When To Open a Second Location

This podcast will help you to become more confident with your patients , more successful in your practice or business and a leader in pelvic health , and we're going to have some fun along the way . Join us as we rise together .

We're Jesse and Nicole Cozin , founders of Pelvic Sanity Physical Therapy and the creators of the Pelvic PT Huddle , and this is Pelvic PT Rising .

There's just we're not in the room without many people all the time . Like it is just a really huge energy and a little bit of a let down when we're back in the clinic and back home . But overall , we cannot wait till next year . There will be a 2024 and we're so stoked about it .

Honestly , I mean , you can always tell what we think by what we do . So if you look at what we're doing , we don't have a second location . We haven't done it . That's the caveat out there . But , nicole , how do you feel when you get asked that question ? Should I start a second location ?

We grew from myself to five clinicians , two front desk staff , massage therapist we were spilling literally out of our suite . We had to rent a suite across the way . We were rocking all within two and a half to three years of being open . It was crazy and we did as we were growing out of our space .

We at that point were like , should we open another location ? A lot of people were saying you know a lot of people this is like my parents and people that don't really know anything else to say except for like , oh , you're clearly growing out of your current location , you might as well open a second location .

And we did a lot of numbers and math and this is all before . We had pelvic PT , rising business , mentorship .

You know , some of the advice that we gave is because we were in the situation ourselves and we did all of the numbers and all of the nerdy things and all of the metrics and Jesse was like up all night doing all the projections and calculations and predictions and we ended up not doing it and we're super happy that we didn't .

And we still expanded in our current location a little bit after that . So it's not because we didn't have the opportunity to . We made a very strategic decision to not Now .

With that being said , there are many people in our pelvic PT rising business , mentorship people that it does make sense for , and we're going to go through the things that you should be thinking about if you are thinking about opening a second location .

You know , at the time where Nicole and I were thinking seriously about starting a second location for pelvic sand B , we were also starting to think about starting a family and we were thinking about what we wanted the future to look like , and for us it didn't look like driving 45 minutes back and forth between two different locations or having twice the headaches

and twice the overhead and twice the stress of trying to keep company culture great at two different locations . So part of this is going to come back down to the why from your business . But if we really think about why people are asking this question , I think there's a couple of really big reasons that we get this question so often .

One is just that sometimes people think it's just easy money . Hey , I was able to start something here and if I started another thing there , I could do the exact same thing and I could double my revenue and that's not always incorrect , but it usually is a lot more complicated than that , as we're going

to talk about . I think that was also a measure of success , especially for more insurance based practices . So a lot of times , if you were in a practice like that , that's how they measured success .

Oh , they have three locations , they have seven locations , they have 15 locations and that's a very insurance based , volume based way to think about things , where that totally makes sense for an insurance company when your margins are super low . But does that really make sense if you're a cash or a hybrid model with what you're doing ?

But I will say this too is a lot of times people will think that , like Jesse said , that it's easy but that it's the next smartest thing to do , and you're hearing that from different people .

I think there's also this idea of , like a perceived opportunity . A lot of times we find people starting to struggle with this question and when something pops up , hey , this OB-GYN group offered me to rent me a space . This chiropractor said that I could use their place on the weekends .

This opportunity just fell into my lap , and you guys who have listened to us for a while know that I'm always very skeptical of opportunities that just fall into your lap . Usually those are opportunities that you wanted at all from the beginning .

But now it's like oh well , how could I not join this midwifery or this cool place that wants me to rent a space from them ?

This opportunity just sort of comes out of nowhere and it sort of makes sense , especially if it's in a chiropractic office that sees a lot of perinatal clients or something like that .

I can get there , I could see where you think that , oh , this is your sign to do something , and so maybe that's why we make a good team , jesse , as you say that's why we coach so well , because you're like , hey , this is an opportunity , you should look at it .

What if I don't do that ? Nicole's actually previous employer did it basically because of this If I don't put something there in this new hip growing community , whatever it is , someone else will and they're going to come in and take my lunch if I don't do that .

And I think the last one is one that we were hitting a little bit ourselves , to be honest is ego and prestige . It sounds cool to say I have a multi-clinician or a multi-clinic practice , I have several locations .

That sounds really cool , until you actually start looking under the hood and that's what we're going to do in this episode and start talking about the pros and cons of those . But anything else there that I missed , nicole on the why people are asking this or why people are thinking this way .

You're adding , basically , rooms to your overall number of clinicians you can put in there . It's just an extra space , that's it . That pause afterwards was deliberate , like that's the end of the pro list , and those aren't insignificant pros , so don't let that necessarily the volume of things on each side of this list sway you , but those are really it .

And so when Nicole and I were looking into this and when we advised our people and our people have gone , like Nicole said , in different directions with this question we have quite a few people who have multi-clinic practices and we have quite a few people who considered those and said you know what ?

That's not fitting for me , or it's not fitting for me right now , or it's not fitting with my life and my goals . But , nicole , when we start running through the cons , you've got to talk for a second because I'm going to have to take a deep breath before we hit some of these cons I know Hang on one second , jesse , getting real fired up here .

It was a great location and so it started to seem a little bit seductive and attractive to hey . Well , what if we just kept those five rooms at the public sanity original spot and now we can get three or four other rooms at some other satellite clinic ?

That's a very valid decision to make , but it doesn't mean that these cons don't exist . It just means that you have decided that the pros outweigh them and that that's your vision , that's your passion , that's where you want to go . I have no problem with that .

I think that's actually can be very much the right decision for certain people , but you have to go into it with your eyes wide open .

That's probably the number one thing that Nicole and I spent time at Public Sandy on now is actually training Nicole , the clinical staff and me the admin team . And now all of a sudden you're having to double that because you've got two locations . So you go in and , nicole , we do a clinical collective once every month , once every other month , whatever that is .

Now you're doing that at two different spots , you're preparing it for two different places . We're training two different admins , or four different admins if there's two in each spot . You've completely doubled your entire training time .

You've doubled the number of admin staff that you need to hire generally , because it's not usually great to just throw somebody off in a satellite clinic all by themselves and not have any admin support . It really is just adding to the kind of HR training , administrative burden of what you're doing at your practice .

Now you've gotta have all that stuff . And even if you are going to be a solo printer , some of these other cons are also going to hit you there , because one of the next ones here is are you cannibalizing patients from another location ?

And this is one of the big things that when we were running numbers , we realized and I actually looked at the patient distribution of where people are coming to pelvic sanity from , and it's actually almost an hour in every direction . We have a sizable amount of people coming in .

So when we're saying , well , cool , we wanna start a second location , what's that gonna do ? Well , what that means is , if we were gonna go , let's say , north , toward Los Angeles , which is about an hour north of us , let's say we put a clinic 45 minutes north of pelvic sanity , all that means is not that we're gonna necessarily get new patients .

But the new patients who were coming from further north are just gonna go to that new location , but it's gonna cannibalize those people from coming all the way down to us at pelvic sanity in Orange County . So at that point , all we're doing yes , we're cutting drive time for our patients , but they were already driving to us . So what are we really doing ?

We're actually cannibalizing our own business and some of those like this is one of the problems of the franchisee model of fast food chains and stuff . But have you guys ever seen like two subways on like the opposite sides of the street ? Clearly they're just cannibalizing the business from each other at that point .

So are they far enough away to make sure that you're not cannibalizing your business ? And then here's another con is , if they are that far away , usually that's putting an additional burden on you to get there to actually drive .

So for us we're gonna be saying , hey , we need to put something all the way up in Los Angeles , we need to put a clinic an hour , an hour and 15 minutes away . Well , I don't wanna drive an hour and 15 minutes every day to you .

And then you don't realize that logistically you're gonna be at one location and it's not always gonna be that you wanna go home . Sometimes you wanna go from location to location or the marketing that you're gonna do is now around each of those different locations .

So the actual distance that from clinic to clinic is that 45 minute drive plus the radius around that . So now all of a sudden you might have extended and you might be actually an hour and a half from each of the radii , from each of the clinics . I hope you can see what I'm talking about like in your brains with this map situation .

And now you're saying , hey , you have to go be this solopreneur off there and not see anybody all the time and be able to do what you're doing . So are you gonna be able to create the same kind of culture at both of your locations ? Is it gonna be the kind of place you want somebody to work ?

Or is it gonna be you who's always driving off to the satellite location and seeing your patients there , in which case now you're not around to create that culture at your main location ? So Nicole could have just treated patients out of her house all the time they would have come . But is that what we would want for pelvic sanity ? The answer is probably not .

We wouldn't want a boss who's never around or who would three days a week is at another location . So think about is that gonna be a conducive to hiring and keeping and retaining great people if that's not really what they signed up for and not really what they wanted to do .

Now , if you did that and you essentially gave in or made it like an actual decision , pros outweighed the cons and you actually put that person there .

Now all of a sudden they're like wait a second , I'm not grabbing coffee in between patients and asking about this patient with vaginismus and it's hard to see unless it's actually being done , especially for someone who's not on the business side telling you that that seems like it's a really good idea .

If you're not around or there's two different places where you're splitting your time between and splitting your training between , you have way less control over what's going on , from the way people are greeted to the kind of clinical care that they're getting .

And that's a big thing , especially because a lot of us got into this because we wanted control over how people are doing , like a lot of us who are business owners have control issues . That's one of the reasons we're entrepreneurs , right .

But I will say this that what you can't see sometimes is that at the second that you get a second location , everything changes . And so now your clinic that was running great while you were there . Now you're not there 100% of the time , you're there 50% of the time , or at the beginning you're there 10% of the time .

You're actually at the other location a lot more . And so this is what actually , when we started to think about does pelvic sanity wanna expand ? One of the questions we asked ourselves is is pelvic sanity right now running like the best well-oiled machine ? There's never any problem , jesse and I are on autopilot all the time , no problems .

And we said absolutely not . That is not what's happening . It was going objectively great . But we had to be very involved and we were like , if we're gonna then spread ourselves out a little bit thinner , then that's probably not a good recipe to try to implement .

I'm just thinking about things we've had to deal with in the last week at public sanity , right .

And the last thing that I have in this kind of con model is a lot of times I think people who are espousing this or who do this , and actually some people who do this well , have almost like a franchise model of this .

They sign the lease and they just put one of their clinicians in there and then they have that clinician do all of the marketing and most of the admin stuff and kind of just put them on an island there and you can grow pretty quickly with that .

But A your profit margins are going to be terrible with that and B you're going to lose clinicians , because why would somebody work for you if they're going to have to be going out and marketing and doing all of the things doing the admin ? Basically they're running a business for you but they're only getting 40 , 50 , 60% of what comes in .

Anybody who's halfway intelligent , who's doing something in that model , is going to sit there and say , well , wait a second , why am I paying a 40 , 50% tax to somebody else who's never here ?

So , unless you've got crazy non-compete laws and you make people sign a bunch of stuff that they can't ever go out on their own , which you can debate the ethics of that however much you want , but unless you have that kind of situation , you're going to lose people because you've basically forced them to run their own practice within yours and give you the lion's

share of the percentage , and they're going to start saying , well , wait , if I'm doing all the marketing and all the admin and answering the phones and treating all the patients , what am I paying you for ? Is it a website ? What is that ? So just be careful there .

If you're setting somebody up in a position where you're basically making them a mini business owner , they're going to start saying , well , why am I working for you then ?

It's not that we think that nobody should do it . There are plenty of people that have done it , that have done it successfully . There's people that have done it not successfully that look successful .

So I feel like what we want you to think about with this episode is , if you are a business owner and this thought has crossed your mind and it should have if you're doing well , that is the next logical step for you to think about . But I want you to really sit down and really go back and think about why am I really doing this ?

Is it because I have FOMO and an opportunity that just fell in my lap ? Is it because I think that's what I'm supposed to do ? Is that because my friend did it that way in a different model or a different arena and it worked for them ? Therefore , it will probably work for us .

Like , is it because I'm fearful that someone else is going to eat my lunch , like all of those things that we talked about with why you would potentially want to do this . I want you to really think deep about those things and really take an introspective look and think about am I doing this for Jesse the right ?

You need to be able to take a four week vacation from the place that you're at with no concerns in order to feel really confident in doing something else . And you need to have a passion to expand , to reach more people , to whatever that is , and we've had plenty of people in our programs who that has been a driving factor Is .

Look , I fully believe that people should not have to drive as far as they're having to drive to get care , and that's a passion , it's a mission that you have . And if that's the case , absolutely right , have a plan for these cons , but do what you have the passion to do . You can make it work , but , again , doing it for the right reasons .

With that and I will tell you of all of the people that we've worked with , which is now 400 plus pelvic health businesses , we've helped just as many consolidate and actually cut extra locations as we've helped others expand . So we've had people come to us who are in two or three different places and say this isn't working .

How do I get back to one primary thing ? How do I raise my profit margins ? How do I focus again on what I loved about the business ? And what I loved about the business wasn't driving 45 minutes to go to a broom closet in an OBGYN clinic because they told me they had this cool opportunity .

They were going to refer me a shit ton of patients and then , surprise , surprise , they didn't .

So what that might look like is , you know , we've talked to people a lot of times , too , where someone will be like , great , I want to go into my second location and we're like awesome , what are your hours of your clinic ? They're like , well , I'm at the clinic from 10 to four and you're like , great , that is not maximizing your space .

I'm talking you're seeing patients from eight to seven . You're seeing patients on Saturdays . You're really truly maximizing the square footage and the space at your current location .

Our advice would be to really think about that first and then , if you're busting at the seams and you can expand and you have the passion and the mission to expand more in your market and you actually need more space and your physical place , like your city , your town , there's a reason why somebody wouldn't come to your location .

Like we've had people with bridges , like people over here don't like to cross bridges , for instance , or this is over this free way and nobody really like goes on that other side . If that is a thing for you , then you can think about opening another location and then still go through that con list .

I know we have an opinion that's heavily weighted on one side of this , but it's because we've seen it a lot and we've seen people burned by that desire and we just want to make sure that if you do it again , it's not a bad thing if you make that decision , but if you do it , you're doing it with eyes open and with a plan to overcome some of those cons

and those obstacles that you will face .

And I think a lot of times we just and us very much included when we were thinking about this ourselves just get excited about the idea and excited about the vision of like , oh cool , I've got two places , I've got three places and all this thing is going so great , and not thinking about all the effort and energy and struggle it's going to take to get there

and maintain three different places , two different places , and make sure that those are running the way that you want them to run .

Now , all of a sudden , you are having all those cons , all of those things on the con list . You've hired us , you've done a second location and now you're an employer before you ever really decided if that's what you wanted to do . So just because you're busy does not mean that it's a good time to expand and add a second location .

dot . Yeah , just a lot of times we make some bad decisions when we're feeling busy , when we have a long wait list , when patients aren't able to get in . But you have to exactly what we're talking about here stay true to why you started the practice and , if you started the practice , have more time with your family .

One thing I promise that will not do that is having a second location . So be thinking about what's the reason for it , why do you really want to do it and does it really make sense at this juncture in your business career ?

So I hope that's been helpful if that's been something you guys have been noodling or really just thinking about for the future , something to be thinking about before you dive into making a decision about that . So , as always , we'd love to hear from you .

I know there are plenty of exceptions to this rule out there , so if you want to write in and tell us that you're running eight places and that we're full of shit and it's the best thing in the whole world , please do it . Let us know . We'd love to hear from you . We always want to keep this conversation going .