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Milestone Maker: Gaining Confidence in Her Pediatric PT Practice with Karen Tanso

Karen Tanso, CEO of Inchstones PT

Today's interview features one of my business coaching clients, Karen Tanso. She is the owner and operator of Inchstones PT, a pediatric cash based physical therapy practice located in Massachusetts. Karen clues us in to many of her experiences as a business owner and the journey she's taken to get where she is today. Learn how Karen gained confidence in herself and her practice by trusting her marketing message and having a true passion for helping others!

What we're covering:

Tell us who you are, what do you do, and about yourself.

Karen: I graduated in 2014 from PT school and I just always knew that I wanted to do pediatrics. My clinicals were peds. I went to Simmons College, which is now Simmons University in Boston, and I went there because I wanted to get a clinical at Boston Children's Hospital. I ended up in Texas Children's, another story for another day, but I loved it. I loved being out in Texas, that was really fun. I set up everything to try to get as much peds experience as possible.

Then I got out into the real world and I started working in a few different clinics. One right off the bat, right out of grad school, and on my second day I just knew like "this is not the place for me." Luckily I was able to network with some people and I started at another clinic outside of Boston. I started their Pediatrics program there. I was doing pediatric outpatient, I was doing aquatic therapy, I was doing pediatric concussion management, and it was great.

Then the pandemic hit and I was one of the first people that got laid off. It definitely threw me for a loop because I was there almost six years. I was like "I just need a job." So I was doing all these virtual things, kind of planting the seed for Inchstones. But, I needed to get a full-time job so I transitioned to the schools because I knew no matter what, schools needed a therapist.

Ever since then, I knew I wanted to do my own practice one day. I decided one night I just needed to start Inchstones tomorrow. I always knew what the name was going to be and so I just did it. It just started off as a website and a Blog and Instagram. I kind of did that for a little while and then I was like, "I need to turn this hobby into a business." I really got serious about it within the past year and then I found you [Morgan] and it's been amazing to work together. I've learned so much in the past six months and just really come a long way.

Karen and I were talking about our days so far and this thing that is called burnt toast is like the universe's way of preventing something even worse from happening. Do you want to talk about your burnt toast?

Karen: I actually did burn toast this morning for real, which was a sign. I didn't mention it, but my practice right now is just mobile based and you have to have a very dependable car. My car has been great, it's a 2021 and I bought it out two years ago. I went to go run an errand right before this and gave myself plenty of time. On the way home I was going through a construction site and popped a tire. It's one of those things where I'm like, "Morgan I don't know if I'm gonna make it." I called Triple A, they told me it was going to be at least another hour so I'm definitely thinking I'm not making it to the live stream.

As soon as I said that, somebody pulled over on the side of the road. He literally just quit his day job at Toyota and was opening a sandwich shop on the plaza I got stuck at. He just changed my tire and we talked about business for a half an hour.

This was one of those things where it helps you remember that there are still good people in the world, and like you said, maybe it prevented something horrible from happening. Or maybe I just needed to meet this person and have this experience. A not great thing happens and then you end up diverted down another path and in my case, I ended up doing some networking by accident.

Morgan: Yeah, so we were just talking about that and how I feel like burnt toast theory definitely comes into play when you are running a business. In a lot of ways things are not going to work out the way that you want. I'm sure I can think of a few examples, but do any examples for you come to mind thinking about that Karen?

Karen: I mean, starting from scratch, right? In PT school we don't learn anything about business. I also thought I was running Facebook ads and you informed me that I wasn't running ads, I was boosting posts. I thought I was running ads all along but now I actually know how to do them.

With website stuff, I would sometimes get down into the weeds before we started working together and then that was one of the things we talked about. You were just like "put a time on it" and only spend "this amount of time on it." Don't go down into this dark rabbit hole like I used to where it would be 1 o'clock in the morning and I'm trying to fix something on my website but can't figure it out. But then, I wake up the next morning and try to fix it and am able to do it in a second.

You just have to have that "pause." Sometimes I wish there was a notification in life that comes up and says "this is not working for you." This fact has been a huge learning curve for me.

Morgan: I think that is a really big thing, you know, that I try to get across from us working together. There's big value that I have as a business coach because I want to teach you how to do things on your own. Which, is very similar to PT because as much as we love some of our patients, we would rather not keep them forever. I mean, if they want to hang out, great, but the whole objective is to teach somebody how to be independent so they can go off and do their own thing. This is just something I would like to impart on anybody who's starting a business.

I think it is very important for you to learn a lot of the stuff on your own. You can have a guide, you can have a coach, as you said, but you have to do the practical stuff yourself, just so you have some familiarity with it. And then, over time, you'll be able to figure out these are things that I really like doing or that I'm good at doing. These things, not so much, and either, you know, you can outsource it or get more help with it or things like that. It just, it's going to make you a much more confident business owner because you have a solid foundation and you can talk the talk, and you're not just kind of floundering.

Karen: At the beginning, I thought I saw my practice going one way. Then, I collaborated with this other business, and all of a sudden, I was going that way. You were just there for all the changes, and every question I had, here's my resource on that, here's that. I definitely felt like I was all over the place at first and then you kind of steered me the right direction.

Morgan: I feel that brings up another good point. I was just talking to one of my other clients about this morning. I think it is a very positive characteristic as a business owner to be somebody who has a lot of ideas—you can brainstorm, problem-solve, and think of all the things that you do. It's a hallmark, I think, of an entrepreneur. But, at the same time, it can hold you back if you try to take action on all of them all at once. So, the thing that I suggest for people to do (and I do this as well) is to keep a note of all my ideas that I have, whether it's in Google Docs, a note on my phone, or whatever, so that I can come back to them. Just remember all the ideas that you have; it's not that you can't do them, it's just not right now. You can do them in the future.

Karen: Yeah, and I think even just going back to the basics because I was far ahead in some things, but I didn't even have my systems in place. I was all over the place. That was one of the reasons why I wanted to work with someone, and after our call, I'm like, "all right, yeah, she's definitely gonna be good for me." I needed someone to reel me in, and I also needed to organize and just go back to the basics.

I think that was really important for me because I just had to slow myself down. I definitely get a little impulsive sometimes, just wanting to do all the things. For people that are going into this, I do feel it's pretty common that people try to do it on the side first because it's really hard to make that leap.

My situation is I'm in Public Service Loan Forgiveness, so I have 21 more months until my loans are forgiven. That's sort of my plan to then go full-time, but I didn't have that much time to give to my business. I think that was one of the things—I wasn't being intentional about the things that I needed to do. Going back to the basics, which is why it was nice to work with you consistently. Having a plan, your roadmap was amazing because I could just go through it. Sometimes we had to skip around because it was things I was doing within the next few weeks that I had to learn on the fly.

But if you're a PT, I mean, if you're a PT, you learn on the fly. That's just what we do, right? I don't care what setting you're in. Nobody's just sitting there not having to think on the fly, no matter what setting you're in. Especially with pediatrics.

I remember back in clinicals, I would plan every session, write down every exercise that we were going to do. But I work with kids, and a lot of them are kids with disabilities. There's no plan that you're going to follow. It's just, "What do we need to do during this session? What are the parents looking for this time that we meet?" But that was really good because even if I was doing things and I was off on a tangent, you would bring me back, and I would go back to the roadmap. I'm like, "Okay, I need to finish this. I need to do this." Just accountability of having our homework, my checklist, and the to-do list week to week was really what I needed.

Morgan: Yeah, it helps to be a little bit organized. I think it's fairly common when you jump into this, too. Once you get past the bare minimum of setting up an LLC, knowing how to document, take pay, whatever, you start to realize that the process of starting and growing a business is, fortunately and unfortunately, never complete. For a lot of us checklist people who like to complete things, it just completely blows your mind, and you don't know what to do with it. It always feels like there's just more and more to do, and there is. But by keeping it at kind of smaller tasks and more granular on a weekly basis, it sounds like that was helpful.

What kind of practices or things are you doing on a daily or weekly basis to help you be intentional with your time as far as working on the business?

Karen: I think boundaries are huge, right? So when I first started advertising people would reach out, which was new, but my leads were turning into conversions. I would say "Yeah, I'm available anytime outside of my full-time job." I think this happens with a lot of PTs, but maybe just me personally, but I think we want to people pease. I just wanted to try to work with everyone and one thing you said that's really stuck with me is that you can work with anyone, but you can't work with everyone.

All of your mindset stuff is invaluable because it has really changed my whole approach to being a business owner and having boundaries. Even making sure that it's not just that you're the right fit for the client, but they're right for you too.

When I went back to work from the summer, I was really intentional about what days I would have my calendar open and really trying to not change. On the weekly, Mondays are kind of like my admin day, so I'm going through all of my checklists. A lot of the stuff from the DPT to CEO Road Map, I've sort of taken and modified it for the things that I'm doing.

My weekly lists are smaller, but like my monthly ones are bigger. I do a lot of admin at the end of the month too. Even just the Profit First book, I read through it and everything is really great because when you first start a business, you often have a lot of expenses and when you start making income, it's like "what do we do with this?" One of the times we met, I remember you saying "You need to pay yourself."

I'm giving myself free time too, so not every day of the week am I going to be available. Tick Tick has helped me a lot with time management but also just prioritizing things. I've set myself up so that most things I do for the business now are at the end of the month, but weekly it's just a few things that I check off and make sure I'm staying up to date with.

What do you feel like has been the biggest challenge for you so far?

Karen: I think just selling myself was definitely the hardest thing at first. I've done marketing sort of, but not what I think of marketing now. But you know, like going to doctor's offices and making flyers or doing community outreach. I had done that kind of stuff before but it was never my name or my picture or for my business. So when it came time to really think about how I was going to try to market myself, it was definitely something that was really hard for me. Just figuring out how to do that and how to have confidence was really challenging for me.

It's just so funny because I've been a physical therapist almost 10 years and so I have all the confidence in the world in PT but then with business and having the confidence in it, that was really really hard for me and was a huge learning curve and mindset shift. Everything in the program, especially at the beginning, definitely helped with looking at it as this is my business, this is mine, and just going with it, and knowing that burnt toast happens.

Obviously the other business stuff that we never learned about in school was an obstacle, but that kind of stuff was easy to learn. I think the mindset shift and figuring out how to sell yourself or if you get a cold discovery call, like my first ones I definitely rambled through, but having a concrete plan how you are going to tackle them.

I think also one of the things you said was that “no” is an answer and no is a complete sentence. So if somebody isn't right for you or you aren’t right for them, you're not going to waste your time or their time and hopefully you can find somebody else that you can better serve.

Morgan: Yeah, that's some pretty powerful stuff that has changed this year.

Do you remember, like say maybe a year ago, when it came to selling yourself, the specific types of thoughts that you were having and comparing those to what kind of thoughts that you're having now?

Karen: I think I wasn't exactly sure of what my package was or what exactly my services were. I think I was saying yes to things and I wasn't putting enough value on myself and my time. I was saying yes to everything and I did help a lot of friends, which is like okay, I'll see you for this but I think just being unsure of what I was doing and what I was offering.

I had all of my prices on paper but I wasn't convinced of it myself and I think being cash based too, that is sometimes really uncomfortable at first unless you're entirely sure of your business model and your business plan. So I think over the past year that's probably been one of the biggest things that’s changed.

Morgan: So, it sounds like making up the actual details and deciding on them and committing to them gave you a lot of the confidence that you needed.

Karen: Yeah, absolutely. I had it in my head and I had it written down. When you're a solo business owner you don't always feel like you have to do all the things at first but it really does change the way you think about things. Even with Profit First, it just changed the way that I looked at finances and the way that I looked at my business. Like I said, at first, I looked at things as sort of a hobby and then it came to the point where I was like "I need this to be a business" so I need to invest in a business coach and get going and do this for real.

Morgan: I think that this just reminded me of another thing that I think your example of feeling unsure about yourself but knowing that you need to do something with it and take action committing to the details about what it is that you offer and who you're working with gave yourself the confidence to do the marketing and sales stuff. I think that just reminds me of this thing a lot of therapists do when they're first getting started. One of the first questions people always ask is "how do I find clients’" and "how do I do marketing." My first question back to them is "well, what do you offer?"

You have to know what you're selling in order to do any marketing so if anybody is out there listening and you're stuck on marketing go back to the basics and make sure that you know what it is that you're selling and to who. Because if you don't know those things it's going to be very hard to try to sell yourself.

Is there any advice that you have for therapists who are specifically going into pediatrics?

Karen: Yeah, like I said, I always knew I wanted to go into peds. So I think if you are going to be opening your own mobile based pediatric business or private clinic, you probably have years and years of experience treating pediatrics. Try to think of other practices as collaborators rather than competitors because I have received referrals from other PTs or other business owners within the area and so I think that collaboration is huge. I don't know how many coffee dates I've gone on and met people or zoom calls I've had, but you can just help each other. For example, I'm cash based but I was trying to help a patient with an insurance question and I called my friend who had started their own practice out in Western Massachusetts and we just chatted for like 45 minutes and were able to answer each other's questions. I've referred people to her and she's referred people to me, so I think with the peds world it's a lot of word of mouth and networking.

A lot of times parents are looking for you and they clearly have a concern, and when a parent has a concern that is not to be taken lightly. Sadly, a lot of parents get dismissed by other pediatric providers so building a good network and spreading awareness about your business through word of mouth was one of the best ways that I have been able to grow my business.

I've collaborated with some mom groups and some businesses that were there to help moms and I've done a lot of free events and a lot of times my referrals would come from those events or parents that have come to those free classes. I think getting out into your community in and being collaboration with other business owners, word of mouth spreads like fire.

Switching into more of the digital aspect of marketing, can you tell us a little bit more about your adventures into Facebook advertising?

Karen: Yeah, so I thought I was doing Facebook ads but in reality I was just boosting posts. I remember you asking me if I did Facebook ads and I was confident with my "yes" when in fact, I wasn’t running ads at all. But thankfully, with your guidance and watching some YouTube videos, I was able to correctly try Facebook ads and I've had really good success locally.

I also offer wellness services and I have some free guides on my website so I do both local marketing on Facebook and just across the US but it definitely has been successful. Facebook ads have been really helpful in my business getting leads and also getting people to come to my classes and be able to find me.

Morgan: I think we've gone over a lot of the data together and overall a big part of running ads as we've talked about has been to help grow your email list and grow your audience for future promotions. But it's also ended up with you getting sales too which has been awesome. You basically run ads with a call to action to sign up for class or sign up for a free guide and my theory is the reason they're so successful is because they're so specific. They're very specific offers so the people who are seeing them are immediately like yes that is exactly what I want. I think this is a good example of an age-old marketing concept of being very specific in your offer and very specific in your target audience to be successful.

Karen: When I first started I also didn't know how to use social media and I think with any practice in the pediatric world, there are a lot of really big accounts on social media. There was no way I was going to be competing with the big accounts so that's what kind of led me to Facebook ads because I realized I didn't have to post every day and I didn't have to try to make different reels. The Facebook ads were finding what audience I wanted and targeting it and it's been working great.

Morgan: Yes, it takes a lot of the pressure off of trying to constantly push out more organic content. It sounds like you've kind of found a good balance between the two between sharing things on social media and keeping the ads running so that it creates this illusion that you're everywhere which is cool. That's one of the best compliments I think you can get about your marketing for your business is if anybody's like "Karen, I feel like I see you all the time on Facebook" or "hey, you're everywhere."

Karen: Sometimes it feels like you're just throwing things into the abyss and that's the one thing with social media, it can be pretty horrible. So the thing with ads, like you said, it's definitely finding the balance between the two. I feel like once you do it, you can just put that on repeat and it can become a lot more passive without having to think.

What is your least favorite part of running a business?

Karen: The data. I am go, go, go, and I don't sit down so I think that's why I have a little bit of avoidance behavior when it comes to data. But I also like routines so that's been really helpful too to try to get myself into routines like you're saying but I had to get past that boring stage and really look at the numbers. But once you do it a few times it's not as overwhelming and it becomes way more routine.

Also, you can't please everyone and I think when it's your name and your face on the business, there's a different level of expectation. Being on the internet and putting yourself out there was definitely challenging at first. But people don’t show up for things and people you know on the internet aren’t going to commit right away because they’re basically strangers. So, just figuring out expectations at first and not being disappointed.

Morgan: I think that's a really really good point: just hope for the best but basically have no expectations of the marketing stuff that you're putting out there until you have objective evidence that it is something.

What is your very favorite part?

Karen: Just the successes and you know being able to continue to grow and the small wins. Definitely over the past few months I changed my SEO and got three phone calls the next day, and I was like "wow that actually worked." One of the phone calls turned into a patient, so when things work for me I get excited and that's probably the best part. I think that goes back to if I wasn't tracking things as carefully as I am now, then maybe I wouldn't have even seen that small success to be able to celebrate it.

Morgan: That's great you're doing so good Karen, doing all the things.

How to contact Karen:

*Find her on Facebook

*Find her on Instagram

Listen to this episode on my podcast!

DPT to CEO: The Podcast

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