PT owner Chad Madden sits down with industry veteran Bob Kowalick to unpack what it really takes to scale beyond yourself. They cover the #1 book that shaped Bob’s approach, painful (and expensive) lessons on “trust but verify,” and why data. not opinions, must drive your systems. You’ll hear how to invest in yourself, innovate through experimentation, and the coming shift to PTs owning musculoskeletal health management. If you find this valuable, subscribe for more practice-growth playbooks.

Time Stamps

00:00 - Intro & guest setup

01:21 - The #1 book for scaling: Scale (Hoffman & Finkel)

06:11 - Biggest failure: trust—but verify (billing & IP lessons)

12:25 - Best investment: invest in yourself

13:12 - Unconventional edge: innovate & experiment

15:31 - What changed most in 5 years: data as foundation

16:43 - Advice to new PT owners (2024 realities)

24:28 - Bonus trend: PTs owning musculoskeletal health

Book a free demo call and get a behind-the-scenes look at the exact systems, tools, and frameworks Chad used to grow from a solo PT to a $20M practice — and the blueprint he's using to reach $100M. https://getbreakthrough.com/demo/

If you run a PT practice, you can almost feel the calendar tighten around Thanksgiving, January deductibles, or early summer. Schedules thin. Margins evaporate. Anxiety spikes. What if those same weeks became your busiest?

Most clinics brace for a slow season by doing less: pausing outreach, leaning harder on physician referrals, or trying to outspend big-box retailers in Q4 ad auctions. That combo leads to fewer evals, underutilized schedules, and profit leaks. Worse, it creates the illusion that slow seasons are inevitable.

Key Insights

1. Focus on the channel you own. Of the five New Patient Pathways—Reactivations, Word-of-Mouth, Physician Referrals, Partners, and Cold Traffic—only reactivations tap a list you truly control: your past patients.
2. Text beats everything. Start with SMS, then email. Response rates are faster and higher, especially when your message is clear and patient-centered.
3. Messaging is no longer the bottleneck. AI has crushed the cost and time of copywriting. Great subject lines, benefit-driven offers, and empathetic body copy can now be generated and refined in minutes—so bad messaging is no longer an excuse.
4. Conversion is about questions, not scripts. Move away from didactic monologues. Use calibrated “how/what” questions: What’s going on with your shoulder? How long has it been bothering you? What have you tried and how did it work? These open doors and build commitment.
5. Track everything and automate. Without attribution, you can’t scale what works. Marketing software and AI conversion agents (think an assistant who “works” nights/weekends) handle replies, keep conversations moving, and hand off to staff to schedule.

After two brutal Q4s—including a ~60% drop in new patients (October to December) and a six-figure loss—Chad asked a better question: What would it look like if Q4 were our busiest quarter? The team doubled down on the past patient list and launched a focused campaign: a half-day of free screens/rechecks in early November. They used direct mail plus email to invite former patients. Result: 73 reactivations in one morning and a seven-week waiting list that carried the clinic through year-end. Q4 flipped from a liability to their best quarter.

Putting It Into Practice

• Run the “Greatest Promotion Ever.” Offer a limited block of free screens/rechecks to past patients in early November. Cap slots to create urgency and protect clinical time.
• Cadence that compounds:
• Past Patients: 1 direct-mail piece/month, 2 emails/month, 1 text/month.
• Partners: at least 1 workshop/month per location (e.g., employers, gyms).
• Physicians: 1 monthly mailer + handwritten thank-yous.
• Cold Traffic: workshops + paid social/search to fill them.
• Upgrade follow-up: Use an AI conversion assistant to respond after-hours, ask calibrated questions, and progress the conversation to “ready to schedule.”
• Tighten the eval-to-POC handoff: Train clinicians on a 7-step exam with a signed plan-of-care summary to convert evals into committed treatment.

Slow seasons aren’t a law of nature. When you own your list, ask better questions, and run a simple, repeatable cadence, Q4 can become your clinic’s growth engine. Start with one reactivation campaign this month, and build your automation and tracking as you go. For the exact questions to boost conversions and details on the upcoming Virtual Summit, check the show notes—and commit to running your first free-screen morning in early November.

Ready to scale your practice? Schedule a demo with us and see how Breakthrough's growth platform can fit into your practice. https://getbreakthrough.com/demo/

Link to register for Virtual Summit

Link to demo Breakthrough

Link for Chapter 7 in Killer Marketing Secrets

Link for Top 10 Questions