Dr Andrew Greenland: 0:02

Okay, so welcome back to Voices in Health and Wellness. This is the show where we speak with bold clinic owners and health innovators who are reshaping care delivery from the ground up. Today's guest is Davis Bradley, a licensed physical therapist and the founder of Uncommon Physical Therapy in North Carolina. Davis has built his clinic around simple but powerful belief that success in healthcare comes from doing common things with uncommon standards. At Uncommon PT, he and his team are challenging the norms of traditional physical therapy with a patient-first, values-driven approach that cuts through red tape and focuses on results. Davis, I'm really grateful for your time this afternoon. Thank you very much for joining. Are you in Carolina at the moment?

David Bradley: 0:42

Yes, andrew, presently in Charlotte, north Carolina. My wife and I moved up here from Charleston, south Carolina, a few years ago and opened up Uncommon Physical Therapy in January of 2024. So we've been cracking on for almost a year and a half now, I guess.

Dr Andrew Greenland: 1:02

Okay, so could you maybe start by telling us a little bit about your journey and how Uncommon Physical Therapy came to be?

David Bradley: 1:09

Yeah, absolutely so. It's a little bit of an interesting story where when I was in physical therapy school, I did an internship with a clinician in Charleston who was a private practice owner and had a couple private practices himself, and I kind of took a leap of faith after school and wanted to work with him just to learn about the business of physical therapy, ultimately thinking that down the road I would want to potentially own my own office With him at Imagine Physical Therapy in Charleston. I was actually able to partner and we opened up an office together where I was a part owner and his guidance was kind of invaluable, if you will. He actually graduated physical therapy school the year I was born, so he'd been doing it for a little while, and so I managed that practice with him for eight years and really got to understand and build the foundation, based on some of his beliefs and successes that he'd had over the years, of what uncommon physical therapy would come to be. We were really patient focused there in Charleston, putting their needs above kind of the norms of business at times. And then my wife had an opportunity up in Charlotte and we took the leap of faith and she said to me wouldn't it be fun to start all over again and open up your own office. And I said, boy, does that sound fun. So we did that back in January, again with that basis that I'd kind of grown to know over those 10 years or so in Charleston. And that was just that. Despite what everything looks like on the outside, if you're in control, you can kind of make the decisions based on how you want your practice to look.

David Bradley: 3:07

And I'm very much a passionate person about the care that our patients receive. And that's where kind of the basis for Uncommon started. Of course we want to be the best physical therapists that we can be and provide the best care. But the experience overall in health care sometimes is what you hear people have the biggest troubles with, and so our experience stems from our first touch point with the patient how they're integrated into meeting us, how they're integrated into meeting us, how they're integrated into getting their forms before the appointment. We call them within 30 minutes of receiving the referral. Sometimes they haven't even left the doctor's office and you know they're kind of amazed by that.

David Bradley: 4:00

So it all kind of boils down just to this level of care. If you will, I think about how we're a service industry at the basis of what we do, and our service just happens to be physical therapy, be physical therapy. So when I'm out in the world I'm constantly evaluating what things make me feel good, right as an experience through a service, whether it's at a restaurant or getting my oil changed or going to the dry cleaner and seeing what sorts of things we can incorporate into our business. That alludes that same sort of feeling. So that's kind of where we've taken some of that, you know, non-medical approach to the business.

Dr Andrew Greenland: 4:56

Nice. And when you say uncommon, if somebody picks up the phone and say, oh, so what's uncommon about what you do? What would you kind of pin down as your kind of main headlines, as the uncommon?

David Bradley: 5:07

So it would be that kind of what I was alluding to is is.

David Bradley: 5:12

You'll get a call the same day. We'll schedule you within a couple of days. You'll get to see your therapist for an hour, one on one. We're not going to pass you off to other practitioners to try to lighten the load. We're not trying to just push volume through our office. We're going to be successful through the level of care. Our patients are going to finish their kind of care prescription because of the service that they get. They're not going to show up on their third visit and go oh, I'm seeing someone totally different who knows nothing about me, and they just sit here and watch me do exercises.

David Bradley: 5:56

You really build a relationship with the person who's working with you. I think that matters immensely. I'd say that some of our patients, if not all of our patients, know more about us and we know more about them at times than we do with some of our friends because we get to just spend that level of time with them. I think in medical practices that's uncommon, right, and so I think that kind of stems from it. It doesn't necessarily have to be the specific treatment that we're doing with someone.

David Bradley: 6:33

People in physical therapy a lot of times talk about you know what your niche is, right, are you a sports medicine specialist? Are you the best vestibular treating practitioner? I would say that our niche is the care, and then the physical therapy comes with it. Right, we do simple things, as you know all of our therapists, when we walk through the waiting room, we say hello to everybody, right, and it's just. It just creates this atmosphere of enjoyment and, again, I think that's uncommon. There can be a patient in our waiting room that one of my therapists has never worked with and they've said hey to him 15 times, and then that patient, through chance, has a scheduling conflict and they need to schedule on someone else's schedule and they already feel like they know the person. So it's no, it's no challenge. Um, they go, I'm happy to work with them, um, which, again, just isn't always the case. So again, that's kind of our definition of uncommon. It's the simple things that we can do, almost unrelated to the true physical therapy.

Dr Andrew Greenland: 7:47

Brilliant. So what does a typical day look like for you? At the moment, I don't know how much time you spend in sort of practice versus being the business owner, the clinic owner, and I suppose no day is typical. But what does a typical day look like?

David Bradley: 8:01

So a typical day for me is I'm probably spending 60% of my time still treating, right, I don't think there's ever a time where I get out of treating.

David Bradley: 8:12

We also don't want to be the last people to jump on the trend if science backs it and so, being evidence-based in the way that we approach our actual physical therapy, I don't think there's a time where I'm just completely out of treating.

David Bradley: 8:42

You have to kind of keep those skills, keep that mentality of you know one foot in front of the other. We kind of are saying is if we're doing everything exactly the same that we are now, in a couple years we're probably doing it wrong, but if we're doing everything completely different in a year, we're also probably doing it wrong. So there's a little bit of evolution of how you know the treatment side goes. And then on the business side, I'm trying to spend time mentoring my therapists. We have a couple young therapists as far as when they graduated from school, so we have it set up in our kind of program, if you will, to spend specific time mentoring, making sure that they're supported in feeling welcomed and comfortable with their treatment, practicing skills, having time to read evidence and then trying to build relationships around town with referring providers or patient pools where we may kind of expand to. So it's a little bit of everything.

Dr Andrew Greenland: 9:56

Nice, and one of the big themes we're hearing from other clinic owners in this space is the increasing pressure from insurance and insurance and regulation.

David Bradley: 10:06

just wondered how that's playing out in your world yeah, so, um, I actually listened to your other podcast with christian on who runs the billing company, and I happen to really agree with a lot of the things that he was saying in that podcast. As of right now, you know, my perspective is that the reimbursement is there. It's on the clinic side of understanding the back end of it and making sure that you are getting the most out of your visits, your approach to billing and reimbursement and working the claims. I've kind of accepted that insurance will be an ever-changing challenge and we just need to be able to evolve efficiently with that. I think the way that we approach it is realistically.

David Bradley: 11:08

Our patients who have insurance would want to use their insurance at this point in time because the cost per visit to them is going to be less, and so, if we can still figure out a way for that to be beneficial for the clinic, that's the way that we want to do it.

David Bradley: 11:29

Patients deserve to use their insurance if they have it, especially if they have good insurance. I think we would be limiting our patient pool at this point if we just went to a strictly cash-based option point. If we just went to a strictly cash based option. We have some patients who have great insurance and they pay fifteen dollars, you know, and and they don't have visit limits. And so for us again, that uncommon level of care means we get to see you ten times for one hundred and fifty dollars and you're better because you're not limited in the amount of time that we get to spend with you. So that's kind of how we approach it. We take it as it's our responsibility to make sure that it's worth it for us, not the patient's responsibility to kind of pay us what we need.

Dr Andrew Greenland: 12:16

And do you think you've nailed the insurance side of things? And I only say that because I've spoken with lots of people, not just in physical fitness space but across the health niches, and it's one of their bottlenecks, it's one of their major problems. You seem a little bit more chilled about it. I just wondered if you've managed to crack it.

David Bradley: 12:35

I don't know that, it's crackable. I think I've managed to wrap my head around what it is right and knowing that we're going to have to be flexible and change, Knowing that this year what the requirements are for certain insurances for us to get paid, if you will, may be different the next year. Right, and as long as the effort and time of doing those things still equates for the best experience for the patient, then I think we do that, because it only again allows us to build our brand, if you will, of being this uncommon level of care. Right, If we're one of the only small clinics in town who's still taking insurance and providing great care, that opens us up to a huge patient population, because not everyone can afford to go out of network or to pay a cash-based price. So until we can't do it, our goal is to do it.

Dr Andrew Greenland: 13:36

Brilliant. What about patient expectations in terms of things that you're seeing? So, do patients find it surprising your approach? You do this uncommon thing where you give such a high level of service. Does that sort of surprise patients? Are they more expecting to see the high volume models that our other clinics are doing?

David Bradley: 13:57

I. I think that that's one of the most interesting things, andrew, and and honestly, one of the most um complimentary things sometimes is when we have someone who has been to therapy and they say you know, I don't know if this is going to work, but my doctor, my friend, recommended that I come and see you guys. I did therapy before and it was okay. One of our first questions is okay, great, tell us a little bit about your experience. What did you guys do? What worked for you, what didn't work for you? And almost always it is not what we do here. It's kind of what you described of a higher volume. I felt like I could do some of the things that they gave me to do at home. I didn't feel like I got great one-on-one attention.

David Bradley: 14:43

You know, I always ask patients a lot of times when they come to an office like mine. You know they've got some sort of big musculoskeletal irritability or a knot or a trigger point if you will somewhere and I say, hey, did anybody ever lay their hands on you or stretch on that, or massage on that, or you know? And they say no, and I go oh my gosh, how did? Well, of course stuff didn't work. You didn't, you weren't getting the best care did. Well, of course, stuff didn't work right, you didn't get, you weren't getting the best care. And so in a visit or two, they they almost always go oh, this is different, I, I like this is kind of what they say. I like your approach to this. That isn't a promise that will get them better, right, but their overall feeling about the way that they're being approached is different and they really enjoy that. So great.

Dr Andrew Greenland: 15:36

It sounds like you provide a wow experience, which is very impressive we try to yeah, what do you think is the biggest misunderstanding about what it takes to run a sustainable private practice today? Because a lot of people looking in at these things think it must be an easy ride. But what do you think is the biggest misunderstanding that people might have about running something which is clearly as successful as what you do?

David Bradley: 15:57

um, I think that the biggest misunderstanding probably is that there's no magic formula. Um, I think in my perception, I see a lot of almost like quick fix marketing out there in the PT world, especially in the US, of if you do these seven things, then we'll 10 times your revenue, sort of deal. I think the sustainability in private practice really comes from understanding what your goals are as a clinic owner, understanding where you want to see your clinic go and then honestly just taking one step in front of the other towards those goals. There's no quick fix, there's no magic pill.

David Bradley: 16:46

If you can do the things that matter to you really well, um I I think over time, you can be successful. Um, I think it's just kind of for lack of a better term outlasting other people. Um, and if you're passionate about it and you're really proud of what you're going to do, you're going to do that it and you're really proud of what you're going to do, you're going to do that. Um. I think being honest with yourself matters too as far as where you're moving, what your goals are, how it's going, being willing to pivot but also being willing to just be consistent great um.

Dr Andrew Greenland: 17:27

so what's been working really well for you in terms of growth or patient outcomes, in terms of the things that you do and obviously you mentioned some of them already in terms of creating this wow experience? But is there anything else in there?

David Bradley: 17:40

Yeah, so honestly for us as far as patient outcomes, we try to do a really good job from the beginning of being honest with patients. We try to do a really good job from the beginning of being honest with patients. One of the hardest things in physical therapy is we're fixers. Right, Our goal is to fix people. We try to be honest with our patients and say if we're consistent with what we do and you're consistent with what we ask you to do, very rarely do we have people who don't make some progress. Right, some better is always better than no better.

David Bradley: 18:17

But I never promise anyone that we'll go from a 10 out of 10 pain to zero out of 10 pain. I say that would be wonderful. That's always my hope. But we're just honest. And when you set that honest expectation, when you are making that progress, the patient understands. And when you set that honest expectation, when you are making that progress, the patient understands.

David Bradley: 18:33

And if you do have a plateau, then you can be honest with them and say, hey, we're doing all of the right things that we need to be doing.

David Bradley: 18:40

There's nothing about your care that needs to change, but maybe it's a referral back to your physician.

David Bradley: 18:45

Let's see if something else is going on. So we try to just be really truthful and honest, not salesman like and going, hey, if you give me 10 more visits then I promise it'll get better and then as far as kind of I think your other question was, you know, the growth of the clinic we try and be really genuine when we meet with potential referring partners about who we are and the experience that we provide and then hope that in turn we're fortunate enough to receive a couple of their patients and we treat them like we are an extension of that practice. Our goal is for the patient to go back to the practice and say, oh my gosh, thank you so much for sending me there. You were right. Right, it has nothing to do with us. It's the doctor who referred them, made the best decision for the patient. We just happen to be that extension of the doctor and then the patients turn into your biggest cheerleaders and it all kind of reinforces itself.

Dr Andrew Greenland: 19:54

And what's felt like the most persistent or frustrating challenge that you have to kind of deal with recently.

David Bradley: 20:03

Honestly, being patient with growth you know I mentioned that my office here is about a year and a half old. You know I mentioned that my office here is about a year and a half old being driven and excited about what we're doing. We're receiving wonderful, generous feedback from the patients that we've been able to touch and the doctors that we've been working with. Being patient and just making sure that you don't get ahead of yourself, expand yourself too fast or too quickly, that changes the level of care that you give, because ultimately that's going to be what defines us.

David Bradley: 20:41

I think in the industry, one of the things that we deal with are there's more need for PT than there are PTs. So finding those exceptional people who share the same values in a process of growth for an office like mine is always going to be a challenge. You know I'd be. I'm willing to do 10 interviews and hire no one if it doesn't fit for our, our office Um. But when you find the right person, you also have to be willing to pull the trigger, maybe before you have the need for them. So kind of playing that game of um. You know, fulfilling the need for a clinic like mine with great people that's kind of what I tell people when we're interviewing for a position. I say I'm always looking for great people. We can become great physical therapists.

Dr Andrew Greenland: 21:35

So you're kind of always recruiting at some level always looking out for people. Yeah, got it.

David Bradley: 21:41

Yep, because if you find the right person, andrew, they'll create the need. Is the way that I approach it right. They'll buy into the philosophy. Here at Uncommon, the patients will go. You know what? I don't want to see Davis. I want to see somebody else because I had a great experience with them. I had a friend ask me one time when I know that I think I've been successful and I kind of sat back and thought about it for a minute and I think this office will be successful when I'm considered the least best therapist therapist I've. I've given everyone else what they need to become excellent therapists, excellent people. Um, and it's never been about me, and at that point it'll definitely not be about me um, it'll be purely about um uncommon. So brilliant.

Dr Andrew Greenland: 22:45

Are there any um metrics or signals that you keep a close eye on in your business, whether those are clinical indicators or business focused ones, things you kind of use to get a thermometer of your business?

David Bradley: 23:09

going back to Christian again. We track a lot of data as far as our insurance what we're receiving based on per visit. We track the codes that we're billing and how viable the reimbursement of those codes is. We track we have a standard, if you will, that we track for we call a full day for our therapists, so we work an eight-hour day. We call a full day seven and a half visits a day. Obviously you can't have a half a visit, but that's the standard of. We want to keep the schedule relatively full. When we keep the schedule full and we bill correctly, it allows us to keep our patient volume relatively low. That then transitions to less burnout of our therapists. Right? Our therapists take no notes home at the end of the day they're done. So you know that's a pretty good work-life balance, if you will.

David Bradley: 24:03

So we track all sorts of things like that. We track how quickly we reach out to patients after we receive their referral. If we don't get them the first time we call, we track when we call them the next time. That's usually within another day or two. If we don't get in touch with them after three times, we let their doctor know that we reached out to them a couple times in touch with them. After three times we let their doctor know that we reached out to them a couple times again. So kind of all just this experience, if you will, of how do we make this whole thing enjoyable for everyone and it comes down through to understanding kind of those metrics that make it possible thank you and if you could, um, I was say where do you want to be in six to 12 months time?

Dr Andrew Greenland: 24:48

You kind of indicated you're always trying to grow and recruit good people, but where would you like the Uncommon PT to be in six 12 months from now?

David Bradley: 24:57

So six to 12 months from now and I think we're on the road there of I really want us to be synonymous with one of the best private practices in Charlotte. I want our name to be known as you go here if you need PT, because of the experience that you'll get. And then down the line from that, I think one of our core goals is people always ask me you know what happens if you get too busy? Do you find a new space and grow bigger? And I think that that actually changes the perception of the office. Two years, one year, who knows, maybe we're replicating this in another part of town to provide that same level of service in an area that maybe isn't seeing us currently because it's a 20 minute drive or something like that is there a?

Dr Andrew Greenland: 26:02

is this going to be organic growth or is there anything that you're working on to try and get that level of growth that you're looking for?

David Bradley: 26:12

What would you mean by organic growth?

Dr Andrew Greenland: 26:14

So just the natural thing of you know, word of mouth, referrals and more and more inquiries, or is there anything you're actively trying to do to grow the business?

David Bradley: 26:24

Yeah, so some of both. We keep in active word of mouth and for all there are the best, they're the biggest compliment. We try and create relationships with local doctors, orthopedists, primary care physicians. We'll set up lunches, if we can, with them and introduce ourselves again, just trying to be really genuine. You know, we're kind of open to all of it and not being super specific in any of it, if you will, we kind of let the patient population drive where we go with some of this, drive where we go with some of this.

David Bradley: 27:11

We've done some classes at a local YMCA where we've talked to 55 plus age adults just to practice talking about physical therapy, nothing other than that, and then we happened to receive a couple patients from it. You know we're willing to workshop with people if we need to, but nothing totally specific. As far as you know, creating a game plan of this is how we're going to drive the patients in and in the future. A little bit of all of it seems to work best. Again, when our niche is kind of just this level of care, right, we maybe target practices who we know get to spend a significant amount of time with their patients, because then their patients expect that level of care.

Dr Andrew Greenland: 28:02

Amazing. And if you could wave a magic wand and remove one obstacle or roadblock, whether that's an internal thing or an industry-wide thing, what would that be?

David Bradley: 28:10

currently goes back to the insurance and the inability of patients who have medicare you know, government issued insurance they always have to have a doctor's referral before they can be seen in clinic. So even a patient who's been a previous patient of ours who says you know, I've got the same shoulder pain that I had a year ago Davis fixed it and made it feel great for a year I'd love to go in and have a touch up they need to refer back to their doctor before they can come and see me, which that's just a little road bump. Again, we, if we received that call from the patient, we'll actually reach out to the doctor for them and try and make that request. So it's not on their shoulders, but that's a little road bump, and the expanse of care is ever growing that at times patients get confused on who is the appropriate person to answer their questions, if you will, and so practitioners or healthcare individuals, personal trainers, yoga instructors, doctors, kind of helping educate patients as far as where their kind of clinical expertise lies and falls.

David Bradley: 29:58

We'll have patients who come in and ask us medication questions, and that's out of our scope of practice. And then we'll also have patients who will have gone in and saw someone who, out of their scope of practice, would be diagnosing a musculoskeletal issue, may say, hey, my X, y and Z told me that this is what I have going on at it because technically that's not their job requirement. So a little bit of that understanding the space of care is a little bit. I wouldn't say it's an issue, but it's a little bit of an ever-evolving kind of conundrum, if you will all right, davis, thank you so much for your time this afternoon.

Dr Andrew Greenland: 30:44

It's been a really interesting conversation. Thank you so much for your time this afternoon. It's been a really interesting conversation. Thank you for your honesty and giving us some insights into what you do, how you make your experience a wow experience by providing such excellent care and the reason why you're uncommon in inverted commas. But I really appreciate your time this afternoon, so thank you so much.

David Bradley: 31:00

Thank you so much, Andrew.

Dr Andrew Greenland: 31:02

Thank you.