Nick Schuster Clinician | Entrepreneur | Educator

From the moment he walked out 1/2 way through his first job interview, Nick has been forging his own path. Now 40, Nick has experienced most things associated with the business world of Physiotherapy; including going into debt to buy his first business, expanding too fast, firing too late, crunched during the GFC and creating a very popular FB group where business owners get together, share a rant + electronic coffee, discuss common business issues and problem solve.

Nick has many stories to share about how to grow your business, and I am sure that listening to this episode will provide you with much to consider if this is your niche currently or in the future.

You can also watch this conversation on Youtube.

Thanks for listening.

Biography
Nick Schuster is a 40-year-old physiotherapist, clinic owner, business coach, husband and father of 2, living in beautiful Northern Bayside Brisbane.

At age 21 he bought his first clinic on a credit card. Today he employs 25 people across 2 clinics.

In 2016 he created Ultimate Physio – a consulting business community of more than 1600 Australian private practice physio clinic owners, which is 1 in 5 across the country. He speaks to private practice physios and clinic owners daily and is at the absolute forefront of the challenges facing private practice physiotherapy in Australia today. Ultimate Physio’s flagship product is a 9-month business, leadership and personal development programme for physio clinic owners only which 69 clinic owners Australia-wide have completed since 2018 to give them more time, profit and freedom in their clinics.

He has written 3 books – one for patients in private physiotherapy clinics, one for physiotherapists, and one for clinic owners. You can view his books, courses and offerings at www.ultimate.physio .

He enjoys 90’s music (particularly Radiohead and the Smashing Pumpkins), playing the piano, MMA (his dream is to have only one MMA bout), sailing and drinking a good quality ice-cold German beer 

AAP Education
Educating aspiring health professionals

Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.

Transcript

Doug: [00:00:00] This is your fortnightly installment where I interview a trailblazing physiotherapist that has shaped the profession we're today in celebrating their journey. Knowledge and insights. You gain the opportunity to plan and guide your own professional journey. My name is Doug Carey, and welcome to Physio Plus 10.

Welcome you and previous listeners to Physio Plus 10. Thanks for joining us again today. Special guest today on the podcast is Nick Schuster. Welcome. 

Nick: Doug, thank you very much for inviting me. I, uh, I love doing things like this, so thank you so much. That's cool. 

Doug: Hey, can we start with a bit of background, like where you grew up and what your early schooling entailed?

Nick: Yeah, so I'm, I'm a 40 year old guy from, um, a town in Queensland, Australia called Toowoomba, which is called the Gateway to the Golden West. Um, so I'd say I moved around a bit, but grew up there. Grew up pretty poor like a lot of people did in the eighties. And my [00:01:00] parents were quite educated, scrimped and safe to send me to the best schools and helped me realize an opportunity.

Um, and I moved to Brisbane to study physiotherapy in the year 2000. Um, and Doug, and I'll obviously go into the rest of my story and I've, I've basically been pretty settled around, um, the northern Bayside part of Brisbane since then in this, in this beautiful peninsula called Redcliffe. So I'd, I'd say that's where I'm from, Doug.

This year we get our own n R L team with Wayne Bennett as the coach. So we're now on the map. But for you guys in Perth, you're afl so yeah, you're talking a foreign language. Exactly. Some of your, some of your East Coast Australians will identify with that. So now were 

Doug: either of your parents in the health sphere?

Nick: Um, so both of my parents were, um, you know, university, PhD educated, and they're actually in sort of, my dad was agricultural science and my mum was a marine biologist. Uh, but [00:02:00] when I sort of trace back my family in. My grandfather who died the year before I was born, ran a small country town, optometry clinic.

And, um, my grandmother was probably my greatest influence growing up and she saw a lot of him in me. And the funniest story that I'll tell is that, you know, this was, you know, post World War II and a lot of people couldn't afford the services and, and he was often paid in chickens. Would you believe chickens were like the currency back then for optometry services?

So I got one throw. But it's very specific. It's a small town allied health, so maybe that's where it's. 

Doug: And where do you fall in the family structure? Kim 

Nick: Byers. Um, okay. Oldest of four boys. So what's that say about me psychologically? The weight of expectation, the high achiever. I was probably a bit of a pain in the ass to the brothers below me.

Um, I didn't really know how to talk to women cuz I was one of four boys. So very, very male dominated household and, and the [00:03:00] oldest. So yeah, very fun upbringing. Um. But yeah, I can see that I would've given my brothers a bit of hell mate. So, and I'm 

Doug: And I'm guessing 

Nick: your mother as well. Oh yeah. Yeah. My mother was a saint, so, um, yeah.

But my brothers and I all turned out really well, so, um, big credit to, to her for raising us and again, educated woman taking 12 years off her career. Like how many people these days have be prepared to do that. 

Doug: Yeah, that actually sounds pretty awesome. And particularly if you've got a PhD as well, a hundred.

So how was it you got interested in physio? I mean, the long arm of your grandfather reaching from the grave seems a bit long. So what was it 

Nick: that got you there? Um, okay, so my early life until age five was in Canberra. Doug and I had very bad asthma. So those of you who know Canberra, it's one of the coldest places in Australia.

Very dry, not good for asthma. So I probably spent about a third of my life in. A large hospital in Canberra and I think that, you know, as a kid at that age, like to not be able to breathe like is pretty [00:04:00] distressing. And I had no issues once we moved. Um, but I remember back to some of my hospital experiences and I think that.

It's almost like I felt safe in the hospital, Doug. So like I think back to being in hospital, being admitted and like I remember one term, like I was one school term. I was in hospital for fricking eight weeks out of a 10 week term. And I suppose my memories of it aren't that good cuz I was very young.

But yeah, just felt safe, felt, felt confidence with, you know, people. In the health system that they were keeping me alive and, you know, looking after me. And I think, you know, that they say that a good part of your belief system is built before age six. And, you know, that's probably what I actually would trace it back to at, at a first.

Um, first memories. Yeah. Okay. 

Doug: So quite, quite eding in that sort of sense. Was it physio that stood out for you or was it like, did you dabble with medicine or 

Nick: how'd you get to physio? Yeah, so that's a great [00:05:00] question. So I'll, I'll take you through a bit of my schooling. So I was, I was a. A very distractable child and I had what was called a d d then Attention deficit Disorder.

So, you know, the way that my parents directed me was into sport and music and academia. So I wasn't off roaming the streets and, um, In high school. So I went to this, this really varied high school that had, you know, we had a good academic record, but we were the best at rugby and we had a cattle stud and we had army cadets and it was a very traditional school.

Doug, would you believe the girls still did deportment and typing and things like that? So real country school. Um, and. My strengths were always the maths and sciences, and I, I did that because I figured I wanted to get the best results at school. And if I got the right answer, no one could. There was no subjectivity.

So I veered away from English and biology and those things. Um, now in the nineties, It was very, very hard to get into medicine and the government made some structural [00:06:00] changes that made it almost unachievable. And I think Tony Abbott was the health minister of the time. Um, I had a very good doctor and I was very friendly with him, and he gave me all his old textbooks when I was in grade nine or 10, and it was medicine that I wanted.

Um, But I was a pragmatist growing up. Poor Doug. Like I wasn't prepared to put my family through the hardship of having to get a science degree, then go on to do medicine. It was too long a path. Um, and in Queensland there was this thing called Q tac, which is like your tertiary entry preferences. Doug and I had chose engineering and business because I was a very process driven thinker.

I was like, okay, engineering. It follows all the stuff I did in school and business. You know, I, I liked, the thing I liked about business was the ability, Make your own luck really, and to not follow someone else's path for you. Um, and I just had this sneaking feeling about a day before this thing was due.

I was like, I can't get into medicine. I've chosen [00:07:00] engineering and business. And pardon me for saying it. I was like, fuck it, I'm gonna choose physio. Because I looked at all of the courses I could choose. There were very few people doing it, and there was a very high entry score. And I must admit it was probably.

The fact I couldn't get into medicine, but I still wanted to help people and I wanted to make an impact in health. And honestly the prestige, it's like this thing you needed the top entry result. There was only physio and dentistry that needed that at time. And I'm like, screw it. This thing's probably as good as medicine.

I'm helping people. I hope it's process driven. And we'll go to this in a sec cuz that's what I was good at. So I chose physio. Um, it was a confused choice, but looking back on a lot of what I do in my life now, I made the right choice. I'm not an engineer, so that was, yeah. Crazy story. And just, 

Doug: just touching back on something that you asked, or you mentioned that you weren't very good at speaking with girls.

Yeah. When you rocked up to that first aid physio, what was [00:08:00] the, um, what was the balance of male to females 

Nick: in that first year? Oh, that's funny. That's funny. Well, uh, I remember looking at some of the old photos, you know, around the, you know, how they got the graduation photos from like the sixties and the seventies and I think, I think in the seventies.

The first bloke was, was in physio at University of Queensland in Brisbane. And I'd say this split was two thirds females, one third male, still strongly female dominant, and I think it's just, just more female dominated than male today. But yeah, I, I looked at the people there and, and guess what I felt even in the first week, I felt like I was outta place.

I really did. I, I thought, I didn't think, what have I done? But I thought, is this me? Because, yeah, my early university experience, which was very formative for me, I went to a college. Now, some of your listeners will have gone to a college. College is fun and you do a lot of cool stuff and a middle of, there's a lot of drinking.

And most of my friends at college were engineers, lawyers. Couple did [00:09:00] dentistry, couple did optometry. I was the only physio. So it was, it was not a crisis of confidence, but I was like, oh, none of my mates are doing what I'm doing. It was a strange feeling. Doug. So you went to uq? 

Doug: I did. And what, I guess, what were your big experiences for you at university that sort of have it stuck with you going forward?

Nick: Yeah, so UQ is a four year degree at Bachelor of Physiotherapy. I went there from 2000 till 2003. Universities have eras and I went to UQ in the ta, deep Neck Flexer era. Um, so in my first year I enjoyed the varied nature of the course. And when I look back at the subjects that were probably most vivid to me, Doug, it was actually the psychology.

It was the, the entry to psychology subjects that really got me intrigued. And, you know, [00:10:00] I suppose physiotherapy has evolved from the body to the body and the brain to potentially the brain more than the body. And I think that I could even see at that stage that psychology had more importance in waiting than what it was probably given in our course.

Um, I remember very vividly a microbiology lecture where the lecturers. 50 minutes teaching us to wash our hands, and I almost quit the degree on that day. But that woman was a genius because she somehow predicted what we need to do during Covid. So the first year, I really loved the second couple of years.

Um, I, I struggled because I, I was a process driven person and I really did struggle with the anatomy. And I, I severely struggled with the neuroanatomy in second year. I remember, um, going into pracs and I'm a kinesthetic learner, and there was pins in brains and I was like, oh God, I'm not gonna remember what track that was.

I [00:11:00] remember my first anatomy exam in first year, Doug, there was 450 multi-choice questions. I knew 250 and I guessed 200 of them and I just passed the exam. So the first couple of years while being open to different elements of the health, um, education system, the switch from process driven learning to content driven learning was a real stretch for me.

It was really hard. Um, but once things became kinesthetic again, like I really enjoyed the, um, musculoskeletal physiotherapy prac. I remember I hated cardiothoracic in 30. It was the only subject I ever failed and I had to do a supplementary test for it, and it was almost like two thirds of our cohort hated cardiothoracic.

So that was confirmed to me during my prac year. So do you want me to, do you want me to go into the final year, Doug? The prac year, it sounds like, like it was your mate or break year. Absolutely. And that's where I [00:12:00] stepped up. Cuz again, it's all kinesthetic. You're doing stuff. So I think that I was one of these people that I wanted this accelerated journey and um, I had a really great prac here.

So I had a burns unit placement. I had a uni clinic placement for Musk. We had some really high level lecturers who then became, you know, heads of school of these other physio universities in Queensland as they popped up. Cuz UQ was the first and only one at my stage. Um, so I had some really. Musculo musculoskeletal placements, which was the direction I knew I wanted to head.

And I had some placements in cardiothoracic and rehab that confirmed my bias towards Musk, that I didn't want to head in those directions. So I think what I can say about my uni education, which was varied. I felt like I got a bit too much TA and deep flexes in third year, but that was probably all of us.

Um, and I did however, feel that we were very well prepared for the workforce at the end. Doug, with a full year of prac. Eight prac placements, [00:13:00] variety, you know, real patients. And at our uni, um, clinic, patients had to pay, I think they had to pay like $20 for an appointment. So that was really good for me because I was starting to associate my need to provide value for a patient.

You know, they were coming. They weren't coming for free, like in the outpatient system in the hospital, and I had to really give them good value in whatever way I felt like I could at the time. So I, I felt like we were very well prepared, Doug, back in those days. 

Doug: Yeah, that's good. It's that, that payment's an interesting point because I think that's one of the things that.

I'm not sure if threatening is the word, but when new grads come into a private practice arena, they suddenly get that realization that they're sitting down with a person, not only to help them, but there is gonna be a financial transaction and that. Can put pressure on them in addition to trying to do a good subjective and a good objective and provide some sort of me, me, me, meaningful treatment at the same time.

So it's a good, it's a good thing to be aware of. 

Nick: I think so too, Doug, and [00:14:00] we've in, in the group that I run for private practice clinic owners and physios, we've spoken about this many times over the years and for younger physios, You know, in, I don't, I'm not sure about your prac year, Doug, but in mine, I couldn't have a job because I had to work 40 hours a week, and I worked as a gardener at the uni for three months before I started prac to save up enough money to live for the year.

So I've thought about this long and hard, and I've written this in one of my books. It's the poorest year of your life as a semi adult in your final prac year, and you. The beliefs that you developed during that year, and you project them at least for the first couple of years onto your clients, um, in your first couple of years of work.

So it, the, the way that our final year and first year is designed can be quite mentally challenging from that, providing value and taking people's money for a provision of a service type of perspective. So yeah, [00:15:00] it's. 

Doug: Yeah. So I think what you're saying, and I hadn't really put it with words before, but I think you're saying is that we graduate as a fully qualified REM illuminated physio, but we are thinking still like a 

Nick: student.

A hundred percent. And like, put it this way, you know, how long have you been doing this, Doug? And how long have I been doing it? I'd, I'd speculate that both of us still have some, you know, high school level beliefs holding us back in certain areas. So like, you know, with a lot of mentoring under my belt of young therapists, The first step is for them to just know that they might be thinking like this.

You know, you don't have to change it. Just be aware of it and don't sort of put it in the back of your brain and pretend it's not happening. So yeah, it's, it's tough. Like, I'd say that in systems like, um, yeah, doctor World where they're. Um, residents up to registrars. They're working in a system where people don't have to pay.

Like it's possibly a bit easier for them. I think other professions have nailed it better than ours, like pharmacists with their internship year. Uh, if I could flick one switch, Doug, in the uni [00:16:00] system, it'd be a parting of ways in third year for Musk versus non musk. And then an internship year, the first year you get.

That'd be nice, wouldn't it? Or something 

Doug: similar. Yeah. That with the rainbow and the pot of gold at the same time. So look, once you graduated, this is, I find this interesting, like you've gone, what do you decide to do now that you've graduated? You know you're going to Musk. Yeah. But what were the key decisions that you made to further that pathway?

Nick: Oh, you get gonna love this. You might not have heard this story before. Some who know me well, it's pretty nuts. Um, okay. So I remember. Doing what everyone did about three quarters of the way through the prac year, which was applying for the hospital jobs. It was like the jobs that were seen to be the best jobs.

Um, and so I applied and I got an interview, um, and I did my selection criteria and I got into the interview. And in the interview, the people asked me the same questions as I'd filled out in the selection criteria, and it just blew my mind. I'm like, what is this all about? Why are you asking me the same?

I actually walked [00:17:00] out of the interview and I'm like, hospital's not for me. Um, after I walked out of the interview, my head was spinning. Doug and I was at, um, uni get this, there was a flyer. The flyer was. In the, um, on the notice board, it was one of those ones, the little dog ears that you take. Um, and it said clinic for sale and the price of it was, I think it was seven and a half thousand dollars and.

I, I was intrigued by it. I'm like, clinic for sale. I don't know anything. But somehow this, this opportunity, it just grabbed me, Doug. It just grabbed hold of me. And I didn't take the dog ear. I was a, I was a bit of a bastard. I took the whole flyer, um, and cut out the competition. I just, I just took I, well, well, I think at that time I decided that I was just gonna go all in on this.

And what happened was I drove up and I met the owner. This was a lady named Donna. So Donna had run this clinic for a couple of years. She only worked a couple of days a week cuz she had this desperate desire to get back into [00:18:00] the uni education system. Um, and it was almost like a straight swap. I wanted to get out and make my way and she wanted to get into the education system.

So she had a few different people who wanted the. And they had to be in, it was in a medical center, so you had to be interviewed by the doctor who owned the medical center and she got to choose who got it. Uh, and she chose me because I reminded her of her son. So at that time I was like, I'm gonna make, I'm gonna make a go of this.

And it was so interesting, Doug, because it was probably, it was probably the most amazing drinking from a fire hose moment for someone who got out. And you know how capable you are in your first year. You can hold down a conversation with people, but my God, you, you know nothing. And you know, at the time you're on the peak of the Dunning kruegger effects curve where you think you know everything.

And I thought, bugger it. I'm gonna, I'm gonna grow this business and I'm gonna get a great reputation in this area and give clients maybe what they might have been lacking, which I was able to work [00:19:00] out over the next couple of years. And yeah, that was, that was probably the biggest decision I've ever made in my career, the riskiest one.

But yeah, it's paid. Yeah. Um, 

Doug: that's, that's, I didn't know that. That's, that's pretty ballsy. 

Nick: Well, I, my parents had also divorced that year, so they, neither of 'em had any money and I went and got an unsecured line for the money and I'm like, screw this. I'm just gonna give it a crack med fin. Can't thank med fin enough.

Any of you guys who are looking to borrow to start your own clinics, they supported me. They, they, they give health professionals extra benefits than they would if you're a non-health professional cuz you deemed less risky. So this was about as risky as I could have been, but yeah, worked. 

Doug: Yeah. Okay. So what happened then?

Like you, you literally moved in, you gotta practice everyone's dream. When did the reality actually hit you that you had this not only clinical challenge, but you had a business challenge as well? 

Nick: Yeah, so what happened was I was able to, [00:20:00] Extract a good amount that I've learned. Like even even things like I did accounting in school, like I was able to draw from things I'd learned from family members and in school.

The business side of things initially, um, clinically I was floundering. Like I can hold down a conversation with anyone. So like, it, it's interesting what we, we often discuss, Doug, what makes a good physio and, you know, I suppose now you'd call it therapeutic alliance and I probably, you know, my diagnostic skills and the, the treatment tools available to me, I needed to sort of step up pretty quickly through, you know, fairly significant amounts of external courses and.

You know, even though the internet, the internet wasn't as, as accessible and in 2004 as it is now, so I literally, I sort of sweated on every mailed out issue of in motion where it had the PD section at the back with all the courses. And I, I probably would do four or five of those courses a year to upskill myself clinically.

But, um, [00:21:00] strangely, Doug, I didn't find the business side hard. It, it sort of unlocked a part of me that was probably locked during my physio degree. You know, I would do my accounting and my invoicing and things like that on a Saturday afternoon before I'd go home to my mates and where I was still in the share house, and we'd have a few drinks.

But the biggest step I made, Doug, was after about six months, I bought my first house and I moved away from my buddies up to this area by myself. I was like, no, I'm, I'm all in on this and I love the area. So probably only took me three months to get a full caseload. Um, but then my biggest regret is I really did nothing with the business for about five years until I was forced out of my premises.

So, um, back then in the early two thousands, you know, it was sort of fairly widely accepted for business minded people that, you know, if you bought houses and you bought shares, you were gonna be a millionaire. Um, so I started doing that, but then a little thing came along called the gfc and. [00:22:00] Yeah, I had some interesting experiences there, Doug, where I'd built up, I'd almost paid my first house off and I had some assets.

I was only 25. I was doing good. And I, I met someone from an investment company that turned out to be one of Australia's biggest, um, scams called Storm Financial. So these guys get you to borrow against your house and take out a margin loan on top of that. Some of you know what that is. It's just basically unsecured debt.

And then the stock market halved in the gfc. I went from a guy who thought I was gonna make my, make my way through property and shares to, oh, everything I've worked for for the last five years is gone now that, that flicked another switch in me, Doug, which was, I wanted to go all in on learning about business.

I became very skeptical of investing of property and shares because I didn't have control over it. I thought, what, what's the one thing I've got control of, which is my business education? And, and that started in earnest, um, just around the time of the g f. 

Doug: Yeah. Now I spoke with, um, [00:23:00] variety about something along this line as well when he sort of moved.

Nick: He was my, he was my men first mentor. Yeah. So he, 

Doug: I think one of the things that he would probably say he realized or stung him to was realizing he didn't have control of his own business in the sense of his venue. And so he really wanted to have control of that aspect. Yes. And it sounds like you've had a similar experience where you build up a business, you build up a clientele, it's associated with a particular venue.

And then, I dunno your story, but something happened where you said you got kicked out. So Yep. What did you learn from that 

Nick: process? Okay, so I started in a medical center and starting at a medical center's low risk, but it's rarely where many owners want to end up, Doug. So basically the um, the support I had in the first two or three years by the doctor's referrals really grew my.

But there's a little thing called a landlord and it, and it might depend how rational one's landlord is. So, um, my, I, I started on a lease at $500 a month. [00:24:00] Uh, and then the lady doctor sold to a male doctor and he was my new landlord. It went to 700 a month, a thousand, 1500, 2000, and I decided to leave when he was bumping my 30 square meter space to $4,000 a month, which I actually had a conversation with someone about this the other day, twen 15 years later, that's actually twice Brisbane inner city market value rent in like the best towers there.

So what happened was he had that conversation, like I just didn't do anything. And then I went and found my first premises to. Where I was for five years and then 10 years ago now we bought the, the reasonable size clinic we're in now. And I suppose while, while, and stretchy at the time, I found that, you know, our business is is 20 staff, six physios, four massage, two psychologists, Pilates instructor, practice manager, and a team of.

And owning the premises is a very helpful thing, Doug, because, um, I pay no [00:25:00] rent and that gives me a little bit of extra money to play with, to reimburse my team and to, you know, reward them in different ways and to, um, incentivize them and, and basically run a business where my team are at the, the center of what I do.

Yeah. 

Doug: So when you moved, when you've moved clinically, I guess, into a practice, What do you think's more important for? So for young physios listening to this and they're sort of having some thoughts along the lines of going towards business themselves. Hmm. How important is the clinical side and how important is the business side?

Nick: That's a really good question. I suppose I, I might answer it by talking about what I would've done if I had my time again. So, if I could have done this process again, what would've been better than what I did? And by, by. I, I wanted, I wanted an accelerated clinical journey and an accelerated business journey.

And what I missed in that first five years was a mentor. And as I said, I did a lot of courses, but I didn't have a mentor. So like [00:26:00] if, if I could take my 40 year old brain, put it in 21 year old Nick's head, I would have gone to probably 10 private practices in a region that I think I wanted to be or end up met the owners of each of those.

Asked to shadow the owners for half a day or a. Seen who I wanted to learn from and found myself a mentor to work under to learn physio and business for anywhere from two to five years. And at some stage during that two to five years, talked to the owner about what a succession plan might look like, which might look like buying into the clinic, might look like starting my own with their support.

Um, back to your original question, Doug. What's more important, clinical or business without business skills? Your clinic doesn't work. But without getting results for clients, your reputation and your results won't allow you to thrive or won't allow you to,

to [00:27:00] sleep at night. I suppose like, you know, if you are, uh, you know, you, you've lived in the era of people, you know, doing freaking 10 sessions of inferential with every new patient that comes through the door. Um, I. Starting my career, there was such a variety in quality of physio, and I think I, I do believe that quality has improved over time as an average.

Um, where like, I, I thrived because there was one practice where everyone got ultrasound and heat packs and there was another practice where, you know, everyone was a fresh graduate. So I made my way pretty well at the start just. Getting more experienced, laying my hands on people, developing that good, you know, we'll call it now.

Motivational Interviewing Therapeutic Alliance. Basically plotting out a good consultation where you understand the main reason why someone is here to see you. You have an ability to work your way towards a provisional diagnosis, which you [00:28:00] can meaningfully convey to. The treatment is a mix of hands-on and exercise and self-management, and you have a plan for that person, so, Oh, I would say they have reasonably equal importance, Doug, but there are ways for young physios to learn that stuff from people like me or you.

That is almost always better than just starting it on your own. 

Doug: Yeah. Okay. Uh, I was thinking that there is a transition from, um, I guess you call it a worker bee to a queen bee in the sense that you're taking on more of a management role, more of a, you know, a buy-in role, a business role. But even with new graduates, I find it an interesting conversation to sort of say that, you know, at some point you're gonna ask for a pay rise, and that's fair enough, but the business owner can't give you a pay rise unless you're earning more for the business, because otherwise the business is going backwards.

And if a business goes backwards, it goes broken. You don't have a job at all. So, mm-hmm. Essentially, as a new grad, recent grad, working with somebody, [00:29:00] You kinda have to think of yourself as a business within a business. Like if you generate more clients, you increase the throughput, you develop some classes, you can then go to your boss and say, Hey, look, you know, in the last six months, this is how I've built my caseload, and this is how your business, your business, the owner's business has improved.

How about we do a bit of an equity share here and what about a pay rise and as a business owner? That to me, yeah, absolutely, because I want, it's music to my motivated, but they've gotta realize, they're gonna realize that a business can't pay somebody more unless the business is doing better because of what they bring to it.

So profitability. And productivity, then we can pay you more. And it is not like in the hospital, you, another year you get a pay rise. Well, private practice, it doesn't work like that. So Doug, 

Nick: there's, I find that there's two types of therapists in private practice. From the perspective you're referring to, those that understand how private practice works and those that don't understand.

And there's a surprisingly high proportion of those [00:30:00] that don't understand, but I won't talk about them in this segment here. So the ones that do understand, um, there's this concept that we discuss in my circles, which is, Um, a, a therapist can only be paid from the pool of money that they generate because there are no external ge externally generated pools of money In a private business, the way that, you know business works in physiotherapy is physios bring in money from that.

Money is paid the expenses of the business, the wages and benefits of the therapists and profit is left over. Better businesses don't leave over profit. They plan for it, but we won't go into that. The conversation you just described is generally facilitated by an owner in a non-threatening way, introducing the concepts that I described to a therapist reasonably early on.

Um, and sometimes if a therapist doesn't want to think in terms of revenue, they can think in terms of patient numbers, which they're generally a bit more okay [00:31:00] with. Um, and you are right that a therapist. Therapists have different goals when they start. Like some are just hell bent on learning as much as possible.

Some do want money, some want freedom and autonomy. Some wanna be recognized, some want positions of responsibility. Um, People that I work with are developing more psychometric tools to help us as owners, Doug, determine which of those pathways somebody wants. Uh, but I want my therapist coming to me having the conversations that you just described, cuz it means that they have demonstrated this understanding between either.

I need to either see more clients or I need to get better so I can charge more, or I want to develop these novel services and streams. Or the first thing that young therapists need to do, Doug, is just plug their gaps. So like if you, if you are a young therapist and you see a client two or three times and they don't come back, Call them, find out why they haven't come back.

Almost always, it's actually nothing to do with you. You [00:32:00] know, my dog died, my freaking battery died on my car, or my kids got sick, or I got covid. One of the biggest problems that young physios face is they think that the person doesn't come back cause of something they've done wrong and it affects their confidence nine outta 10 times.

It's not. But back to the, the financial side. Want to be giving. My therapist pay rises as often as they can sort of demonstrate those results. But until I understand it, Doug, they can't easily demonstrate that. So much of that falls on me and the other owners here. Yeah. 

Doug: When you're helping new and recent graduates develop themselves as clinicians, Or as physios?

I guess more broadly, what are the common kind of clinical and personal and business type advice you find yourself saying time and time again? Like what are the key things that you tend 

Nick: to mention to them? I love that. Okay, so, so to answer that, I'm gonna think about what the, the average problems are. So like, At, at the root of it.

So I'll describe what I think is a root problem a young physio [00:33:00] has that limits their performance and growth and, and happiness in, in their first few years of their career. Because the physio is inexperienced, they don't perceive that they're offering the level of value to a client. As say a five or 10 or even a third year experienced therapist, and that young therapist then compares themself with the more experienced therapist.

So what are some of the symptoms of not perceiving that you're offering value? Um, I, I find the main one is what I refer to a lot as projection. So if a 21 year old physio who's never had an injury sees a 60 year old professional who has a sore knee and they're either facing a knee replacement or giving up golf, or never being able to take an overseas holiday, it's very hard for that 21 year old to truly understand and e.

With the impact and magnitude of the problem that the [00:34:00] 60 year old is bringing to them, that's very difficult, isn't it, Doug? It's, it's one of the hardest things now. That lack of understanding and the fact that that therapist is inexperienced and doesn't know what the potential, um, natural history or prognosis for that condition is, whether that person may A, need a knee replacement, b, get one without needing one.

C get worse. Um, d develop psychological issues because of this problem. Um, e have a really good recovery guided by the therapist without being able to understand that those pathways are all possible. I, I suppose I would just call it overwhelm. I think, I think the first few years are very overwhelming cuz all of your clients are new.

You know, when you've been doing it as long as you and I. You've got people you've seen for 20 years on and off and you know them. You don't have to build that rapport and you know how to motivate them and what they need. Um, but yeah, start of your career, you don't [00:35:00] believe you're providing value.

Everyone's new. You're comparing yourself with more experienced therapists and frankly, there are clients that you are not going to get good results with. Like, I remember, I think I had like my first C R P S. A month after starting the clinic, Doug. And how the hell do you think that's gonna go? Like I did my best.

I researched the condition. Um, back then it was called reflex sympathetic dystrophy. So, um, young physios expect the hard patients to sort of emerge at the start of your career. Doug, you've probably got a story like that as well. And when you look back, I did my best, but there's no doubt that that person would've got a better outcome seeing me now than back then.

But to a degree, you can't beat yourself up about this. Like it's the pastors in the past. And so the most common thing I see with these young therapists is this belief that they're not providing enough value for [00:36:00] what the person is paying. Like at our clinic, um, we had a new graduate last year who moved cities and, you know, he was charging $150 for an initial consultation.

And I had to, I had to say to him, Think about what you are providing. Like you probably listen to this client better than an experienced therapist like I was, I was treating until mid last year, but I was distracted and my appointments were shorter. This person had more desire to help that person and they had fewer distractions.

So the young therapist, you really gotta think about. The fact that there are some things that you are probably doing better than a therapist of my stage. Like I, I've had young kids and I've had consults where I'm freaking falling asleep because the kids have been sick, you know, stresses with the business during covid, you know, young therapists.

You, you guys provide more than you think you do, honestly. Hmm. Sorry, Doug. I was ranting a bit there. 

Doug: No, it was, it's all insights. [00:37:00] Um, what would you say is the hardest lesson that you've learnt as a physio? Like you've taken some quick pivots earlier than I would've normally advised the physio, so that's, then that's fine.

You've survived, you've still got hair in your head and that's good. Yeah. Um, so what would you say has been your hardest lesson you've learnt in your career so far? Oh, 

Nick: wow. As a therapist. 

Doug: Well, if you want, I mean, you have a, you have a big business process component to your makeup. Yeah. So if you wanna have one, either way we'll 

Nick: give you a Yeah, okay.

The business one's easy and I won't elaborate on The biggest mistake I made in business is being on my own by myself for too long, which was five years. And I can talk about that at some latest stage as a therapist. Um, I've just gotta try and differentiate it cuz there'd probably a few biggest learning biggest.

Yeah, I would say not getting myself under a good mentor soon enough. So again, in that first [00:38:00] five years, like I don't think I did damage. But I think I sold some people short for what I could have done for them. Funny example, Doug. I was at a restaurant a year ago. This guy came up to me and shook my hand.

I'm like, who are you? I didn't say that to him, but that's what I was thinking. He said, oh, Nick, I saw you back in 2004. You said you couldn't help me, and you referred me to the chiropractor, and I've been going twice a week, ever since, for the last 15 years. I'm like, oh, what have I done? So, yeah, like I think that.

I think that as a physio, like physio is a very adaptable profession where the therapist that you become and the business owner you become, should you choose to are exactly what you can make of it. You don't need to follow someone's pathway to the T. What I did, both therapy and business-wise, between probably 2007 and 2015 was fine.

Three or four mentors who I believed in for both business and therapy. That I built a method [00:39:00] that was based on what I, the best parts of what I learned from those mentors. And if there was something that I didn't like that they did, I just didn't do it. So, you know, I'm, I've lived a life where, because I was under mentored for the first few years, I probably overcompensated Doug and become over mentored for the rest of my career.

Um, yeah.

Doug: And for a couple of, you know, a couple of shorty questions maybe, For a couple hundred bucks, what would you say has been your best investment in either a book or an app or a, a session or something's that's assisted you in your development? 

Nick: It's evolved so much, Doug, and I like this question when I saw it asked.

And guess what, I can save your listeners 200 bucks. Um, there are now these things called Facebook groups. And they are absolutely incredible because they are forums of people similar to you. So there are clinical groups. There are business groups. So like I run a business group with 1600 [00:40:00] Aussie physio clinic owners on it, but I'm part of four or five different clinical groups where.

People ask questions and other people in the group answer those questions. Now, I think that format is more valuable than any passive tool, like a, um, a book, um, an online course. I think the interactivity, legacy, and. There's one thing that people don't use enough in these groups, Dougs, that's the search function.

There's this little magnifying glass in the top right, like if you wanna know about a certain condition, like I just mentioned, C R P S, if you're on like the APA Musculoskeletal Physio Australia group, that thing's been going six years, go type in C R P S and look at what everyone's said about it before.

Look at what references they've given. Look at how experienced therapists treat it. Same from a business perspective. If it's like, you know, do I have to pay? Superannuation on this type of bonus, just freaking type that into the search bar. So I'm a member of probably 10 of these groups, Doug. [00:41:00] I'm interactive in probably half of them, and I facilitate and share two of them.

And the feedback we get on the free education and the gaps that we solve for people, it's like nothing that existed before these forums, like they're, they're remarkable. They really. Yeah, and I think 

Doug: that speaks to a couple of things. One is the first that we are so, or can be so in the, in the present.

And so we only re scroll down the first two or three things we, okay, yeah, I've got on contact. But they don't realize, as you say, there's, there's literally a blog of archival stuff there that if they hit the search button, it's the same an on our blog, the, that I've got, you know, probably, uh, 15 years of stuff and people ask me a question and say, look, if you just went type this typed in the search.

Pregnancy and dry kneeling, you'll find probably three or four articles, a hundred percent, and it's, it's a, yeah, it's an interesting thing. Just keep reminding you, there is an archival amount of material that can be quite handy on that particular topic. It doesn't have to be there in the last couple of weeks.[00:42:00] 

Nick: Absolutely. And I think that's what makes these groups like modern evolving encyclopedias or Wikipedias for the, the younger people, um, listening to this or watching this podcast is that everything you need is there. You've just gotta learn how to navigate the system. Cuz again, you know who read an encyclopedia from start to finish, Doug, you gotta know what you're looking for.

I was, you could probably see I wasn't that diligent to do that. I just went to what I. 

Doug: Yeah. Well, I mean, and, and, and those sort of groups or forums, they're so niche and targeted. So if you're in your right niche yeah. The information you're getting is quite specific also to what you're sort of looking for.

Nick: Oh, it is. And the best way to learn from people is not to reinvent the wheel, it's find someone that's a couple of years ahead of you that's done what you want to do, and. But like what they do, you know, it's not rocket science. Yeah. 

Doug: And it's the same, the patient, I say, look, we don't, we don't live in the age of information Now that's come and gone.

We live in the age of synthesis. So you wanting to find a, a practitioner or a person or a mentor that's [00:43:00] been there, done that, and then can filter out the 99 articles and give you the one that you actually need. And that's a good 

Nick: clinician as well. Yeah. And I think that sometimes, like you describe it better than me, like I'd call it experience, you call it synthesis, which sounds better.

Um, But determining the validity of that is difficult and yeah. Do not underrate experience and expertise in terms of helping you to get where you'd need to in your career, whether it be physio, business, whatever. Yeah, honestly, it's, it's how I've made my way. 

Doug: Hmm. And you gave us one out on the limb decision, which was the bio practice from a, a piece of paper on the wall after walking out of a job interview.

Mm-hmm. Is there another one that you've made in regards to your career and what was the outcome of it? 

Nick: Yeah, good question, Doug. Um, probably the other one was in around 20 15, 20 16, um, [00:44:00] once I was getting bored. I felt like there was something more that I needed to both do and be in my life and for the profession.

And I was, at the time, my identity was a therapist. I was looking after a lot of people and a business owner. I was growing a business looking after team, but there was just this something extra and I was like, what is it? And what I started doing, Doug, was I started a Facebook page in group and I called it Ultimate Physio, and I started talking.

Concepts that were affecting the profession or the, the, the area of private practice physiotherapy in Australia. And I, I shot a lot of videos, Doug, and I didn't really know who I was talking to. I, I was unsure at that time in 2016 whether I was talking to therapists or owners. And what started to happen is I started to get a lot of engagement from owners.

And so while I have produced resources for therapists, [00:45:00] Um, so my business, ultimate Physio is a consulting business that works with clinic owners to give them time, profit and freedom through business leadership and personal development resources. So I know that's a rehearsed spiel, but so be it. It's probably the easiest way to describe what I do.

And so to go out on a limb was me creating this consulting business without knowing who my market was. And I basically put a year into it. Doug, I thought, I'll give this a. I'm satisfied to not earn a cent for a year to see if I can create something and to see if what I'm saying is being received by anyone and whether it's worth me talking to people.

And the community that we built has just the, the tightness of the relationships in that community and the help that people give each other has proven to me that I did the right. And like my life now is split between my family, my two clinics. I started another one six weeks ago in this consulting [00:46:00] business where I, I deliver like a nine month business educational program to a group of clinic owners.

So that was the other limb cuz when you get to a certain stage of life, Doug, anything that takes a larger block of your time, um, one needs to very carefully consider to not have too many spinning plates in the air at. But I'm very glad I did because basically I've got these clinics and I've got this consulting business and the relevance of what's happening in my clinics feeds this and the great ideas that everyone comes up with here comes back to the clinics.

Like it's this symbiotic relationship that I would've never thought possible. So yeah, it, it was not a risk on anything apart from my time, which is very valuable as yours is, and everyone listening to this, and yeah, I feel like it's paid off. Yeah. 

Doug: What three things in your professional life stand out for you as being highlights?

Either high or low, 

Nick: I guess. Okay, so highlights. Yeah, that, that [00:47:00] decision, that initial decision to go all in. Um, the G F C and my response to that. So going all in on business and, and becoming a better physio based. Some pain. Uh, and probably the third one is last year, so last year, 2022. Is fairly widely amongst the, the clinic owners that I work with, known as what, what was our hardest year of business ever.

Uh, obviously it was a year. Covid was let loose in Australia. There was significant challenges associated with the mental health of our team and the viability of our businesses based on significant volumes of canceled appointments and therapists. Lack of availability due to sickness. I lost 15 of my 20 team last year and I rebuilt the team.

So that's probably actually my proudest thing that I've ever done is rebuild a team that was crumbling last year due to many factors. Um, probably the predominant [00:48:00] one, Doug, would be the, the covid soup that we were all sort of swimming in and what that was doing to our mental health, um, as a collective.

So yeah, those three things, they're all pretty big things. 

Doug: If you could stand back, well, if you could stand, send yourself back in time to your younger self stepping out of that sort of job interview, I guess. Hmm. And in part three pieces of wisdom, what would they be? 

Nick: Probably only need to in part one, really, which is just to be more patient.

So I think what I believe Doug is. At the start of my career, I was rushing. Everything was fast, everything was, um, to get to somewhere, and that was in business. That was clinically. Sometimes if you don't step back to think about where you want to go and learn more about who you are and what you want, you rush.

But it's like not [00:49:00] setting your gp. And you get in your car, Doug, and you started in about half a second, and you drive as fast as you can, but you dunno where you're going. And then what happens is after an hour of driving, you are like, where am I? I'm in the forest somewhere, but I wanted to go to the beach.

So I think that being patient and spending time thinking about, as I said, who you are, what you want, what's stopping you, how to get what you want. So patience thinking. Um, and we've talked about it a couple of times, advice from people that are two to three years ahead of you. I think if you get advice, like I like the concept of physio plus 10.

I personally found for myself, if someone was 10 years ahead, I couldn't realistically see how I was going to get there. I thought that was potentially too big a step. Um, on reflection for me that two to three, it's like, oh, well you are three years ahead. It's like the graduate learning from a fourth year.

I [00:50:00] think it's easier for a graduate to learn from a fourth year at physio than a 10 or a 20, cuz the 10 or the 20 sometimes loses perspective of what it's like to actually be a graduate. Which is why in my clinic I have these stepped mentoring structures and I'm not doing the clinical mentoring cuz I'm 20 years out and I'm not a dinosaur, but I'm.

I don't have the empathy for the younger ones that someone two or three years older does. So yeah, patience, thinking, time, mentorship, three things. 

Doug: I think that's the nature of youth though, isn't it? The um, I love the energy and it's, that's the thing I love when I go and do some teaching. They have so much energy.

A hundred percent. And that in itself is quite a refreshing, uh, quality. That, you know, when you interact with it, it sort of enthus other people too, which I think is great. And then as you say, the directing is good. You know, we need to, we could probably be a bit more strategic perhaps when we're younger.

If we know what we're wanting to do, then we can get there a little bit quicker. And I like the [00:51:00] analogy of having a map. It's much easier to get from A to B if you've got a map gps, there's an age thing, you'd be using gps and I'll be using a map compass. Um, but yeah, I think that that, that, you know, the combination of the two, the.

Energy and the older wisdom, strategic planning and the benefits of it. It's a good combination. That's what you say. You know, we've got under umbrella of me. 

Nick: It's a great team and well, one of my favorite, um, analogies I've heard, Doug, is you got, you are at youth, middle age, old age three variables, time, energy, and money.

When you are young, you've got time and energy, but not money. So what do you want? You want money in middle age, you still have energy and you've got money, but what don't you have Doug time. That's what people like you and I crave. And then the older. Remember this as therapists, they have money, they have time, they don't have energy.

They're coming to you to help them get their energy and their vitality back. That's what they want from you. But how can you understand that as a 21 year old when you got energy in spades? [00:52:00] 

Doug: Yeah. I've always said the government needs to pay more when you're younger cuz you need the money and they check tax you harder when you're older cuz you don't.

Yeah, you don't, don't need the money. Well, 

Nick: it's, it's more correct than the system we have, isn't it? 

Doug: Looking forward, where would you sort of like to see our profession of physiotherapy heading in the next few years? 

Nick: My vision for physio as a service itself, I, I thought about this for many years, Doug and I, I tried to come up with a couple of things.

I think the most clear thing that I could come up with is it's said that every individual has a doctor and every individual has a pharmacist. I would love every person in Australia to have their physio and to have their physio's number saved in their phone. Obviously there's a lot of lot of work being done behind the scenes now to, um, I won't, I'll say it.

Remove GPS as the gatekeepers of Neuromusculoskeletal medicine. Uh, I believe in 10 or [00:53:00] 20 years. Physios can be seen on an equal level to gps, but physios are neuromusculoskeletal first contact experts, and every single person has a physio that they see. I think that many of our professions challenges and problems will be solved by that.

Doug, I'd say the main. The main rod we've created for our own back is undervaluing what we do as a profession. And I think that the flipping of that system and some concurrent education from people like you and myself, and people with influence in the profession to those, um, less experienced than us, can probably help to shift our identities to be able to take that mantle.

So that's what I want. I want every person to have a physio. Yeah. 

Doug: Well, no arguments from me there in the sense that I think that, you know, the gateway is skewed in a direction which is not beneficial for the system or the finances of the system. Yep. Um, and [00:54:00] that certainly, or the user. Yeah. Well that's, that's the point behind the system, isn't it?

It's the benefit of that person. So yeah, if you ask, you know, the question would be if a person comes in with a worker's comp injury and they hurt their. Um, or they're an, an athlete that's, you know, rolled their ankle and they gotta claim insurance. It's, it's crazy to be going to the GP because you just wasted an appointment, you've was a consultation.

You've wasted time of a profession that really is time poor anyway and could be better utilized. So to me it's more a recognition of the better utilization of resources, which are finite. But at the same time, we have to step up. I think the R S E G P as a medical profession also has to realize and acknowledge that they aren't the best people for that particular type of consultation.

And until the two parties come to a recognition, you know, cuz they, you know, that's where Medicare comes in. We've got this big review of Medicare. But if the medical profession is fighting tooth and nail to say no, no, we don't want any other profession on the Medicare [00:55:00] schedule. Well, it's a user which is missing out, and it's a taxpayer which is paying unnecessarily for services which aren't ultimately provided.

Nick: I think R A C G P has to realize that if they gave us that responsibility, it will actually make their members' lives better. Not worse in many 

Doug: ways. Yeah. Well, and, and as you know, as a business owner, it's all about showing possibilities, potentials, benefits, and that's to both parties and I think, yeah, we need to put out.

A positive benefits case to the medical profession, how it would benefit them and their other clients to utilize our services to a high degree. 

Nick: Hundred percent. We, we've gotta show 'em how it's good for them, Doug. Not bad, don't we? Yeah. 

Doug: It's the benefits we've gotta look. Yeah. The half glass full thing.

Mm-hmm. So where do you see yourself focusing, Nick, in the next few years? What are your sort of goals for the next few years going ahead? 

Nick: So I'm starting to feel now, like I did six years ago, Doug. I'm starting to feel like I've got this extra thing in me. I'm not sure what it is. So I'm at the [00:56:00] stage where, Um, my goal with my clinics is to hire as many people as I can in my local region, but I, I'm big on creating tiers of leadership below me, so, uh, it reduces my responsibility.

I still have leadership and influence, but not day-to-day responsibility to buy me time. Um, I want a bit more time to do things that I haven't. Done enough of in the last 20 years, like we've just bought a unit on the Gold Coast, you're probably a surfer. Being a West Australian, I need to learn how to surf properly cause I'm not that good and my wife is, she's better than me.

Um, I wanna be involved in the coaching of my kids in whatever they do, uh, professionally, I would like to take more people through my Ultimate Physio program, but I just feel like I've got this one. Business in me that's sort of sitting above ultimate physio from an impact perspective. And I don't yet know what that looks like.

It may not be even relating to physio. Like, um, yeah, I'll go very deep with you. So I'm a, I'm a driven business bloke and too many of my friends who are driven business blokes are getting divorced. And I did a [00:57:00] program a year ago to help. Driven businessmen not end up with divorced, um, homes. So that's something I'm extremely passionate about.

Cause what's he used to doing this all? If, if you become so driven that you fail to, um, be fulfilled with, with what's around you, Doug, and you just seeking achievement the whole time. So yeah, you asked, I had to tell you it's 

Doug: difference. Well, I mean maybe that's, that, maybe that's the business. Maybe it's, you know, you know, Because essentially when you look back on the business of physiotherapy, it's come, we've come as clinicians.

Some of us are migrated to be business owners. Some of us have realized the deficiency and we've gone out and sought external information from other sources on how to run a business. Cuz it's completely separate to being a clinician. Yes. So maybe you are talking about one step further than that. So saying, well now we've got the clinician, we've got the business owner.

But we've also now got an issue where the person's outta balance and their life skills. Yes. Maybe that's what we need to bring back into our profession. Say, yeah, you can have your [00:58:00] life, you can have your business, but you also need to be careful of your family and those other things that are close to your doorstep as well.

Nick: Maybe that's what it's, I've actually heard, Doug, that in business and once you reach a level where you are solving bigger problems, it's often said your ideal client is. So like, I think that what I've found at every stage of my career, that as I level up my ideas, focus on what I actually need for myself and helping other people who are going through similar.

So, you know, at this stage of Covid, w we're trying to solve structural challenges in our profession, but I really do want to look after the mental health and lifestyle of the people that I serve who are clinic owners in a. So that's what I'm very passionate about and I'll, I'll help them solve those problems in whatever way I can.

Great. 

Doug: Well thanks very much for your insights and time, Nick. It's been a real pleasure. I'm sure people listening to this podcast on Physio plus 10 are gonna pull out some real gems and, um, it's all because of you. So thanks 

Nick: again, all I [00:59:00] appreciate it, Doug. And, um, Yeah. Thank you so much for listening if you've made it this far, and yeah, feel free to contact me if you've got any questions.

No obligation, no charge. Just look me up on Facebook, Nicholas Schuster, and just message me and ask me something. Happy to help. Cheers, Nick. Thank you, Doug.

Doug: Thanks so much for listening to this episode of Physio plus 10 in which I trust you gain some valuable insights. It'd be awesome if you could leave your 2 cents worth as a review or rating of this podcast. Now I look forward to sharing the story of another trailblazing physiotherapist with you in two weeks time.

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