All right,
we're doing PT Breakfast Club a
little early.
I'm on the left coast today.
I've only been out here a couple times,
but I'm near San Francisco.
So I'm doing it live at five thirty.
I must like you guys without coffee,
by the way, because the downstairs,
the breakfast at the hotel
lobby didn't crank in front
of the thirty minutes.
But Tony Maritella,
you're up and you're up and
about here at eight thirty
in the morning on the East Coast.
What's going on?
Yeah, not much.
It's beautiful, beautiful,
sunny day here in Ohio.
I already started treating patients.
Dave Kittle is out for the day.
I'm not sure what he's doing,
but he's out and about.
So I wanted to ask you,
you and I had talked about
this a while back today on the episode.
I want to talk about AI agents.
Jerry Durham,
I still don't know exactly
what he's doing,
but he's doing a ton of stuff,
it sounds like,
with AI agents and automating things.
I want to talk about not
selling the outcome.
which is what most of the
time I'm hearing people say.
People say, sell the outcome,
sell the dream, sell the vision,
sell the European trip,
not the flight there, not the TSA,
not the baggage check,
not the screaming kid kicking your seat.
I don't know.
I don't think we can get
away with selling the outcome.
There's a part of that,
but the reality is,
We're the ones in the
trenches actually having to
make the patient do the exercise.
We're the ones having to
make the patient do the
thing that they probably
didn't want to do.
I think we have to focus on
attracting patients who
want the experience, want the adventure.
And I was thinking about this,
and I'll turn it over to you.
This morning, I'm talking to my wife.
We have our coffee.
We're just hanging out.
We're chit-chatting.
And she was like,
why are so many women in
particular so afraid of
lifting heavy weights?
And I think CrossFit did a
lot to help change that paradigm.
But even within my family,
I've got women in their fifties, sixties,
you know,
in-laws and different people
that I'm associated with.
You give them an eight pound
dumbbell and you would
think you ask them to lift
one hundred and fifty
percent of their body weight,
which should be lifted like a reasonable.
So the question is.
Why are we so scared to lift heavy things?
Why are we not more focused
in therapy on selling and
packaging the experience
rather than the outcome?
The outcome doesn't matter.
Even if you give them pain relief,
it's temporary.
Everybody's going to get
pain again of some kind.
Let's focus on marketing the experience.
Yeah,
Rory Sutherland is big on this where
he says,
Well, OK,
so who does sell the outcome in
our profession or in health care?
And I found this when I was
treating patients,
which was patients would
come post knee replacement,
hip replacement, some surgery,
and they would say,
I don't understand any of this like this.
This was not in the brochure.
Somebody, maybe a surgeon,
had sold the outcome, which is, hey,
twelve months from now,
you'll be able to do those things.
What they forgot to mention
was the thing that you'll
need to do or the things
that you'll need to do from
day one post-surgery until
that twelve months.
And unfortunately,
PTs were sort of caught in the crossfire.
We were now looked at.
This was not.
Am I an abnormality?
Is this going wrong?
So Rory Sutherland talks
about this in terms of
people don't fear necessarily pain.
People fear uncertainty
where I think people are
smart enough to know that, like,
if I'm going through physical therapy,
it's,
there'll be something physical on it.
And most of them are smart
enough to know it's not
just something physical a
therapist is going to do to them.
So they don't necessarily
fear the pain or the
difficulty or the lifting of the weights.
They fear the uncertainty of knowing like,
is this going to work?
How hard will it actually be?
Will I be able to do it?
Will I keep up with it?
So the worst part of PT isn't
maybe the actual things that you're doing,
it's the not knowing.
So going along your lines of saying,
don't just sell the outcome.
Don't just sell the lifting
the grandkids again.
Be like,
I've seen a lot of great PTs and a
lot of people in business too.
You get to the no as quickly as possible.
Like that's one of the ideas.
Get to the no as quickly as possible.
Meaning,
you want to weed people out who are,
who aren't going to make it
past visit three.
Anyway, this isn't going to be for you.
Right.
I'm, you know, fight club them.
And I think I have to
qualify down that because
of the movie has been out for so long.
Fight club them is, you know,
there was this super elite
underground fight club in a
movie with Brad Pitt and Ed
Norton and anybody that wanted to apply.
I don't think I have to say spoiler alert.
If the movie is more than two years old,
right.
Anybody that wanted to apply
to get into this, like it was a cult.
I mean, essentially what fight club was,
it was a cult,
but anybody that wanted to get in,
you'd be originally told no.
Like, no, you're too, and the person,
if the person was tall,
they were too tall.
If they were short, they were too short.
If they were fat, they were too fat.
So you had to fight club them.
And then the idea was if
they stuck around long enough,
they were the people who
actually wanted to get in.
Academics feels a lot like this.
A job that you want,
like really a tough job
that you're really reaching
for feels like this because
usually you're denied once
and you've got to go
through another acceptance process again.
So everybody wants to know
how long this will take.
Am I doing it right?
Is this even working?
I think what's worse than a
difficult journey is when
you don't know when the end is.
So instead of just selling
the outcome or not selling
the outcome or not selling the outcome,
I think you should show,
if you create and sell clarity,
that's something that's
even more powerful.
So I was just working with a
patient ten minutes ago and
we were talking about some
painful areas on his body.
And he was saying, you know, man,
this thing is just not getting better.
And I was like, you know, I mean,
it might never get better.
And I said air quotes better
because I'm like,
it's it's it's one of those
things that they're degenerative changes.
There's other stuff that
absolutely we can't change.
It's not about feeling good
or getting to that point
where you're quote healed.
It's about the journey.
It's about coming in every day.
It's about working out.
It's about getting stronger
and improving yourself.
And I feel like,
If we talk about burnout and
frustration and therapists
who just feel like they're
treading water and they're
never getting anywhere.
Because we're trying to help consumers,
again,
that don't really want what we want
them to want.
I think if we do what CrossFit did,
what yoga does,
what all these other brands do.
They repel the wrong people.
They attract the right people.
You did a triathlon, right?
You did the Iron.
I was the Ironman.
Yeah.
So so that takes a very
special kind of human
wanting to achieve a
special kind of thing.
And it wasn't just about, you know,
how you place.
It was about the experience of doing it.
It was.
I feel like we need to
figure out for ourselves, OK,
what do I deliver for me?
I don't deliver pain relief.
Pain relief is a lucky, you know,
lucky thing that might
happen because even if we
achieve pain relief today,
I don't have pain relief tomorrow.
Like there's no guarantee.
I want to achieve for me, education,
information, empowerment,
I want you to feel good doing hard things.
And I want people coming to
me that want that experience.
And so that's what I try to
convey in my messaging.
That's what I try and convey
in my ads and my social media.
It's not about achieving pain relief.
It's about doing more things
with the same pain,
maybe even with more pain,
like pain is just a part of life.
We can't
be void of pain forever.
And I think that would help
just so many therapists,
if they embrace that, hey,
we're not a drug that relieves pain,
you know, maybe some people do.
But the rest of us,
we want you to want to be healthy.
We want you to want to do hard things.
We want you to not be scared
of lifting eight pounds,
when it's reasonable that
you should be lifting a
hundred and eight pounds.
So I sort of took this into account,
I think,
maybe on my own experience of not
understanding, like,
where are we in this?
Like, wait, was this forever or whatever?
So this is a dummy account.
This is the Othellus AI scribe.
And I've been playing around with this.
one of the things that
allows you to do is when you're done,
when it's every,
everyone knows an AI scribe
will write the note for you, right?
It'll suggest billing codes, yada, yada,
yada.
What I like about this one too is it'll,
it'll create an email for
the patient and the referring provider,
but then I can go in and judge up.
How do I write?
Number one,
at no point will any email I send say,
I hope this email finds you well.
Like I literally wrote that
if that comes out, that is,
I've been kidnapped by the way.
Like that's my,
If I've been kidnapped,
I will give you a proof of
life and it'll say,
I hope this finds you well.
Blink three times if you're not okay.
So I literally put that in the prompt.
Do not say cliches like,
I hope this email finds you well.
But it might be hard to see here,
but it says, based on similar cases...
I'd say you're currently at
about sixty percent of your
normal status with our plan.
We aim to get you as close
to one hundred and dancing
without issues.
This is like a mock patient
who hurt herself dancing.
But I think if you set the
expectation early, they understand like,
OK, I'm going to buckle.
I'm going to buckle up or OK,
like we're we're almost towards the end.
If I just finish this thing,
I'll get a little a little
bit more out of it.
Both of those things are clarity.
They're setting you up for success.
at least being okay with what,
or understanding, not even being okay,
understanding what happens next.
And I was on a big kick for a while there.
Like what I think the reason
for communication is the
reason for communicating
isn't to have communicated.
Like the reason for,
for going to the gym isn't
to have gone to the gym.
It's to elicit a change, right?
I know that going to the gym
and doing whatever I do isn't going to,
be the whole thing,
but it's going to elicit a
small change and then change over time.
Well,
the goal of communication is to have
it is to achieve understanding, right?
So I give this example too, which is like,
I could be the most
efficient third grade teacher ever.
I could save school
districts so much money.
I'll teach the entire third
grade curriculum in like three weeks.
That's it.
I could blow, dude,
I've read the third grade curriculum.
There's not a whole,
it hasn't changed since I was in school,
right?
So I could rip through that
whole third grade
curriculum in three weeks.
Now,
I will have a bunch of third graders
staring at me very confused
because I went way too fast, you know,
because if the goal is just
blow through the curriculum, that's easy.
I could read out loud and blow through it.
But if the goal is to make
sure third graders go from
not understanding to understanding,
that's different.
So understanding what the goal is.
I think what you're talking
about is shifting the goal
of what we're actually
being able to provide,
which is the journey.
And if you don't like this, I can't,
you're going to hate me.
I'm really sorry.
Don't step in here.
Don't start.
And we met those people on
initial evals where you're like,
this person isn't sticking.
You know that,
but you go through it anyway.
Yeah, I was listening to a guy.
It's a new to me marketing channel.
And he was talking about like,
you don't go to a buffet
for an amazing steak experience.
Right.
You go to a steakhouse.
It's a completely different experience.
And I think Dave's not here.
I was going to talk to him about this.
Like Dave Kittle would be
the quintessential steakhouse.
And you have the
well-trained server and you
have the wine list and you
have all this stuff.
And then my kids love Golden Corral.
You know, you go to Golden Corral and,
For fifteen bucks or whatever it is,
you've got a thousand
options and the dessert bar
and they go straight for that.
None of the food is amazing,
but you're not there for amazing food.
You're there for a breath,
a wide experience of different foods.
And the same thing within what we do.
If you look at most physical
therapy websites,
it's more reflective of Golden Corral.
than it is of a high-end steakhouse.
Oh, they want anybody and everybody.
Yeah, like everything is on the menu.
Everything is being offered.
None of it is going to be amazing,
but it's all going to be
relatively good enough.
But I just,
I go back to so many of our listeners,
people that are paying
attention to this show,
You deliver that steakhouse experience,
fine dining like that's what you want.
But I don't know that it's
really conveyed to the right people.
And then the real killer is
the person who wants to
deliver the fine dining
experience at a buffet style price.
Yeah.
And you just you can't burn
that candle from both ends.
I was just I was just thinking that.
And then and then and then hold on.
There's one more level.
There's the people who want
to deliver or they're okay.
So there's the people who
are or want to deliver the
steakhouse feeling Smith
and Walensky in either a
Smith and Walensky setting.
Those people are fine.
Those people are not in
Facebook groups pitching.
They understand who they are,
what they deliver.
And if they're not finding
the people that want to buy it,
they're either selling the
wrong thing in the wrong
place or they're not good at it.
The person is like,
I am a high-performance
physical therapist.
I'm going to work with elite athletes.
And enough athletes show up and go, no,
for whatever reason.
And those people wash out.
The funny part comes in when
the people who are
delivering or attracting
buffet-style customers yell
at the large PT chains for being mills.
That's the funny part, right?
So like you said,
is McDonald's good or bad?
Oh, it's horrible.
It's horrible.
Well, not for, I don't know,
a million people per day per location.
I don't know.
I don't know what the data
is on each McDonald's franchise.
But like enough people
understand what they're
getting at McDonald's.
If McDonald's put a filet
mignon on their –
menu what like that would be
a great social experiment
like what would happen like
would people not order it
because like this doesn't
make sense or they'd be
like this is a great deal
because I'm getting a filet
mignon at McDonald's like
why don't you think they do
they could they could it
doesn't make sense they
could they choose not to
because they understand the
business they're in the
messaging did you see that
post that I shared with
Ronald McDonald no
Oh, it's on LinkedIn.
I shared it last night.
I prompted chat GPT to give
me an image of Ronald McDonald.
I said with his big clown
feet up on the desk,
hands behind his head,
stacks of money around him laughing,
saying, quote, Oh, no,
they can make a better
hamburger because the whole
the whole post was about that.
McDonald's,
I showed my kids last night the
stock chart of McDonald's,
and it's just a beautiful
slope up accelerating.
They make so much money, they don't care.
Yeah, this was from ChatGPD.
They don't care about
everybody else who can make better food.
They understand the business they're in.
They serve millions of happy
customers every single day.
They don't care what
everybody else thinks of them.
The they've embraced who they are,
what they are, what they do best.
And they're amazing at it.
And I mean,
there's very few stock charts
over the course of a
lifetime of the business
that can show that kind of
success and growth.
That's what drives me crazy
when therapists love to beat up on, quote,
the mills, corporate PT,
all this other stuff.
And in reality,
they wouldn't exist if
there wasn't a need,
if there wasn't demand,
if they weren't doing something right.
There's a function and a
purpose for them in the market.
So what do you think people
should take most away from that post?
To me, I'll tell you what I took away.
You tell me if that was part
of your intent.
To me,
it's understand what you... Where
would you start?
I would start with what you
want to provide.
Because if you come into a
profession or if you're like,
I'm going to open a business and look,
there's a big need,
you could be successful.
But if you don't like it,
six months or a year down the line,
You're going to hate it.
Right.
So I think start with what you like to do.
And if it's working with
this type of patient or
doing these types of things, start there.
Then you have to look at if
if there's a need for it,
like maybe you're in a
really saturated market.
Right.
So then you have to change.
You can't be McDonald's.
You have to be Wendy's, which is similar.
But they make a point of
pointing out where their differences are.
Right.
So what was the what do you
what were you hoping people
were taking away from from that?
I think my main intent with
that post was really just to say,
you know,
it doesn't matter what you like.
It doesn't matter what you want.
I'm going to go opposite of
what you said in the sense that, like,
just look at nature.
Like, you can't control nature.
You know, the rhino.
is like the perfect
amalgamation of all of
these different traits for
the environment the rhino
is supposed to live in.
Put the rhino in Manhattan,
he's going to die.
He just can't survive.
So it's like,
I don't think about what I want.
I think about what the
environment supports,
what is already proven to
be successful out there,
and is there an opportunity
for me to build something
that's going to fit into
that environment?
If I want to go big, if I want to scale,
if I want hundreds of
locations and a thousand therapists,
that is going to be a very
different animal than if I
want to do just me doing, you know,
manual therapy for sixty minutes,
one on one with every individual.
And if that's the business
that I'm going to build,
then I'm going to do it at
a three hundred, four hundred,
five hundred dollar price point,
not at Medicare reimbursement rates.
But I have to put that
animal in the right environment.
I can't force the
environment to accept the
animal that I want to deliver to it.
Right.
I was saying start with what
you want because if you're
actually starting a business,
I don't know that you'd
want to keep doing it.
Ask yourself,
is this the business I
actually want to get in?
Because I think a problem
comes in a lot of times
when people start in two ways.
They conform to what they
think they need to do.
Right.
Well, this is how it's going to be.
And you hear those people
complaining a lot.
And then three years in, they're like,
I'm still doing this
because the goal was to do
this and then change.
And yet you built a business
that was built on this.
Or.
Yeah,
not understanding what you will
actually drive you like I
knew in PT school,
I didn't want to do patient care,
but I kept going because
that's what I was supposed to do.
Yeah,
I'm halfway through the degree and
I'll learn to like it.
And I was surrounded by
thirty seven other people.
who the more they did it,
the more they liked it,
or at least that that's
what they were saying.
And I was like, Oh man, I'm the,
I'm the mole of the group.
Like, what do I,
what am I supposed to do here?
But I knew.
And then I tried a couple of
different settings.
I was like, I it's, it's not, it's not me.
I don't, I don't like what is me.
I don't like this.
So I need to find something
different and that's okay.
Yeah.
What would be,
what would be not okay is me
sitting in a clinic bitching about it.
Right.
You knew, you knew what it was.
So real quick, Will Boyd's here.
Will, I am trying program, no, what is it?
Like whatever Facebook
automated ads are right now,
I'm trying it where I
basically just told Facebook, here's my,
I think it recommended a
three dollar budget.
Here's my three dollar daily budget.
Just run whatever ad you want to run.
And I gave it a list of
videos that are already on
my Facebook business page.
So I didn't give it any
other information than that.
I'm going to see what
Facebook does with that information,
which kind of leads us into
the next topic about AI agents.
And, you know,
Facebook has AI running ads right now.
It's making decisions just knowing, OK,
Tony wants more inbound leads.
I want people messaging me and calling me.
never do a facebook will is
saying no with several with
several o's never do a
facebook suggest always
always ends up the worst
performance and then he
says call but keep me
posted keep me posted so
he's he's telling you to to
go left when you're going
right well we're gonna see
what happens so uh I could
I could handle losing three
dollars a day um but yeah
like we we know we're moving towards
A AI future.
I think I shared this.
Did we talk about this?
You got to tell me.
Back in the day,
you remember being up late at night,
two o'clock in the morning,
infomercials took over television.
Television used to end.
There was a point where
you'd see the American flag and one of,
you know, I don't know,
was it the anthem or Star
Spangled Banner or
something was playing and
literally the television
would end broadcasting.
Then infomercials came on
because that attention
could be monetized.
And I was thinking about it this week.
I was like, man,
if people are in pain and I
don't want to sell a solution for pain,
but if people are in pain,
they're up at night.
My audience, total knee replacement.
They can't sleep.
They're up at night.
They're flipping through late night TV,
scrolling their phone.
I'm like, why don't I buy that time?
I used to only run ads
during the day when I had
people to answer the phone.
But now I'm like, well, shoot,
I can get cheaper ads in
the middle of the night.
I'm going to capture that.
I'm going to focus the
message on the person who's
awake at night, can't fall asleep,
getting frustrated.
But I don't have somebody to
answer the phone.
So this is where we talk about automation,
AI.
Can I get an AI agent who
can answer the phone for me
at two thirty two a.m.?
What do you know about this?
And I know Jerry Durham's
talking about this a lot.
Yeah.
You, you could do this yesterday.
You know, this was, I think,
I feel like we, we, we, we knew this,
like when you called Delta or whatever,
like you knew that this was happening,
right?
We weren't,
we weren't planning on doing this,
but do you want to test one out?
Sure.
All right.
So I'll just, I'm opening myself.
While you're getting that ready, you know,
my understanding, it was, what do I do?
Thank you for calling Parabella.
This is Sophia.
How can I help you today?
yeah I uh I was doing
karaoke last night and I
fell off the stage and I
need a physical therapy
appointment okay just to
make sure you're looking to
book at terra bella palo
alto right yeah we have an
appointment available with
sarah thompson uh today
tuesday may twenty seventh
at nine o'clock a.m would
that work for you no that's
way too early anything later
Let me check what else we
have available for today.
Tuesday, May twenty seventh.
We have an appointment with
Sarah Thompson at two o'clock p.m.
Would that be more to your liking?
Yeah, that's better.
All right, great.
So to book that two p.m.
appointment with Sarah Thompson today,
Tuesday, May twenty seventh,
I'll just need you to
register with our system to
finalize everything.
Is that all right?
Yeah.
Before I go ahead and book
that appointment,
may I know your first name, please?
So now the rest of that
appointment will be making
sure they know my name,
spelled it properly,
making sure what insurance
I have and my numbers and
what type and all that.
So then it just it's going
to appear on the EMR.
for Sarah Thompson booked,
right then and there.
Now that was a pretty unsophisticated,
medium sophisticated, right?
Sometimes when I do that demo,
I always like do something funny.
Like I fell off the stage doing karaoke or,
you know, I was playing polo or whatever.
Sometimes she'll react.
Sometimes she'll go, oh my gosh,
like I love karaoke.
That's horrible.
Sometimes she doesn't, like there,
she was business, right?
So can you program an AI agent to react
in certain ways and triage?
Yes.
I'm working with a client
right now who is a surgical
center who also does like
urgent care hours.
And right now it's an
answering service that has
to figure out when to call
the surgeon on call.
And I'm like, well, how do they know?
It's like we have a,
remember logic in eighth
grade or ninth grade math?
Like if then, if then, if then.
That's what AI is.
It's a big giant if then engine.
So if the person says this, tell them,
can you see the bone?
Yes.
Go to the emergency room.
That's not us.
Or just forward them to,
I'm now forwarding you to nine one one.
So can you, for what you're looking for,
create an AI agent?
Yeah, you could do it yesterday.
Okay,
so what was that agent that you just
shared?
Is that from Thales?
That was from Thales, yeah.
Okay,
what are your thoughts on what you
just shared with me?
Yeah, I think it's a really good B-,
I think it's a B- in terms of audio,
right?
Like, I want, like,
I knew it was an AI agent because, I mean,
I think most people would be like, yeah,
okay, it's not a person yet.
I think in twelve months, maybe less,
it'll be so sophisticated.
Like,
in terms of tone and time and delay
and processing, like, again,
you've called Delta, right?
three years ago to change a
flight and you knew you
were talking to a robot
representative
representative like right
just hitting zero like
because it was annoying I
think so much effort and
people can see there's so
many people looking for
something like this now the
average person's looking
for this they're putting so
much effort into the speech
the tone the timing in
twelve months you I don't
know that you'll be able to
discern discern the difference
And we talked last episode
about do we need to inform people?
I know there are some
federal laws that were in
place with health care and calls,
robocalls and things like that.
Did that say you're talking
to an AI agent or what's
the deal with that?
It doesn't right now.
I don't know the legality on that.
I appreciate your honesty, Scott says.
The latency is the killer
part for me with that.
But I think the latency
could be addressed right now.
I think you just say, hi, this is Sarah.
I'm an AI agent for Total
Therapy Solutions.
I just wanted to let you
know that there's going to
be a slight delay while I
process what you say,
just so the person on the
phone understands why.
Because the very first time
that happened in that call, I was like,
did we get cut off?
Are we on mute?
Like, what happened there?
And it takes me a couple times to realize,
oh, this is just latency.
It's just taking longer.
It's like, still, I think I use Waze.
or Google maps in the car.
And it gives me the turn
just a half a second too late.
Like I want it just a little bit earlier.
I want that response just a
little quicker or tell me
I'm processing what you're saying.
Give me just a moment and
then give me the information, you know?
But like you said, I mean,
months in months,
it's going to be amazing.
Right.
Um,
What other kind of uses do
you see for something like that?
Yeah,
there's some insurance companies
require that if you're
going to work a certain denial,
you've got to do it by
phone or it's faster by phone,
but then they'll put you on
hold for an hour.
What does that mean?
So like if I get a denial on
my claim as a provider.
You might have to.
There are certain situations
or it's been elevated to
the point where you have to
call to actually work to
get paid for that denial.
So you could use an agent to
now make the call.
So like I think in my mind,
that's where my head went,
which was it's a catcher.
It's going to handle things.
It's going to catch and
block and route and understand.
Take your information and
put it into an EMR.
well, we have,
I don't have the video pulled up now,
we have a demo of an AI
agent calling a
representative from an
insurance company and saying,
I'm here to work this, you know,
there was a problem with
this claim being paid.
And you can tell the person
on the other end probably knows a little,
that knows that they're
talking to an AI agent and
is sort of giving her, and I'm using,
let's use a pronoun, I just said her,
using the AI agent a little bit of, eh,
Like, well, what's the date of service?
I don't have the date of service,
but I have the total.
So it knew, like, well, in lack of this,
I have this.
So it has access to all that information,
and it's able to say, in lieu of this,
do this.
If this, then that.
So it's able to make the phone call.
You know, and I think the layup things,
too,
would be a phone call or a text
message when someone has an
appointment or has to take a turn.
Make sure you give that
person the text message,
a reminder of their
appointment in time and on time.
So Scott brings up an
interesting topic that we
kind of talked about on a
different topic.
Scott says AI agents need a
bit more empathy to improve engagement.
My question is,
and I think it's when I was
talking about is an AI right now ready to,
you know,
generate my entire plan of care
based on my clinical
information that I provide.
When Scott says that,
I think what Scott is
comparing is his level of
empathy and engagement to the AI.
But what about the level of
empathy and engagement
across the entire profession?
Like if we have two hundred
plus thousand licensed
therapists in the profession,
is the level of empathy with AI right now
higher than the average equal to below.
I know a lot of angry, frustrated,
just hateful physical
therapists in the profession right now.
I know a lot of angry, hateful,
like unhappy front desk people right now.
I think a completely muted
agent is already better
than a lot of what is out
there right now.
And I remember having this
conversation with Jerry Durham.
The first time I met him, I was like,
The standard of
communication and empathy
and happiness in health
care right now across humans is so low.
The bar is so low.
You just have to be half
awake and reasonably
curious and you're going to
be light years above everybody else.
You're comparing this
against your all star.
Yeah.
And you're like, well,
it's a be my like I was
comparing that against a human being.
She didn't have empathy,
but if I did that same
phone call with my same words ten times,
she would say, she's done.
Oh, I'm sorry to hear that.
Karaoke is dangerous sometimes.
You could tell she
understood what I was
saying and played with it a little bit.
Right.
The other thing, I mean,
I just we used to have a
front desk person who when
a new patient would call,
they would follow this
written out process of
asking these questions,
collecting this information,
putting it straight into an EMR.
That's obviously replaceable
right now with the AI
agents that are on the market today.
Go through a twenty question
and I can do this with ChatGPT right now.
I've done it where I make up a fake case.
I say,
ask me twenty questions and then
generate a physical therapy
evaluation and plan of care.
Generate function-based goals,
generate impairment-based goals,
consider these CPT codes
based on these typical conditions.
And it's completely possible
to have your finished
physical therapy evaluation,
documentation, plan of care,
plus the next ten to
fifteen treatment notes
auto-generated right from
that phone call before
you've ever spoken to the human.
You know, and we can do that right now.
Yeah.
So the funny part was,
did you see the video that
I had recorded in response
to your question and the response and the,
and the, and the comments in that,
in that Facebook group?
Tell me about it.
I don't know.
So I was just,
I was just pointing out how
like people were like,
people are quick to defend.
Cause now it,
the question feels pointed at them.
Like,
do we now have something like my mom
worked for the New York
state toll authority for years.
Okay.
And when they started
putting easy pass in,
I couldn't figure out why
she was so pissed because I was like,
this is great.
Like, I don't think stop.
Like, look at the traffic jams.
Yeah.
Memorial Day weekend.
You knew every thirty miles
on the New York State
Thruway was going to jam up
again because everybody had
to get out their nickels.
And throw it in a basket or
hand over dollars.
And they did it.
And it's just like multiply
that times a hundred thousand cars.
And it's chaos.
Now we barely, we don't like, then,
then you had to slow down
to to get counted and now
you don't even have to slow down.
It's like, you don't even, Oh,
is that a toll barrier?
I wasn't even sure.
Yeah.
She was so angry.
And I didn't understand why.
I was like, this is great.
And then I understood it.
She was looking three or
four steps ahead and saying, well,
if they don't need us there,
where else won't they need us?
And where else won't they need us?
But no, what I do is special.
You need me to do this, right?
So I think a lot of the therapists were –
in that Facebook group who
were writing comments were
feeling a little bit like
they're taking it personally.
They were getting defensive of,
of course not,
because I am special and I
have special this and I have special that,
and you couldn't possibly
know what I know.
So is this the trait of the entrepreneur?
Because, you know, the entrepreneur in me,
From the beginning,
first time I ever read E-Myth Revisited,
everything was about
putting myself out of business,
putting myself out of a job,
putting myself out of business,
replacing myself either
with other humans or technology.
Like my entire fifty years
of life has been,
how do I replace myself
with something else?
Whereas I can certainly see
a person feeling threatened,
their identity feeling threatened,
I would hope that that
person would recognize that
it's just insecurity and
kind of get past it.
What did your mom end up doing?
Was that the point that she said, OK,
I'm going to retire and I'm
out of the workforce?
Did she shift it into something else?
She knew that this was her last job,
but I think she was looking around.
She's like, you know,
there's kids who are twenty
five years old who work here.
But but I'll take a more modern approach.
To me,
I did the morning announcements in
sixth grade.
That's all I wanted to do.
I was like, I don't know what this is,
but I like it.
Then went to school for communications,
internships at radio stations,
worked at radio stations, big ones,
small ones, didn't matter.
I was driving home.
Now I'm twenty eight years
old and I'm running my own.
I'm running two radio stations like.
Four eleven year old me
would look at twenty eight
year old me and be like, holy cow,
we made it like that's my
that was my version of
getting drafted by the
Yankees and playing first
base for the Yankees.
Right.
Which was my second choice.
That was my second choice.
Running radio stations was my first.
And I'm driving home with my kids.
We didn't call it an iPhone one.
We just called it the iPhone
because we didn't think
there would be a two.
We're like, this is revolutionary.
Right.
I'm driving home from the
radio station one day at
seven o'clock at night.
And I plugged my iPhone into the aux cord,
and someone had texted me a link.
And I tapped it,
and I was listening to KROQ
LA while I was in Pennsylvania.
And it was crappy.
The signal was crappy,
and it was buffering.
Kids,
there used to be this thing called
buffering.
Essentially,
just like the internet wasn't
working right.
And I was listening to a
radio station in Los
Angeles while I was in Pennsylvania.
And I was like,
and I literally did the math.
And I was like, I'm out.
Like, I cannot compete with this.
I could have hung on in
radio for another ten years.
So I could have went from twenty eight.
I could went to thirty eight.
But I was like,
I don't like where this was going.
Here's why.
Because there were other things.
People were simulcasting.
So you'd have like a morning
show in Dallas would be in Ohio, Florida,
Seattle, LA.
So you had simulcasting, right?
So you were able to do that.
You had voice tracking.
I was on the radio in
Northeast Pennsylvania seven days a week.
I wasn't at the radio
station seven days a week.
I was recording that.
Right.
And I was recording a lot of
that one on one like that
was only being used once.
In that moment,
like I knew I was recording
for Tuesday at, you know,
at three o'clock in the morning.
Right.
And then it was burned.
But I was still like,
this isn't a this isn't a place.
This is a place where people scale.
So I was looking at that the
minute I saw the minute I
heard KROQ in Pennsylvania.
I'm out.
Went to go to law school, hated it,
went to go to business school.
didn't hate it, didn't love it, came to PT,
and I saw some opportunity.
But that's my point,
which is like I don't – so
to answer your question, yeah,
I think it is part of your
personality and my personality,
which is like we're doing
the math six or seven steps ahead,
and you're like, nope.
I either had to own the
radio station at that point
because even though I would sell that,
actually,
I wouldn't want to own that for very long,
or I need to be somewhere
else where I can –
I can create something
different because what I
saw right then and there at twenty eight,
I'm not going to be doing
this at thirty eight.
And I wasn't.
And a lot of people who
looked at me were like, dude,
but you have the dream job.
They were excited, too,
because a lot of guys were like, well,
Jimmy leaves.
I can move up.
I just move up one level on the ladder.
And I was like, get off the ladder.
This is not a ladder to be on.
This is like a ladder on the Titanic.
And a lot of those guys and
a lot of those girls don't
have jobs anymore.
So I think that's what a lot
of those people in that
Facebook group are looking at,
which is like, they're just naysaying it.
Like everybody was naysaying me.
Radio is never going to die.
Really?
Okay.
Well,
I got the numbers to prove that
podcast use has now
surpassed radio use in the
United States for people above twelve.
That's not just adults.
It's above twelve.
Um.
I think PTs are looking at that going,
well,
if this is true that I'm out of a job,
I'm not valuable.
I don't think that's true.
I think you think that all
this is part of the magic
and you're so good at magic
where I think that you need
to be good at another part of this,
which is the human connection.
So the saying was, you know,
AI is not gonna put you out of a job.
Somebody using AI will put
you out of a job.
I came to that and I said, yeah, AI,
somebody using AI is gonna
put ten people out of a job.
And that's where I'm seeing
the real sweet spot here.
So we realized pretty quick
AI isn't taking away the
stuff that needs the actual human.
AI is not going to rub my patients back.
The human is going to rub my
patients back.
But AI is going to do a
thousand times of a better
job doing the evaluation,
processing millions of cases,
collecting the information.
You and I talked about Hinge
and Sword and a lot of
these companies where what
happened was in my best of times,
I'm going to manage twenty
or thirty active patients
in a week that are coming
two or three times a week at my best,
at my peak.
A therapist working for
Hinge or Sword is going to
manage seven hundred
patients because of the way
the system is designed.
Talking about what we've talked about,
if the AI can do the interview,
can collect the case history,
can ask the questions,
can process the information
better than a human, better than me,
the AI with me, now I've got clones of me,
it can ask the questions that I would ask,
it can learn from the way I do things,
even if it's gonna
replicate me in that sense,
it gives me scale,
it allows me to manage,
Hundreds of patients now at the same time.
So the questions that I'm
thinking about with this is,
is this one solution to the
declining workforce?
If we're losing therapists,
we don't have enough
therapists to fill the jobs.
Schools aren't attracting
enough therapists because
the return on investment isn't there.
Can one therapist now do more without,
you know,
the typical expectation of you
got to build more units and
you got to see more people?
You can see more people
because the AI is allowing
you to see more people.
Laws are not going to keep up with AI.
So now the question is,
if I have all of the
information required for the evaluation,
but I'm missing the
face-to-face time that is a
required element of billing
the evaluation,
can I start a plan of care
if all of the other
checkboxes are checked?
Even if I can't bill for that plan of care,
or excuse me, bill for the eval,
If I have all the information,
can the PTA or the other
people start delivering the service?
Because if the evaluation,
if I could do a hundred AI
evaluations in ten minutes, right,
now the cost of an
evaluation drops to virtually zero.
Yeah,
so I don't need the reimbursement for
the evaluation,
but I need the legal
requirement of the evaluation.
So what does the State
Practice Act require for the evaluation?
This opens a whole new line
of thought in potential
opportunity to let the
people that are actually hands-on,
boots on the ground, doing the care,
do it in a different way.
Yeah, I was, uh,
I was playing around with that, uh,
that very question.
But the question was, I was driving,
and I was using AI hands-free.
I was talking to ChachiBT hands-free,
so don't come at me.
And I have conversations,
because instead of listening to a book,
I'm like,
I could have someone who has
read every book answer me
based on the author.
And I was saying,
and I have friends who are cops,
family who are cops,
but a significant portion
of my little village's
income is based on tickets.
And some have been public
and say we have quotas.
So they know that that
police officer is going to
bring in X number or should
be bringing in X number of dollars.
What happens when AI is driving cars?
No more traffic infractions, right?
Because the AI knows to turn
the blinker on or it won't turn.
The AI knows that this is fifty five.
Do not do fifty six.
Yeah.
Now you have traffic cops going.
How many traffic tickets did you write?
Zero.
So AI was I said, listen,
based on the fact that you
know that police officers
and traffic infractions,
it's an income driver.
It got to a point where you
can't erase it because it's I don't know,
making up figures,
but it's enough of a budget
of a town where if you took it away,
we'll collapse.
I'm not anti-government,
but I'm smart enough to
know that the government is very,
very efficient at doing a couple things.
One of them is separating
money from its constituents.
So AI just started extrapolating.
It gave me like,
like a lot of times you
have to prompt AI to give
you more than like five or six ideas.
It gave me like fifteen.
And it was like essentially
like AI usage fees.
It was infractions for what
people are doing in the car,
which I thought was funny.
Like music's too loud.
And I was like, oh my gosh,
now we have to start
policing things that are based on like
activities right um it would
give you well ais or these
cars are driving on our
streets then the usage fees
on the streets would go up
so it would just be a usage
fee they would start
passing that along to the
door dash driver and by say
driver I mean the the ai
agent or whatever that's
driving the car so the
money's gonna come the same
amount of money is gonna
come from somewhere we're
just gonna put a different
label on it so as soon as
you squish this out it's
gonna pop out somewhere
don't worry about it like
they're gonna get their money
They're already thinking
about different ways to do that.
You should be already
thinking about different
ways to do this too,
which is how can you
provide something of value
if the way that you're
providing it now went away tomorrow?
Kids,
a thirteen-year-old used to bike
around my neighborhood and
throw newspapers at people's doors.
And now...
That would be most of the time.
That's absurd.
You get your news from a
website or an email link
sent to you every single morning.
It's insane.
It just changed.
So I would start skating to
where that change actually is.
Yeah, you know,
it's funny you bring that up.
On a morbid fact side,
I remember during COVID,
somebody brought this up.
There were fewer drivers,
fewer car accidents.
I don't remember the exact number,
but it was an unreasonable
amount of number, a financial number.
When a person gets in a car
accident and dies on the road,
somebody had calculated out
how much money that pours
into the system of local government.
I don't remember like
between hospital and
ambulance and all the other stuff.
Um,
It just blew my mind.
I had never thought that
people dying on the road
increased domestic product
for the local government.
One of the ideas on the AI side though,
and this is the stuff that
I talk to my kids about, I'm like, okay,
so we drive virtually the
same routes every day in my neighborhood,
like around the city and
going to baseball practice,
going to school.
My phone is usually plugged
in and sitting on the dash
like a dash cam,
although I'm not recording anything.
And I told Lucas, I'm like,
why hasn't somebody, one,
created an app that follows GPS,
starts tracking the timers
on traffic lights,
and starts getting a
knowledge of understanding
traffic flows so that it
optimizes my speed?
I am happy to drive slower.
If there's a better chance
that I'm going to make the
traffic light and if the
light's running on a sensor
and there's cars ahead of me,
the camera can see that.
So there should be a
predictive algorithm to say, Tony,
if you drive slower,
if you hit forty two right now,
you're not going to have to
hit the brakes.
And then the secondary benefit,
I think this came from Joe Rogan.
One of the main drivers of
air pollution is brake pads wearing down.
So if I need to hit the brakes less,
there's less air pollution.
If, you know,
better economy of scale and I
save gas and I'm like,
I don't think that app exists.
Why doesn't this app exist
out in the wild?
So I was thinking about this, too.
We must think about weird
things like this.
We've just invented trains.
Right.
Because if I'm going from A
to B and I just got in the car,
why wouldn't I?
And now I'm going to be on
that road and I can't pass
this guy because that would
violate speed.
Right.
We're going the same way.
But now our now our cars just link up.
And they're going to go the
same rate and they're going
to slow down or speed up
based on intersections.
Right.
And this is also like why
Americans we love we love
ninety degree turns and red and red,
yellow and green.
But the rest of the world is
like traffic circles.
It's just more efficient.
The traffic never stops.
It just sort of slows down.
We love our ways.
So like I see the types of
roads changing and how
we're and how those things are monitored,
because, yeah, if two of us are coming
Towards a collision.
Right.
If we're coming at ninety
degrees to each other,
we don't have to stop
anymore because the A. I'll be like, OK,
I got it.
I'm going to go because I
couldn't communicate to
Tony if I'm driving next to
him unless I just do this.
Honk, honk, honk, honk, honk.
Like honks just sound negative.
Yeah.
Like that doesn't say
anything unless I'm tapping
it out Morse code.
So now you can now those
cars can talk to each other and say, OK,
we're going to keep this
track because the purpose
is to be the most efficient.
Right now,
the purpose of roads is just be
a road and everyone has to
follow this ridiculous set of rules.
But I have friends who came
from Asia and they're like,
we thought we were a very
neat and orderly society,
but American driving is like, woo,
like you guys have rules.
And if you violate one of those rules,
trust me,
the other drivers are going to
tell you those rules are
going to have to go.
They're going to start to go
away from the humans won't
have to understand those rules as much.
I remember reading a book
when I was in elementary school.
This is in the eighties and
looking at a car design.
where the front passengers, the parents,
their seats swiveled
backwards and they were
playing a board game with their kids.
Like that's not far away, right?
Watching a movie or playing a board game,
you know, whatever.
turning around.
Why do you have to look forwards?
Like will, will, you know,
Dave's got a one-year-old, right?
Will Dave's one-year-old
have a driver's license?
Do you need a license to sit
in a car and have something else drive?
I, I don't think you will.
So we're thinking three or
four or five or ten steps ahead.
I think healthcare providers
have a big upside, but you have like,
I give that monkey bar analogy.
The only way to get ahead on
the monkey bars, right?
You got to reach forward big,
see the future and,
You got to let go.
You have to let go of some things.
And some of those things are
tied to your identity,
where I think that's where
the hesitancy is.
Yeah.
Because we have a couple of
young pilots in the family.
These guys are just getting
out of college.
They're just getting into, you know,
they've got their private.
I don't even know what it is,
but they can fly a private plane.
They can't fly a commercial plane yet.
And I'm talking to them like, guys,
I don't understand this.
If you're in a cockpit.
You're looking at monitors
basically all around you.
Why is there a human pilot
when there's all these laws
and rules and restrictions
against how much you can fly,
when you can fly?
Why not just put a person in
front of a computer that
looks just like a cockpit
and let anyone from
anywhere fly the plane?
And they were like,
I think part of it is the
passengers want a human
that if he dies or if we die, he dies.
But when you look at those
single passenger autonomous
flights that are going like
San Francisco and some of these places,
none of them have pilots.
Like you get in this thing,
it lifts you and flies you
across the river or
wherever you're going.
It's happening now.
Right now, like right now,
these are fully autonomous
passenger flights.
I think it's one to four people.
I just watched the big
interview with four of the
main companies that are doing this.
They've got redundancy and
all of this other stuff.
People don't think of it like an airplane.
So I think they're more willing to do it.
Plus, they're in tech hubs.
So the people there are just, yeah,
they already have autonomous driving.
They already have taxis that
are driving them with no human.
So it's just,
these are the early adopters.
Did you hear how, you know,
you're familiar with Waymo, right?
Yeah.
Did you hear what they did
when they were going to do a beta test in,
I forget what city, probably somewhere,
I'm out in California,
probably somewhere out in California.
The first thing they did,
it's a brilliant PR move.
They understood the problem.
They had the Waymo cars
driving around without
anybody in them for six months.
OK, because they were going to ask people,
these people, these people,
that person here to
eventually get in them and ride in them.
So they let them watch them from afar.
If you were going to have
your kid pet a dog for the
kid had never seen a dog.
I don't think you run your
kid right up to the dog.
Maybe you would.
And maybe that kid would
have a fear of dogs.
I think the smart people
would let the kid watch the
dog from across the room.
First time,
like you can't understand that.
what it's like to see a dog
for the first time when
you've seen a dog your entire life.
You have the curse of knowledge.
But looking at a three-year-old,
it's hairy, and I've seen dogs on TV,
but Bluey does not look
like that because Bluey is a cartoon,
right?
But seeing it in real life
is also real different.
So Waymo was smart enough to say,
we're going to let these
cars just drive around town.
and be there and people and
of course you believe me
when you when you drive
next to a car with the
steering wall on the other
side you notice yes that's
really because it's pattern
interruption it's a purple
cow it's one two one two
wait a minute two one that
doesn't make any sense so
people were noticing these
driverless cars for months
and then they started
taking passengers and it
was less of a leap
Right.
A leap from what we know to
what is completely new is a giant leap.
They just moved.
They made the leap smaller
and people it it it went smoother.
I bet you if they did that
beta test in a different
town and went from we're
legally allowed to take
drivers and riders and
we're taking riders,
there would have been a lot
more of this friction.
I would actually love if
they could test that
because I think that would
be a great way to prove the concept.
But I saw that on Sixty
Minutes or something and
thought it was brilliant.
Yeah, yeah.
So let's wrap up the show.
Let's bring it full circle.
You know,
when we were talking about cars
and turning cars
effectively into a virtual
train with virtual connections,
it reminded me,
I had mentioned nature earlier,
like how ants,
we have leaf cutter ants at
the Cincinnati Zoo and you
see these leaf cutter ants
just going in like synchronicity.
How do we bring some of
these concepts back into patient care?
I think going from in-person
straight to telehealth is
too big of a leap for a lot of people.
So that's where you're like,
you start to introduce telehealth,
even from the respect of, okay,
I send the human physical
therapist assistant to the
house and I'm there through the phone.
And then eventually I start
to step back from the phone
until I'm not even,
or the human is not there
as much and we initiate the calls.
I think it could be done and
just like this we have
telephone calls
supplemented with the AI
agent and then eventually
the AI agent just
completely takes over the
telephone call which then
eventually completely takes
over the patient history
gathering which then takes
over the full evaluation.
I think inch by inch,
we're going to get there.
And I think that's going to
be the solution to not
having enough therapists,
not having enough students
going into the DPT programs.
We have to be able to do
this without the therapist
feeling like we're taking
away more of their independence.
They still have to feel like
they play a role,
even though they probably
don't do as much as they think they do.
That's my parting shot.
What you got?
What is your parting shot?
I feel like therapists don't
do as much as they think they do.
We need to start to bring
these AI agents into our
day-to-day operation,
even if it's done subtly,
until all of a sudden we
realize it's doing way more
than we ever thought it would do.
I would say...
You can, you can do any,
you can do a lot of things.
You can.
I think even if you're
saying you're sitting there and you're,
let's say you're on the far
left of the bell curve.
You're like, I'm never going to use AI.
It's just, I don't love it.
I hate it.
It's going to replace humans.
And I'm all about humans.
Good.
Understanding its
capabilities and then
doubling down the things
that you think will take it
the longest to get to.
right?
It's going to permeate in healthcare,
in business, in remember movie phone?
It used to be like a directory,
a phone directory to find
out what movies and book your tickets.
But you can do a lot of things.
Number one, staying right where you are.
You can do that.
You can.
I would not recommend it.
There are still horse-drawn
buggies in New York.
There are,
but they're the exception at the
rule because they're the last one.
Now they're cute,
but they're not functional, right?
I mean,
they're functional for what they are.
I would say paying attention
to what AI can do simply
and then how does it work
you out of the business?
Start with the stuff you hate doing,
right?
I've got
I've got a bunch of things
in the background that I do that I'm like,
I hate doing this.
I hope that I hope to tell me,
figure out what to pack to
come on this trip.
And what time to leave to
get to the airport efficiently?
Because I hate thinking about that.
So I didn't.
I didn't have to.
Some people are saying it's
going to create dumb humans.
And I'm like, I don't know, man.
I sat there and had that
conversation about how
municipalities will make
money when no one's getting
traffic tickets anymore.
I liked to do that higher level idea.
So AI, you can do a lot of things.
So could AI find out what
those things cross and where they don't.
And I would spend a lot of
times where they don't,
at least right now.
We're back on Tuesday.
Dave will probably be back on Tuesday.
Tony, have yourself a good week.
I'm going to hang out here
on the left coast.
I'm going to go to an
In-N-Out burger because
people have been talking so
much smack about it.
I'll let you know on Thursday.
Animal style, baby.
Animal style.
I'll do animal style,
and I'll let you know if
the juice is worth the squeeze.
All right.
See you.
We'll see you on Thursday, guys.
Thanks.