All right, so yeah, welcome to the show.
We have Megan Donaldson and Jake Magel.
I am really excited about
this session today.
I think it's a topic that is
going to be of interest to
a lot of our PT colleagues,
and I couldn't imagine two
better people to really go
through this presentation
this information with us
today and so again welcome
Megan welcome Jake to the
podcast here Megan you're
not a stranger to this
podcast actually
interesting because you're
a you're actually a host
and now I'm hosting a host
so this seems a little bit
awkward and weird but uh
I'll see if I can do my job
the way that I'm supposed
to do my job but um
certainly happy to have you on
And Jake,
I know that you've probably been on many,
many podcasts,
maybe not as exciting as this one,
but I'm sure that you've
been on many podcasts,
so you know exactly what to expect,
I suppose, here as well.
Not as exciting, that's right.
That's right.
All right.
So, you know,
I wanted to get into a little
bit of this conversation
specifically around the
report that was recently published.
And, you know,
I think it's probably worth
noting that many of us
probably have no idea what
this report is.
And I guess the first
question that I have right
off the top here is, and Megan,
maybe this is the question
best addressed to you.
What
What is this report?
What is it all about?
I mean,
I know that I haven't I wouldn't
have seen this report, especially without,
you know,
your bringing it to some of our
attention and such.
But so if you can give a
little bit of background to our listeners,
that would be fantastic.
Yeah.
So
oftentimes what you find is
this is a report that falls
under like market research,
which aims to inform market decisions,
funding, even healthcare policy.
I mean, this can have some broad reaches.
So the fact that this came out, you know,
I would say probably early
summer and a lot of people
didn't hear about it or
talk about it because they
were just kind of, you know,
it was kind of more hearsay.
Many of us are in the
funding areas of virtual MSKs,
which we'll talk about the
digital health technologies.
But there is actually a
group called the Peterson
Health Technology Institute,
which evaluates these
digital health technologies
and the commercial interest
and funding interest behind them.
So that's really what started this project,
which is it's a market research project.
They want to know,
is there resources here
that people should invest in?
And what could those
investments look like?
Could it save money?
Is there an economic value?
Is there an access value?
and then how can that shape
healthcare going forward so
it could impact policy and
that's where some of these
groups have been out there
for a while doing this in
various pieces but this
one's specific to us in
virtual msk no that's great
to hear and I think any
time that we start talking
about ai and virtual health
things that probably matter
to us a lot as physical therapists.
Most of us are probably, well,
all of us are native more
to the setting where we are
actually working in the
environment with the patient.
I would imagine that some of it is,
it's obviously exciting.
I think we're on a new
frontier and there's things
that we can look forward to,
especially as we progress and such.
But I guess another question
that I have for you is why is this
report really essential for
us to talk about today
especially as I just
mentioned manual therapists
obviously a lot of our
listeners are probably
manual therapy listeners
and if they're manual
therapy listeners they're
orthopedic pts who you know
we put our hands on
patients and we do these
sorts of things so why is
this so important for us to discuss today
Yeah,
so the report is super interesting to
read.
So I'll state that first,
which you should read the report.
I think it gives you insight
into the way people
perceive our profession.
And I'll be candid.
I think some of this starts
in the research.
I think some of it is what is PT?
What is typical PT?
And what we see is that
people believe that
exercise can be done more efficiently.
And so they started to look
at these MSK reports.
And some of this was, I would say,
couched as an access piece.
If you read the report,
there's some limitations of
our profession, right?
They did identify that there would be some
workforce demands around
seventeen percent in deficit,
like that we definitely
needed to have more PTs in the workforce.
And then the other areas of
that is actually in the
rural health areas is some
of that access and
workforce needs are much greater.
And so they kind of couched
it as an access workforce support.
for virtual MSK.
Again,
knowing that PT sometimes takes a
little bit of time to get into.
So having this as a easier
access point was one of the
pitches as why these may be
viable solutions for healthcare support.
So I think you have to
appreciate that was some of their gap.
That's what they see that these tools,
the virtual health tools,
would support and they
identify it as being like
for patients who have
mobility limitations,
work commitment limitations,
or geographical barriers
such as living in rural
areas with low access to
getting to in-person PT
sessions each week.
I think that's what we have
to understand the context to that.
But when we actually
appreciate that virtual technology,
so Derek, when you say like AI,
AI may be different than
these virtual technologies and I think
We don't even talk about AI
generated per se in this.
I mean,
there's going to be specific things
that we say that are
included in this study.
But there's a big reach that's happening.
And I think we have to
really inform ourselves.
What is this?
How does this have impact to
our practitioners on the daily?
And some of it is
understanding how our profession is seen.
What's the value of PT and
what is it they need to
come to a provider for
versus what can they get
through this interaction,
which has maybe little or
no human interaction at all?
with a PT.
So I think this is a key piece.
It's also an advocacy piece.
This report actually so
interestingly kind of puts
into question the value of PT campaign.
I would actually say the
economic value of PT.
We show in the APTA's document,
which I so value that piece too,
is that we are a value,
economic value for a lot of
MSK conditions.
That includes low back pain,
carpal tunnel, knee osteoarthritis,
lateral epicondylase.
I think they called it
lateral epicondylitis in the studies,
but that we actually have
value in those areas and
that we are a low cost option.
And so interestingly to me
is that in this virtual health report,
They did look at knee,
they looked at low back and
still trying to make it
more economically feasible.
So again, just kind of looking at,
we are already a low cost option.
So making us even more low cost,
I would question some of the gain there.
And then just the other
parts of that is that we
have to appreciate what you
had said before,
which is virtual health may be PT,
but it may be coaches not trained as PTs.
It may be AI.
And I just think we have to
appreciate that we're not
seeing this virtual MSK
happening on other professions,
like chiropractic,
where there's more hands-on focus.
So I just think we also have
to advocate that, like,
PTs do more than just exercise, right?
And I think we have to learn
to advocate for that as well.
Yeah, I appreciate that.
And actually, I glanced at the report too,
just full disclosure.
And so definitely there's a
discussion around that, obviously,
around the...
physical therapists or
clinicians or whatever it
might be that could be
providing some of these services.
So I think that last piece
that you brought up there
and the value of what we do
and what we distinguish
ourselves as is certainly
an important piece of this
equation as it looks there.
It's interesting too that you bring up,
obviously if you look at
the report and you sort of
brief over the report,
it could be viewed as
something that seems relatively positive,
right?
I mean, obviously we get a lot of our
information and some of us
actually probably use app
technology to help us with
various aspects that we
have in our life but
understanding our role and
our importance I think is
really key there so I
appreciate that answer there
So Jake,
you're going to get on the
question board here pretty soon,
but Megan, I've got another one for you.
So could you kind of, you know,
we've been talking about
this report and I think a
lot of our listeners are probably like,
wait, wait,
tell me a little bit more
about this report.
What are you talking about
with this report?
So
A little bit of the cart in
front of the horse there, Sam.
But tell us,
give us an overview of this report.
And if you can,
can you outline some of
those options that they
highlighted in this report
for treatments and such?
Yeah, that's a great question.
So what I would first say is
that you have to appreciate
they kind of categorized
the types of digital health
technologies that they
wanted to focus on.
So the technologies that
they put three different categories,
so PT guided solutions,
app-based exercise solutions,
and then remote monitoring.
And so
Each one has, I would say,
different levels of PT interaction.
And so, again, when you read that,
I think that's a really
important piece because
they do some direct comparisons.
And maybe even I would say
this will dive into some of
Jake's conversation pieces, but about,
you know,
what the findings actually mean
from a clinical practice perspective.
But PT-guided solutions may
have moderate level
involvement from a PT.
So again, definitely they are, I would say,
a little bit more simulated
or similar to in-person PT.
And so they did a lot of
comparisons to in-person PT
with these PT-guided solutions.
The app-based therapy
solutions used some app monitoring,
some ACT
some activity engagement,
such as adherence tracking.
But typically the PT set up
the treatment plan.
But then after that,
it was like a little bit more hands off.
So again,
I think you can appreciate that
the app base may not have
as much interaction.
It would typically set them
up and then kind of go to minimal to no.
interaction at all.
And then remote monitoring
were actually
supplementations used in
addition to in-person PT.
And this one is what would
they use is billing codes, is RTM,
so remote therapeutic monitoring.
So that would be in addition
to in-person PT,
this would be the augmented piece.
This would be some
additional things that they were doing.
So those are the three
categories that this report
generated around those types.
Um,
they did talk a little bit about rural
health as being one of the aims,
but really their studies
didn't focus on rural health access.
So remember those who live
in rural health may not
actually have great wifi.
And so some of these
technologies and barriers
and challenges weren't
really detailed out.
So I think we have to
appreciate that report piece.
But then the last thing I
feel like you want to know
just before we get into the
studies more is that they
prioritize some assessment pieces,
which if you think about it,
there were two pieces that
they looked at.
They looked at in-person PT
and usual care.
And so heterogeneity is
pretty large when you think
about in-person PT and all
of these conditions and diagnoses.
But really with that,
it didn't prioritize it.
It had to be hands-on.
It didn't prioritize what
those interventions specifically were.
And again,
I think we have to appreciate
in-person PT,
a lot of range of interventions.
The usual care is actually
what we would see in some
other studies is, again,
where it's not PT,
that actually usual care is medications,
which is over the counter,
application of ice.
They may actually get some education,
but most of it was like PT
visits or no care at all.
So, again,
each individual study kind of
reset their own standard.
And this study that was
included in the virtual
health kind of categorized those.
are those in-person PT
interventions or are those
usual care interventions?
And that's kind of how they
dichotomize them,
but a ton of heterogeneity
within each of those studies.
So again,
just to kind of give you a high
level overview of the way
it was organized.
Yeah.
So basically comparing
something highly variable
to something that's highly variable.
We know where that can go, right?
And so, all right.
Good to hear.
Jake, you've been quiet here now.
We've got to get you,
I feel like you're ready to
roll into this as well too.
But I wanted to get,
obviously as a background
and research and
NIH funding and somebody who
has contributed a lot to our profession.
I remember you've been on a
lot of studies that
actually probably do compare usual care,
PT,
those kinds of things in the infancy
of when we were looking at
those kinds of questions,
specifically with hands-on care.
So I think having you on
here as a guest is really,
really key and important.
I think it really validates
some of this conversation
that we're going to have here.
So appreciate you being on here.
So we're going to go in a
little bit into this
because this is sort of a yes, it is a
sort of a marketing kind of a thing,
but it's also set up to
look like it was a research being done.
And so I think it needs to
have some of that criticism there.
So I wanted to ask you,
why is it important to then
critique this document?
And especially that it's not
a peer reviewed paper and
it's not necessarily maybe
intended to be a peer reviewed paper,
but I think it warrants that critique.
So why is that important?
Yeah, great question, Derek.
Thanks.
And I think it's important
just to retouch on the fact that, yes,
this is really a report to
industry and investors.
And as a part of this report,
kind of the foundation of
it was a systematic review.
And a systematic review is
used to synthesize data and
to help us understand a lot
about a particular topic.
And in this case,
it was virtual musculoskeletal solutions.
And when you do a systematic review,
you register the review
with an organization and
which basically you
basically tell an
organization what it is
that you're going to do in
the systematic review so
that people can come back
and then and then check
your work and make sure
that you did what you said
you were going to do in the
systematic review.
So they actually did that.
But then, as you mentioned,
it didn't the the actual
systematic review itself
and anything else in the
report did not go through a
normal peer review process,
which would typically be
which would be common and
which would be standard
practice if the report were
to be published in the in
the scientific journal.
And so it really subverted
might not be the right.
term to use,
but the fact that it did not
go through a peer review
process basically allows
whoever's writing the
report to frame the
findings in whichever way
that they feel like they
want to frame them.
And so some of the things
that to me that were a bit concerning,
well,
let me just first say that the
report included both
randomized trials and
observational studies.
And the great majority of
the studies in the
systematic review were
observational studies.
It's important to know that
kind of the gold standard
for determining
effectiveness of an
intervention is a randomized trial.
And observational studies
are subject to lots of
different types of bias
that typically are not
present or present in
lesser amounts in randomized trials.
And so it's just important
to realize that when we're
talking about making
recommendations about the
effectiveness of an intervention,
when we have the great
majority of studies in a
systematic review are
studies that are really subject to bias,
then that should just give
the reader some concern.
And I think that in the report, they did,
report the level of bias and
they evaluated bias using
standardized methods of evaluating bias,
both for systematic reviews
and for observational studies.
And they found that about
seventy five percent of the
studies that were reported
in the systematic review
had high levels of bias,
were rated as having high levels of bias.
And so
When you put that together
with their strong
recommendations for
immediate adoptions of
these musculoskeletal solutions,
I think it should just give
us pause to make that leap
to immediate adoption of
these solutions in the
presence of high levels of bias.
And I'm not sure that a peer
reviewed manuscript of the
same systematic review
would allow such a strong recommendation.
And so to me,
I think that that's important
to point out here.
I appreciate that.
As somebody that just
published a systematic
review and has had some
history with publishing
systematic reviews, yeah,
I think one of the things
that we're looking for, and maybe,
you know, twenty years ago,
we could just say, OK,
the studies were bad,
but here's the results and
take with it what you may.
But we're a little bit more
of an advancing research profession now.
And I've noticed that even
when I've tried to, you know,
get published systematic reviews,
appropriately so, where we actually half
to factor that bias into our
recommendations,
just not basically saying
these studies were terrible
and then here's our recommendations.
And that would definitely go
through that peer review process.
And so appreciate that lens
on looking at that,
because I think a lot of
times people don't
understand how that can
sometimes impact the
results and the research
and those sorts of things.
And the peer review process
certainly takes away some
of that layering there.
So, yeah, that's great.
Well,
if I could also point out something
else is that there's
something called the grade,
which is a way of basically
assessing risk of bias or, you know,
I have to cut this out for
a second because I want to
figure out how I want to say this.
It's not really, let's see.
It's more determining the
evaluation of the, yeah,
it's used to be applicable.
It's a quality rating,
an overall quality rating.
Yeah.
But it's an evaluation piece.
So you step back and do that.
Yeah.
Okay.
Ready?
I'd also like to point out
that it's recommended that
systematic reviews and
other types of publications
like guidelines use an
overall evaluation for
evaluating the quality of the evidence.
And that is called,
one thing that's recommended,
one version of this is called the grade.
And grade is a quality
rating that can be applied
to the evidence essentially.
And really what it does is
the researchers then use
this grade to say that
their level of certainty
regarding the findings of
the studies is very high or very low.
Although this is recommended
for systematic reviews to use the grade,
it wasn't in this case.
And so again,
I think that we just need to
be aware of these,
what I feel like are
shortcomings in the conduct
of the systematic review.
Yeah, no, great.
Probably brought that up there.
So you've kind of mentioned
this a little bit,
but can you tell us a
little bit about the
studies and why the
listeners may need to read
the report cautiously?
You've mentioned a little bit of that,
but maybe you can expand on
that a little bit too.
Okay, pause for a second.
I'm not sure what I want to
say here because I think that...
I don't know.
I mean, how should we frame this?
Because I think that the, the main,
the main issues there are
the fact that it's
observational studies and,
and they're more subject to
bias and randomized trials are,
I think I've kind of said.
Yeah.
You might've said that when you,
when I asked the question,
it was in my list of questions to ask.
So that's why I did it.
But I would just,
I would just restate like, so, I mean,
in that study, right.
I mean,
and I've got to just pull it back up, but,
um,
majority of these were high risk of bias.
I mean,
and you could even state what that
number.
So just so we know,
like there's twenty seven.
I just have it right here.
Exhibit seventeen or exhibit thirteen.
So nine studies were
moderate risk of bias and
twenty seven were high risk of bias.
And I think you just state
that and then maybe what
that means for people.
You know, remember,
clinicians don't always
understand risk of bias.
I would even say, like,
what does that mean in the
way that they should interpret it?
Okay.
Yeah, I think that's a great idea.
Okay.
Get ready.
Let me mark.
Yep.
Go for it.
So I think that just to
reiterate that we had nine
clinical trials,
randomized clinical trials
in this systematic review
and twenty seven observational studies.
And among the clinical trials,
six of the nine were
reported as having high risk for bias.
And among the observational studies,
twenty one of the twenty
seven were reported to have
high risk of bias.
And so why we need to be
concerned about this is
when you have risk of bias
in a clinical trial or
observational study is that
essentially it can impact
the results and you can get
potentially a misleading result.
And so that's the big
picture of why we need to
be concerned about risk of
bias and these high levels,
particularly high levels of risk of bias.
Remember, that's it.
Seventy five percent of the
studies in the systematic
review had high risk of bias.
yet the reports suggested
that we ought to
immediately adopt these
musculoskeletal solutions
when the risk for
misleading results is high.
You know,
and I guess one of the things
that I'm just thinking
about here right now is, you know,
I think a lot of our
listeners might be looking
at this and saying,
especially if they look at
the report and you just
read it kind of quickly and
you forget about some of
the things that we talked about here,
you might say, wow,
this is pretty interesting,
maybe even alarming, right?
Like, wow, holy cow,
we've got ways that we can
or things that might even, you know,
oh no,
we could be replaced in a certain way,
right?
I think that that's some of
the fears and the concerns
that a lot of industries
are going through.
And maybe we've always felt
a little bit protected
around that in physical
therapy because of that.
But now we're seeing that
infiltrate into what we are doing.
And I think what I wanted to
get at here was especially
with the research aspect of this.
So, you know,
all three of us are a little
bit nerdy in our research ways.
And some of us more than others, Jake, we,
you know,
we look at things very differently,
maybe than, say,
clinicians might look at
things or certainly the consumers.
Right.
I think that's actually
probably even a bigger
population that might see this and say,
hey,
this is this is fascinating and
interesting.
And actually,
it was just today that I
perused my social media and
I'm on like these
runner group pages, right?
And on the runner group
pages are always like,
putting a picture of their leg and saying,
I have pain here.
What is this?
And then you have a lot of
people that provide input and, you know,
opinions and, you know,
we ourselves or other
people are probably doing this.
It's like, okay,
I'm not going to type anything.
I'm not going to type
anything because you just really can't,
you know,
but that's kind of what this is
a little bit like, but like you said,
this is such a big stakes thing, you know,
where it's replacing
something that is so important.
Whereas in research,
what I think is most
alarming with this is that
research we know takes what
five to seven plus years
for findings to then
translate into clinical
practice and that's
research the unfortunate
thing with this is that
it's actually something
that is put forth by
industry that actually
probably has a bigger
engine in it than even our
research bodies do and I
think that's probably one of the more
alarming features of this is that yes,
while it didn't follow the
research process, like we say it should,
um, the outcome and the, uh, potential,
uh,
fallout from that is actually much
greater than in the research.
I really think that's really
important and key for
listeners to understand
that process and that
systematic methodology for
being able to come up with
answers and address those things.
So appreciate that Jake a lot.
Yeah.
And if I can just kind of reiterate that,
that, uh,
You know, that this is, again,
being a report to industry,
the thing that we're really
concerned here is that
there was no peer review
process for this product.
And as such,
there's no way to let potential consumers,
being clinicians, policymakers, and so on,
any concerns that we might have.
And I, and I'll add, I mean,
so it's interesting, right?
Is when you read in the top, you know,
the beginning of the document,
it does have who contributed
to the writing of this.
And there was one PT, again, clinician.
The rest of them were physician-based.
And so again,
that's who constructed the study.
And when they looked at
getting some additional
stakeholder involvement,
they actually looked at
more of those that were in
the virtual health side of
things rather than the PT side of things.
I think that's a gap that I
just want to re-highlight.
And then I want to gap
that PTs, we're not a dime a dozen.
There is a wide range of what we do.
However,
it's usually patient driven and
they put a lot of different
types of patients together.
And then again,
there's a lot of
heterogeneity in the types
of approaches that we use.
And again,
it just adds layers of what I
would say variables that
then muddy the waters into
really the validity of what
their findings were.
So stepping back,
saying maybe we didn't get
the right input,
maybe there was some risk of bias,
it maybe overinflated some
of the outcomes from those studies,
but now we're putting it
out as a marketing product
without that layer of
complexity to state.
It simplifies it,
like there is more value in
this maybe than what really may be there.
It may be an overestimate.
Yeah, I would agree.
I think hopefully a lot of
our listeners do agree as well too,
right?
I mean, obviously our product,
our bulk of our listeners
are going to be listening
into this and having some
concerns and hopefully
feeling proud about what
they do from an actual
physical therapy
perspective and the
training that they've
received and what they
bring to the table when it
comes to managing these
patients and individuals with
you know, lots and lots of problems.
And I think the impact that
we can have on society,
I think all those things
should be things that we
should be very proud about.
So I guess for both of you,
what can our said consumers,
our physical therapists,
especially those that
really believe in what
they're doing in terms of
either hands-on or being present.
So it doesn't have to always
just be hands-on the care,
but being present in the moment, right,
is also important.
What can our consumers do?
And is there sort of any
kind of call to action to our,
especially musculoskeletal practitioners?
Yeah,
I'm going to step in a safe space and
just say advocacy.
But when I say advocacy,
I'm actually being very specific.
We need to actually
understand the complexity
around this problem.
And part of this is just making yourself,
first of all, a little bit more informed.
Read this.
The other part is that you
also need to look at the landscape.
I mean, so I need to say, and again, Derek,
you brought it up in the
beginning of the conversation,
but AI is different than
virtual health technologies
that were grouped into this study.
And the reality is AI is
picking up even faster.
We need to be prepared for
that conversation.
And I'm going to even say
one of the major virtual
MSK contributors was Sword
Health that was in these studies.
Again, not speaking bad about it,
but I'm going to give you facts.
The facts are is that Sword
Health just laid off
thirteen PTs in order to
ramp up their AI
technologies in their in
their type of services.
So, OK,
so the PT is going to have oversight.
Who's verifying?
How do we know that this AI
isn't taking over maybe into
areas that are concerning
I'm going to step into
another space so united
healthcare is now under a
major class action lawsuit
because they actually have
algorithms that were used
by ai to determine cutoff
points of service and so
now they've cut off
essential rehab services
for those individuals with
injury or sickness and
medicare advantage
beneficiaries and there's
actually a lawsuit on this so
Advocacy.
If you have patients who are
seeking those technologies,
they absolutely need to be
aware that it may not be
considered the same.
If they're not getting the type of care,
we have to think about how
are our insurance companies
now using AI and
technologies to make
decisions on how they're
going to provide care
benefit coverage to our patients.
So this is really advocacy as in like,
talk to your legislators,
get active and talk about
what these technologies do
to the patients that we so care to serve,
not just with our hands on,
but with our brains that we
ended up seeking so many years of,
you know,
degrees in education to best benefit.
It's not the same as a coach.
And I don't know that AI is
going to do it in the same
way with personalized care.
I do think there's formulas,
but I don't know that
they're going to ever
replace the human touch piece
and the human conversation
piece that is essential to what we do.
I really appreciate that answer.
And I think,
especially those of us that
are a little bit involved in advocacy,
maybe we think about it this way,
but maybe it's time for all
of our PTs to start
thinking about this way a
little bit more so,
is being proactive instead
of being reactive.
And a lot of things in the world,
we can be a little bit
reactive because the wheel
moves a little slowly.
But I think, as you said,
the AI wheel moves a little
faster in certain spaces
than we can appreciate.
So I think, you know,
not waiting to be reactive
because by that point,
maybe far too late.
We don't know, but very well could be.
So I appreciate that
proactive advocacy response.
Jake, what do you think?
Yeah,
I just really agree with everything
basically Megan said and that you said,
and doing our best as
physical therapists to find
a seat at the table where
decisions are being made
about whether or not these
types of solutions are
going to be available for consumers.
And that requires some work,
but I think that we need to have that
Cut that out.
Leave that in.
Especially the tongue.
We are going to do outtakes at some point,
but yeah.
Love it.
I think that most of what I
said was good except the very end.
Yes.
It was all good.
Do I have to reshoot that or what?
Because I don't even remember what I said.
No, do you remember where you were at,
like thought-wise?
You were talking about seats at the table.
Yeah, I think that it's just, yeah,
if we can stop it at everybody needs to,
we need to be making
efforts to make sure that
we have a seat at the table
where these decisions are made.
I'll find that somewhere.
Okay.
All right.
And begin.
Oh, you just want to stop it there.
Oh, yeah.
I think I don't really have anything else.
I think that's good.
Then I may fire a question
back at you then.
Yeah, fire another one.
Yeah.
Well, wait.
I'm going to get us on the
right timer here.
So Jake,
I think that's really interesting
that you mentioned getting
a seat at the table.
I feel like in this space,
especially with what we're doing in PT,
there are a lot of tables in this.
And I know that this is
putting you a little bit on the spot,
but have you any thoughts
on what that might actually look like?
Megan's brought up talking
with your legislators and
those kinds of things that
can actually have impact on
swift policy changes and
that sort of thing.
Any other thoughts on how that might look?
I especially want your
thoughts and your opinion
because you've been
involved in a lot of
different things like the
opioid misuse and different
types of ventures and such.
And I know that so you've
had seats at the table.
And I just would love our
listeners to hear how you
get those seats at the table,
what you've done in the past.
Well, I think that related to this,
the seat of the table could
be making sure that you
have a good pipeline to
your health system
leadership when decisions
are being made about what
types of insurance options
are being provided.
And that could be,
and it could also be
actually banding together
as local clinics,
more mom and pop clinics
banding together to figure
out how you're going to
respond to some of these
potentially virtual
solutions that might be
pushed upon us rather than
being given really an option
of whether or not to adopt it.
And so being able to have
kind of a critical mass in
order to go to health
system leadership and
insurance companies to have
these conversations and
advocate for our profession,
I think will be critical in
the coming years,
particularly as Megan mentioned,
related to AI,
because that's not going away,
it's only going to accelerate.
Yeah,
the competition changes a little bit
there instead of being
competing with the
clinician down the street,
we're competing against
something very different,
very interesting perspective.
Yeah.
And it's going to be couched as access.
I mean,
so I think we really need to
appreciate that it's couched as access.
I live in North Carolina or North Canton,
Ohio.
Right.
And so when we think about, you know,
where you live, Derek,
and where Jake lives,
I would say we're not in
rural areas for the most part.
I received a solicitation
from the insurance provider
of a local hospital systems
around here that they're
now offering sword health PT services.
And I'm thinking about all
of the access of PT local to him.
Like there's a ton.
I was solicited.
I don't live in rural health areas.
Access is pretty easy.
And so is it going to be one
of these solutions?
And again,
it was through sword health and
now I'm actually more anxious.
Is it AI generated?
And so,
Here's another advocacy tool.
Go through it yourself.
That's what I'm going to do.
I'm actually going to sign
up for Sword Health PT,
and I'm going to evaluate it.
And then I'm going to write
to the hospital system and
the insurers if I see
something that would be a
high variation of typical practice.
So start small.
You can go big,
you can have big conversations,
but we can't put our head
in the sand and pretend
like this isn't existing in
a current concern.
We have to engage in the conversation.
My bigger concern is how are
these algorithms going to
then decide who gets coverage,
who doesn't get coverage,
or when does coverage get cut off?
These are conversations that
we have to start to
appreciate in our science.
We've come a long way.
But we're not all the way
where we need to be even
about dosage in all of the
research areas that we
still need to explore what
is best practice in the various areas.
So I would continue to
encourage clinicians in the
listening areas to make
sure that they're doing best practice,
such as the guideline-based cares.
I mean,
we really do need to be at the top
of our game for us all to unite together.
so that we don't have a low
variation in our practice
and that that's who gets
picked on and then it
changes the practice
profession for all of those
who truly do believe in the
best hands on care,
the best solutions for our patients.
We definitely need to step
up our game as practitioners, too.
So there's there's a lot of
low levels of hanging fruit
that we can do.
There's some higher,
bigger things that we need to target.
But I think the biggest
thing I can say is engagement.
and advocacy.
Those are the things we have
to start to believe that we
can make a difference and
we have to start somewhere.
I appreciate that.
Really good advice.
This has been great.
I really do hope that our
listeners have enjoyed some
of this conversation, this dialogue.
It's not doom and gloom, by all means.
We're a wonderful profession.
I think that we should all
be excited about it.
And that's how we should
actually walk away from
this podcast is who we are
and what we do and what our identity is.
But realize that there are
people that are always
wanting to have a little
bit more say in this space.
And we need to just make sure that we are
for society and for the
individuals that we serve
protecting that space.
So appreciate.
We're already an economic value.
We're an economic value.
I don't need to be cheaper
to just be cheaper.
We need to be cheaper with high quality.
And I think that's the piece
we just can't lose sight of.
We are already a great value.
So we just need to keep the
message consistent.
Yeah, there we go.
Great words to leave on.
Thank you, Megan.
Thank you, Jake,
so much for being on the show.
Pleasure being here.
Thanks, Derek.
Bye, Jake.
Bye Megan.