities and so if they have some, if they understand what they have to do to break even, we did a pro forma of 200 visits a month and Goff would make less money profit sharing

at 200 visits a month than the 28% collections. Is that right? Yeah. Yeah, so they would make less money out of which one? Profit sharing. Profit sharing at 200 a month versus making their 28%. Yeah. Right.

And so I think one of the key things here is like understanding, like although you want buy-in from these people and you want them to run good profitable business, I think one of the key things here is understanding, although you want buy-in from these people and you want them to run good, profitable business, you also don't want them to have to worry about that. This is kind of one of the things that we talked about off set, right?

The fact that sometimes as entrepreneurs ourselves, we want everybody else to be entrepreneurs. And I don't know about you, but I've been burned a lot in that type of situation having that expectation. Totally. That's been a hard lesson for me to learn that people don't think the same way that I think. It's kind of mind blowing.

Yeah. Trent, have you ever had that type of experience where you're like expecting somebody to operate like a business owner, but they're not? Absolutely. Yeah. Share with us. Well, nobody loves your business like it's your business, right, everybody's just, they get the paycheck, they go home to their families and nobody thinks, hey, this company doesn't have any money.

Right. Right. They don't care. So everybody else gets paid, the entrepreneur goes home and goes like, what do I do? It's just like you're working for everybody else. So when there is an element of profit sharing or equity or any of those options, the employees feel a different sense of ownership

that they're also pushing the wagon forward. But some people don't wanna push the wagon. Well, then you have your choice to work with them or not. But if you wanna recruit A players that wanna push the wagon forward, that's who you want on your team like Dr. Tim your husband shout out. Dr. Tim. What up? He does a great. He does a phenomenal job of Of getting referral businesses, right? He's always going out into the market

He's talking to doctors and he's getting those referrals those referrals have almost no customer acquisition cost other than coffee or bagels or Whatever. Dr. Tim is bringing. The other locations are not going out to do the referral business at that capacity and you're leaning heavily on a higher customer acquisition cost through traditional marketing channels, traditional digital, social, etc. If there was nothing else except that the doctors at the other locations had a different mindset to go acquire inexpensive leads through their referral business and bring patients in and they got to reap the benefits of profit sharing.

It's a different, again, it's a different mindset and it's the path to yes, it's the path to how are we going to make this work. Some other structures that I've seen in the medical world that work really well is like where you have a quota that you have to hit and everything that's out over and above that quota, you get a bonus for, right? That would be good. You're right.

And so, and essentially the way that you would structure it is like, okay, you look at like what their salary is and what the quota has to be to basically compensate them at that. And then anything over and above that, you give them a spiff. And the reality is because you have really no, any cost of goods sold,

like every additional dollar collected, like you can incentivize them a lot. Right, yes. I mean, you could, I'm not suggesting you do this, but you literally could give them 80% of the revenue and you would still be more profitable past that quota. Totally. Right, because up until this point,

you're only hitting that quota, you're paying your bills, you're making your money, and so like, this is so important like in any business, understand your breakeven. Like once you're at breakeven, every dollar over and above breakeven is so, so, so important. And so I think coming up with something along the line that's creative where once they've hit quota,

they have this nice little bonus and it could come in patches for every five visits over and above quota, you get X dollars or whatever else. And so then there's even like stairs. It's not just like every single one, they get extra money. It's like, if I hit this and I get more and I get this, you know, type type deal and they're really pushing to make sure that those things are. Would you do that by visits or by dollars like collected? Well, the real, the real question is do the doctors have influence over the dollars collected?

If they sell orthotics, if they sell CBD, if they push for surgery. There's some ancillary stuff that they could do. Kind of. So yes, they could go and, you know, have a more profitable niche and they could say, I see like sports medicine, for example, PRP injections, the lifetime value of that customer is higher. So if they like niched down lifetime value of that customer is higher. So if they like niched down into something that was higher than they could. The more alignment that you can create with the business alignment, right? Like if the business makes more money on a certain product or certain service, creating

the incentives and the alignment with that is absolutely important. So that's the cool place that you're at. As long as you protect your 25% net profit, you have creativity to build up these step up programs that he's talking about. You know what your cogs are, right? You know what your expenses are. If the 25 is protected, like let it be creative,

let it be art. And then once you find out what art works, let it become science. So part of the problem is that we're not hitting our break even at these numbers because we haven't figured out marketing yet. Once we like once we are really breaking even at every single clinic, then it's easier for me to be like, oh, yeah, here's your incentive structure.

Do you know your current cost of acquisition? No, we know from PPC, we know how much it costs to get a phone call. The booking rate is a black hole still. We have an EHR, not a CRM, and so it doesn't track those types of metrics. And so we've been getting our front desk gals to start collecting that type of data, but it's still very much in the training process. Got it, got it. That was one of the metrics that we wanted to dial in

because she's spending an enormous amount of money on marketing, and you're getting all these referral businesses, and then the calls aren't being booked, for whatever reason, you can't move it forward. Do you have an idea of how much, so you said you do know your dollar per call right now? $50.

$50 to get one phone call? To get one phone call. Okay. I have to imagine that the booking rate should be extremely high as long as you pick up the phone. That is what I told Trent. And as long as when the person picks up the phone, they don't say, yeah, the doctor can't see you

for three weeks, we'll call you back once we have a doctor. That was a real life problem that we had. Right. Yeah, so- I mean, that's just money wasted. Right. I mean, based on what I'm seeing here,

you're operating at best, at 40% capacity, which means you should have openings tomorrow. We do. Right. And that's one of our marketing spiels to especially urgent care, so it's like we will do same day do. Right. And that's one of our marketing spiels to especially urgent care. It's like we will do same day appointments. Right. And they referring physicians love that because if a patient is going to an urgent care but

they really need a specialist it's easy for the urgent care to just say like call Pearl Fentanyl they will get you in. That has been successful for us. So when you when you say $50 a call, these are $50 for a call from somebody looking for an appointment. So this is for our Google Ads campaign. We started with $1,000 in marketing spend and got however, 1,000 divided by 50.

We got that many calls. And then we increased it to 2000 and it stayed. I just sent you that email. I was super stoked. Yeah, 40 calls. Yes. And so it doesn't always happen that way. I know, I wasn't expecting it to happen that way.

That's why I'm like, maybe we need to like pour more gas on this fire. I've been telling you that you're spending 5% on marketing. Yeah, I mean, the reality is if it scales at the exact same rate, you should have no budget. Right. Until you hit capacity. Capacity is the only determining factor of budget.

So like we started with a thousand, then we did 2000. We reran it for 30 days at a thousand, 30 days at 2000. What's the next jump and what's the timeframe? I mean, so here's the thing is how much can you afford to lose? Oh, to lose? Oh, I don't know. Well, 23,000 last month.

There you go. And so, this is the way I would look at it. If I have to imagine, okay, if I'm getting a phone call that I'm booking 80%, I have to imagine that. Right. And if I'm not, then it's some basic twists. Like I personally, I've never called a doctor and shocked. Right. Exactly. Correct. Unless they couldn't see you. Unless they can't see you. Right. But again, but that's, that's not shopping. Right. That's not, that's not shopping. That's not shopping.

That's being turned down by the doctor. Right. Right. And so, you're in the business where there literally is no shopping. It's a need, and if you can fulfill my need. Right. Right. And so, I gotta imagine 80% booking rate. So if I'm getting 20 calls per thousand,

which means I'm getting 16 appointments per thousand dollars, okay? That means our cost of acquisition is 1000 divided by 16. Okay? Now, this isn't 100% accurate because I don't know for a fact that it's an 80% booking rate, but I have to imagine that right now. That's my hypothesis is gonna be, as a scientist, I'm gonna say, look, this thing is probably going to book at 80%, okay? Because I have the capacity, I can see people tomorrow, the next day and the next day, right?

I've gotta be there, okay? So if I'm at $62, okay? That means, out of 250 bucks, my cost of acquisition is 25%. Okay, makes sense? Yep. Okay, so which means, how much is it going to take to fully get me to capacity?

Okay. Run that number. Yeah, so if I have full capacity is, let's say full capacity is 300 okay like because it's not but it like you can move it around and make it work or whatever so that would be 900 visits a month between the three clinics okay one's open five one's open two one's open four but I think yeah for the most part we can get to 300 average across per unit. Totally.

You there? I'm there. Okay. Now we have this last month you did 160, 290, 333, 433. So minus 433 equals 467 appointments to get to that 900 capacity times $62.50. That's your marketing budget. Okay, well, 29,000. We're almost there.

Okay, but what I'm saying is, okay, if you made $0 next month as a net profit, would you guys be able to survive? No. $0. Oh, $ dollars, yes. Right, not negative. No, zero is great.

Okay, if you broke even next month, okay. So you have, the one problem is you do not have visits. You have a marketing, you have a marketing cost of marketing and a cost of acquisition, that scales. And you have $23,000 extra from this last month. The best advice I could give to you is spend $23,000. Okay? That sounds scary, Chris, because do we know,

so we've hired a marketing agency. Okay. Do we know that that's the best use of our $23,000? Okay, where else can you spend money and make money in this business? Yeah, you cannot. The other thing that's important for your business is that it's a repeat business.

So your customer acquisition cost is offset by the amount of visits that the patient comes to see you. So that $62 customer acquisition on the second visit. Right, zero. Right, so. Now it's $31. And now continuously offset. Yes, so if you know that.

Oh, I see, okay, I get it, I get it. So if a patient is gonna come see you, let's say four times, it's $62 divided by four. And then on the next one, you make money on the page. So let's work through this, that is scary Chris, because I think it's important. Okay, it's important to address the real things that hold us back as entrepreneurs, okay?

It's not the numbers, it's the feelings, it's the mentality, it's the, right? Because like from a pure logic standpoint, you were losing $50,000 a month. Right. Okay. Yes. And you were like, that sucked, but you survived.

Okay. So if you went from losing $50,000 a month to making zero, losing zero, would you be okay with that? Yes. Okay. So, why would you be scared of zero again? Yeah, I guess I'm more scared of giving the marketing people our money and them not performing well.

But, which is valid, but, so, you don't even necessarily have to bring 23,000, here's the issue though. You paid $1,000 and you got 20 phone calls, right? Then you doubled it, cool, but you really only put $1,000 at risk, right? Like, and so like, what can you afford to put at risk? Right now you can afford to put $23,000 at risk, okay? You don't even have to do all 23,

but like, let's get a little bit crazier because the opportunity cost is what's killing you. So the fact that you did. It's like a full circle, we're back to opportunity cost. Yeah, we are 100% in opportunity cost. Because when we're at 400, what I say, 434 appointments, so 900, you have 466 appointments that you are, that's your opportunity cost. So not getting those booked cost you $116,000 last month.

Yeah, okay. Okay, so like that's what cost you. And that's not even at the 400 capacity, that's at a 300 capacity, right? If we add in 400 capacity, that's an extra $75,000. Yeah, yeah. Right? And so like literally you're somewhere between

100 and 190 thousand dollars of opportunity costs that is literally should be showing up on your P&L. Per month. Right. Per month on your P&L. So like are you more scared of potentially losing 23 thousand dollars or the fact that you're missing out on 120 thousand dollars every single month? Well, I didn't know about that part, so I wasn't scared. One of the scary pieces for you, I think, early on, like February, March timeline was that you're like, if I spent an enormous amount of money on marketing, but I'm not booking calls, but people are saying they're dodging calls and A, B, and C, I could see why you'd be afraid because, of course course you're spending money without the back end infrastructure

Having said that you've done and I just want to say to you and to everybody's listening. You're an amazing operator You've gone on there and really changed the way that the infrastructure the company operates You are doing one-on-ones with your teams. There's clear expectations. There's accountability So now that the infrastructure is right now now it's time to invest more into marketing. Yeah, the operations can handle it. And like, worst case scenario, okay, your cost of acquisition goes from 62 to 150 bucks, right? Like, you're only booking 30% of your calls, your systems are breaking and whatnot.

Even then, you're still making more money. Yeah. or what not, even then you're still making more money. Like for you not to cover your marketing spend would mean that you would have to only book 25% of your calls, right? Or somehow your cost per call just doesn't scale at all. But again, you don't even necessarily need to go to $23,000.

Let's take that 2,000 bucks and go to 10. And let's spend $8,000 more this next month. What does $8,000 look like for you? $8,000 divided by $62 a call gets you $62 a call, get you $62 a deal, get you an extra 129 visits this next month, which puts in another $32,000 into your pocket. And so by putting at risk $8,000, you're going to make an extra $32,000. It's like sitting with Ray Man.

I know. He's like, I love the numbers. I love the numbers. It's like sitting with Ray Man. I know. He's like, I love the numbers. I love it, I love the numbers. He's like that in Vegas too. He's like, can you see all the, can you guys see all the numbers? But like, but like that's- These are good numbers, I like these numbers.

But like this is the stuff that gets me like, you're sitting on a freaking gold mine here. I know, okay, yeah. You know, and you're like beating yourself up over like, oh, this guy's not working or I got culture issues or whatnot. Like, man, I would much rather be like, address this and then go address,

like this is science stuff that if you can get this down, opening a fourth, fifth, 50th, 60th, 70th clinic, all of a sudden becomes extremely scalable. Now you're sitting on a multi-hundred million dollar empire, all because you understand like the basics of these are my cost per call, these are my booking rates, this is exactly what my cost per appointment transitions, the average ticket, everything goes into it.

Now, when we say 250 bucks, is that 250 bucks that's collectible or 250 bucks that's billable? No, collected. Okay, good. I got you on that one. All right, good. 750, 750 bills, 250 collected.

That was another piece of the infrastructure that was broken early on where it should be doing all these jobs, but the money wouldn't come in for 180 days when it should have come in at 90. And we identified one of the problems was that the information in the system wasn't inputted correctly. So then the insurance company bounces it back, says, you need to redo this. You redo it with the proper information

and it starts the clock back at 90 days. Now you've solved that to a great extent. So this is with the billing codes. It's with our front desk. When you're collecting insurance information, if you don't collect it correct, then... Or if you collect it correct and don't put the right information in.

Right, like typos and stuff. And so now we are running reports that show, one, that it's even in there. I mean, there was a lot. There was just no insurance information put in there. And then we can go over it. And if there's a typo, we won't be able to see if it's correct or not. But there are some like glaring errors that were happening previously.

So our front desk, they're doing a great job of that. And they're getting now there we have KPIs and they're being held accountable with those weekly, which is they're all responding perfectly to it. That was another piece early on, where like everybody was busy, but nobody ever knew what they were busy with. People were just generally busy. And the question I asked you to ask your team was,

how do you, if I was to ask you, how do I know if you're doing a good job? Or how do I know if I'm doing a good job? What would they say? Yeah, they would look at me like you're crazy. Right. I have no idea. And now you can say, hey, I know I'm doing a good job because I have a 80% booking rate.

I have a 92% accuracy on A, B, and C. And we ask for reviews and we get this amount of views per month. And so those metrics empower your employees because they know they have fulfillment. They know if they're doing a good job or not. They know how to win. They know how to win.

Right, I mean, going back to video game theory, like if if they're doing a good job or not. They know how to win. They know how to win. Right, I mean going back to video game theory, like if you're playing in a video game and you have no like. Scoreboard. There's no scoreboard, no destination, no end of the level, right? Like you literally do not know what the point of the game is. Like you're wandering around aimlessly

and that's exactly how it works in business. People have to have a clear direction and way to know, am I winning, am I losing, how am I being measured? And then as the architect of the game, that gives you clarity and peace of mind that the infrastructure, the game that you put into place is gonna work, right? Absolutely.

Just kind of like going back in time, talking about like an 80K base, all of this stuff was very scary to me because I just feel like it's just a liability. But if we can, if we do spend $10,000 in marketing and that hits, then that's like way less, it makes everything less scary and more like we can just reproduce this thing and like... Right. Yeah. Right. And then you can go and track the right people and really they're no longer a liability,

they're an asset to the business. Right. Right. Versus where you're spending, so previously, like when you were losing $50,000 a month, how much were you spending in marketing? $100. Yeah. I mean, there was no, we had no marketing spent. And back then, what was your marketing strategy?

Was just hoping a prayer that you get referrals over? We did have, and we still do use her, a gal that like goes and like knocks on referring physician doors. So we still do that, and that does seem to work. But also somewhat of a hope and a prayer, right? It's like it works. A total hope and a prayer. You hope that they can bring it in. It's not very measurable. It's not scalable. Right? Yes.

Right. She may be good at her one thing, but you can't all of a sudden say, Hey, I want three more of her. Right. Right. Without having to go through a whole lot more training where you have like these incredible metrics like through Google, where it's literally just increased budget.

Right. Right. Yeah. And with the referral strategy, like what we're facing is that it's very doctor dependent. And so you can't just pull out one doctor and put in another one. Whereas with Google, like they don't know who they're booking with. And so, you know, whoever.

I love it. Yeah. I love it. And you know, it's crazy because you are in an industry where there's not a lot of entrepreneurs. And, you you know I am constantly frustrated in fact I've been I've been trying to I have an elective surgery that I've been trying to get done and I literally can't get a doctor

to call me back like like the health field is surprise it actually doesn't wild to me like I've been trying to do this for 12 months. Well what are you trying to get done? Can we help you out? Is it a foot problem? Not a foot problem. I'm trying to be able to not have any babies anymore. So I got a guy for that.

I'm sure you do. Dr. Tim's brother is a urologist. Oh nice, nice. But yeah, again, it is the craziest industry to me. In no other industry, you have people begging to be able to give you service, and people turning you away. Right, yeah.

Or not returning your phone calls. And so understanding that that's your competition, all you got to do is just play this thing like a game, and you'll be crushing it. So let's talk about that a little bit. Because one of our struggles has been, for our front desk staff, paying them enough so that we get. We're competing with the hospitals again at all levels.

And so minimum wage in Oregon is ridiculous. Probably same here. So they're wanting more money. They're not doing a very good job. Well, we have two new ones. And so, but we turn over front office stuff like crazy. So a couple things. One, up until now you haven't known your numbers.

And two, you don't even quite know your numbers. You don't know your booking rate, you don't know these things. Like if these people don't know how to win, you're not going to be able to retain them, right? And so, and if once they understand how to win, if you can create incentivization structures that actually create alignment with winning, right?

Like, hey, you maintain a 90% booking rate, you get X bonus or X, you know, based off of how many appointments we do. Like, I mean, these are people that you can, X bonus or X based off of how many appointments we do. I mean these are people that you can, you think about the two ends of the business, the front end of the booking and the back end of the fulfillment.

It's literally, your people that are booking are your salespeople because once somebody shows up to an appointment, they don't need to be sold. Unless they're being upsold on a product, that's your doctor, right? And so the same way as you'd incentive in a normal type business that you incentivize salespeople,

you can incentivize these front end people. So now all of a sudden you don't only have to attract in minimum wage type talent because think about it, we talked about if you got up to 900 appointments a month, how much more money is that? I can't remember. It was like $112,000 a month. Yeah.

Okay, with $112,000 a month, you think you can carve out a little bit for three front office ladies? Yeah, totally. Right? Yeah. Right, and so, like, I mean, an extra $1,000 a month to each of those people that are running that would be? Yeah, it'd be huge.

It would be huge. I mean, that's, and that is a small fraction. Now there's that option, but then the other option is like artificial intelligence. Like, I mean, AI answering service, not like your, you know, 20 years ago AI, which is like press one, press two, book this, did I hear yes, did I hear no?

No, it's like literally AI voice is in a position now where they can have a conversation and be structured exactly how to get them booked. And so I think those are your two options and things, like really understand your opportunity costs with these people. It's really easy to go cheap on them because you're like, oh, they're not doing anything.

They're like, they're punching numbers into a computer and they're answering phone calls and just doing that. But understand the opportunity cost. If they aren't booking, so one, you've got to be able to measure them. And if they're not performing to those measurements, how much is that costing you? The interesting piece, to use Chris's example of his special appointment that he's waiting on surgery for, if that CSR were to continuously call him, if that was the metric, like, hey,

these missed calls or missed opportunities, and they were reaching out to him, he would of course say yes. He's still shopping for it, right? Oh yeah, if I get a call from a doctor, a text from a doctor right now, hey, you still wanna get that surgery done, reply, why would, yes for tomorrow at three, yes, done. So that's the downtime that they have because again, we've established that you're not at

capacity. We know that there is sitting time here. If it was a metric for outbounding, for either patients that they've seen in the last couple months that, hey, are you interested in coming in for A, B, and C? Or for patients that wanted the service that it couldn't be fulfilled for whatever reason, to call them out again.

So a couple things to think about. Right now you have, so front desk people, is it just one per location? Yes. Okay, so think about this. is it just one per location? Yes. Okay. So think about this. You made $23,000 last month. $23,000 in cash and we've already said, hey, we're going to allocate an additional eight

of that to marketing. Okay. That leaves you with $15,000 in growth capital. Okay. So if I took, and how much are you paying these front desk ladies or people? $20 an hour plus benefits. $20 bucks an hour, so they're making $40 grand a year, right? Okay. If I went and I said, look, instead of hiring somebody that makes $40 grand a year, I'm

going to hire somebody I pay $65 grand a year. Okay? So $65 grand a year is going to be an extra 12 bucks an hour, which is going to be roughly about $1,500 a month, $1,600 more a month. So from the 15 grand, I take $1,600 a location, so that's 5 grand, 4,800. Now I have $10,000 worth of growth capital. I have three way more qualified people running my front desk that know their metrics, know their incentive. You train them up on how to-

Outbound? Yeah, how to do outbound. What I would be looking at is not even necessarily people that have medical experience. You could be like loan processors, right? Like people that have been in the mortgage space. Friendly loan processors. Yeah, friendly debt collectors. But I'm saying, mortgage space. Friendly loan processors. Friendly debt collectors.

But I'm saying, no, I'm saying loan processors on the back end that are used to like going and collecting paperwork and gathering the stuff and doing outbound and those types of things. Like how much more could you get from a $65,000 or a year employee versus a $40,000 a year employee? Yeah. Right? And now like, yes, it costs you an extra $40,000 a year employee. Yeah. Right. And, and now like, yes, it costs you an

extra $5,000 a month. But like, again, what's the opportunity cost? The opportunity cost is $112,000 a month right now. Yeah, we got to add that to the P&L just opportunity cost. Every single time, like we lost a hundred, like yes, we made 23, but we lost 112. Every single time, like we lost 100, like yes we made 23 but we lost 112. Yeah. Like that's how every business owner should be looking at their business. Always, always, always like what are my capacities? What did I actually miss on

even though the bottom line shows positive production, right, because then it allows you to make strategic decisions like, I'm gonna spend more money on my front-facing people that actually drive our whole reputation, our whole booking, our whole schedule, because ultimately, there's two things that lead to your appointments not being filled.

Marketing and your CSRs. That's it. That's Right. That's it. Totally. That's it. Yeah. I would also say I would return customers as well. So the doctors, which would cultural fit, right, would be huge. Right. That's what I was going to add. Sorry. That's okay. Yeah. And you know, we haven't like there's so much opportunity. We haven't even sat our doctors down and like told them like orthotics is a great example. The margins on orthotics are crazy. Like if

we just sat the doctors down and said like talk to every single patient about orthotics because this is how much money like we haven't even done that yet. Can I give you a recommendation there? Yes. Are you gonna tell me not to do that? Don't do that. Oh really? And the reason I say don't do that, the most important thing you can focus on right now is filling your calendar. Okay. That's it.

Yeah. Once you're there, now work on refinement. Orthotic sales, up sales, those are all just slight like training or whatever, because like, for example, how much do you sell an orthotic for? Well, we bill insurance. Okay, but how much? We bill insurance $1,100. Okay.

We get. Collect $400? Anywhere between three to 800. Okay, and what do you pay for that? Our cost is 110, but we collect that from the patient before we bill insurance. Okay, so you get the full cost covered. Yeah.

Awesome, so maybe there is, I mean, obviously that is sweet. I know. That is a sweet opportunity, but like what things could you do that don't even require training that would allow, be like in your rooms, do you have a thing that says,

ask your doctor about orthotics? No, we don't. We should definitely do that. I mean, good for the front desk lady when you come in, do your intake. Right. Hey, here's a pamphlet while you wait on orthotics. It's really popular for 90% of our patients.

Just ask the doctor if you're interested in it. Like literally without even having to like implement better training with your people, you could do some things in your process that are just really simple, right? A couple posters, a couple like ask your doctor about this. I mean, literally doctors don't even have to do work anymore. Like I watch television,

it tells me what medicine is to ask my doctor about. I go in, I say, hey, can you do this? I consult with Google, I consult with Chad my doctor about. I go in, I say, hey, can you do this? I consult with Google, I consult with Chad GBT, and literally I come in and I just get a prescription from the doctor. Yeah. Yeah. And so figuring out ways to be able to do that. But yes, obviously there's a huge opportunity

there, but opportunity number one, get the calendar filled. Opportunity number two, figure out how to sell more orthotics. So let's go back to marketing specifically, because I think that, so if we spent $10,000 on marketing this month, if I called my guy tomorrow, I'm like up it to 10,000. When should we start looking at other marketing channels other than just PPC? Like we don't do any Facebook or should I just like double down on the PPC experiment, see what happens after 10,000? No, that's a great question.

I think there's a lot of opportunity with like Facebook and different things like that, like hey feet aching or whatnot. It is an interesting business because it's very inquiry based, right? People feel something, they are looking for it. You know, I think I wouldn't be lean heavy on like Facebook, Instagram, whatnot, but I would always have it as a part of what I do. Okay. Right. Just so that like, because people may be feeling pain while they're scrolling, right? And then they see that and like, oh yeah, I should get that looked at, this is gonna be able. So I think there's an opportunity there,

but I think most of it's gonna be driven by an inquiry base. Yeah, okay. I guess it's like orthotics is a pretty good niche for Facebook, I feel like. Yes. Everybody could use orthotics. Yes, like that is a huge niche, especially if somebody's coming in to buy it

and you have an 80% margin, which is what it sounds like. Yeah. Yeah, I think there's a huge opportunity there. You should find all the cross. It's covered by insurance. Yeah, right. Like Goodfeet Store is not covered by insurance and people pay loads of money for those.

Yeah, I would definitely be like, hey, have you looked into orthotics? Most are covered by insurance. Contact Dr. Menao today or whatever. Yeah. OK. I was going to say, you should find all the CrossFit locations and put up big billboards right outside of those.

Yeah, we've done running stores with QR codes. Yeah, running stores is great. We could definitely up it. But maybe just do $10,000 PPC, then we'll have even more capital to work with. Cause like Facebook seems really scary to me. Like how are we gonna do that? Yeah, I would test it, you know, a thousand bucks a month or whatever.

Yeah. Would I, what I would call like a decent test. Uh-huh, okay. So get it rocking and rolling. I mean, that's really only 30 bucks a day, right? Like, and, but the beauty with all of these things So get it rocking and rolling. I mean, that's really only 30 bucks a day, right? But the beauty with all of these things is you can turn it on and turn it off, right?

Like if you turn on, you say, hey, let's go $10,000 this month in Google, and in a week you haven't seen a huge increase in call volume, cut it. Yeah, okay. Like don't just sit and wait until the $10,000 are spent. Like these are things that should work or don't work. It's not like you give it time, let it,

you know, like a branding play is something you have to give it time, right? Like, hey, we put up a billboard and I didn't get a call right away. Oh, but you gotta let people see it six or seven times or whatever else. Digital marketing is not that way. Digital marketing should yield a result the minute it starts eating in the budget.

How do you feel about TV commercials? I mean, definitely there's all different kinds. Frankly, this is the way I think about anything. If it works, use it. And one thing I've learned about marketing is it's really hard to judge without testing. Preconceived notions, perception on whether something works or whether it doesn't, kills more businesses than actually testing in those things. And frankly, there's certain

industries that just hit way better on certain marketing mediums. And so it's really hard for me to say like, yeah, TV's going to work great. Because I don't know. I've never ran a podiatry clinic. But it could be like that these 60 and 70 year olds that are watching Fox News and baseball and everything else, they see a foot commercial. That could be your your primary audience and that makes up 90% of the viewers yeah Right, okay We'll take a great guy when you want to do that a TV guy. I got a great guy

Yeah, yeah, I'll tell you about offline. Okay. He's great. I love it. I love it Amber We appreciate you traveling this way come coming, sharing with us your experience. Last but not least, for anybody that's watching this now, this Hang On, by the way, if you've hung on this long, we appreciate you, we love you, Hang On, what can you share with them how Next Level has changed your business? Next Level has made a tremendous impact in our business. I mean, like we talked about, we were negative. It was terrible.

And now we're positive. And like even this conversation, like so many light bulb moments, especially about opportunity costs, like I'm serious, I'm putting that on our P&Ls from now on. And like these very tangible action steps, I've had these over and over again just with meeting with Trent.

All right, appreciate it. Thank you so much. Until next time.