No Appointment Necessary

Michael Schumacher - HMDG

This is the podcast clinic owners listen to when they’re done with gurus, funnels, blueprints, and templates pretending to be strategy. No hacks. No 'proven' 10X systems. This comes from HMDG. We have worked with more than 1,000 MSK clinics. We see the accounts, the utilisation rates, the failed ideas, the profitable ideas, and the reality behind the noise. We do not deal in theory. We deal in numbers. Most of the industry advice collapses the moment it hits real-world finances. You get the truth about how clinics actually grow. Why some print money while others burn out. What patient numbers mean once you stop pretending templates can fix capacity problems or that “mindset” builds a business. The idea that a clinic becomes successful because someone journalled harder is fantasy. We talk to people who have actually achieved something. Multi-site owners. True specialists. People with real P&Ls, not testimonial slides about a “life-changing £30k month”. We break down marketing, pricing, staffing, finance, AI, and operations without pretending there is a magic blueprint that saves everyone. There isn’t. The only thing that works is understanding the fundamentals and executing them properly. If you want comforting stories, find a guru. If you want the unfiltered reality of running a clinic, you’re in the right place.

  1. Clinic Owner & Product Founder: What It Really Takes to Build a Rehab Device

    6 FEB

    Clinic Owner & Product Founder: What It Really Takes to Build a Rehab Device

    Overview Every physio has thought about building a better rehab tool. Very few follow it all the way through. In this episode, we speak with Matt Anstey, clinic owner and co-inventor of AFLEX Pro, about what really happens when a clinician turns a rehab problem into a global product. From DIY prototypes and government grants to elite sport adoption and B2C growth, this is an honest look at innovation without the hype. We explore the difference between running a clinic and running a product business, why “boring but effective” rehab tools are harder to sell than flashy gadgets, and what it actually takes to scale ethically in MSK healthcare. Show Notes How AFLEX Pro started as a personal rehab problemFrom garden prototypes to elite sport and clinic useThe real cost of patents, IP, and product developmentClinic cashflow vs product ROIWhy physios are hard to sell to, even with evidenceBoring effectiveness vs flashy rehab techSelling to single clinics vs large chainsThe B2B to B2C shift in rehab productsWhy education matters more than awarenessWhen a product outgrows the clinic that funded itWhat You’ll Learn Why most clinicians underestimate the cost and complexity of product businessesHow to think about product development as a multi-year commitment, not a side projectWhy clinical evidence alone doesn’t guarantee adoptionHow credibility with peers differs from impact with patientsWhy physios struggle with pricing, even when ROI is obviousThe difference between “cool” products and clinically essential onesHow staying in clinic can strengthen, not weaken, product credibilityWhat it actually takes to go direct-to-consumer in healthcareWhy education beats awareness when patients don’t know the problem existsHow to recognise when a product is ready to scale, and when it isn’t Who This Episode Is For Physios thinking about creating a product or deviceClinic owners curious about diversifying beyond hands-on careMSK clinicians frustrated with gimmicks and buzzwordsHealthcare founders balancing credibility and growthAnyone interested in ethical innovation in rehabClinicians considering B2C, digital rehab, or online programmesNot For People looking for overnight success storiesAnyone expecting products to be easier than running a clinicClinicians chasing hype over outcomesFounders who want to avoid risk, complexity, or long timelinesAnyone hoping evidence alone sells products Guest Details Matt Anstey. Clinic Owner & Co-Inventor, AFLEX Pro Matt is a UK-based physiotherapist and founder of Azzurro Physiotherapy & Training, alongside being the co-inventor of AFLEX Pro, a medical-grade ankle mobility device now used in elite sport, private clinics, and rehab settings worldwide. Developed with his brother, an engineer, AFLEX Pro was built to solve a real clinical problem: restoring stubborn ankle range of motion when traditional techniques fail. What started as a DIY prototype has grown into a patented, internationally used rehab tool, while Matt continues to run a busy clinic and treat patients. Visit https://hmdg.co.uk for further information. Follow Michael on LinkedIn. https://www.linkedin.com/in/mjschumacher100

    56 min
  2. Cuddles Don’t Scale with Rehab Guru

    27 JAN

    Cuddles Don’t Scale with Rehab Guru

    Overview In this episode of No Appointment Necessary, Michael sits down with Simon and David, the founders of Rehab Guru, to unpack what it’s really like to build, grow, and scale a healthcare software company from the ground up. From military roots and clinical practice to bootstrapping a tech platform used by thousands of clinicians, the conversation explores the realities of running a founder-led business in healthcare, including growth pains, customer support at scale, product development, pricing, and why simplicity often beats shiny features. It’s an honest, behind-the-scenes look at the intersection of healthcare, technology, and business, without the hype. Show Notes How Rehab Guru evolved from a simple exercise prescription into a full clinic platformWhy bootstrapping shaped their product, culture, and customer relationshipsThe trade-offs between “all-in-one” systems and modular softwareWhat most clinicians misunderstand about software developmentThe hidden cost of poor onboarding and underused featuresFounder-led businesses vs private-equity-backed tech companiesScaling customer support without losing the human touchHow tech can improve patient experience beyond the treatment roomWhat You’ll Learn How to think more clearly about choosing clinic softwareWhy most clinics only use a fraction of the tools they pay forWhat great patient experience actually looks like when tech is used properlyHow founders balance growth, product focus, and customer careThe questions you should be asking any software provider before committingWhy feature lists matter less than outcomes and usabilityWho This Episode Is For Clinic owners considering new software or a platform switchPhysios, osteos, chiros, and MSK clinicians interested in digital transformationFounders running (or thinking of running) a healthcare business with a partnerAnyone curious about how healthcare tech really gets built and scaledGuest Information Simon & David - Founders, Rehab Guru Simon and David are the co-founders of Rehab Guru, a UK-built healthcare software platform designed by clinicians, for clinicians. With backgrounds spanning the military, physiotherapy, sports rehab, and software engineering, they’ve spent over a decade building tools that support better patient care while reducing admin burden for clinics. Unlike many healthcare tech companies, Rehab Guru remains founder-led and bootstrapped, with a strong focus on usability, customer support, and long-term relationships rather than rapid PE-driven scale. Visit https://hmdg.co.uk for further information. Follow Michael on LinkedIn. https://www.linkedin.com/in/mjschumacher100

    1h 16m
  3. All Things PMI, Payments and Getting Paid Faster with Ben Morfoot (Effra)

    20 JAN

    All Things PMI, Payments and Getting Paid Faster with Ben Morfoot (Effra)

    Overview Most clinics don’t have an insurance problem. They have a systems problem. From the moment a patient walks out the door, clinics are relying on manual steps, outdated workflows, and disconnected software to get paid. What feels like “just admin” quickly turns into delayed payments, hidden under-billing, and avoidable cashflow pressure. In this episode, Michael is joined by Ben Morfoot, co-founder of Effra, to break down why insurance billing is still so broken in healthcare, what actually causes bad debt, and how speed, automation, and better systems can radically change how clinics get paid. The conversation covers PMI workflows, patient excesses, insurer behaviour, open APIs, manual errors, and why many clinics think their billing process works, until they look closely. This episode is about fixing what happens after the appointment, protecting cash flow, and building processes that scale without more admin. Show Notes Why PMI billing creates bad debt by defaultWhat “aged debt” really costs clinics over timeWhy most insurance billing fails after the patient leavesThe hidden risks of manual invoicing and outsourced billingHow slow billing damages cashflow and patient relationshipsWhy insurers respond better to speed and clean dataThe role of automation in reducing admin and errorsHow poor tech integrations create unnecessary workWhy billing problems don’t disappear as clinics scaleWhat You’ll Learn Why insurance billing feels harder than it shouldHow speed dramatically improves payment ratesWhere clinics are losing money without realisingWhy manual processes increase errors and bad debtHow patient experience is affected by poor billing workflowsWhat “end-to-end” billing actually looks like in practiceHow to reduce admin without hiring more staffWho This Episode Is ForClinic owners working with PMI or private health insurersPractices struggling with aged debt or slow paymentsGrowing clinics adding sites or cliniciansOwners relying on manual or outsourced billing processesAnyone frustrated by insurance admin and cashflow issuesWho This Episode Is For Clinic owners working with PMI or private health insurersPractices struggling with aged debt or slow paymentsGrowing clinics adding sites or cliniciansOwners relying on manual or outsourced billing processesAnyone frustrated by insurance admin and cashflow issuesNot for: Clinics expecting insurers to “just pay eventually”Owners unwilling to review or change broken processesPractices comfortable with high levels of bad debtBusinesses avoiding automation in favour of manual workGuest Details Ben Morfoot Co-Founder, Effra Ben is a former GoCardless product builder and co-founder of Effra, a platform designed to automate end-to-end insurance billing for healthcare clinics. His work focuses on removing manual admin, reducing aged debt, and helping clinics get paid faster through better systems, cleaner data, and smarter workflows. Visit https://hmdg.co.uk for further information. Follow Michael on LinkedIn. https://www.linkedin.com/in/mjschumacher100

    53 min
  4. All Things Planning, Strategy and Coaching with Celia Champion

    16 JAN

    All Things Planning, Strategy and Coaching with Celia Champion

    Overview Choosing a coach should make running your clinic clearer. For many owners, it does the opposite. The industry is full of confident promises, packaged systems, and “proven frameworks” that look good on the surface but rarely fit the reality of running a clinic. When the advice doesn’t land, owners don’t just lose money; they lose confidence in their decisions. In this episode, Michael and Celia explore what good coaching actually looks like, why so many clinic owners end up in the wrong programs, and how to spot the warning signs early. The conversation also moves into planning, understanding your numbers, pricing decisions, and why many clinics are unknowingly running on guesswork rather than clarity. This episode is about asking better questions and choosing support that genuinely helps your clinic move forward. Show Notes Why coaching has become confusing in the clinic spaceHow marketing disguises weak adviceEarly warning signs you’ve chosen the wrong coachWhy most clinic owners don’t know their true profitThe risks of running a clinic based on bank balancePlanning beyond “we’ll see how this year goes”Pricing decisions that quietly cap growthWhy more patients doesn’t always mean more moneyWhat You’ll Learn How to tell if a coach actually understands clinicsWhat to look for before committing time and moneyWhy sector experience matters more than credentialsHow financial clarity changes decision-makingWhere small pricing shifts make a big differenceWho This Episode Is For Clinic owners considering a coach or consultantOwners questioning the advice they’re currently paying forPractices that feel busy but unclearClinicians moving into business ownershipNot for: Anyone expecting a coach to “fix” their business for themPractices unwilling to look at their numbers honestlyOwners chasing shiny systems without foundationsClinics resistant to pricing or strategic changeGuest Details Celia Champion Founder, Painless Practice Celia has worked in the healthcare sector for over 20 years, supporting physiotherapy and MSK clinics with coaching, consulting, and strategic planning. Her work focuses on helping clinic owners build sustainable, profitable businesses through better decision-making, financial clarity, and realistic growth strategies. Visit https://hmdg.co.uk for further information. Follow Michael on LinkedIn. https://www.linkedin.com/in/mjschumacher100

    46 min
  5. The New Clinic Playbook: Pricing, Technology, and Retention

    9 JAN

    The New Clinic Playbook: Pricing, Technology, and Retention

    Overview: Most clinics don’t fail; they stall. They reach a comfortable size, decent revenue, and a full diary, and then everything gets harder. Margins tighten. Staff costs rise. Insurance work drags profitability down. Growth feels risky, but standing still feels worse. In this episode, Michael sits down with Steve Hines, founder of Wandsworth Physio, to unpack what actually changes once a clinic moves beyond survival and into scale. From pricing strategy and tiered services to customer experience, technology investment, AI, and the shift toward polyclinic models, this is a candid look at how advanced clinics think defensively as well as offensively. This isn’t about chasing growth at all costs. It’s about protecting margin, upgrading the offer, and building a clinic that can evolve as the market changes. Show Notes Why most clinics plateau in the middle of the marketThe shift from growth obsession to margin protectionPricing strategy beyond annual price risesTiered services and what they reveal about demandMoving beyond physio + massage into advanced servicesHow technology and AI are actually being used in clinicsWhy customer experience drives retention more than CPDWhen insurance work stops making commercial sensePolyclinics, lifetime patient value, and service expansionStaff development, autonomy, and scaling leadershipWhat You’ll Learn Why “being busy” is not the same as being profitableHow successful clinics think about pricing beyond yearly increasesWhat actually differentiates high-end clinics from the middleHow to upgrade your offer without racing to the bottomWhy customer experience beats clinical excellence aloneHow advanced clinics use technology defensively, not just for growthWhere AI genuinely saves time, and where it doesn’tHow to retain staff without aggressive KPIsWhy polyclinic models are becoming inevitableHow to think about long-term patient lifetime valueWho This Episode Is For Clinic owners stuck at a revenue or growth ceilingFounders running “busy but squeezed” practicesClinic owners considering tiered pricing or advanced servicesOperators thinking about AI, automation, or admin efficiencyAnyone exploring expansion, acquisition, or polyclinic modelsPhysios transitioning from clinician to business ownerNot for: People looking for shortcuts or hacksClinics unwilling to raise standards or pricesAnyone expecting technology to fix a weak offerOwners who want growth without operational changeGuest Details Steve Hines Founder, Wandsworth Physio Steve is a physiotherapist with over 20 years’ experience, including a decade in professional football with Fulham FC. He founded Wandsworth Physio and has grown it into an advanced, multi-service MSK clinic through organic growth, technology investment, and a strong focus on patient experience. His work spans clinical practice and clinic operations, with an increasing focus on expansion and acquisition. Clinic: Wandsworth Physio Location: London, UK Visit https://hmdg.co.uk for further information. Follow Michael on LinkedIn. https://www.linkedin.com/in/mjschumacher100

    45 min
  6. How AI Phone Answering Saves Clinics Time, Money, And Patients

    2 JAN

    How AI Phone Answering Saves Clinics Time, Money, And Patients

    Overview: The phone rings, no one answers, and the patient disappears. That tiny moment is where clinics lose revenue, trust, and momentum and it’s exactly where AI can quietly do the heavy lifting.  We unpack how AI phone reception helps clinics capture bookings after hours and during peak spikes while protecting data, avoiding lock‑in, and freeing staff for high‑value human moments. We also share a vendor‑vetting checklist to spot wrappers, weigh security, and implement AI that works. Show Notes Why missed calls kill conversions and fuel no‑showsHow clinics are really deploying AI today (out-of-hours, overflow, full replacement)Where AI reception fits: after hours, overflow, first‑contact triageReal AI costs, security layers, monitoring and escalationWhy white labelling and wrappers risk data and trustChatbot risks, prompt injection and safer voice workflowsDisclosures, recordings and compliance trade‑offsImplementing change management for teams and patientsHow AI is already changing productivity in professional servicesThe real reason most practice management systems cannot keep upWhat an open API actually is, explained simplyWhy standardising on one “all-in-one” tool is a long-term mistakeWhy AI phone answering is such a crowded marketWhere AI phone answering clearly worksWhere it fails and why forcing it backfiresWhy many clinics say “we tried AI and it didn’t help”The single biggest implementation mistake clinic owners makeHow AI changes front-desk roles in practiceSecurity risks with AI chatbots and why voice is differentWhy funding matters in healthcare AIWhen clinics should not use AI phone answering at allWhat You’ll Learn How to think about AI phone answering as infrastructure, not magicWhy missed calls quietly cost clinics more than most owners realiseHow open APIs protect clinics from vendor lock-inWhy “sounds human” is a terrible way to assess AIHow bad AI implementations lose bookings without anyone noticingWhat actually happens to reception teams after AI is introducedHow to evaluate AI vendors without being technicalWhy cheap AI phone answering should raise immediate red flagsWho This Episode Is For Clinic owners considering AI phone answeringClinic owners who tried AI and were disappointedPractice managers responsible for admin and receptionHealthcare founders evaluating tech stacksAnyone sceptical about AI hype but open to evidenceNot for: People looking for quick wins or gimmicksClinics unwilling to change processesAnyone expecting AI to fix broken operations on its ownGuest Details Tanmay Co-Founder, Lyngo Lyngo is an AI phone answering platform built specifically for healthcare clinics. It handles inbound calls, bookings, patient queries, and escalation while integrating directly with practice management systems via open APIs. Website: https://www.lyngo.ai/ Email: tanmay@lyngo.ai Visit https://hmdg.co.uk for further information. Follow Michael on LinkedIn. https://www.linkedin.com/in/mjschumacher100

    1h 25m
  7. Why the Smart Money in Clinics Is Moving to Pilates

    17/12/2025

    Why the Smart Money in Clinics Is Moving to Pilates

    Overview Pilates is either a nice add-on you never quite monetise, or it becomes the engine room of your clinic. In this episode, Michael speaks with Lowry O’Mahony (Max Physio & Pilates, and Maxona) about how she integrated Pilates so tightly into a multi-site MSK business that it now generates roughly half of revenue, stabilises cashflow, and creates a workforce pipeline when physio hiring gets tight. They get into where Pilates fits in the patient pathway, how to make it recurring without it feeling “salesy”, and why the best lessons often come from entrepreneurs outside MSK, not the usual industry gurus. Lowry also explains why she built Maxona: training, studio fit-outs, equipment, and smart reformers designed to measure progress and keep people engaged. Show Notes Why so many clinics “offer Pilates” but fail to integrate it properlyAustralia vs UK/Ireland: why Pilates is more embedded in private practice therePilates as recurring revenue: why it smooths out the peaks and troughsThe patient pathway: where Pilates fits (day one, mid-rehab, end-stage, or standalone)“Physios hate selling”: how free intro classes remove friction and awkwardnessThe real Pilates customer base: why 50+ and 60+ is the market, not influencersStaffing reality: using Pilates to broaden your workforce beyond the physio bottleneckCulture and systems: KPIs for behaviour, values, and how to protect standards as you scaleExpansion: opening multiple sites off the back of stable demand and better predictabilityMaxona: teacher training, Pilates Academy, maintenance/support, equipment financeSmart reformers and measurement: using objective feedback to drive adherence and outcomesCommunity strategy: macro events and micro cohorts to improve retention and seasonalityWhat You’ll Learn How to position Pilates as a core service line, not a side hustleHow to move people from reactive physio to proactive memberships without hard sellingWhat to prioritise first: space, training consistency, booking tech, and retention mechanicsHow to use blocks, memberships, and community to reduce seasonalityHow to think about staffing when physios are scarce: building a parallel workforceWhy measurement and progress tracking matter for adherence (and revenue stability)Who This Episode is For Clinic owners doing £300k to £2m who want a second engine of growthOwners stuck on physio capacity, utilisation, or staffing constraintsClinics offering Pilates but not making meaningful money from itAnyone considering reformer Pilates and worried about space, cost, or team buy-inOwners who want more predictable revenue before scaling, hiring, or exitingGuest Details Lowry O’Mahony Founder of Max Physio & Pilates (Ireland) and Maxona. Trained as a physiotherapist (RCSI, Dublin) and Pilates instructor early in her careerWorked in the UK and Australia, where Pilates is deeply integrated into private practiceBuilt a multi-site physio and Pilates model with Pilates contributing ~50% of revenueCreated Maxona to help clinics implement Pilates end-to-end: training, equipment, support, and studio successFind Lowry and Maxona Instagram: @lowryphysiopilatesLinkedIn: Visit https://hmdg.co.uk for further information. Follow Michael on LinkedIn. https://www.linkedin.com/in/mjschumacher100

    1h 2m
  8. No One Gets Out Alive! Networking for People Who Hate Networking

    16/12/2025

    No One Gets Out Alive! Networking for People Who Hate Networking

    Most clinic owners think they’re networking. Jonathan Shearer explains why they’re wrong. In this episode of No Appointment Necessary, Michael speaks with Jonathan Shearer, podiatrist and founder of Footsteps Clinic, about what networking actually looks like when it works. Not letters to GPs. Not one-off events. Not vague “being visible”. They unpack why networking fails for most clinics, how trust is built through consistency and inconvenience, and why transactional thinking kills long-term results. Jonathan traces his approach back to selling fruit and veg as a teenager, where presentation, urgency and human connection decided whether stock sold or rotted. The same principles now underpin his referral networks across sports clubs, businesses and communities. If you think networking “doesn’t work”, this episode explains exactly why. Show Notes Jonathan’s background Nearly 30 years in podiatryNHS training, then building a five-chair multidisciplinary clinicHow early retail work shaped his focus on presentation and experienceDefining networking properly Networking as a sphere of influence, not an activityWhy sending letters isn’t networkingVisibility vs trustJonathan’s networking system Why it starts with team culture, not referralsStaff as the front-facing networkWhy owner-only networking becomes a bottleneckHow networking generates revenue Real examples from football, hockey and sports clubsWhy inconvenience builds trust faster than pitchesHow free help led to hires, referrals and new servicesThe “free work” myth When free help worksWhen it backfiresWhy forcing early ROI leads to bad decisionsEducation as a lever Small talks that produced the biggest clientsWhy audience size doesn’t matterEffort and follow-up over formatMaintaining relationships Networking as “watering a plant”Why neglect kills resultsHow Jonathan cuts parasitic relationshipsTeam-led networking Staff attending events and visiting businessesWhy this needs PAYE or hybrid modelsWhy associate-only models struggleTracking what works Offers and vouchers for offline attributionWhy “vibes” aren’t metricsMeasurement still mattersCities vs towns Why networking works anywhere if executed properlyCities as opportunity-rich environmentsAffinity beats geographyMindset Networking isn’t about being extrovertedFear of rejection is the real blockerStart small, repeat, build confidenceThe 90-day reset What Jonathan would do in the first 90 daysVisibility, relationships, talks and clubsWhy something has to giveThey finish on collaboration, why isolation fuels bad advice, and why real networking is about being known, trusted and useful over time. What You’ll Learn Why most clinic owners misunderstand networkingTransactional vs transformational relationshipsHow trust is built through inconvenienceWhen free help works and when it doesn’tHow to turn teams into networking assetsHow to measure offline networking properlyWhy networking works in cities and townsWhatVisit https://hmdg.co.uk for further information. Follow Michael on LinkedIn. https://www.linkedin.com/in/mjschumacher100

    1h 1m

About

This is the podcast clinic owners listen to when they’re done with gurus, funnels, blueprints, and templates pretending to be strategy. No hacks. No 'proven' 10X systems. This comes from HMDG. We have worked with more than 1,000 MSK clinics. We see the accounts, the utilisation rates, the failed ideas, the profitable ideas, and the reality behind the noise. We do not deal in theory. We deal in numbers. Most of the industry advice collapses the moment it hits real-world finances. You get the truth about how clinics actually grow. Why some print money while others burn out. What patient numbers mean once you stop pretending templates can fix capacity problems or that “mindset” builds a business. The idea that a clinic becomes successful because someone journalled harder is fantasy. We talk to people who have actually achieved something. Multi-site owners. True specialists. People with real P&Ls, not testimonial slides about a “life-changing £30k month”. We break down marketing, pricing, staffing, finance, AI, and operations without pretending there is a magic blueprint that saves everyone. There isn’t. The only thing that works is understanding the fundamentals and executing them properly. If you want comforting stories, find a guru. If you want the unfiltered reality of running a clinic, you’re in the right place.