Ep 6: Mastering your niche in allied health business

Michael Dermansky

Hi everyone and welcome to the show that explores with allied health business owners and managers what’s important about being in the allied health business today. I’m Michael Dermansky, senior physiotherapist at MD Health and I’ve got Darron from the TMJ and Facial Pain Center. Welcome to our show Darren.

Darron Goralsky

Thank you for having me.

Michael Dermansky

Well, it’s great to share your story. I’ve known you for quite a years now and, you know, where you were and how your journey has been in last few years. I think it’s a fascinating story. So I’m very excited to share it with listeners because it’s some great learnings of where people have got, where someone has gone with their health journey with their business.

Darron Goralsky

I’m happy to share it with your listeners too.

Michael Dermansky

Well, let’s start with the first one. Why did you go into VJ therapy in the first place?

Darron Goralsky

I was very keen on gym as a youngster and I think I was the youngest guy to join my gym back in the day. I was probably 12 or 13 years old. And like any keen gym goer, I had some injuries and we had a family friend in Johannesburg where I used to live who had a physiotherapy practice and she was my go -to for any injuries. And so it was a combination of my interest in the body and in fitness that really got me interested in physiotherapy as a career.

Michael Dermansky

right. And so what happened after that? So you went and did you do the course or Australia University?

Darron Goralsky

Well, I didn’t actually get into physiotherapy in South Africa. The biggest intake of physiotherapy students was the university that I went to, the University of the Witwatersrand in Johannesburg. And we were the biggest intake that they ever had. And we were only 38 people. And in my physiotherapy cohort, only eight of us were male. That was very intentional because they knew that a lot of the males would ultimately go into private practice just from an earnings perspective because there was very limited in the hospital system back in the day in South Africa. And so they purposefully wanted people to stay in the public health system and they were very open about their discrimination and said, we accept less males because we know they’re more likely to be primary breadwinners, be forced into private practice. It was just the dynamic of the day. And so I never got into physiotherapy when I first applied. I actually started off doing a Bachelor of Commerce, which I soon realized wasn’t really my passion. And then I switched over to a Bachelor of Physical Education because I didn’t get into physiotherapy a second time. And I did two of the four years of Bachelor of Physical Education, it fed the need to learn more about body and fitness. It wasn’t really what I was passionate about. And so after three years of full -time uni and having done pretty well at my physical education subjects, it put me in the position to reapply as a mature age student for physiotherapy. And so I got into the course and it was another four years full -time because there were no credits that accrued from the other degrees. So it was seven years of full -time study in order to get my physiotherapy degree at the end.

Michael Dermansky

So how learned and so what, where did you work then and how did you end up in Australia as well?

Darron Goralsky

So I was incredibly lucky that in my first role in South Africa, I worked for a highly regarded physiotherapist called Fran Mallon, who unfortunately passed away very young. And she was actually a guest lecturer to us in our final year in the muscular skeletal lecturing capacity. And I remember saying to a friend of mine how in awe I was of this woman and her clinical approach. And I was just very fortunate to be one of two people that she employed as new grads when we graduated in October 93. And I worked for her for three years while I was still living in Johannesburg prior to immigrating. And during that time, I enrolled in the postgraduate course in South Africa. It’s called Orthopedic Manipulative Therapy.

It’s like the manip therapy post -grad here, but because you could only do it if you were working in private practice, so it was a part -time course over the course of a year. And so it wasn’t transferable to the manip therapy qualification here in Australia. So yeah, and then I immigrated to Australia in January, 97.

Michael Dermansky 

right and then where did you work in Australia when you got here?

Darron Goralsky

I came to a job and that job was at a physiotherapy, private practice, very sports focused private practice in Mount Waverley. within my, within my probation period, it became evident to me that it’s just not the way that I wanted to practice. It was very high volume.

curtains and cubicles type of sports practice. I had come from, I come from an environment that was much more boutique. You know, there were separate rooms, 30 minute sessions for every consult. And I wasn’t comfortable in that high volume sports type environment. I was more interested in the spinal type stuff rather than the sports med type stuff.

So I left there and actually reached out to another private practitioner who had offered me a job after I’d already accepted the first one. And I joined that practice for a number of months. But again, I wasn’t really happy in that role. And at that time, a colleague who I’d become friendly with from my first job reached out to me and said, look, what are you up to? Because I feel like there’s the opportunity to open a private practice in Mentone. And the two of us got together and formed what was called back in the day Kingston Physiotherapy Group. so we had a practice together. And shortly after establishing that practice in Mentone, we got the opportunity to open up a satellite practice in High Street Armadale in a medical center. And because of the proximity of where I lived, that became the practice that I ran. And eventually after two and a half years, we realized we were really just running two separate practices. So we split very amicably and we still catch up every so often for dinner and a drink. And that’s when I established my own practice out of the medical center, which was called More Than Physio.

Michael Dermansky

Yeah. So where did that go? mean, I know you’ve got a very different practice now. When did you decided to shift in a different direction as well? So about 11 years ago, you changed, focused much more on TMJ and facial pain, but how did the journey go from where that was in more than just physio and to where to where you are right now?

Darron Goralsky

Yeah, so back in the day when I was working in South Africa, Fran used to say to the team, you know, that it didn’t matter what part of the body we were treating, the principles of treating musculoskeletal issues were universal, you know, and they were scope of practice. So back in the day, I remember putting on gloves and doing something intra -orally for TMJ patients.

I’m sure it’s very different to what we do in the practice today. But I just assumed that it was scope of practice. And when I set up my own practice here in Melbourne, one of the list of many conditions that I said I was interested or could treat was TMJ related issues. So I started treating them back then. But what really led to the, I guess, to the change and the decision to make it my sole focus was a number of things. One was the realization that very few and a lot of health people in the manual therapy space, so physios, osteos, chiros, were actually treating TMJ related conditions. And that was largely, I believe, because it’s not considered scope of practice or wasn’t considered scope of practice. Therefore, we weren’t adequately trained in that space. And so that on the one hand, it was a lack of people offering those services and physios, osteos not being confident to do that work. And on the other hand was the attitudes that I was met with out of the dental profession who have been tasked with treating these conditions. And they considered what I was doing not scope of practice either, albeit we bring a completely different set of skills to the table. And so after, you know, a period of time, I felt like I was hitting my head up against a brick wall. I just wasn’t getting referrals. And as my interest and skills grew, I realized that unless I make a concerted effort to learn a lot more, learn more about what the dental understanding and approach is, and then specifically focus my practice in terms of branding, in terms of professional development in that one direction, I wasn’t really going to make any headway. So that’s what I decided to do. It was a pretty scary decision at the time, I have to be honest. Because once you put your hand up and you say, you know, we’re Melbourne TMJ and Facial Pain Centre.

Then the next day you wake up and go, my god, what have I done? Like, can I do this? Do I know enough? But it was actually very liberating also in a way because having practiced for a number of years, like a significant amount of time, I felt that I was a solid enough physiotherapist in other areas to be able to deliver a reasonably good treatment and get good outcomes. And so I gave myself permission to not have to read every single journal article that came out unless it was in this area of interest. And it gave me the opportunity then to tailor my own professional development so that I could dive really deeply into this area. And there’s so much to learn that we’re on a constant learning journey.

Michael Dermansky

That’s an amazing story. you know, I think all the best business decisions in every, every decision you can ever hear is always, my God, what have I just done? you know, that’s, you know, I think, I don’t think you’ll talk to any business owner who’s been successful, not successful, anything they haven’t had that moment in their life. Like, my God, what have I done? How do I keep the lights on now? and it’s, it’s always, always a brave decision. And you know that that’s it. I mean, that’s our jobs as as as business owners to see where can we really stand out. Differential strategies have always been the strongest things we can do. And we were in the same boat like we this is what we do. This is what we’re really good at. And we’re not good at everything either. And this is where we’re going to hang our hat on this and say we’re to give it a go. And it’s bloody scary.

Darron Goralsky

Yeah, I’ll tell you a funny anecdote around the learnings. So once I made this decision and very close to that period of time, I was fortunate enough to attend a course by Mariano Rocabada, who is really the grandfather of physiotherapy in the TMJ, orofacial space. And he very much promotes a multidisciplinary approach to this and back in the day, he was the Dean of the dental school in Chile, but he’s actually a physiotherapist. And so he really brought these two professions together to have a better understanding of what each other’s perspective was and also the fact that you need this multidisciplinary approach. So anyway, after doing lots of dental reading and learning their terminology, in his course, which was peppered with dentists, and then every dentist had to bring a body worker with them. So there were some chiro, some osteos, and some physios. I asked him a question, and then he said to me, based on the way you’ve asked that question, it’s very clear to me that you’re a dentist. So I had a good laugh, and I said, actually, I’m actually a physiotherapist. I’ve just learned the dental lingo so that I can better communicate with the dental world. But yeah, it was a funny story that, yeah, worth sharing.

Michael Dermansky

I just got a comment on a particular point you made and that was, as you said, you put your head on, you would hang your head on this TMJ thing and then said, you know what, if I’m gonna be known for this as well, I’m not getting referrals. I have to learn a lot more you had to work on yourself more than anything else and say I’m going to do this and going to know more about this and understand this, understand what my referrers really have the way they see the world. I didn’t say, it’s not fair. You said I’m going to do something about this too. And it’s a really brave and important decision you made.

Darron Goralsky 

Thanks. It felt scary at the time, but it paid off.

Michael Dermansky

So, so 11 years ago, you decided this is what I’m going to do. How does it come from an idea to reality? And how’s that? How’s that business change over the life?

Darron Goralsky

It’s been an absolute ride. Initially, it actually led to quite a lot of overwhelm in my personal capacity because the more successful the business became and the more the reputation of the business grew, the more those particular types of patients were my responsibility as the treating practitioner because not there was nobody at that point in time, nobody other than myself on my team that had this interest. And I felt it was unfair to coerce the therapists that I did employ into an area of clinical practice that they didn’t sign up for or weren’t interested in. And I remember having this conversation with one particular therapist and she just said, look, I’m not interested if I see somebody who I think has got these conditions.

I’ll refer them to you, but I’m not interested in pursuing this, which is fair enough. So I reached a point where I was consulting literally 60 hours a week. And I was pretty close to burnout. was at that point in time trying to put two kids through private schooling, pay a mortgage, run a practice,18 months out from my 50th birthday, I said to my wife, I don’t feel like I can do this for another 50 weeks at this pace before the next two week break. And so I had to make some big decisions about changing my whole practice structure. So that’s only part of what changed. The other thing that changed was the fact that I was approached by a dental colleague who had initially referred his sister to me for this, TMJ related issue and then had become a referrer. But then he’d moved into state and gone to work in Darwin where he studied dental sleep medicine and did a lot of additional study himself in the dental approach to treating temperamentability disorder and orofacial pain. And when he relocated back to Melbourne, he contacted me and he said, we have to work collaboratively, but not just as referral partners. We actually need to be working together. And that was a tricky decision as well, because I had a lot of referring dentists and I didn’t want to upset that relationship by having somebody in -house.

And so we had to very carefully consider how we would do this while at the same time respecting the referral relationships that we had built up. And it’s still something that is very, very front of mind when we’re managing patients. But the addition of the dental side to the practice definitely was a huge catalyst to a lot of the other things that we’ve landed up learning about and incorporating into our clinical approach because the learnings were huge. so that together with the fact that I knew that I needed to change my modus operandi was the two things that really transformed the business into what it is today. And so I got to the point where I realized that I was of a lot more value to ultimately to the patients, but to the practice who were serving those patients. If I wasn’t in a consulting room doing what I was doing up to that point, because when you’re there, you don’t have the head space to do anything else. And I reached, I reached a stage where I felt like I needed to make a change. And so that was the start of completely restructuring the way we do things in the practice and led to the growth of the practice as it is today.

Michael Dermansky

So it’s interesting what you’re saying that too, is that, you you didn’t say, you know, my aim is to get out and, you know, run this practice and just not see clients for the sake of that to have, you said, I’m more valuable to this business when I’m not seeing clients and I can actually have the head space to grow this practice to what it should be.

Darron Goralsky

Yeah, I remember a pivotal conversation that I had with an incredible guy called Daniel Gibbs, who is the founder of an amazing organization called Clinic Mastery. And he said to me, this is before I started working with them, but he said to me, how many people can you help in a week doing what you do? And I said, well, at the moment, it’s between 90 and 100 half hour consults a week. And it’s killing me. And he said, but how many more people could you help if you taught others to do what you do? And I never really thought about it in that way before. I’d always thought about myself and my personal exertion being the agent of change for these patients. I was the intervention alongside all the things that I educated them to do for themselves. I never really thought about the business being able to, as a business, have other people doing things in the same way that I did. And it was a huge catalyst to me thinking about how do I take what I’ve learned and educate a team of people who actually sign up for this? How do I support them and mentor them?

Darron Goralsky

so that they can go on to become the best versions of themselves and help these patients in their niche. And it took 20 months from that time to the time that I officially came off the tools and actively said, I don’t want to be consulting anymore because I see the value that I bring out of the consultation room.

Michael Dermansky

Yeah. And I mean, guess that’s another question. Just want to ask this because it’s a question I suspect some of us are thinking is that, okay, you’re not seeing clients, you’re not bringing money in. How do you afford to do this and have the lifestyle, have a livable lifestyle? How did you make that jump?

Darron Goralsky

It really boils down to a financial calculation. So what we did once the business was ready to employ that first new team member in a way that we felt that we could train and mentor and support them adequately. But when we got to that stage, we realized it was purely a financial calculation that in order for me to replace 15 hours of my income from not consulting. I needed to hire and train and mentor a physio to get them up to 80 % capacity in their 38 hour week. And that would sufficiently pay them a good salary and then replace those dollars that I was losing out. So it was one full -timer per 15 hours that I wanted to pull out personally and I had to do that four times.

And I had another really interesting conversation with a friend of mine who is in the professional medical indemnity insurance space. And his clients are mainly medical centers. And he said to me when I was having this conversation with him about my nervousness about coming off the tools and not consulting at all and you know, feeling financially irresponsible for me not to be doing that, knowing that if I put myself in the diary, I could fill myself up, you know, without too much problem. He said to me, look, he said, I can tell you that in the medical centers that I look after, where the principal doctor is a part -time practitioner and part -time business owner or manager, if you compare that situation to medical centers where the principal doctor is no longer consulting, but their focus is on running their practice, he said they are completely different businesses financially. So that was, it was good confirmation to hear that from him who’s from a completely different industry, that that was his experience because it’s what I was hearing from the people that were coaching me as well. But I needed to experience that myself through the journey. And what I realized is that when I created that space and the ability to give myself the opportunity to just spend more time looking at my practice, looking at my processes, looking at my training all the things that we often don’t have time for if we are full -time practitioners. Once I started to do that, I started to see the opportunities to improve those one percenters. And I recognize, I also started to realize that the business wasn’t suffering as a consequence. It just needed a lot more support because there were more people to support, but I had to then create the systems to make that happen.

Michael Dermansky

Yeah, yeah. That’s some really valuable learnings and the, you know, the scary decision of the professional coming off the tools. Like, do I do this? Well, you started with a, you know, you, talk to other people to get your, know, your feeling that this is okay. And then secondly to that, to like, let’s the financial calculations I need for every full timer that gives me 15 hours. And so if I want to be off the tools, I need to have four full timers. And that’s what you work towards and did. And each one allowed you that little bit more freedom to come off the tools and really grow the business. And in hindsight, everything’s always easy. But before that, it’s a scary jump.

Darron Goralsky

I videoed myself. I decided that I was going to create a video, a vlog every single month from the time that I made the decision to do this until the time that I came off the tools and I was going to talk to the camera and express how I was feeling, I, what I, what I was proud of, what I was disappointed in and what I was hopeful to be able to achieve in the coming months and I remember, I remember and I’ve watched it a number of times and I’ve shared this video a number of times with some friends and some colleagues. But I remember talking into the video that very first time. I was, I had just come back from a weekend clinic mastery workshop and then was starting my process on the Monday, you know, the Monday when I got back and I was talking, the words that I was talking were that the words were words filled with hope, but the tone of my voice and the expression on my face and my whole demeanor was one of absolute exhaustion. And I remember showing this video to somebody a couple of years ago and their comments where they said, that was like watching a hostage video.

Michael Dermansky

Wow.

Darron Goralsky

They just looked so different and you just looked so under pressure. And yeah, was a scary prospect, but I was absolutely determined to make the changes that needed to be made. And I also promised myself that I wasn’t going to question everything that was recommended to me to do. I was just going to run it through my own filter and see how I could make it work in my circumstances rather than saying, I’ve been there, done that, got the t -shirt, it’s not gonna work for me because I asked for help because I needed it and I needed to be willing to accept the help that was offered.

Michael Dermansky

Yeah, yeah, yeah. And interesting, it’s when you allowed yourself to get out of your own way that allowed you to grow to that next level as well. It’s so easy for us to be our own barriers to growth.

Darron Goralsky

Yep, we are always definitely the biggest bottlenecks in our own business. And I saw that again a couple of years ago when we made the very scary decision to not renew our lease where we were trading in High Street, Armadale. And we did that for a number of reasons, but primarily because we had maxed out of our consulting space. So we had seven consulting rooms and we just had no more ability to grow and we decided that we were going to do a fresh fit out in a much bigger space. I wish I owned the property, which I don’t, but I invested significantly in a beautiful fit out which gave us 13 consultation rooms. And as soon as we moved in, literally the very first month that we moved in was our best month ever and so our physical constraints was the bottleneck to our growth. It was just waiting to happen, but we just didn’t have the space to give the business room to breathe. So another good learning is that if you’re ever doing a fit out and you think you can squeeze that one extra consultation room in, I’m always encouraging people to think that each room is an income generating center and I had the same conversation with a lovely podiatrist who I became friendly with through the clinic mastery process. And he was doing a fit out. And he said to me, give me your input here about what I’m designing. And I said to him, is there any way you can turn four consultation rooms into five? And you know, because he only really needed two at the time, it seemed like a silly suggestion, but fast forward 12 or 18 months later and he saw me and he came up to me and he said, I owe you a huge debt of gratitude because I listened to you. And he said, and it’s given us the capacity to grow. Whereas it would have maxed out much sooner. So yeah, so sometimes the sometimes it’s an attitude or a belief that becomes the bottleneck, but sometimes it’s just something very physical that can be addressed.

Michael Dermansky

but it’s also an attitude too and a belief because like, I don’t need this. Why should I build it? And you’re saying you can’t always see where the future’s going and you need to be able to have the capacity to grow and you don’t be your own limitation in that too.

One last question as well. If I’m an allied health practitioner and I’m looking at starting my own business as well, where would you recommend to start or to do?

Darron Goralsky

I would say to anybody looking to start is to be very strategic in the way that you set things up. Is to allow, use technology as much as you can from a systemization and a reproducibility and a leverage perspective. And if you feel like you’re heading, you have a clinical interest in a specific niche, then if you believe that you’re a good enough therapist that you wish you had more mini me’s, then make sure that you set up a process whereby which you can adequately train and mentor people in your style of treatment or your philosophy of treatment. Because what that does is it gives your business massive capacity to leverage. And it gives you the ability to step away at some point without the approach being lost.

And so that’s what we needed to do. We needed to give my clinical approach, which is always being added to and tweaked, but we gave it my name. we, you know, everybody in my practice is trained in the Goralsky cranio mandibular method. And we internally certify people in that method, which gives my referrers the of knowing that although they’re not referring to Darron Goralsky anymore, they’re referring to somebody trained in the Goralsky craniomandibular method. And so that transfer of trust is really important when you want to build out a team of people and assure your referral base or even your word of mouth base that although they don’t get to see practitioner X, practitioner Y has got a very similar approach.

So that’s probably the thing that’s the hugest ability to leverage in our practice. And so much so that when we couldn’t find more physiotherapists to do the work we do, I started to employ osteopaths because I knew that I had to train them myself anyway in my practice approach. So it didn’t matter what their base qualification was. They needed to be good. They needed to be APRA registered manual therapy based practitionersthat could provide the same clinical approach. And so our TMJ therapy team is made up of physios and osteos for that reason.

Michael Dermansky

Yeah, that’s fantastic as well. mean, it’s funny what you say. It’s the most contradictory thing in the health professional space is that you, you worry that you get taught all this stuff and you need to know your stuff and like, if I give it away, like I’ll lose my competitive advantage. It’s the opposite. You know, if you don’t give away, you can’t prevent an advantage that your knowledge, you actually can’t grow and you become the biggest bottleneck. As you were told before, how many people can you see in a week? Well, X. So you need to leverage your knowledge not hoard it and it’s going to be a big as bottleneck to growth.

It’s pretty simple math, but it’s not intuitive though.

Any final thoughts, Darron? This is a great conversation, by the way.

Darron Goralsky

Just a little bit about the mindset of coming off the tools. It was something that I had to really retrain my brain into thinking about because my sense of self -worth at that time when I was providing for my family by working 60 hours a week, my sense of self -worth was very tied into how many hours a week I can work and how many patients I can help in order to earn the income that I needed to afford to pay the lifestyle stuff that we wanted. So it was very transactional. Like if I know that if I worked 10 hours, it equated to a certain amount of dollars, which equated to a certain amount of people helped. And when I stopped treating, I needed to find my self -worth again? What am I actually bringing to, who am I helping here? What am I doing? You know, am I just taking a holiday? And I remember putting a sign up on my desk that I had read somewhere and it said, I’m no longer paid by the hour, I’m paid by the value I bring to that hour. And so, yeah, I think that’s just something to bear in mind is that when you sell time and then you no longer sell time, you need to make sure that you understand the massive value that you still bring to that hour.

Michael Dermansky

Yeah, and that’s a massive mindset shift. And I don’t think it’s gonna be unique to health practitioners. It’s gonna be the same to lawyers, accountants, everyone that sells time. It’s the same equation and the same mindset shift that needs to be created.

Well, thank you very much for your time, Darron. There’s so much learnings in everything you said today as well. And it’s, it’s just amazing hearing, you know, practitioners stories about where they started, where they’ve gone and where they’re taking their life. And it’s, and how much of it’s a mental shift. Thanks very much for your time. And it’s been a great, great conversation, Darron.

Darron Goralsky

Thank you for having me. I’ve enjoyed sharing it with your listeners.

Michael Dermansky

Fantastic.