Lately, I’ve been pondering professional networks. With the advent of Facebook, Twitter and the like, I believe we actively manage our social networks better than our professional networks.

As a young physical therapist, I decided to move back to my hometown. I was very passionate about what I had to offer—both as a rehabilitation specialist and a strength and conditioning specialist. I wanted to be a community resource.

If you’d prefer to listen instead of read,
here’s an audio version of this article,
Episode 54 of Gray Cook Radio


I could have easily joined a network-marketing group that met every Thursday morning at a local restaurant. I could have taken that opportunity to encourage people to refer their clients and patients to me for either conditioning or rehabilitation. I just didn’t like the confines of those networks. The busiest people in my town didn’t have time on Thursday mornings to go to a network-marketing group—they were too busy servicing the needs of the people who were already coming to them.

That left me asking myself the uneasy questions: ‘who was actually at those meetings and did I want to be their equivalent for my profession?’

I decided on a different approach. My staff and I began covering local football games. In the rural area where we resided, we did not have certified athletic trainers on the sidelines. We had EMT’s and paramedics in the end zone to deal with the high-end trauma and transport, but we wanted to be there to manage the orthopedic and sports medicine issues. We wanted to keep the emergency response team ready for when they were truly needed.


We also tried to encourage our local sports coaches: “Don’t just call us in-season to deal with injuries. Let us interact with you pre-season to try to manage some of those. Let’s live the ‘ounce-of-prevention’ strategy and not just quote it.” We would speak to local runners’ groups or at tennis camps. We would accept any opportunity to be an educational resource.

We gave away a lot of time and service to try to distinguish ourselves as a professional group that could help the community.

We started talking to the podiatrists in town: “Can we help you manage your foot and ankle patients? We’ll look above the foot and ankle and deal with the issues that your specialty doesn’t have time to deal with. You’ve got plenty of patients with foot and ankle problems. What can we do to help?”

Here comes the important part. If you’ve only read that I was trying to educate the professionals in my community about how I could help them with their clients and patients, that’s not the whole story. From every person who I tried to be a referral for, I also asked for help.

I always sought out good nutritional counseling in my community. That may require two different people because the needs of a competitive body builder are different than those of someone with diabetes.

It is imperative that physical therapists know when to refer out to a surgeon. If we’ve mapped out some problems that obviously need a surgical consult, we need to act on that quickly—not after four weeks of rehabilitation doesn’t work. We should know the signs, symptoms and structural issues that probably need to be vetted by greater investigation through surgical consult or MRI.


I received cases from my professional network and I referred cases to my professional network. When I sent people, I didn’t just blindly refer them. I informed the provider, “This is what we’ve done and this is why I think you are the right person.”

There’s some vulnerability when we send a client or a patient to someone else. We have to know that there will be consistency in treatment and management. I think a lot of people are scared to make a referral—they’re scared that they will get blindsided.

Personal trainers have been scared to make a referral to me because they believe that they’ll lose the client or that I’ll tell the client not to train at all. That’s far from reality. These clients value fitness so much that they’re probably trying to cover a medical problem by staying fit. I wanted to help them with that problem, so we let the personal trainers and performance coaches in our community go through a movement screen and see the benefits. We let them attend the evaluations of the clients they referred to us.

We helped them deal with some of their physical issues and they in turn had a story that they could tell another client. “This is not just a mundane physical therapy referral. These guys know what they’re talking about. These guys know what they’re doing.”

For every person that you try to get to refer to you, also find a specialist or an expert to whom you can refer out. Got a cyclist? You should know somebody who can fit a bicycle. Like kettlebells, but you’re not certified? Find somebody who is. Think yoga is the right thing for this person as they become independent and free of low back pain? Find an instructor.


If you want to increase your professional network, by outsourcing problems so they can get managed by a specialist and by pulling stuff back in when it is your turn to be that specialist, it’s extremely important that you don’t just follow a recipe of network-marketing.

Know how to treat people when they come to you. Make their experience with you good and they will talk about it. When you’re not the expert, just make sure that the expert is in your contacts and you will still get the credit.

That’s right, when you make a referral, you share the credit of that good decision. Most of my professional network are people who I would trust with my family. Do I get a secondary gain for making that referral? In most cases, I don’t.

The ‘good’ people don’t need a kickback system. They’re busy enough. If many of your referrals are generated on the basis of a financial decision, you may want to reconsider how you work. It happens frequently in medicine—a referral is made and it’s somehow profitable or it locks somebody into the system. This is evident when medical professionals send friends and family to one place and everyone else to another.

Some of these same people are angered when you mention a second opinion of their assessment. I’m not scared, intimidated or insulted when somebody tells me, “Gray, I appreciate what you said. I’m going to get a second opinion.”

Here’s how I view that statement: either they’re getting ready to learn something or I’m getting ready to learn something. Learning is good. I missed something or I didn’t miss anything and they’re going to see that the integrity and authenticity of my examination was superior to the convenient diagnosis that someone else gave them.

If they go to someone else and they find something I missed, I don’t need to defend that miss. I need to own it and say, “I am so glad you got a second opinion because we haven’t been looking in that direction for your problem.”

That level of honesty makes you better. If we all managed our professional networks like people manage their social networks, we would all be so busy that we’d never have time for that Thursday morning network-marketing group.

“What’s Behind a Mobility Problem” is my new talk at It’s a good look into how my mind and our systems think about the causes and remedies of mobility problems.



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