Dr Dimitrios Kostopoulos: “Be profitable from day one”

Be profitable from day one. In other words, when you start the business and you start having your initial revenue, if you get a hundred dollars, take ten dollars out and pretend that you only made $90. And figure out how you’re going to pay your expenses with $90, or increase your level of necessity […]

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Be profitable from day one. In other words, when you start the business and you start having your initial revenue, if you get a hundred dollars, take ten dollars out and pretend that you only made $90. And figure out how you’re going to pay your expenses with $90, or increase your level of necessity to make $110, so you can be able to pay your expenses with $100. And I learned that the hard way by the way. Made a lot of mistakes in that area.

Startups have such a glamorous reputation. Companies like Facebook, Instagram, Youtube, Uber, and Airbnb once started as scrappy startups with huge dreams and huge obstacles.

Yet we of course know that most startups don’t end up as success stories. What does a founder or a founding team need to know to create a highly successful startup?

In this series, called “Five Things You Need To Create A Highly Successful Startup” we are talking to experienced and successful founders and business leaders who can share stories from their experience about what it takes to create a highly successful startup.

I had the pleasure of interviewing Dr. Dimitrios Kostopoulos.

Dr. Dimitrios Kostopoulos has more than 30 years of clinical experience and over 20 years of experience in electrophysiology testing. He is board certified in clinical electrophysiology. He is a leading, world-renowned expert in myofascial pain. Dr. Kostopoulos is the co-founder of the family of Hands-On Companies, including Hands-On EMG Testing, Hands-On Physical Therapy, Hands-On Diagnostics, and Hands-On Seminars.

Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?

I have been a physical therapist since 1987 and a physical therapist in private practice since 1992. Through the years as a private practice owner and an entrepreneur, I expanded together with my business partner, our business from a single physical therapist facility to 13 physical therapy facilities, becoming the second largest private practice physical therapy owned organization in New York City.

But it was in 2014 that I created Hands-On Diagnostic Franchising. It was a reaction to a phenomenon that occurred between the years 2002 and 2004, which was the significant decrease in reimbursement in the physical therapy space. My goal became to create a model that can bring not only effectiveness but greater efficiency in operations to physical therapy offices, so that they can not only to survive but thrive as an organization.

Originally, before 2014, I was focusing on applying this structure to my own practice, this addition of diagnostic tests. But as my partner and I looked at the marketplace, we realized that the vast majority of private practices, 97% of them around the country, had no idea that they can perform these tests and get paid for these tests. It was this realization that led to the creation of the franchise business. We created Hands-On Diagnostics to service a specific need that existed in the physical therapy space, both from a business perspective as well as from a clinical perspective.

What was the “Aha Moment” that led to the idea for your current company? Can you share that story with us?

The vast majority of physicians or physical therapists or many other healthcare providers, they go to school to learn the specific area of healthcare that they want to practice. So the training that is being provided is more of a clinical training. But there is little to nothing taught in the area of business and operations, of marketing or finance or anything like that.

And it was from the very beginning of my involvement in the healthcare industry that I had the desire to expand my influence to the world of physical therapy especially and help other physical therapists provide to their patients the type of benefits that we were able to provide to our patients. That led to a natural expansion and involvement into the area of business. Because for me to be able to help other physical therapists understand and learn how they can help more effectively their patients, I had to view this as a business. I had to market to them, I had to manage the relationships with them, I had to receive compensation for teaching them how to do this.

Was there somebody in your life who inspired or helped you to start your journey with your business? Can you share a story with us?

My parents and relatives, they were always involved in developing their own business and running their own businesses and dealing with the headaches of running their own business. But, quite frankly, when I chose the path of expanding our physical therapy and medical business, I did not have somebody in particular where I would ask questions and get guidance. I wish I did. My business partner, Dr. Rizopoulos and I, we walked that path trying to draw from resources and learning as much as possible from books, seminars, courses that we did to educate ourselves.

So, I would say there was a lot of self-learning that took place and learning by making mistakes and also by observing what works and what doesn’t work. And then trying to do the thing that works.

What do you think makes your company stand out? Can you share a story?

There are many clinical stories that I can share that would describe how these private practice owners and physical therapists engage with Hands-On Diagnostics and are now able to really provide amazing services and make a difference in the lives of their patients.

A specific story I like to share is of one or our franchisees, Joe and Angie. Joe and Angie had a very successful physical therapy practice in Fort Myers, Florida, when hurricane Irma hit. The hurricane literally obliterated their entire practice. The roof was completely gone, their equipment was destroyed, their practice was destroyed. And they were, for a long period of time, without having the ability to see patients and service their community.

That was a time instead of them succumbing to the situation and becoming the effect of the situation, they started thinking of how they can be a cause of their environment, how they can be the ones that will determine their future. And they decided that the best way to predict your future is to create it. That’s when they reached out to Hands-On Diagnostics, they wanted to rebuild what they once were and more. They wanted to access a system that would help them rebuild fast and exceed even faster what they had before. Hands-On Diagnostics helped do just that.

And their decision turned into one of the best decisions they could have ever made. Not only did they recover their clients very fast, but because now the practice had the ability to offer services that other physical therapy practices around them they were not able to offer, they got an enormous influx of new patients and revenue, too.

It was this marvelous moment, obviously for them, but for me and Hands-On Diagnostics, too. It was a clear sign that the company, Hands-On Diagnostics, was doing exactly what it set out to do: helping physical therapists not just survive, but truly thrive in their area.

How have you used your success to bring goodness to the world?

Oh, absolutely. So, let’s think about this for a moment. I think a good example, a place to start, is the opioid crisis. It’s one of the biggest problems we have in society. What happened was that years ago, the pharmaceutical industry promised to the medical industry that opioid medications would be able to handle the patients’ pain problems without causing addiction. And this ended up being the “big lie” of the pharmaceutical industry, and now we have tens of thousands, if not hundreds of thousands, of people around the United States and around the world who are addicted to opioid medications.

But here is how physical therapy plays a role. If you have someone in pain and we want to help that person, to solve their pain problem without using opioids, we seek to do that by treating the root of their problem directly. And the addition of diagnostics into this field has upped the effectiveness of this kind of treatment exponentially. There are studies that show that 62% of the time the patient management changes with a diagnostics assessment. That the initial diagnosis, without the use of the diagnostic tools, may miss the mark. And the outcomes for the patients are far better when we work to find the patient’s root problem.

So, if a patient goes to a doctor and the doctor does not identify the root of the problem, then the treatment will not be effective to resolve the patient’s problem and eventually the patient will have to rely to opioids as a solution. But with the use of diagnostic testing, the physical therapist can identify directly the patient’s problem and can find more effective solutions resolving the patient’s pain problem without the use of opioids. This can save the lives hundreds of thousands of people from potential addiction to opioids. And this is something that I am proud of, for any contribution I have made in that area.

You are a successful business leader. Which three character traits do you think were most instrumental to your success? Can you please share a story or example for each?

Being persistent is one of them. Not giving up even when having some failures. Getting up, dusting off, and trying again. That goes with the belief that the only time you fail is when you stop trying.

Another would be to listen to others. To listen and to observe. Observing is not an easy thing to do. Life is filled with different inputs: the media, for example or other people who provide opinions rather than facts. These things become filters through which we observe life, filters through which we observe situations in life. So observing, really, true observing, has to do with removing any of these filters and be able to look at things the way they are. And having the courage to see something just the way it is, rather than the distorted way that many others may try to present to you.

And finally, fostering relationships. Fostering relationships is also very important because the road to success is a road that it has challenges, difficulties, failures, wins. You want to have people next to you so that they can help you and support you during the difficult times, but also these people for you to be able to share with them your wins. Humans are social beings, they don’t like to live in isolation. At the same time, people sometimes have difficulty confronting other people, communicating with other people. It’s important for someone to create relationships so they can be able to have support systems around them.

Often leaders are asked to share the best advice they received. But let’s reverse the question. Can you share a story about advice you’ve received that you now wish you never followed?

That’s interesting. You see, here’s the thing. I understand the question, I understand about advice. I think I will answer the same way the question of “What is the best advice somebody gave you and you followed” or “What is the worst advice somebody gave you and you followed.” And I don’t think I have a good answer to either of these questions. The reason I say that is because I’m the kind of person who takes responsibility for his decisions, whatever those decisions are– good and bad decisions.

Advice is information out there. I mean, if I say, “darn I followed someone’s advice and that was bad advice,” what I’m really doing is taking away responsibility from me and putting it on that person who gave it to me. I don’t like that. I have decided that in my life, I am the cause of everything and anything I create. The moment I make that decision in my life, I’m taking total and full responsibility for anything I do. So, it’s my responsibility to take a piece of advice and evaluate it and decide. The moment I evaluate it, it is my own and I own it.

Can you tell us a story about the hard times that you faced when you first started your journey?

When I started, I was so excited and so determined that no matter what was thrown in front of me, I would plow through it and move forward.

That said, a difficult time business-wise for me was around Thanksgiving of 2002. That’s when I received the letter that changed everything. That was the very first letter I received from one of the major insurance carriers in New York state stating that they were reducing the reimbursement to physical therapy from $140 a visit, down to $55 a visit.

That was a huge decrease and it was a take-it-or-leave-it option, and it affected my business tremendously. And that was a very difficult time. We had to identify ways to change the entire operations of the business, a business of over 150 employees and a quarter-million dollars payroll every two weeks, in a period of 60 days. It was a level of pressure I had never experienced before.

Where did you get the drive to continue even though things were so hard? What strategies or techniques did you use to help overcome those challenges?

It has to do with purpose. If you are thinking all the time about the minutia of the things you do every day, the micromanagement of things, then you are seeing just the “pen” or the “phone” or the “little calendar here.”

But if you just step out of that for a moment and you look at things from a distance, and you start looking, “okay what is the purpose of that thing that I have created,” then you step away from the problem and you look at the purpose. Once you look at the purpose that you have about your creation, about the business you have established, the organization you have established, what was the initial purpose? And you rekindle that purpose and the failure you’ve had, the challenge you’ve had goes away.

The journey of an entrepreneur is never easy, and is filled with challenges, failures, setbacks, as well as joys, thrills and celebrations. Can you share a few ideas or stories from your experience about how to successfully ride the emotional highs & lows of being a founder”?

If I remember correctly, Walt Disney went to 60-something financial institutions to ask for financial backing to create Disneyland. He was rejected from every single one until the last. So, after 65 or 66 times, the 67th institution lent him the money and he created Disneyland.

It’s about not giving up. When you are in the situation and you are dealing with it, you feel that dealing with it, is hard or sometimes impossible. But, like I said earlier, you have to think about purpose. What is the purpose that you started all this, what is the purpose that you went into business? What are you trying to create, what is your motivation for creating that business? Once you start thinking about that, then you can deal with problems much more easily.

I like to think of life as a game. A game has purposes, it has barriers, it has problems and wins. Without having problems or barriers it’s not really a game at all. So when there’s a problem in front of you, you are overcoming that problem, and that’s a win.

Let’s imagine that a young founder comes to you and asks your advice about whether venture capital or bootstrapping is best for them? What would you advise them? Can you kindly share a few things a founder should look at to determine if fundraising or bootstrapping is the right choice?

I would say that both of these things have value. It depends on one’s level of responsibility, of handling money.

If someone feels that they do not have much experience or knowledge about handling money that comes to you, then I believe slowly developing the business using whatever funds you have is the way to go.

But if someone does have the knowledge about using funds, then they can grow much faster having capital, significant capital. But, again, it’s very dependent on one’s personal and honest understanding of his or her financial abilities.

Ok super. Here is the main question of our interview. Many startups are not successful, and some are very successful. From your experience or perspective, what are the main factors that distinguish successful startups from unsuccessful ones? What are your “Five Things You Need To Create A Highly Successful Startup”? If you can, please share a story or an example for each.

Number one would be to seek knowledge about the various areas of the business they want to open. Get knowledge. How do I create a business and what am I selling? Who is my audience? Who are my customers?

The second thing would be that it’s important to learn about the fundamental functions of an organization. There has got to be a sequence of things. You start with the business, you hire someone or have a person that can provide the service, you collect the money, you provide the service. So, knowing about the organizational structure is very important.

The third thing is the finance area. Be profitable from day one. In other words, when you start the business and you start having your initial revenue, if you get a hundred dollars, take ten dollars out and pretend that you only made $90. And figure out how you’re going to pay your expenses with $90, or increase your level of necessity to make $110, so you can be able to pay your expenses with $100. And I learned that the hard way by the way. Made a lot of mistakes in that area.

Number four, become a communication terminal. Be open to receive and give communication, you should be a conduit of communication. Have your business cards always with you, talk to people, give business cards. Even if it’s not relevant to what you want.

Finally, it would be to push away distractions. When you have a goal for your business, try to maintain a path and try to maintain those activities. Try to maintain those people next to you that help you reach that goal. Anything else would be a distraction. If you want to go from point A to point B, anything that pushes you away from getting to B is a distraction.

What are the most common mistakes you have seen CEOs & founders make when they start a business? What can be done to avoid those errors?

Yeah, I would say one of the things is choosing associates not based on merit but based on pure emotion. It can become a problem when you choose associates and employees based on emotion or looks of the person or other things other than merit, other than skill. That is something that is important. Another mistake is people getting involved in business without doing all the due diligence and keeping all the legal rudiments in. If you don’t keep all the legal stuff in, that can come and hurt you in the future.

Startup founders often work extremely long hours and it’s easy to burn the candle at both ends. What would you recommend to founders about how to best take care of their physical and mental wellness when starting a company?

I still don’t believe that someone who is a real entrepreneur can disengage themselves completely from their business and from what they’re doing and function with the mentality of “I am the owner only between the hours of 9 to 5.”

The real entrepreneur has that thing inside their DNA, it’s part of their structure. You’re always the business owner. But, making time to do other things is a very important thing in life, too. If you are just doing 24/7 that one thing, then you become a bit monolithic and you don’t have diversity in your life. Making the time, creating the time, doing other important things in life– family, children, education, arts, hobbies, travelling, being with other people. These are extremely important things in life.

People say “time is the most valuable thing,” but if I tell you that time is just a consideration, then you can manipulate it. Time is pliable. You can change it, you can stretch it, you can make it more, you can make it less. So, you can create time.

You are a person of great influence. If you could start a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂

The answer to this is not very far from what we already have chatted about, which is education. I would create a system, an organization, something where every being on the planet would have the opportunity to receive as much education as they want.

Education is paramount.

Society asks people to take responsibility all of the time — about guns, about health, about money, about many things. It asks people to take responsibility, but a person cannot take responsibility without knowledge. That would be out of sequence. You first need to know about something, you first need the knowledge and the education so that you can take responsibility for something.

And, of course, when you take responsibility for that thing then you can control it. You can make better, you can improve it, you can change it, you can start it, change it, stop it. But you need first to start with education.

We are blessed that some very prominent names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch, and why? He or she might just see this if we tag them.

Tony Robbins. That would be amazing.

How can our readers further follow your work online?


This was very inspiring. Thank you so much for the time you spent with this. We wish you continued success and good health!

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