E882 | Why Your Clinic Isn't Getting More Referrals

Why Your Clinic Isn’t Getting Referrals (And How To Fix It)

Every week, people walk out of your clinic and silently decide what they are going to do next.

Tell friends you are amazing.
Say nothing.
Or quietly warn people away.

In this episode, Danny breaks down why most clinics live in that quiet middle and what it takes to become the place patients are excited to talk about.

Here is the breakdown in simple terms.

1. “Pretty Good” Is Killing Your Word Of Mouth

Danny tells two food stories from the same day.

Lunch was at Dave’s Hot Chicken with his son. Friendly staff. Clean space. Small details done right. Food that beat expectations. He left thinking this place is awesome and would happily tell people to go.

Dinner was a new Italian spot in his neighborhood. No one at the door. Lost reservation. Clunky service. Food that was just okay for the price. He is not going to trash them, but he is not sending anyone there either.

That is what happens in your town every day. People have an experience with your clinic and file you into one of three buckets.

• Absolutely go see them

• They are fine but whatever

• Do not go there

Most clinics are stuck in the second group. Not bad enough to be avoided. Not good enough to be a story.

2. Outcomes And Experience Are Your Only Two Levers

Referrals are simple.

People only put their own reputation on the line if they trust two things.

1. You get results

   • Do you actually help people get better faster than the average in network option

   • Are you confident with almost anything that walks through the door

2. The experience feels worth talking about

   • Space feels clean and intentional

   • You are on time

   • Communication is fast and clear

   • Care feels individualized, not copy and paste

If you charge cash, you do not get to be average in either category.

And if you are in a noisy gym corner or rough sublease, you are already behind on the experience side. That means you have to overdeliver on punctuality, follow up, and outcomes until your space catches up.

3. Your Space Is Quietly Controlling Referrals

When Danny moved from a little subleased gym room to a true standalone clinic, referrals jumped.

Same staff.
Same approach to care.
Same town.

The big change was that the physical environment finally matched the story patients wanted to tell their friends.

People are not just thinking Will this help my friend
They are also thinking Will I look smart for sending them there

If your space feels awkward, dated, or half baked, they hesitate. When your space feels like a place they are proud to walk into, they talk.

4. You Are Probably Stuck In NPS Purgatory

Danny brings up Net Promoter Score. It is one simple question.

On a scale from 0 to 10, how likely are you to recommend us to a friend or family member

• 9–10 are promoters. They tell people about you without being asked.

• 0–6 are detractors. They might warn people away.

• 7–8 are passive. They forget about you.

Most clinics live in that 6–8 range. It feels safe but it is dangerous. You are forgettable.

To build a referral heavy cash practice, you need to stack as many 9 and 10 experiences as possible. That does not happen by accident. It comes from treating every visit, every email, and every follow up as a chance to earn trust.

5. Obsession Beats Clever Marketing

Average clinics chase hacks.

New ad platform. New script. New funnel.

High referral clinics get almost weird about the basics.

• Clean lobby

• On time sessions

• Fast replies

• Clear expectations

• Thoughtful follow up

• Tight clinical progressions

They keep asking Where did that feel clunky and fix one small thing at a time.

Over a few years, that obsession builds a base of patients who send everyone they know. You can still run ads, but you are not living or dying by them because word of mouth is doing the heavy lifting.

Tools like Claire matter here too. If your clinicians are spending hours a week drowning in notes, they are not following up, not improving the experience, and not fully present with the patient in front of them.

Freeing that time is not just about burnout. It is about making space for the behaviors that actually earn referrals.

What To Do With This As A Clinic Owner

If you want to put this episode to work, here are a few simple moves.

• Mystery shop your clinic
  Have a friend or family member your staff does not know book an eval and go through the process. Ask them to be brutally honest about what felt confusing, slow, or underwhelming.

• Audit outcomes and experience separately
  Be honest. Are you truly better than the average option in town If not, pick one skill set to level up this quarter. On the experience side, list the five most annoying friction points and fix one each month.

• Tighten your space or your behavior
  If you are in a sublease or shared environment, commit to overdelivering on everything you can control. Cleanliness, punctuality, follow up, how quickly you respond to messages. If you have a standalone space, make sure it actually looks and feels like the price you charge.

• Buy back time from documentation
  Use tech to pull hours away from note writing so you can pour that time into patient contact, follow up, and improving systems. That alone can change how people feel about working with you.

• Ask yourself the NPS question
  If you were your own patient, what score would you give your clinic right now If it is not a 9 or 10, decide what has to change for it to be a clear yes.

If you want help figuring out what to change first and how to grow the business around it, you can hop on a call with a PT Biz advisor and go through your numbers, goals, and options together

👉 https://vip.physicaltherapybiz.com/discovery-call 

And if you want your documentation time back so you and your staff can actually be present with patients and earn those 9 and 10 scores, you can try Claire for free

👉 https://meetclaire.ai 

If you are still in the phase of going from part time to full time in your own practice and need a clear plan, you can also jump into the free 5 Day Challenge here

👉 https://physicaltherapybiz.com/challenge

Do you enjoy the podcast?  If so, leave us a 5-star review on iTunes and tell a friend to do the same!

Ready to elevate your practice? Book a call at the link below with one of our expert consultants today and start your journey to delivering unparalleled physical therapy.

Podcast Transcript

Danny: 

[00:00:00] Hey, what's going on, doc Danny here with the PT Entrepreneur Podcast, and today we're talking about [00:00:05] why you're not getting as many referrals as you could or maybe [00:00:10] should, and what you can do about it. One really kind of very simple, effective thing that you [00:00:15] can start to do to get more people coming your way.

This [00:00:20] comes off of a restaurant that I just went, uh, and tried out with my family an interaction that [00:00:25] we, we have with this new restaurant. And, um, and really just sort of looking at basically any business I go [00:00:30] into through the lens of, you know, how, how well are they doing in different things, um, as far as [00:00:35] how likely I am to refer people to these different businesses.

And like many of you, you [00:00:40] know, you, um, you, you probably try to only refer. [00:00:45] People to services and, uh, for products and things like that, if [00:00:50] you honestly think that they're good, right? Um, you, you lose trust to people if, if you just, [00:00:55] uh, say everything's awesome. And, uh, and, and if you're a trustworthy person, you usually take that pretty [00:01:00] seriously.

You don't wanna lose that, that status that you have in your community with your friends and family. [00:01:05] Well, there's a Italian restaurant that opened in our neighborhood that's like walking distance. So we, [00:01:10] we walked there last night. Uh, my, my family had dinner there and I really wanted this place to be. [00:01:15] To be good because it's like a 10 minute walk from my house.

And, um, [00:01:20] when, you know, we went in and I'm, I'm like, I'm pretty [00:01:25] lenient when it comes to new businesses in general just 'cause there's a lot of stuff to work through. Right. [00:01:30] Um, I was a waiter for many years, so is my wife. So I'm also like, you gotta be a pretty horrific [00:01:35] waiter or waitress for me to, to, to not just, you know, think that you [00:01:40] did a good job and, um.

It was, it was, [00:01:45] okay, let's just put it that way. This place was okay. Like the food wasn't great. Uh, it was real clunky. [00:01:50] The waitstaff, I think just kind of just still figuring stuff out and, [00:01:55] you know. I thought to myself like, I'm not gonna badmouth this place. Like, [00:02:00] I'm not gonna tell people specifically not to go there.

Uh, but I'm definitely not gonna tell people to go [00:02:05] there. And, you know, earlier in the day, ironically, my son and I, uh, [00:02:10] were out, we were grabbing lunch and we went to this place called, uh, [00:02:15] Dave's Hot Chicken, I think is what it was called. He, my, my son wanted me to, to go there 'cause we were [00:02:20] out running some errands and he was like, oh, I've been wanting to try this place.

So we went. And this place was [00:02:25] awesome. It was so good. Like, it was like a, it was like a nine outta 10. And [00:02:30] uh, I didn't think it was gonna be that good. It was, it was really good. Um, and we just [00:02:35] had that for lunch and then we go to this Italian restaurant and it just, not very great. [00:02:40] So maybe that made it worse, but you know.

It makes me think of the NPS score. So [00:02:45] the net promoter score, which is one question. On a scale of zero to 10, how likely are you to refer a friend [00:02:50] or a family member for this product or service? Right. That is the one question, and it's highly predictive of how [00:02:55] likely somebody is going to be to refer people to your business.

And in this scenario, there's [00:03:00] two places I went to. I a hundred percent would recommend go try out day side chicken, [00:03:05] uh, I think is what it's called if, if you like chicken sandwiches and fries. Um, [00:03:10] and I would not recommend going to this Italian restaurant, buy my house. Um, and [00:03:15] it's because of two things, two things.

Number [00:03:20] one, um, you have your client experience, your customer experience. So how friendly are [00:03:25] you? How, you know, um, punctual are you, how well do you help people [00:03:30] understand the next steps and things? Um, uh, you know, how clean is the facility? [00:03:35] All kinds of things that, that make you feel like, you know, the experience that you're having is really good.

So we [00:03:40] go to this Dave's hot chicken place. The lady at the front, uh, that, that is, we're ordering, [00:03:45] she was awesome. She's like. Here's a little secret hack. Put a little honey on it with when [00:03:50] it's hot. It's amazing. Like you can definitely grab a honey packet. You know, she came and checked on us, like [00:03:55] while we were sitting there.

Uh, it was a tiny little place. Um, and, and, uh, the experience was great. It [00:04:00] was clean. It was like better than I expected it to be. You know, honestly, we go to this Italian restaurant [00:04:05] and it's like kind of clunky. There's nobody, there's no like person there [00:04:10] to seat you. Uh, you know, we had. Made a reservation and they didn't even have it.[00:04:15]

Um, you know, it was. It was just like, it was kind of clunky. [00:04:20] It wasn't, it wasn't, um, you know, kind of well put together in terms of the, [00:04:25] the, the customer experience, right. It looked fine enough in there. They, for what it cost, it was [00:04:30] like pretty expensive. Like, I would've expected it to be a little bit nicer and for the waitstaff to be better trained, um, you [00:04:35] know, on, on the menu and everything else that they were, they have.

So, you know, like. Well, obviously one is a [00:04:40] is a little fast food place and the other one is a sit down restaurant, so they're not the same comparison. But the experience [00:04:45] I had at this chain restaurant was way better than this little local Italian place. So, you know, I think [00:04:50] that like, alright, cool. So the customer experience wasn't that great.

It's the food awesome, right? Because I'll put up with [00:04:55] some, a terrible customer experience for fantastic food. Like there's a guy that had [00:05:00] this Greek spot in our neighborhood. I was maybe like, I don't know, a short drive from [00:05:05] my house. And this was, he was an old Greek man, and he was so difficult to deal [00:05:10] with.

Like he would just yell at people. Uh, he, it, it would take [00:05:15] a long time. And, but his food was amazing, right? So I would go back, uh, because he [00:05:20] just, he killed it on the, the actual like product itself, right? So. With this Italian [00:05:25] restaurant, the product was not good. Like, it just was, it wasn't good. It was like just, I would say [00:05:30] average whatever, food.

So this is inside the mind of a consumer for this business, right? [00:05:35] But, but you, you'll never go probably to this restaurant in my neighborhood. That's not the point. The point is this, [00:05:40] you have to think of yourself through the lens of your consumers a, a, [00:05:45] and, and try to understand what is it that you are missing.[00:05:50]

That is either going to, it's going to detract from your customer experience, [00:05:55] experience, or from your product or service. That's the whole, [00:06:00] that's the whole game. I mean, aside from like scaling past yourself, [00:06:05] which is obviously outta systems and leadership, but like early on [00:06:10] that's it. It's your customer experience and your outcomes for us as outcomes, [00:06:15] as as clinicians.

So. Are you an average clinician? [00:06:20] You know, are you maybe not as good as you should be to [00:06:25] go out of network and charge people, you know, cash for, for what you're doing? Um, that's [00:06:30] gotta be honest with yourself about that. You know, maybe you are and maybe your [00:06:35] outcomes are something that you really need to address before you go and step out on your own.

For a lot of people, [00:06:40] that's not the case. They're fantastic. They've been in the profession for quite some [00:06:45] time. They get great outcomes. They feel very confident, uh, dealing with anything that comes [00:06:50] through their doors and what they might, uh, you know, [00:06:55] lack is essentially their client experience. So if you're in a little subleased office in [00:07:00] a gym.

It doesn't look great. It's [00:07:05] uh, loud, you know, it's, uh, unpredictable in comparison to a standalone space. [00:07:10] It's cheap, so it allows you to get in your foot in the door. I've been there, you know, and so if you have a, if [00:07:15] you have a poor customer experience as far as your facility is concerned, then you have to make up for it with things [00:07:20] like punctuality, individualization.

Attention to [00:07:25] detail with the people that are coming in to see you. You know, really being laser focused on them, really following up [00:07:30] with them in a, in a quick manner, communication, making sure that it's a, it's as fast as, as you [00:07:35] possibly can, you know, getting those. Insane outcomes that the people were not allowed, not able to [00:07:40] get other places because you're just better at what you do.

So once that happens and [00:07:45] you jump up to a standalone space, right? And now all of a sudden you can improve your client [00:07:50] experience, your customer experience, they'll, they'll match up. And I can tell you, I noticed this firsthand. [00:07:55] Whenever we went from a sublease space to a standalone space, we saw this massive jump in referrals that [00:08:00] happened in our, uh, in our facility.

And it wasn't expected. 'cause we'd actually moved to a different part of the [00:08:05] city. And we actually thought we would take a step back for a few months as we sort of rebuilt our reputation in that [00:08:10] area. But what we saw was a huge jump in referrals. I talked to a few patients about [00:08:15] this and they were like, yeah, like we didn't really feel comfortable sending you people to the little gym area that you were [00:08:20] at because it's sort of, you know, it's loud and dirty and you know, whatever else, but now [00:08:25] you got this, this, this like great standalone space.

I'll te I'll definitely refer more people [00:08:30] because. It's their status, it's their reputation. They're not gonna tarnish their reputation [00:08:35] just for your business like that. That's something that they can't buy. That's a, that's something they have to earn. So [00:08:40] you gotta look at your business through this lens.

Which of these two areas are you, [00:08:45] uh, you know, are, are you missing the mark on? And you need to get [00:08:50] obsessive over improving these. Areas, [00:08:55] these two different things, whether it's your outcomes and your service or your customer experience, [00:09:00] because you have to have both in order for people to give you a high NPS score.

So a high [00:09:05] NPS score would be a nine or a 10. We want a nine or a 10, meaning they're highly likely to refer somebody our [00:09:10] way. Most businesses are not a nine or a 10. Most clinics are [00:09:15] not a nine or a 10. Most are gonna be somewhere between probably like a six and an eight [00:09:20] and, and that's, that is just like.

Limbo, that's [00:09:25] purgatory for your business. You're not bad, you're not good. Like you're not so bad that [00:09:30] people are going to tell folks not to go to your business. You're not so good. They're gonna tell [00:09:35] people to go to your business. And as if you can improve to the [00:09:40] point where you're gonna be a nine or a 10, they're gonna have people spewing their opinions of how awesome you are [00:09:45] to everybody that they know that has an injury, which is probably a lot of people.

So you've gotta double down [00:09:50] and refocus on your business in these two areas and be honest with yourself about where you're [00:09:55] missing the mark. One thing you can do that's a great exercise is have a friend or a family member [00:10:00] that your clinic doesn't know. Just come in and be a patient in your business.

Uh, come in [00:10:05] for an eval like mystery, shop your own clinic and get some direct feedback from somebody. [00:10:10] You know, just be like, please, I really want you to be honest about this process. We've done this, we've had this done for, uh, you [00:10:15] know, people in our, in our mastermind. It's, it's a great exercise. But at the end of the [00:10:20] day, a lot of businesses are frankly just their mediocre.[00:10:25]

When it comes to these two aspects, and if you, if you wanna be mediocre, you're [00:10:30] going to put yourself in a pretty dangerous place to have a business that's around for a long time. [00:10:35] And if you commit to excellence, right, if, if you commit to small changes over [00:10:40] time that are going to improve your business.

You're gonna be around for decades. Not only have you around [00:10:45] for decades, but you're not gonna have to worry about marketing. You're not gonna have to worry about hiring, you're not gonna have to worry about, [00:10:50] uh, you know, tech changes and, uh, algorithms and things like that. Where [00:10:55] are, are you gonna be able to run ads effectively and get people in the door?

You're gonna have this. Stable [00:11:00] base of referrals from people that have worked with you, that's gonna be enough to, you know, have a [00:11:05] business thrive for a very, very long time. And that is a really good place to be. But it doesn't come by accidents. [00:11:10] It, it, it requires a lot of hard work and consistency over a long period of time.

And you borderline [00:11:15] need to be obsessive over. Your [00:11:20] outcomes and your experience. If you do those two things, your business is going to crush [00:11:25] it in 2026. You just gotta be honest with yourself about where you need to improve and the [00:11:30] things that you need to really work on so that you can take your business to the next [00:11:35] level.