How Much Does Pain Cost?

DANO WEIR: True or false, Josh, people have walked in your office who have been told they need surgery and they've walked out of your office at a certain point not needing surgery.

DR. JOSH MADONICK.: That would be very true.

DANO WEIR: Welcome to It's All Money.

DR. JOSH MADONICK.: Hosts are right here in front of you. We're taking out It's All Money.

DANO WEIR: Welcome to It's All Money. Today we are live in East Petaluma. We're just behind the auto row and I am in the studio of Basecamp Physical Therapy. Why is Sonoma Wealth Advisors with Basecamp Physical Therapy? I'm so glad you asked.

DANO WEIR: We'll get to it a second after I introduce my guest. I have it written here, so I want to read this all properly. A founder, a healer, an athlete himself, and even though he doesn't wear a lab coat, he is a doctor of physical therapy. Let's welcome to the show. Dr. Josh Madonik.

DR. JOSH MADONICK.: That's a beautiful round of applause. Thank you, guys. I'm super pumped to be here.

DANO WEIR: So if you're an It's All Money fan, or perhaps you are a follower of Josh, let me introduce myself and him. This podcast is It's All Money. If you haven't yet, like and subscribe. And we are sponsored by the company I work for, Sonoma Wealth Advisors. I'm the marketing director.

DANO WEIR: At Sonoma Wealth Advisors, in addition to, we're registered investment advisor, we're a fiduciary. In addition to investments, a big part of our service is behavioral coaching. And that is where this show comes into play because a lot of life is where life intersects with your checking account.

DANO WEIR: And the decisions you end up having to make that involve money, but also very much involve things like your health. So I need to say up front. That none of this is medical advice. None of this is financial advice. This is for educational purposes only today, based on experiences that I have had with Josh. So that's a lot of ado. Let's get to Josh. Josh, tell me, what is Basecamp Physical Therapy?

DR. JOSH MADONICK.: That's a great question. Basecamp is a lot of things, but really it's, in my big vision for the company, it's a one-stop shop to allow you to live basically at your peak. And that's where the name comes from. But really, it's physical therapy clinic where we don't just do physical therapy.

DR. JOSH MADONICK.: We also do strength and conditioning. We work with people to figure out like what is the thing that's limiting them from being able to actually accomplish the goals that they have, whether they're performance based, whether they're health based, or if on the instance that it's behavior based.

DANO WEIR: What you said you work with people. Tell me about some of your clients. Who do you work with?

DR. JOSH MADONICK.: Good question. Yeah. So, again, we're a little bit different than most physical therapy clinics in the sense that. The largest part of our clientele are athletes. These could be runners. These could be individuals who are doing triathlons.

DR. JOSH MADONICK.: These could be high school athletes, football, soccer players. But generally speaking, the easiest way to categorize them is these are people who are very highly active and want to live a high performance, pain-free life.

DANO WEIR: So here's how I met Josh and here's where my story comes in. So it's 2021. We're still very much living the COVID life. And one of the ways that I worked my way through COVID, is I started running and I started running a lot. I started running a hundred miles a month and, I have always been a runner.

DANO WEIR: I've never run that much though, but my body was taking, I was doing fine and I've never had a problem, until I was in my garage and I was in a low crouch, lifting a heavy box. From one shelf to another shelf. So I'm like spread out with my legs. I'm lower than this. And as I'm moving it, this foot rolls. And then with the weight of the box, I fall over. So this foot basically gets wrenched.

DANO WEIR: So I go to a major health system in Northern California. I see my doctor and the doctor looks at it. He asked me a few questions, then tells me a story about how he used to run and his hips started hurting. And he went high up in that major health system. And they told him the smartest doctors at that health system said, stop running.

DANO WEIR: And that was his solution was to stop running. So he said, stop running. Then he referred me to a foot specialist who gave me basically like a heavy Tylenol and said, stop running. And I said, I guess the answer is to stop running. This is dumb.

DR. JOSH MADONICK.: Yes.

DANO WEIR: The story is still going, Josh.

DANO WEIR: So I do what I always do, which is that when I get an answer I don't like, I guess I wonder what else. And I happen to be, there is a Facebook group for Petaluma runners and I posted in the Petaluma running group and I just said, Hey, here's what's happening to my foot.

DANO WEIR: Has this happened to anybody else? And this guy named Josh Madonic piped up and said, well, I don't know for sure, but come and see me. Do you remember my injury? And you remember the treatment that we did? Do you remember that?

DR. JOSH MADONICK.: Oh yeah. Also, first off, like big shout out to Petaluma running club, join them on Facebook. If you haven't already. People still use Facebook.

DR. JOSH MADONICK.: Yeah, you came in. You basically had an injury to the foot in which you were having nerve pain. And it was this like really intricate thing where I think part of it was you being bent over and trying to lift and then rolling the ankle.

DR. JOSH MADONICK.: It was pretty evident early on that you had weakness in a couple of different places. This is very common for runners. Ouch. Yeah, sorry. Bro. Shots fired here. Bro.

DANO WEIR: So this is going out on the internet.

DR. JOSH MADONICK.: I know we spare no punches. Yeah, I'm a realist. So like having weakness in these areas is just going to create stress to the ankle, to the foot. And if you don't have the right balance of musculature, tissues are going to get irritated.

DR. JOSH MADONICK.: You just happen to have one instance, which then exacerbated some other things. And that's ultimately what the plan really focused on is, hey, can we get you stronger in some of these areas? Can we make sure that nerve calms down and most importantly, get you back to running?

DANO WEIR: So I sit with Josh in this office and we sit on the edge of a table like this higher and he starts explaining to me, he gets out the anatomy book. The anatomy book is coming out. That has never happened to me in a medical appointment. And he starts to explain how nerves, if it is indeed nerve pain, nerves are branched.

DANO WEIR: And actually the nerves in your foot are part of a tree of a network of nerves that run all the way up to your skull. And so he says, one of the things you need to do is this thing called nerve gliding, where you put your foot up and out at the same time as you move your head back. And you're doing that, right? Am I doing that right still?

DR. JOSH MADONICK.: It's pretty good. Yeah, it's pretty good. Okay. Not medical advice. Pretty good.

DANO WEIR: So I did that among a few other exercises and the pain went away. The foot got fixed and it wasn't a bunch of pills forever. And it wasn't a knife. It was a few. Kind of stupid exercises. I was just like, when I was doing it, I was like, there's no way this is going to, Oh, Oh, I'd imagine that my story, you hear all the time.

DR. JOSH MADONICK.: All the time. And in fact, actually I saw a couple of patients this morning and I brought out the anatomy book for, for one of them as well. So yeah, it's, it's incredibly common. It is, you're not the first person to call our exercises stupid. You're also not the first person to say that they worked.

DANO WEIR: They And I mean that in the most loving way, but it just feels like there's no way.

DR. JOSH MADONICK.: What am I doing here?

DANO WEIR: It has to be something. It has to be a laser. There has to be a big tech thing that fixes this, not just like...

DR. JOSH MADONICK.: Yeah, I just have to move my body in this weird... Yeah, absolutely.

DANO WEIR: Okay, so now we get to this question, which is, why is a physical therapist on a show about money? That story I told was just about health, right? Well, the reason why is that Josh precisely represents the purpose of this show, which is to say, Josh... Does not take insurance.

DR. JOSH MADONICK.: I'm not sorry.

DANO WEIR: What?

DR. JOSH MADONICK.: Yeah.

DANO WEIR: What? Yeah. So when I saw Josh, I paid cash. I didn't give him a card. I didn't give him a health plan number. I just, it was money in my pocket and I handed it to you. And that, when you're a consumer, is sort of scary because that's just totally foreign. To how you are used to approaching health.

DANO WEIR: And why is that? Why do you not take insurance? Why are you not part of insurance? For what reason?

DR. JOSH MADONICK.: We have a time limit on the show.

DR. JOSH MADONICK.: So I can't get into all of it. But realistically, the number one reason why we don't take insurance is it changes the way that we can provide health care. It makes health care not profitable. And the lack of profit there, the only way to really make... Your profit back is to see more patients. Ultimately, that means less time with each patient.

DR. JOSH MADONICK.: Ultimately, that means less care for each patient. And honestly, it just turns out to be worse outcomes. So it became very clear to me early on in my career, the thing that's preventing me from being able to really practice the way that I think is the most effective is the insurance company. And again, like not to point and say, oh, this person's the villain, this person's not.

DR. JOSH MADONICK.: This was just the reality of the situation that I was in. And so, A, It was a good business model to avoid a third payer who's going to dictate, oh, well, you can or can't do that, or you're going to get paid this for this service. But if you get paid a little bit more for that service, who's not going to take that?

DANO WEIR: Can you give me a for instance, and no insurance companies names mentioned?

DR. JOSH MADONICK.: Yeah, I mean, a really good example. This is perhaps a little bit too in the weeds, but in physical therapy, there's something that we would call massage, and there's something that we would call manual therapy.

DR. JOSH MADONICK.: Well, Every year, the insurance companies change their fee schedule and they'll say, well, you're going to get paid, let's call it X dollars for manual therapy, but you're going to get paid Y dollars for massage. Well, if you get paid Y dollars and Y is greater than X.

DR. JOSH MADONICK.: Who the heck is going to take X? You're going to go towards Y. And now you're literally influencing treatment decisions because at the end of the day, you need to make a profit for business to stay open.

DR. JOSH MADONICK.: My personal feeling is I don't want my judgment being clouded by that. And also for my team, I don't want their judgment being clouded by that. The goal here is just to provide basically unadulterated care at the highest level. And when you remove that kind of...

DR. JOSH MADONICK.: Not filter, but this pressure that's being placed upon you. It's amazing how much more freedom you have in making the right decision.

DANO WEIR: So you're saying apples to apples, a PT at an HMO and you independent physical therapist in Petaluma, if a patient goes to someone watching this show, goes to the HMO PT and goes to you, that it would be different care and different answers based on...

DANO WEIR: The economics.

DR. JOSH MADONICK.: 100%. And there's nuance, right? Whenever you see a healthcare provider, particularly a physical therapist, there's going to be some difference or differentiation, I should say, between what one provider says versus another. It's an imperfect science of a field. Of course.

DANO WEIR: Yeah. I'm not talking about experience.

DR. JOSH MADONICK.: Understood.

DANO WEIR: I'm saying from a... Yes.

DR. JOSH MADONICK.: The care that's provided, the way that care is delivered, all of those things will be very different. Right. And it's largely because the system is so complex. That's guiding it is very different. So the parameters that you have to abide by within that system also become very different.

DANO WEIR: So let's take that to the next step because the insurance company would say, yeah, but you're already paying for this and or it's cheaper.

DR. JOSH MADONICK.: Yep.

DANO WEIR: Right. So it's built into your plan. Right. And you are more expensive than the care that they're going to get from the plan. Oh, yeah. And so that is the purpose of this episode is to say the title of this episode is how much does pain cost?

DANO WEIR: Because you might find yourself sitting there with. Back pain or you might find yourself sitting there with knee pain or whatever it might be. And if you were to look at a private physical therapist, it might seem very scary. It just, the word cash.

DR. JOSH MADONICK.: Oh yeah.

DANO WEIR: It's a cash PT. Whoa. Like falling down a hill. No problem paying cash for gas, but you got problem paying cash for PT.

DANO WEIR: So I, it just, it presents a really interesting scenario for a patient. And it's not necessarily how they've been trained or how they've been raised when it comes to healthcare.

DR. JOSH MADONICK.: No, you're spot on. And I would say, you know, the funny thing that maybe reword the name of the episode, because to me, yeah, pain is, I mean, it's obviously a huge part of what we do. There's no denying that. But the bigger, the bigger piece to this is that pain is obviously painful.

DR. JOSH MADONICK.: It sucks. Nobody wants to be in it, but it's really, what's the long-term ramification of that pain? Let's say you stop running. Well, most people run because, as you already mentioned, it's a mental health outlet for you. Secondly, it's one of the things that's going to keep you healthy.

DR. JOSH MADONICK.: So your blood pressure, your cholesterol, your blood sugars, all of these things are going to react to your exercise levels. And if now you're not exercising because running was the only thing that did it for you, now you're not exercising. Now you're becoming less healthy.

DANO WEIR: Now the whole thing starts to cascade.

DR. JOSH MADONICK.: Yep, you got it.

DANO WEIR: At the same time.

DR. JOSH MADONICK.: Yeah. And this is why, like for us, again, one of the major differences between an in-network or an HMO or an insurance-based practice versus us is what's the stopping point. For us, part of the reason we work with athletes is we know they want to go to the next level, right? They don't want to just like, yeah, my knee feels better.

DR. JOSH MADONICK.: Now I'm just can sit at my desk. Like, no, you're here because your knee's hurting. But your knee, the reason, the real reason you're here. It's not because your knee's hurting. It's because it's taking away that thing that you love. Right. And that thing that you love is going to be the thing that you want to do for the rest of your life.

DR. JOSH MADONICK.: That maybe you want your kids to do for the rest of their life. And it's going to be the thing that honestly keeps you out of the medical system for the rest of your life. That's the real work. And that's why we can't deal with insurance. Because when you get to the point that, okay, your knee stops hurting, they don't pay anymore.

DR. JOSH MADONICK.: And so now as a, as a business owner, I have somebody coming in. I'm not getting paid for that. This is a major waste of resources. And that's where it becomes really important to say, okay, what is our goal here? Like, what are we really trying to accomplish? And taking that zoomed out view instead of saying your knee hurts, let's get you out of pain.

DANO WEIR: Okay. So let's, that's enough of me. Tell me another story about another client who overcame pain. Maybe one of those, potential surgery candidates we talked about.

DR. JOSH MADONICK.: Yeah. Yeah. I can't name names, but we'll just call her Jane.

DR. JOSH MADONICK.: So Jane came in she's a 56 year old she's a runner similar but also it's a brutal sport yeah like over 80 percent of runners get hurt in a given year so that's not good we're not smart this is why you joined the pedal in the running club though so you can befriend other people who are also hurt yeah but that to say the so Jane came in She had knee pain.

DR. JOSH MADONICK.: Turns out she was playing tennis with her son. Her son was making her run all over the court. And then she ends up tearing her Meniscus. And typically Meniscus tear, just for those of you who aren't familiar with the medical system, usually you're going to go see your doc.

DANO WEIR: Your doc's going to... Oh, it's your Meniscus.

DR. JOSH MADONICK.: Meniscus is going to be somewhere in the knee. Okay. So it's like the top of the knee joint or the top of your shin that provides cushion and also allows you to rotate from the knee. And so if that is torn, rotation becomes uncomfortable. But also so does impact. Now, typically you have a Meniscus tear. You're going to end up going to your doctor.

DR. JOSH MADONICK.: Your doctor is going to maybe tell you to go to physical therapy. Maybe not. They're probably gonna send you to an orthopedist. Your orthopedist is probably going to have you do x-rays, MRIs, those kinds of things. You're going to find out, Hey, you got a Meniscus tear. Well, what are my options? Well, the Meniscus doesn't heal.

DR. JOSH MADONICK.: And so people hear that and they're like, I don't know if I can swear on this, but I have a tear and it's not going to heal. I probably have to do something about that. And so they end up getting surgery. Now, the big problem here is they don't get informed of other options or they don't really know what their other options are.

DR. JOSH MADONICK.: And it turns out that if you treat a Meniscus tear with physical therapy and you treat a Meniscus tear with surgery, the outcomes are almost the exact same. So my feeling generally, obviously I'm biased, is go with the thing that's not going to cause you trouble. Now, Jane, let's rewind back to her. She came in. She's having pain.

DR. JOSH MADONICK.: She's a runner. She wants to be able to run. Her husband is an ultra marathon runner. So. This is part of their life. It's interwoven into who they are. Both of their sons run. And she was worried, okay, what am I going to do about this? So we start working on it. We find out, hey, you know, you're a little bit weak in your quads, your hamstrings, some of the muscles around your glute.

DR. JOSH MADONICK.: You're tight in some of the tissues around your knee. Let's try and get the knee moving a little bit more first. All of a sudden, the pain starts dropping down. Then we keep working on it, right? We're trying to now build more strength. Now all of a sudden, Jane, she's back to running.

DR. JOSH MADONICK.: But that's not where the story stops. So here we do what we call performance testing. And really what we're looking at is in the same way that you go to the doctor, you get blood work and you see like, what's my cholesterol? What am I, you know, my lipids, like all of these things. We take the approach of where are you at physically?

DR. JOSH MADONICK.: So she came in for a knee. I'm making her do how many pushups can you do? Can you do a whole, how far can you jump on two feet? And the reason being Jane came in and she said, well, I want to run for the rest of my life. So for me, I take that seriously. Right. What's going to be the plan to get her there?

DR. JOSH MADONICK.: When she came in and we did that first round of testing, she could do three push-ups. Runners, notoriously, very weak upper body. Women runners, even more notoriously, very weak upper body. This matters for a lot of reasons.

DANO WEIR: Okay, I have to tell you this. I can do easily. I have done a 37-mile. That's technically an ultra. I ran 37 miles out of bear Valley. I can do three pull-ups.

DR. JOSH MADONICK.: You gotta work on that. You're so right. We got to work on that. And so, so the really cool thing is with, with Jane, we put together a program within six months. She could do 18 pushups from three to 18. She, at the age of 57, did her first pull-up.

DR. JOSH MADONICK.: She added a foot onto her broad jump. And the reason why these things matter is ultimately these are going to dictate. If she ends up in the medical system or she can live independently and do the things that she loves to do for the rest of her life.

DANO WEIR: All right. Well, let's talk a little bit about you, Josh. Thanks for sharing that story. So people are going to wonder, who is Josh Madonic? How did you end up in Petaluma?

DR. JOSH MADONICK.: That's a really good question.

DR. JOSH MADONICK.: How did I end up in Petaluma? So I ran a half marathon when I was in physical therapy school. I ran a half marathon.

DANO WEIR: Where are you from originally?

DR. JOSH MADONICK.: I'm from the East Bay. I grew up in San Ramon De Amble area and went to school initially, undergrad in Davis, and then came back for a year, worked as like a strength and conditioning coach, and then ended up in Fresno for my doctor of physical therapy.

DR. JOSH MADONICK.: There, I met my now wife, and she put the pressure on me. She was like, hey, we're going to move in together. So what are we going to do about this? Oh. She's from Southern California, so we got a little like NorCal, SoCal beef going on. And she wanted to move back to Southern California.

DANO WEIR: Is she a Rams fan?

DR. JOSH MADONICK.: She's not a Rams fan. Her family could not care less about football. To the tune of like we scheduled a family trip last year on the weekend of the Super Bowl that I had to pull out of because obviously the 49Ers were in the Super Bowl. So priorities here. Okay.

DR. JOSH MADONICK.: But when I was in PT School, I did a half marathon in Calistoga. And on the way back to Fresno, we stopped in Petaluma by chance and had lunch. And it was like. This is a pretty cool place. Like, I like it here. And fast forward to coming out of PT School, my wife and I getting in this debate, trying to figure out where we're going to land.

DR. JOSH MADONICK.: I convinced her that Northern California is far superior to Southern California in every way, shape, and form. And so now we're trying to figure out where we're going to be. Petaluma comes up as being, you know. The East Bay, I didn't really want to live there after growing up there.

DR. JOSH MADONICK.: We both didn't want to live in the city. The South Bay is kind of an extension of San Francisco. And so the North Bay became like this really nice landing place. We thought about moving to Oregon, but really like Sonoma County feels like the perfect mix of Oregon and the Bay Area.

DANO WEIR: We got another one. Gotcha.

DR. JOSH MADONICK.: Yeah, exactly.

DANO WEIR: We gotcha. We do that.

DR. JOSH MADONICK.: I love it here. And so we've been here for seven years. We bought a house here about two years ago. And yeah, we love it here.

DR. JOSH MADONICK.: It's a very cool place that's awesome well let's take a step back then why why physical therapy how did you what was it about that that made that drew you to that career yeah honestly it started with me being a really bad football player just not super athletic i was i'm very tall i'm like six foot three i was six three my junior year of high school but my body hadn't caught up with me so i was trying to figure out like how do i become a better athlete that turned me into like strength and conditioning and learning about performance from that lens And then I got to undergrad and I was trying to figure out, okay, well, what am I going to do with this background and exercise?

DR. JOSH MADONICK.: Like, what can I really do with exercise background? And I met with a lot of different professionals from a lot of different fields. But the thing that really stood out to me about physical therapy was, number one, I really, really like puzzles. I freaking love them. I'm not the kind of person who's going to sit down and do a puzzle.

DR. JOSH MADONICK.: But, like, the way I describe physical therapy is, like, every day I get somewhere between five and eight. Word problems that are like the best word problem you could ever imagine and i get to untangle that and so that's what drew me to the field along with being able to have as a physical therapist i have the ability to to practice strength and conditioning which.

DANO WEIR: Is kind of like my first love it's funny that you describe it like that because the Sort of the way that we approach Cinema Wealth Advisors is, you know, we're curious when we're working with our clients and it sounds like you really care.

DR. JOSH MADONICK.: Oh, yeah. Yeah. I mean, it's funny because a lot of people get into physical therapy and say, like, I do this because I want to help people.

DR. JOSH MADONICK.: I do want to help people, but I really like solving problems. Like, it's just like the way my brain kind of works.

DR. JOSH MADONICK.: But. I think what I've enjoyed most about the profession now is like, I get to talk to people and help people understand how to create health for themselves. And I don't think people really think about that. I think like, you know, from a young age, like all of us get told, like, we need to save money for our retirement.

DR. JOSH MADONICK.: We got to be smart about that. Like everybody kind of knows that you should put money into your 401k or your IRA or whatever you want to say, but nobody really gets told like, how do you save for your physical?

DR. JOSH MADONICK.: Retirement right health span health span not just lifespan exactly and so now being able to talk to people about that like that's really what gets me fired up about the field and that's where the exercise and the performance piece of it like really weaves into it so.

DANO WEIR: It's it's cool it's evolved in that way well you're unique among entrepreneurs because you're not just the the core of the business. You're not just providing the service. You're also running the business, right?

DANO WEIR: I guess that's maybe not super unique, but I mean, it's, it is two totally different jobs that you're occupying both. Some people have their CEO and then they're the chef or whatever it is. So from an entrepreneurial lens and a business lens, what has that been like, starting from zero to where you are now?

DR. JOSH MADONICK.: Yeah.

DR. JOSH MADONICK.: I just get hit in the face every day and just like come back for more. So we don't have any kids yet.

DR. JOSH MADONICK.: But I do think that being a business owner is probably the closest thing you can do to raising a child because it's constantly changing. What worked one day doesn't work another day. And when you're leading other people, you know, when it's just you, it's different because you can you can do things however you want.

DR. JOSH MADONICK.: Right. But now when you have this other person who's part of that team, it's a whole different experience. You have to show them this is how we do things here. This is why we do things the way that we do.

DANO WEIR: So it's not just you at the office?

DR. JOSH MADONICK.: No, no. We got a team now. So it's me. We got another PT here. We have an admin. We're actively hiring for another PT as well. So we're growing as a business, which is awesome. It's also terrifying, but it's awesome. And it's required me to learn a whole different level of skills, leadership and management being the two biggest ones, but also understanding like...

DR. JOSH MADONICK.: The vision of what I initially had when I stepped into this business is very different than the vision now. And that evolves.

DANO WEIR: How?

DR. JOSH MADONICK.: Initially, it was just an outlet for me. Like, how do I practice the way I want to practice unrestricted? Right? But now, the difference is, how do I create a business where people who are like me, who want to be able to practice at that unconstrained level, at the highest degree?

DR. JOSH MADONICK.: Creating a place for them and expanding that vision beyond just me. And honestly, just beyond physical therapy, it's bringing in other fields to its strength and conditioning, chiropractic, maybe even orthopedics, massage, like all of these different pieces, they all have their fit. And ultimately it comes down to, again, back to the question, what's the big goal here? Like, what are we really trying to accomplish?

DR. JOSH MADONICK.: So understanding there, how, how all of those pieces fit together, like legally how does that work yeah just say you're there has to be there's so much a lot of liability a lot of liability a lot of moving pieces and one of my let's say greatest strengths but also greatest weaknesses is i'm an idea person so like ideas are constantly coming into my head the application of those ideas is where i struggle a little bit more and so i've had to learn that about myself and i also i think that's another piece of of having a child.

DR. JOSH MADONICK.: You learn a ton about yourself, your communication style, how you interact with your partner.

DR. JOSH MADONICK.: And that's what I've learned in leading people. It's, it's the biggest mirror I could have to see where are my shortcomings, where are my strengths? How do I play to those strengths? How do I find people to make up for those shortcomings? How do I communicate that with my team?

DR. JOSH MADONICK.: Yeah, it's, it's a very interesting learning experience going through it.

DANO WEIR: Can you share a failure?

DR. JOSH MADONICK.: Yeah. I mean, I think I think one of the biggest things for anybody who's been a solopreneur and then expanded is, how the heck am I going to pay somebody?

DR. JOSH MADONICK.: You, you, you know, for a service provider, especially so much of it initially is, can I feed myself? Can I feed my family? Can I do the things I need to do to be okay at home from our financial pieces?

DR. JOSH MADONICK.: But operating out of fear in the, one of my first hires in setting them up in, in an incentive-based structure which paid them well but didn't give them much security and now in retrospect thinking like well why did i do that well i did that because it was the least financial commitment for me but that's not how a business operates you have to operate in good faith you have to put people in comfortable positions that challenge them to grow but don't challenge them to fend for themselves so that was a big failure on me and we've retooled you a lot of how we work compensation here as a result of that.

DR. JOSH MADONICK.: But that was definitely a big failure.

DANO WEIR: Okay, and now give me a big success.

DANO WEIR: We talk up and downside here.

DR. JOSH MADONICK.: Yeah, big success. I mean, honestly, just being at the point that we're at. To be at a place where we have two other people on the staff other than me and actively looking to hire. That tells me, A, proof of concept. This works, right? People want this. They want higher level of health care. But B, this is not the end.

DR. JOSH MADONICK.: This is just like we're really still in the first couple pushes of the wheel, so to speak. One of the books that I've been reading recently is Good to Great by Jim Collins. It's like a business classic. And he talks about the concept of the flywheel. And the flywheel is like this really heavy thing that you're pushing and trying to spin.

DR. JOSH MADONICK.: And initially, each push doesn't turn the wheel, but only one centimeter. But as you keep pushing and you keep pushing and you keep pushing, now the weight of this wheel starts working with itself. And now it builds momentum. And it feels like we're moving in that direction. We're definitely not at the place where the momentum is carrying us. But I know that we can get there.

DR. JOSH MADONICK.: And, like, that, having that realization is insane. Like, it's just, yeah, it's a totally, it's like a remarkable feeling to have to know you. You had something in your head and you turned that into a reality. And that reality is not only changing the lives of your patients, but it's changing the lives of your employees.

DR. JOSH MADONICK.: That's really cool.

DANO WEIR: A business like this is able to grow a lot of times because of great support from people in the community. So you shouted out the Peddler Running Club. Anybody else you'd like to shout out in the community who's helped you get off the ground, like maybe Radio Dano on Instagram.

DR. JOSH MADONICK.: But anybody else in beyond who huge shout out to Radio Dano yeah there's been a lot of people who have been supportive it's funny when i was young i used to think like i could it was like a badge of pride like i can do this on my own and now i'm let's just say older and wiser i got more gray hairs on my head and same yeah it happens right the the reality is you don't do anything on your own like it really takes a lot of support i mean my wife obviously like from a personal level has been tremendously helpful but locally, the running community at large, I've had, I can't tell you how many patients who just are evangelists.

DR. JOSH MADONICK.: And they're like yelling at people on runs and they're like, Oh, you got to check out base cam. It's like, you don't even know this person. And you're, you know, you're telling them this, that's been really cool. I don't want to name like individual names cause I don't want to leave anybody out, but like local running stores, local personal trainers, community based gyms here in town, soccer clubs.

DR. JOSH MADONICK.: Yeah, everybody has been like really supportive of the vision that we have of this company, which is really cool to me. And again, makes me happy. It's like another one of those pushes on the flywheel of like, you know, this is good. People like this. Right. How do I continue to build off of that? Right.

DR. JOSH MADONICK.: And feed them something that like I get really hyped up about this stuff, but that they get excited about. Because they're the people who ultimately support me. And if I do a good job of creating something, a reality that they want, business-wise, like we'll be good. We'll be in a really good place. But community-wise, like the impact that we'll have is much higher.

DANO WEIR: Once again, thank you so much for checking out the show today. None of this has been medical advice. None of this has been financial advice. It's for educational purposes only.

DANO WEIR: But it's important as a consumer and as a person making decisions with your money, with your health, with your life, to know what's out there. And when I got connected with Josh, this was not something that I knew was out there. I didn't know it was a thing. I had a great experience with it. I have referred many people to it, and they have found success. And so this show will never tell you what to do, ever.

DANO WEIR: But I will share things that I think are interesting, and then it's up for you to decide. And you might, if you've been struggling with pain and you feel like you have no options, a cash PT might be one to consider.

DANO WEIR: If you're new to the show, we definitely recommend subscribing to the channel. So hit that subscribe button. Even hit that like button. If you don't want to fully commit with a subscribe, hit us with a thumb. Give us a like.

DANO WEIR: You can find Josh at PetalumaPhysicalTherapy.com. Any other ways you want them to reach out to you? Should I give out your cell phone number?

DR. JOSH MADONICK.: You got my cell phone number.

DANO WEIR: Home address.

DR. JOSH MADONICK.: Well. Not that either. We post pretty frequently on Instagram. That's probably the easiest place to find any information that we put out. It's Basecamp PTP. It stands for Physical Therapy Performance. That's probably the easiest place. Check out the website. It tells a little bit more about what we do. Or you can do like what somebody tried to do while we're shooting the show here and just try and drop it physically.

DR. JOSH MADONICK.: However, however you want to get in touch with us.

DANO WEIR: I did want you to go talk to that guy. You could have helped.

DR. JOSH MADONICK.: He was in a sling. I know he's like coming to us.

DR. JOSH MADONICK.: But generally speaking, like we're really responsive to stuff. So even if you have a question, if you're like, hey, what's going on with this? Shoot us a message. We more than anything, we just want to educate people.

DANO WEIR: Petaluma physical therapy dot com. Like and subscribe. Find Cinema Wealth at Cinema Wealth dot com. Dr. Josh Madonic. Dr. Physical Therapy, thanks for being on It's All Money.

DR. JOSH MADONICK.: Thank you for having me.

DANO WEIR: This content was produced by Fermata Advisors, LLC, an SEC-registered investment advisor. DBA, Sonoma Wealth Advisors. The opinions expressed by Fermata Advisors, LLC on this show are their own. All statements and opinions expressed are based upon information considered reliable, although it should not be relied upon as such. Any statements or opinions are subject to change without notice.

DANO WEIR: Information presented is for educational purposes only and does not intend to make an offer or solicitation for the sale or purchase of any specific securities, investments, or investment strategies. Investments involve risk and, unless otherwise stated, are not guaranteed.

DANO WEIR: Information expressed does not take into account your specific situation or objectives and is not intended as recommendations. Appropriate for any individual. Viewers and listeners are encouraged to seek advice from a qualified tax, legal, or investment advisor to determine whether any information presented may be suitable for their specific situation. Past performance is non-indicative of future performance.