Kathryn Binkley  

Hello, hello, everyone. Welcome back to the podcast today I have Carrie Pagliano. With this can't wait for you to hear from her and how she has changed her business over the last really, I guess, couple of years. So anyway, let's dive right in Carrie, why don't you introduce yourself and tell us about your business?

Carrie Pagliano  

Sure. So I'm Dr. Carrie Pagliano. I'm a physical therapist in Arlington, Virginia. And really, I've had my business, I guess it's been four years now. But the intent when I went in was purely brick and mortar, just seeing patients and really had that down path. And then there was COVID like everybody else. And before kind of COVID, I had thought about shifting gears and having a little bit better way to scale. Because I'm a pelvic floor PT, I work with pregnant postpartum women getting back to sports and really wasn't interested in hiring another clinician. So really, it was, you know, if I wanted revenue, it was I needed to see a patient in front of me. And obviously, there's only so many hours in the day. And so I wanted to try and change that. And with COVID. My practice continued, it shifted to telehealth for a good couple of months. But it really gave me some time and space to start to dive into digital education not only for clients, but also for postpartum professionals, other physical therapists, coaches, trainers, that sort of thing. So I dove in and probably had no idea what I was getting into. But it's actually, but I love learning new things. It's been a really steep learning curve. But so far, so good. So and that's been, I guess my first online course was summer of 2020. So are we almost two years on that? It's like time has no meaning anymore?

Kathryn Binkley  

No, I agree. I was when I first started talking about when you would have started that transition. I'm like, feels like yesterday and so long ago at the same time that COVID started. So anyway. Yeah, too funny. Okay, so you've talked a little bit about what led you to that decision. But you dive in a little bit more about some of the things that were on your mind when you were thinking about transitioning to that online space having a digital product, that's not dependent on your time?

Carrie Pagliano  

Sure. So in my field, we willfully underestimate things, I think, and you know, this idea of passive revenue, which comes across as Oh, so easy, really isn't? And maybe that's, you know, why why businesses fail, I don't know. But for me, a couple of different things really sort of drove this, again, one from a business side, I really love having just myself in my space. And really, you know, I've worked in a large hospital based practice, I've worked in large private practices, it wasn't I am very happy kind of content being being by myself. But from an accessibility perspective, meaning, how can I impact more women? How can I provide and share more education. And then also, I grew up in a pretty rural area in upstate New York, like the closest big Medical Center was was 70 miles away. And, you know, how can we access? How can I access and help women who don't have resources, right out their front door, or may not have the availability of, you know, getting out of their house, to go see a provider, which was very, you know, that that was very much the issue, initially in COVID. So for me, there was there was kind of a lifestyle, business aspect to it. But very much, my goal has always been to make a larger impact on not only my profession, but postpartum care and that sort of thing. So those two things really sort of combined. And this seemed to be at least a good solution to start.

Kathryn Binkley  

So oftentimes, I think, as someone who provides a service, and we'll kind of put you in that container there, I know, it's, you know, in the medical field, it's a little different. But so as a service, you have the option to scale in a couple of different ways. And you mentioned that you didn't want to scale by just adding more practitioners.

Carrie Pagliano  

That is the easy, most obvious thing. So a lot of probably in the last probably since I started my practice, so it is The last four to five years, there has been an uptick in other it really an increase in PTS getting out of bigger practices, because we're being dictated by insurance and you're being asked to see a crazy number of people per hour. And so with that you get a lot of programs that are geared more towards our profession. But the answer people always had for scalability was, oh, we'll just hire somebody else. And that's probably the joke. I've always said to you from the beginning. I'm like, I have two kids, I don't need that anymore. And I've worked in, you know, I created a residency at Georgetown University Hospital, I've had residents work under me, I've had students, I've had other providers that I have trained, I've been there, it's not something I enjoy doing. Yes, I totally agree that that from a financial perspective would be the most obvious solution. But I'm fortunate that I have a perfect little space two blocks from my house so that if I just want to come over here and get some peace and quiet, like this practice could go under, and I'm keeping this as my seat shed. So for me, it was, again, the beauty of the profession that I'm in is you can do it however you want. And it took me a little bit to get over asking for help period. And working with others periods. I have a team that's growing, but none of them are PTs. And that's totally fine with me.

Kathryn Binkley  

Yeah, and I know one of the very first questions like, you know, as I'm evaluating any business, one of my first questions is going to be would you want to just hire someone else to remove yourself? And pretty quickly, you're like, Nope, I already figured that one out already through. And that's okay. And I really wanted to highlight that because it's okay to do it that way. And I know, I think some people know that. But I think others take for granted that people really know and understand that you don't have to continue to scale by just replicating yourself, you can choose another path. And some of my clients choose more of the agency model and scaling that way. And some choose to scale in a different way with a more scalable offer. And both work. And so it does come down to personal preference.

Carrie Pagliano  

Yeah, exactly. I mean, I'm super picky. From a clinical perspective, that's where that's my superpower. And again, like, I don't feel like because I'm providing education to other providers, it's not like I'm holding it to myself, and not sharing with other people and things like that. And I have some great collaborative relationships with other PT practices in the area. And, you know, if they have somebody that's more my niche, and that's how, again, it's allowed me to hyper niche down. When I first started, I was working, I changed to working from everybody working with everybody, to just women. And then with COVID, actually, and this will probably be a year next September, really hyper niche down to working with pregnant postpartum women trying to get back to sport and not really working with pelvic, pediatric incontinence, those sorts of things. So it's one of the areas that I think I feel the strongest about is what I'm able to do clinically. So yeah, I wasn't going to touch on that one. 

Kathryn Binkley  

Yeah. Which is, again, totally fine. And I think that it's, it's worthwhile to just mention that, you know, when you're faced with that decision, like, you've got to go back to what you wanted. And what you just described is that you wanted a greater impact. And for some people, a greater impact does mean that first step of essentially cloning themselves over and over and over again. And for some, they go ahead and make that leap and go for as great of an impact as possible. And that's what you've done, because you're going to create a far greater ripple effect of change by teaching other professionals and also working directly with the moms who want your support, then, to just replicate yourself and double the number of clients, patients, you could see triple it, whatever, like you've got far greater reach now. Yeah, so Okay, let's be different about your journey than you expected so far. What were some of the surprises or the lessons learned?

Carrie Pagliano  

Well, I mean, the obvious I, again, I don't know that when I first started in my practice that I would even be considering, you know, and I mentally almost held them in two different spaces for a while. And no one expects that half of their, you know, their private practice career is going to be spent trying to survive a global pandemic. But for me, I think the thing that's probably been the hardest is just recognizing the obvious is that I can't do everything. And I know that but I also, if I'm going to bring in help, I need to know at least a little bit of something. I don't want to go on blind faith, because you can get burned that way. So for me, it's been really interesting because the initial phases of my my private practice, I essentially operated a concierge practice out of a hospital for 11 years. And so it was pretty easy to walk into my own space. And there was a lot of new, you know, electronic medical records and automated, you know, appointment reminders that the basic things you would need for medical practice, all that stuff was pretty easy to find, then it was switching gears. And and again, I didn't have to mark it. And I think that's probably been the other biggest challenge, too, is PTs, we don't see ourselves as is doing sales, but we really actually do it every day when I have a client sit in front of me. And I have to explain to them what's going on, and how I can help that sales. I mean, we don't like to think about it that way. But it is and so to take that what I already know what to translate it and have confidence in that in a different sort of way. And not feel gross. Like for 1995 you can have this, you know, so but then also, you know, I come from, I've been in the DC area 20 some odd years, my reputation is very strong here. And to jump into a gigantic ocean of people that don't know me, that hurts the ego a little bit, I'll be honest. And so to kind of get over that be like, Oh, you don't know what a gift I am you don't know, the things that that I can share with you and that this is gold. Like when I work with my pro audiences I have you know, more people know me. But I think that was a little bit harder to to kind of shift gears from a marketing sense, and kind of get out of my own way and still working on the one.

Kathryn Binkley  

Yeah, I think that's gonna be a continual journey, I'm sure. Yeah, so let's talk about like, so you enrolled in scale to seven, after already creating your course you'd already validated by launching. And so you didn't come to me as a beginner in that space? I do. Remember you coming to me, like Am I qualified to join because of this side of my business? Because you weren't thinking about them all as one big business. So maybe talk a little bit about your thoughts around the businesses being separate versus together. And a little more around, like, where you were when we first started working together with your program?

Carrie Pagliano  

I don't know why inherently, they started as separate in my head. And they stayed that way for a while. I mean, even revenue tracking, I think partially because one I was so incredibly confident in and the other I just wasn't and it wasn't proven. And I didn't have data and all sorts of things. And even now, when I'm talking with people, like it's still, I have to be very conscious about, you know, if somebody asked me, well, how can you work with me? Okay, well, these are the different ways in which you can work with me, it may be that you know, and we actually ended up and I think this was the culmination of all this solidifying in my head was inadvertently ending up doing almost like a website, rebrand, last fall. So that I realized I was like, my whole digital site isn't even on my website, what the heck. So it really was separate in all the ways. And so now it's really been kind of pulling it all together and be like, Yeah, you know, you can work with me in all these different ways. But if you want to sit in my office in front of me, this is more like the higher ticket, you know, much more high touch, and really reframing my practice to look like that. But when I think when I, when I first started chatting with you, it was still very separate. And even basics like metrics, again, things that were super easy for me that I understood concepts in brick and mortar, just trying to figure out how that carried over. And there were so many things that were variables. And and again, it's it's ironic how this is all very similar clinically, because one of the things that I do clinically is if you come in, you tell me what's going on, we lay everything out, we find patterns and things, we figure out what needs what, what needs changing, and that sort of thing. And I found myself trying to figure out how to do this in this kind of online, digital kind of side of things. And it just became very obvious to me that even though I had friends that were practicing, I didn't have people that understood this. And I started stalking my friends that had coaches. So that's how I found you.

Kathryn Binkley  

Yeah. I mean, it's funny to me, I think about this sometimes too, like, back in my marketing agency days, working for whoever owned the business, like I didn't think of them like this online entrepreneur or anything like that. Like it was more of a brick order but like, like, it's not actually that different and yet is completely different. It's both, it's like, exactly the same. And then completely different language, sometimes completely different timelines of things. How do you talk about that with the friends of yours that are, they'll brick and mortar? 

Carrie Pagliano  

Well, I was gonna say it's actually really hard. And it's hard to tell like other moms, you know, baseball practice what I do, because physical therapists they get, they understand, you know, you come to the office, you have an appointment, you walk away from the appointment, you pay for the appointment, I mean, and that's even like, oh, my gosh, you don't do insurance, it will blow your mind, although that's, you know, more common here in the DC area. But honestly, I don't. And we kind of forget about this. So fast, digital, anything, was still really fresh and exploded because of COVID, like people forget. And then literally, the first thing with COVID, I think I had a colleague of mine, that she she's kind of in the digital space in where she but she was kind of offering in person education and those sorts of things. And she kind of posted this person who in retrospect, I'm like, was saying, this is how you start an online course. And I just literally sat in on that for like two or three days in April 2020. And I had to start somewhere, because I'm like, Oh, now everybody's going to be doing this, I kind of been thinking about, there's no better time than now. But again, that wasn't really a thing. And so I think people are just starting to get used to purchasing education online, I think it was a very much easier shift for professionals, because essentially, we were going from like our in person courses, to wow, this is really easy, I can make the person talk a lot faster, and get through the content a lot faster and still get my education. I think for the public, it's been a little bit different. Because what I'm offering is not, you know, the $30 product, it's not somebody that looks great in a bikini and took a weekend course, and you can buy this cheap thing for 30 bucks, and you probably won't do it anyway, like, I'm kind of a little bit in the middle. And that's hard to explain sometimes is like, I'm giving you more than that cheap thing that you will never do. But you're probably never going to come to my office because you live on the other side of the world. So this is kind of a nice in between. and So professionally, it's tricky, because there's a lot of people in my field that get very big, it'd be in their bonnet about practice acts and licensure and things like that. And that's where you have to fall back on a lot of the things that are already there, you know, the medical disclosure, like, you know, this isn't, you know, medical advice. But yet, value what I have to say and not hide behind my license. So somebody takes a weekend course they can go out and say what they want, but I can't say a thing. No, that that can't be, that can't be the way either. And so making sure my eyes were dotted and my T's were crossed from a legal perspective, which I think is incredibly important, but also not being held back by things that, frankly, aren't in our practice, because our Practice Act hasn't caught up. Yeah. So that that's been tough.

Kathryn Binkley  

Yeah, let's, let's go there for a second. Because basically, you're taking and I'm curious, from your perspective, someone who really values education, who has a reputation for what you do that is amazing. And then taking that into unregulated industry, do you think that your industry specifically will move towards trying to regulate the online space? And would you want that?

Carrie Pagliano  

I frankly, no, I don't want it. And I don't think we should be there. From a regulation perspective, I think we need to be there as a profession. And, you know, this is all been a unique line to in that I am quite active International Association. I was president of the Academy of Pelvic Health, Physical Therapy and on their board for six, seven years. So this doesn't come from a place of taking it lightly. But also the type of area in which I practice. The amount of research we have now compared to 20 years ago when I started is is dramatic, but I'm not waiting for somebody to write a paper to do what I'm already doing. And so that's where, again, with good legal advice. I've always been the one to kind of push the boundaries and it's easier to beg forgiveness and to ask permission like who am I going to ask? I checked my Practice Act. There's nothing that highlights it specifically. I don't know that anyone does. But at the same time should I stifle what I'm saying? Over somebody who has no medical background whatsoever? Because I'm worried about my licensure. So but that's my feel gets a little. We want to hold ourselves as experts. But yet we're not willing to push the boundaries that we need to push to make sure that people see us in that way.

Kathryn Binkley  

Yeah, I see the same thing in the coaching world, obviously, it's unregulated as well. And I even saw a post just this last week from someone who was talking about the trauma caused through his experience with some coaches. And it was interesting, because as I really started to reflect on that I'm like, Okay, I even know some of the methodology that he was referring to that coaches use. And I think that there's a way that it can be used, that's more harmful. And so, at the same time, I'm also not an advocate for regulating the industry. So I think then my question becomes to go back to you here, what do you do to help really communicate to your audience that you are an expert that you do know what you're talking about? You didn't just decide this was a good idea to create this course with no background?

Carrie Pagliano  

I think. I mean, that's, that's the continuing question. And one of the things that I need to do on a constant basis is educate about vetting your resources. And, you know, we are targeted literally every day like, I do not hesitate to tell people that there's somebody's avatar, same thing with PTs. Same thing with PT students, there are PT students that are somebody's business avatar, while they were in school. And I tell them that there's like, no, no, nobody's talking to us. And to be aware that, you know, where you find out about people, I mean, Facebook, let's just be honest, you know, and I think, you know, understanding that from an app perspective, what little I do understand is, is you will be targeted? And how do you? How do you get through the noise? And most of the marketing in Okay, let's back up basic marketing principle is talk to somebody's pain points, right? Well, what's a pain point for, you know, compare, gosh, I don't know what to make for dinner, versus your organs are falling out, your abs are splitting open, and you're gonna pee your pants your entire life, like, to me those hold two different places in your head from a fear perspective and that sort of thing. But they're treated as the same. And what is unfortunate is when those marketing principles are used in a way to sell to vulnerable women who don't know any better. And that's where I talk about an advocate for education, you know, my daughter's eight, like, we need to start then. So that you understand so that you have, like, knowledge is power here. And so we're not only trying to change, you know, access to care, we're trying to change information, making sure that it's evidence based, but also make sure that we're not, you know, targeting on people's fears and insecurities and lack of information. And then, you know, I've worked in chronic pain for a long time to like, that creates a whole bunch of brain changes and kind of really mess things up from a treatment perspective, too. So the answer for me is really kind of advocating for better education, from the moment that we talk to our girls. And obviously, it can be everybody. But one of the things I always tell people that you know, whether you follow me on social where you take one of my classes, my ask is that you pay it forward, you either tell one of your friends and share that information. So they don't make the same mistakes or that they're aware. Or if your provider doesn't know that you take it upon yourself, if you found the solutions to go back and share with them because the changes aren't going to come from the medical profession down. It's going to come from us as moms demanding better, but we also need to be really good at calling BS on things that just aren't true are fear mongering. And the problem is it happens in my field too. So it's not that you can say, oh, you're a doctor of physical therapy. I trust you know, there's crappy people everywhere. There's people that don't know what they're doing everywhere. And lots of times there's there's coaches and trainers that are my colleagues that are far more educated and much better at treating this population, quite honestly than some of the people with a with a doctorate. And so that's a very hard nuanced thing to explain to people. And I, I'm, again, I've been in this long enough that I frankly could care less if I piss people off. I'm very conscious that I am not in that, you know, professional leadership role anymore, but that's where I feel like I have the clout because I've sat you know, In a leadership chair and professional organization, I have set an advocacy role. I've also sat here as a mom thinking that I knew what the heck I was talking about, because I was a professional and was woefully unprepared myself. So for me, it's being incredibly open about, these are all the hats that I've worn. These are all the chairs that I've sat in. And this is what I'm telling you as kind of a tale of buyer beware. But we have an opportunity to make a change here. 

Kathryn Binkley  

Yeah, absolutely. And as an entrepreneur and business owner, there's the side of it that I'll add here that I think that you do well, and I encourage all of my clients to do and that is to really make sure that you're, you're clear about who the right person is that you're serving, and that you make that clear to them. Even if it's a course that they can buy right off of the sales page that they can tell if this is going to really help them or not, and how to know whether they aren't the right fit for this. But then especially as you increase rates, and you're going more and more, you got to make sure that you're working with people who are qualified for your offer, and that you know that you can help them you've got that responsibility as well. So good. So let's, let's look at some of the things that you're focused on. Now that maybe you haven't been in the past, like, where are you now? And where do you want to go? And what's your focus? What are you thinking about at this level of business?

Carrie Pagliano  

I'm gonna start teaching people how to do Active Campaign. No, I'm kidding. No, I mean, I don't, it's funny kind of when I look back, and on the past year, and really, you know, I think one of the buzzwords I was like, oh, I want foundation, I want information to be able to make decisions, it takes a while to figure out where to get that, I think it takes a while to make sure that you have the systems in place to have information in front of you in order to make decisions. And I think that's really been a primary focus of, you know, the second half of 2021. And then the intent was to kind of use the beginning of 22 as more data collection, which that got thrown back in my face after about 24 hours, when I realized that what I was using, was not giving me the the information that I needed, and I kind of suspected that. So in some ways, I, I feel better that yeah, I've got I've got a ton of information, I can't wait to dive into it, and see what it means. And that's what I kind of feel like, you know, in the beginning, I was like, well, maybe I should fix this. Or maybe I should fix that. And I'm very much a data driven person. So this will feel good to kind of get in some of that comfy space, and see how that goes. But again, like this is the first year, because I've got some launches under my belt to be able to kind of really have a target number and see if I can do it. And if I don't kind of unpack why, because you know that first launch, you get a big boost. And then then you got to do it again.

Kathryn Binkley  

And I think yeah, so many people underestimate what it takes to really build a scalable foundation, and you put in the work to validate your offer, you're now going back and revisiting some tools to make sure that you have tools that can still with you and give you the data that you need to make this decision that you mentioned. And then from there, once you have all of that in place, an offer that you know will sell. And every element of your funnel, you're even switching from launching to Evergreen for a piece. And then so we're working in some other, you know, another business model there to a degree. And as you do that, as you implement these different things and have the data, you'll be able to make decisions and then start seeing the progress. But yeah, it does take some time to get that in place.

Carrie Pagliano  

That's a very far cry from passive revenue.

Kathryn Binkley  

Right? Yeah, I know, I had a team member join. And she's like, you often say like, in your marketing, like this is going to take a while like this is slow down. And she's like, I don't know if that's what people want. It was like, Yeah, but I'm never going to be dishonest about it. Like it's going to take some time. And I you can scale quickly. But that definition of quickly interval. Yeah, exactly. That definition of quickly is for sure when to consider. And yeah, can you keep it long term? That's what I'm all about building to last sustainable revenue, because otherwise, what's it for? 

Carrie Pagliano  

Well, and also again, like not for nothing, it parallels very much the kind of work that I do, like you have to have this foundation. If you try and go for that quick fix. It's going to come back and bite you. And you know, again, like I did, what I'm looking forward to is when when do I feel my foundation is done, but I know the answer is that is there's always something but like looking forward to, you know, whatever kind of that cuz little little pieces because I feel like I've, I've earned my tech degree.

Kathryn Binkley  

So everyone who's thinking about scaling, like, this isn't going to be the sexy stuff that you're interested in, but you're gonna have to learn this the tech, you're gonna have to learn the data. And I mean, I say it's not gonna be the sexy stuff, but the results that come from it

Carrie Pagliano  

will be, well, that's, again, that's the thing. And, you know, if I, if I correlate it to kind of what I know, from a patient perspective, one of the things that I try and teach my clients is like, look, I want you to be able to, if something doesn't go, Well, you have exactly, you know, you've got three things that you know, to go in and triage and try and address and because, you know, these are the things that drive a lot of your issues. And again, just to be able to have an understanding of how the machine runs, I guess it's like the same thing where people just jump in a car and don't know anything about it. I mean, I'm not gonna fix the car. I know some decent things like my husband's in it, and we retrieved the stories that, you know, before I asked him for help, I need to unplug it, reboot, whatever it is, and start over before I ask for. Same thing, I need to need to make sure I cover the basics before I dive in and ask for help.

Kathryn Binkley  

Yeah, well, you're making tremendous progress with your programs. And there's so much more to go. But I'm excited for you and really appreciate you coming on to chat about your experience switching from offline world to online and from one to one to one to many, you also have the one to one practice that we're just adding the one too many into the mix as well. Why don't you share with everyone where they can connect with you and learn more? 

Carrie Pagliano  

Yeah, so everything's pretty easy. My website is carriepagliano.com. And you can find me I hang out mostly on Instagram, it seems to be a lot happier than Twitter, @carriepagliano.

Kathryn Binkley  

And she has some incredible reels. 

Carrie Pagliano  

They're pretty good. We I took a little pause on the reels as we were kind of we just created a new podcast about a month ago, the active mom postpartum podcast, but the reels are coming back. So

Kathryn Binkley  

yeah, I see those from time to time. 

Carrie Pagliano  

So what's creativity? Yeah,

Kathryn Binkley  

Yeah. So love it love that you've just jumped right in. Because I feel like that's not, by the way, something that I would typically imagine a doctor doing and I love it. I don't know. Maybe

Carrie Pagliano  

The content lends itself to a hair bit of humor. Yeah, like so. I'm not as out there as some of the pelvic PTS a dance around and like vagina suits and things like that. So I keep it a little bit real. But yeah, yeah, have that creative side space.

Kathryn Binkley  

Yeah. Well, I love it. I always like seeing them. Well, thank you. So good to have you. Thanks.