The Ultimate Hiring & Retention Guide for Rehab Practice Owners 

If you’re reading this, you don’t need another statistic to know the current hiring and retention environment is difficult. 

This isn’t a small problem. It’s a fundamental challenge to the way things have always been done. The old school playbook does not work anymore…

• Non-competes don’t offer real protection.
• You can’t rely solely on loyalty and tenure.
• And passion alone can’t compensate for exhaustion and a broken system.

The owners who are navigating these challenges successfully aren’t always paying the most, but they are the ones building intentional, people-centered systems. 

This guide provides tactical advice from, real-world operators who have cracked the code on hiring and retention:

• Josh Funk (Rehab 2 Perform) — scaled from 1 to 17 locations by prioritizing process, financial wellness, and a team-first philosophy.
• Justin Stiver (Total Therapy Florida) — scaled from 1 to 7+ locations while hiring a Director of Clinical Education role that not only pays for itself but actively increases retention.
• Jason Collin (PT Revolution) — achieved zero PT turnover in 5 years by focusing on his 3 C’s: Clarity, Connection, and Communication.
• Kate McCommons (Grow Together Therapy) — built intentionally from the ground up by customizing benefits and purposefully refusing misaligned clients to build her pediatric practice.

Let’s jump in

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1. Hiring Right: Stop Filling Seats

Getting the culture right means the hire compounds its value. If you get it wrong, the next 12 months become an uphill battle. Culture fit is a system of observable behavior, not a subjective feeling. 

Remember, culture isn’t just your values statement—it’s your team’s default reactions. 

The true test of culture is not in your mission statement, but in the grey areas—how friction is handled, what happens when someone pushes back, and how leaders respond to mistakes. Clinicians pay close attention to consistency; if rules change depending on who asks, trust erodes quickly. 

Strong culture is built through the repetition of hundreds of small moments that teach people what’s safe and what’s risky, and leadership behavior often mirrors this. 

Remember: Burnout often mirrors leadership behavior more than patient load.

Strong operators don’t “feel it out.” They test for the correct fit..

• Jason requires candidates to submit short videos explaining why they’re a fit.
  This isn’t a gimmick. His practice serves an active lifestyle population, so he’s listening for language, philosophy, and energy alignment. Do they naturally speak the brand? Do they understand autonomy and performance? The video filters out low-effort applicants and reveals cultural fit before anyone schedules an interview.
  
• Jason also borrows a Disney-style tactic: candidates spend time with the front desk before the formal interview.
  This is a behavioral screen. How someone treats non-decision-makers reveals humility, respect, and emotional intelligence. Culture fit shows up in small moments long before it shows up in answers to interview questions.
  
• Kate hires primarily through Indeed and referrals, but she doesn’t hire reactively.
  Her strong “batting average” comes from clarity. She knows exactly what type of clinician thrives in her model, what expectations look like, and what values must be present. Her interview questions are tied directly to how her clinic operates, not generic prompts. That precision reduces misalignment before an offer is ever extended.

The Desperation Trap

Desperation hires are the most expensive hires you’ll ever make. Jason said it plainly: “I made hires out of desperation… Those were the worst hires.” 

Hiring intentionally pays off. Slow is smooth. Smooth is fast.

Always Be Recruiting (Even When You’re Fully Staffed)

Justin networks constantly. “I hate hiring. I love networking.” 

He meets PTs for drinks outside of hours with no agenda. He keeps 7–8 people in his orbit that he would love to hire someday, building relational equity before he needs it.

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2. Onboarding: Where Most Retention Is Won or Lost

Owners obsess over patient onboarding. Few obsess over employee onboarding.

Josh does.

He built what he calls a simple one-page operational cheat sheet. It outlines core expectations, documentation standards, communication norms, and clinical non-negotiables. The goal is simple: if something goes wrong, you should be able to trace it back and ask, “Was this clearly outlined from day one?”

That one page is not the entire system. It’s the anchor.

From there, new hires receive immediate access to Trainual, a cloud-based training and documentation platform that houses the clinic’s processes, policies, workflows, and competency modules. Inside Trainual, employees complete structured onboarding lessons, take quizzes to confirm understanding, and review standardized documentation guidelines.

Nothing is assumed. Nothing is left to hallway conversations.

Josh’s onboarding process reduces cognitive load from the start, which lowers early burnout risk and accelerates confidence.

Ambiguity is exhausting. Clarity is calming.

Jason takes it further. In the first 90 days, new hires are required to have lunch with every team member. Paid for by the company. Connection is not accidental.

The 90-Day Rhythm That Works

• Days 1–30: Connection
  • Meet everyone
  • Learn systems
  • Understand expectations
• Days 31–60: Competency
  • EMR mastery
  • Workflow rhythm
  • Operational comfort
• Days 61–90: Development begins

Justin intentionally delays heavy mentorship until after clinicians find their footing. Then Mason, his Director of Clinical Education:

• Shadows them 5+ times
• Builds a collaborative action plan
• Reviews progress annually

The pacing matters. Too much too early creates insecurity. Too little creates stagnation.

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3. Culture That Actually Retains

Culture is not snacks or pizza parties. It’s how friction gets handled.

Jason distills retention into three variables:The 3 C’s

1. Clarity
   • Are expectations defined?
   • Do employees know what “good” looks like?
   • Are behaviors tied to values?
2. Connection
   • Do they feel safe?
   • Do they feel known?
   • Do they feel psychologically secure saying no?
3. Communication
   • How often do you follow up?
   • Are you closing loops?

After focusing on the three Cs, follow-up is essential. As Jason says, “Follow-up builds more trust than transparency alone.” Leadership maturity comes into play here—ultimately, every owner must decide whether to run a business Team First or Patient First. 

Both Josh and Jason agree: the best way to build a thriving practice with excellent patient outcomes is a Team First approach, guided by feedback from your clinicians.

Recognition That Sticks – Here’s What Josh and Kate Do

Josh: uses a WWE-style championship belt that gets passed around to team members who embody the clinic’s core values. On paper, it might sound gimmicky. In practice, with real team buy-in, it becomes symbolic. It creates visible, memorable reinforcement of what the organization stands for. He also runs “High Five Fridays” in Slack, where team members publicly recognize each other for behaviors tied directly to those same values.

Kate: takes employees out to lunch and makes one rule clear: no business talk. The focus is connection, not productivity. It’s about seeing people as people, not just providers.

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4. Retention Through Growth (Where the Real Leverage Lives)

People don’t leave jobs. They leave stagnation.

Justin noticed something early about one of his employees named Mason. He was exceptional, curious, and growth-oriented, and Justin realized that if he only ever saw patients, he wouldn’t stay. So he built a new role: The Mason Model: Director of Clinical Education.

What Mason does:

• Digests research into usable summaries
• Mentors after day 90
• Builds action plans
• Standardizes clinical thinking

Financially, Mason still generates roughly $100,000 to $110,000 in annual clinical revenue. That production covers the majority of his salary, allowing Justin to fund the leadership portion of the role without dramatically increasing overhead.

But the real leverage isn’t just in revenue coverage.

Every retained physical therapist saves an estimated $10,000 to $12,000 in recruiter fees alone, not to mention onboarding costs, lost productivity, and cultural disruption. By investing in Mason’s growth and positioning him to mentor and stabilize newer clinicians, Justin isn’t just creating a role. He’s reducing turnover risk across the organization.

The Director of Clinical Education role pays for itself operationally. It pays dividends strategically.

The intangible ROI?

• Higher consistency
• Stronger engagement
• Cultural alignment
• Harder to measure. Impossible to ignore.

Justin was thinking about how this model could scale beyond his clinic, imagining long-term impact for other practices. He saw it as a blueprint for retaining talent, improving patient outcomes, and strengthening clinic culture across the industry.

Financial Wellness Is Retention

Josh openly addresses a form of burnout many owners overlook:

Student loan stress.

For younger clinicians, burnout often starts long before documentation fatigue. It starts with six figures of debt accruing interest every month. That financial pressure influences career decisions, risk tolerance, and long-term engagement.

Instead of ignoring it, Josh builds retention strategy around it.

SECURE 2.0 Student Loan Matching (Up to 4%)

Under SECURE 2.0 legislation, employers can treat qualified student loan payments as retirement contributions for matching purposes.

If a PT is prioritizing loan repayment over contributing to a 401(k), the company can still provide up to a 4% retirement match based on those loan payments.

That removes a common tradeoff. Clinicians do not have to choose between eliminating debt and building retirement savings.

Over a ten-year span, that 4% match can total approximately $16,000 to $17,000 in employer retirement contributions, not including market growth. For someone early in their career, that compounding runway is significant.

It signals awareness. It acknowledges the financial reality clinicians are navigating.

Section 127 Pre-Tax Student Loan Assistance ($5,250)

Through Section 127 provisions, employers can contribute up to $5,250 annually toward an employee’s student loans on a pre-tax basis.

Those dollars are not subject to income tax for the employee, and the employer can deduct the expense. The result is greater efficiency per dollar and faster principal reduction.

While $5,250 may not feel transformative in year one, over multiple years it shortens repayment timelines and reduces total interest paid.

Reducing financial strain reduces cognitive load. And reducing cognitive load directly impacts burnout risk.

Profit Share Without Equity Buy-In

For office leaders who open new clinics, Josh offers structured upside:

• 15 to 20 percent profit share
  
• Family health insurance premiums covered
  

This is not traditional equity ownership. There is no capital buy-in, no personal debt, and no legal liability exposure.

Instead, leaders participate directly in the performance of the clinic they help build.

It creates ownership-level incentive without ownership-level risk.

Most practices focus on salary and bonus structures. Josh is building long-term financial alignment.

For debt-heavy, growth-oriented clinicians, that distinction matters.

Customize Benefits

All of these owners do not believe in one-size-fits-all benefits.

• Some want flexible PTO.
• Some want predictable hours.
• Some are caring for aging parents.
• Some are early-career hustlers.

If you don’t know their life stage, you can’t design retention.

Michael Silva, a PT practice owner and consultant, shared a simple example of flexible leadership in action.

Michael once hired a highly skilled physical therapist who was also a competitive bodybuilder and needed time in the middle of the day to train. Rather than viewing that as a scheduling conflict, he saw an opportunity.

They shifted his schedule to early mornings and evenings, covering time slots many working patients prefer but clinics often struggle to staff.

He kept his training routine, and the clinic expanded access, attracted new patients, and turned a simple accommodation into a strategic growth move.

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5. Burnout Prevention Is Operational, Not Motivational

Burnout isn’t just documentation. It’s emotional fatigue from lack of support.

• Jason calls AI transcription a game changer. Not just for time savings. But because it signals: “We’re trying to reduce your burden.”
• Flex scheduling matters too. One employee requested a 3-hour midday break to train and walk his dog. Mornings filled. Evenings filled. Everyone won.

Harmony beats balance. Jason says: “It’s never going to be in balance.” So build rhythm instead.

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6. Measure What Matters

If you’re not measuring engagement, you’re guessing.

Jason runs an ENPS survey about every six weeks.

ENPS, or Employee Net Promoter Score, asks one core question:

“On a scale of 1-10, how likely are you to recommend this practice as a place to work?”

He started using it to track engagement trends over time, pairing it with additional formal surveys and monthly one-on-ones.

But Jason emphasizes: follow-up is where the gold is. Surveys alone don’t build trust. Closing the loop does.

Anyone can send a questionnaire. Real engagement comes when leaders act on it.

In a practice with eight PTs and zero turnover in five years, that feedback cadence isn’t accidental—it’s intentional.

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7. Where To Start

You do not need to overhaul everything tomorrow. Start here:This Week:

• Write down your core values
• Ask one employee for honest feedback
• Audit your first 90 days of onboarding

This Month:

• Meet one PT for coffee with no agenda
• Test one retention initiative
• Run a simple engagement pulse

This Quarter:

• Build a basic development cadence
• Tie recognition to values
• Map each employee’s life stage

Small moves compound.

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Final Thought

Non-competes won’t save you. Bonuses won’t protect you. Hope is not a strategy. Retention is a system.

• Josh built process and financial wellness.
• Jason built clarity and feedback loops.
• Kate built intentional alignment.
• Justin built growth infrastructure.

Different styles. Same conclusion: People stay where they grow. Build that. And the revolving door slows down on its own.

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WORKBOOK SECTION

This section is designed to be utilized. Do not skim it; this workbook is where your strategy is translated into clear structure.

PART 1: Hiring Audit

1.1 Core Values Clarity Check

Without looking at your website, write your core values below:

Now answer:

• Can every team member name these without prompting?
• Are they behavioral or generic? (“Excellence” is vague. “Feedback is a gift” is behavioral.)
• Have you ever turned down a strong clinician because they violated one?

If you have never lost a hire over values, your values are likely decorative.

1.2 Culture Fit Evaluation Template

For your last 3 hires, answer:

Question	Hire #1	Hire #2	Hire #3
Why did we hire them?
What culture signals did we test?
Did we involve multiple team members?
Would we hire them again?

If the reasons are vague (“good vibe,” “seemed nice”), tighten your filter.

1.3 Desperation Risk Score

Rate each statement 1–5 (1 = never, 5 = frequently):

• We hire because we are overloaded.
• We post jobs only after someone quits.
• We lower standards to fill a schedule gap.
• We skip steps in the interview process when busy.

Score: _________________________________________

• 0–8 → Strategic hiring
• 9–14 → Reactive hiring
• 15+ → You are in survival mode
  

PART 2: Recruiting Pipeline Builder

2.1 Always Be Recruiting Map

List 7–8 clinicians you would love to hire someday:

Now answer:

• When was the last time you reached out?
• Do they know you value them?
• Do they know what makes your practice different?

If you have zero names, your recruiting system doesn’t exist.

2.2 Online Brand Awareness

If a PT Googles your practice right now:

• What would they see?
• Do your socials reflect your culture?
• Would your team describe working there the same way you market it?

Gap = opportunity.

PART 3: Onboarding Evaluation

3.1 The First 90 Days Map

Write what actually happens during:

Days 1–30: __________________________________________________

Days 31–60: _________________________________________________

Days 61–90: _________________________________________________

Now ask:

• Is mentorship structured or random?
• Are expectations documented or verbal?
• Do new hires know what “success” looks like?

If you cannot articulate this clearly, neither can they.

3.2 Connection Score

For your most recent hire:

• Did they meet every team member in 90 days? Yes / No
• Did leadership have 1:1 non-clinical conversations? Yes / No
• Did someone check on their stress level? Yes / No

Connection does not happen automatically. It must be engineered.

PART 4: Culture Diagnostic (The 3 C’s)

Rate each 1–5.Clarity

• Expectations are documented. 1 2 3 4 5
• Core values are reinforced regularly. 1 2 3 4 5
• Employees understand how performance is measured. 1 2 3 4 5

Connection

• Team members feel safe disagreeing with leadership. 1 2 3 4 5
• Employees feel known beyond their productivity. 1 2 3 4 5
• Psychological safety exists. 1 2 3 4 5

Communication

• We run regular engagement surveys or feedback loops. 1 2 3 4 5
• Follow-ups are consistent. 1 2 3 4 5
• Feedback flows both directions. 1 2 3 4 5

Score: _________________________________________ (Total points out of 45)

• Under 30 → Cultural fragility
• 30–45 → Stable but inconsistent
• 45+ → Intentional culture

PART 5: Retention Through Growth

5.1 Individual Growth Mapping

For each team member, complete:

Name: _________________________________________

Clinical Passion: _________________________________________

Life Stage: _________________________________________

Growth Goal (1–3 years): _________________________________________

What energizes them: _________________________________________

What drains them: _________________________________________

Retention Risk Level (Low / Moderate / High): ____________________

If you struggle to answer these, schedule coffee. Soon.

5.2 Development Infrastructure Checklist

Do you have:

• Structured mentorship after 90 days?
• Quarterly development conversations?
• Defined pathways beyond “see more patients”?
• Leadership roles with measurable ROI?
• Financial wellness support (loan matching, profit share, etc.)?

Circle what exists. Underline what’s planned. Star what’s missing.


PART 6: Burnout Prevention Scorecard

Rate 1–5.

• We actively reduce documentation burden (AI, systems). 1 2 3 4 5
• Scheduling has flexibility. 1 2 3 4 5
• Leaders model healthy boundaries. 1 2 3 4 5
• Emotional exhaustion is discussed openly. 1 2 3 4 5
• Workload is reviewed quarterly. 1 2 3 4 5

Score: _________________________________________ (Total points out of 25)

• Below 15 → Burnout brewing
• 15–20 → Monitor closely
• 20+ → Healthy environment
  
  

PART 7: Leadership Reflection

Answer honestly:

1. If your best clinician left tomorrow, why would they leave?
2. What are you currently tolerating that weakens culture?
3. What role are you holding onto that someone else should own?
4. Where are you the bottleneck?
5. What does “winning” look like for your team in 3 years?

This is not a team exercise. This is a leadership mirror.30-Day Action Plan Template

Week 1:

One hiring process improvement: _________________________________________

One culture improvement: _________________________________________

Week 2:

One recruiting conversation scheduled: _________________________________________

One onboarding system update: _________________________________________

Week 3:

One development conversation held: _________________________________________

One burnout prevention experiment tested: _________________________________________

Week 4:

Engagement pulse sent: _________________________________________

Results reviewed: _________________________________________

Action communicated to team: _________________________________________

If you complete this in 30 days, your culture will already feel different.Final Reminder

Hiring and retention are not talent problems. They are systems problems. The practices that win are not the ones with the biggest bonuses. They are the ones that:

• Hire slowly and intentionally
• Onboard with clarity
• Develop relentlessly
• Measure engagement
• Customize growth
• Lead without ego

Use this workbook quarterly. Because culture is not built once. It is built continuously.

Ready to build a clinic that people don’t want to leave?

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