Hey guys,
welcome back to PT Breakfast Club.
There's the AI generated yetis.
Good morning.
I'm back.
I missed you guys.
And we're back.
How were your travels?
Travels were great.
Did some family stuff in Oklahoma.
And then did some work stuff in Roanoke,
Virginia, which someone asked me, hey,
have you ever been to Roanoke before?
And I said, absolutely not.
And then I walked into the hotel we
were having the conference in.
I was like, oh,
I've been in this hotel.
So that's when you know you maybe travel
a lot.
And you can't remember being in the hotel
that you are currently in,
in the city that you thought you'd never
been to.
But I've been there.
Yeah, for a wedding.
Very nice.
Yeah.
All right.
So this came across in the group chat
just a couple of days ago.
An article out of California.
I feel like there's a lot of things
going on in California these days.
And a court ruled saying that nurses...
And I guess effectively they're they're
they're issuing the ruling for health care
providers at large.
But in this specific case,
the ruling came that said nurses can't be
called doctor in California,
even if they have a doctoral degree.
The federal judge ruled that the nurses
with doctorates in California can't
actually use the title because it could be
confusing.
They cited doctors.
a survey from the AMA showing that thirty
nine percent of patients mistakenly
believe that DNPs are physicians.
I will say that survey is from the
AMA,
which is completely comprised of
physicians.
So, I mean, we bring this up.
We don't really talk a lot about nurse
practitioners here,
but obviously the parallels between the
physical therapy profession and the
decision there are pretty, pretty close.
Where where are your thoughts on this
issue?
This comes up everywhere.
This comes up as a trend every once
in a while and then goes away.
Let's just throw out a few, I think,
potential facts before we get into our
opinions.
So the DNP, the degree,
correct me if I'm wrong, the DNP.
So is it a doctor of nurse practitioner
that is the degree?
I believe so.
Okay.
So the degree has doctor in it.
It has the word D-O-C-T-O-R.
It has the word doctor in it.
Correct.
Doctor of nursing practice.
Correct.
Right, right.
Same thing with us.
I'm looking at my degree right here.
Doctor of Physical Therapy.
It doesn't say Master of Physical Therapy.
It doesn't say Bachelors, Associates,
whatever.
So if it's in the degree,
And the physical therapist,
or in this case, the nurse practitioner,
assuming neither of them are suggesting
that they are a physician,
none of them are saying I am a
physician the way that some of the
chiropractors are saying I'm a
chiropractic physician,
which is maybe a little bit of a
sidebar.
If the degree has the word doctor in
it, I don't see the problem here.
So I was asking chat GPT yesterday,
you know, hey,
what are some current affairs that might
impact the PT profession and give me some
ideas for tomorrow's podcast?
This article came up,
then I asked further, I said,
and I remember the origins of this,
which I'll bring up in a second.
I said,
is this going to affect all allied health
care?
Also, is it just for nurses?
And Chad GPT's impression was it was
pretty much just in California,
just nurses, and more specifically,
just in clinical settings.
And it was referencing like, look,
if you're in a hospital,
there are people coming in and out of
the room constantly.
If everybody is calling themselves doctor
because that's what their degree is in,
then you don't know who the medical doctor
is,
who the MD is or the DO or
whatever the internist is.
So there were some guidelines around.
It's not that you can't say you don't
have a doctorate degree.
You can't say I'm a doctor of nursing
or physical therapy or whatever.
It is kind of in very specific settings.
But this goes back, and I remember this.
There was a nurse who called herself
doctor because she had a doctorate degree
on social media who ended up getting into,
I think,
legal and financial issues and
Every time any of us see somebody making
crazy claims on social media,
we're always like, you know, who is this?
What is this?
What are the credentials?
Is it a chiropractor?
Is it a medical doctor?
Whatever.
And I, for one,
as a consumer of media,
I want to know who's the crazy I'm
listening to at this moment.
Yeah.
Just because you have an MD after your
name doesn't mean you're not crazy.
It just gives me some perspective on what
kind of crazy you are.
Right.
So I totally get it.
Now, you, Dave,
can probably make the best arguments here
because I don't have a DPT and I
don't think Jimmy has a DPT.
I don't I don't I didn't know that
Dave had a DPT because you never mention
it.
But that being said,
there are some specifics around it.
Yes,
we've had therapists and I've never
stopped anyone from saying, hey,
my name is, you know.
X, Y, Z,
I'm a doctor of physical therapy.
That's fine.
And we've had patients that appreciated
that they were working with a doctorate
level individual.
But I will also say,
and then I'll turn it over.
I've also had patients that they were
like, oh,
how many weeks does it take to become
a physical therapist?
And then I tell them I was a
personal trainer before I became a
physical therapist.
And they're like, what?
You're a personal trainer?
That's amazing.
And they go crazy for it.
So, you know, it's marketing,
it's branding.
At the end of the day,
it's just a label that could mean a
lot or it could mean nothing.
Jimmy, what are you thinking?
Well, Dr. McKay, actually,
I do have the doctorate because I
graduated in twenty sixteen when it was
mandatory.
Do I?
How do I not know both of you
guys have a doctorate degree?
Because we don't talk about it because.
While I was in school and I graduated
in twenty sixteen,
I heard from the social media audience
that it was imperative that the only way
we're ever going to gain respect
was to use that title ad nauseum.
And then I heard in the classroom from
my professors at Marymount University,
they were named Sky and Julie,
and they had PhDs.
Like my professor Sky has a PhD in
biochemistry.
Like that's Dr. Jones or Dr.
Dre territory.
That's different types of doctors there.
But they were very, very...
insistent that we call them by their names
and they you know if you so if
you wanted so we have to go with
words and i love me some words so
number one doctoring isn't a job physician
is right so like there's the disconnect so
all of a sudden we've gone kleenex and
cadillac on the title doctor now do i
think a media campaign is going to change
public perception of if someone says my
kid just graduated from college she's a
doctor
we tend to assume that that person is
in fact a physician.
I get that.
That's what I would assume, right?
But no one has any problem when Short
Round says, no time for love, Dr. Jones.
And he's referring to Dr. Indiana Jones,
who is an archaeologist, right?
So it's funny because in some places,
like Dr. Dre or Dr. Seuss or Dr.
Ruth Westheimer,
we've got a list of doctors everywhere,
right?
For some reason,
it's OK in some contexts and not in
the other.
And again,
I am in favor of communicating clearly so
I can see where someone saying, hey,
thirty nine percent of patients polled no
data on how many people were actually
polled or in what settings or what
questions they were asked were confused.
So that's why.
APTA goes out of their way to actually
message, I am Dr. Johnson,
your physical therapist.
Make sure you qualify what you're actually
a doctor of.
Do I think it's confusing?
I don't know.
Yeah, a little bit.
Do I think it's necessary?
I don't know if it always is.
If someone asks what your qualifications
are,
Tony just mentioned someone got super
excited because they found out he's a
physical therapist and he was a personal
trainer before that.
I think the person is always listening to
see how this person, Tony,
or whoever's in front of them,
how is what they know going to help
me?
And I'll close with that famous quote.
I think it was Eleanor Roosevelt says,
no one cares how much you know until
they know how much you care.
Neither of those things are true.
They don't care how much you know.
They don't really care how much you care.
They care,
do you understand what problem I have?
And are you capable of helping me solve
it?
I understand how using that title doctor
can give you a little puff out your
chest a little bit and say like, oh,
I have advanced qualifications.
So I get that.
But you shouldn't sacrifice quality for
clarity in certain situations.
So I think it's nuanced.
I think this conversation is going to come
up over and over again,
and it's never going to get solved.
The example of a hospital room where
there's providers coming in and out and
the patient or the family not knowing who
the medical doctor is, the actual MD is,
is ridiculous.
Because in every hospital,
a PA that walks in the room,
in a hospital,
and also where I used to work,
my first job was a physician in practice,
outpatient ortho,
and those PAs also wore white coats.
They looked exactly like the physicians.
So even though I just looked up that
the AMA, the American Medical Association,
was not
a part of any of this nurse practitioner
expansion programs and all that.
So they've generally been opposed to all
this the whole time across the country
anyway.
I thought that they were a part of
it.
I looked it up.
As we were talking in ChatGPT,
they've always been generally opposed to
it.
So then why do physicians allow PAs that
are under the guidance of those physicians
to walk in a room with a white
coat on, and I know this for years,
where the patient will say, oh, hey,
doctor so-and-so, hey,
and the PAs do not correct the patient,
the family.
They do not say, oh, I'm a PA,
I'm Steve, not Dr. Kelly, or whatever,
right?
Like, I'm Steve, I'm the PA for,
they don't correct them.
Just like in physical therapy,
the PTAs do not really typically,
in my experience,
They don't correct patients when a patient
calls them their therapist or the patient
calls the PTA, that's my PT.
I don't know how it is in Tony's
office,
but in all the offices I've ever been,
patients do not know the difference
between a PT and a PTA for the
most part.
And so it's just the way it is,
whether it's the physician,
the MD and the PA,
or it's an NP or a nurse practitioner.
And also, by the way, the sidebar,
nurse practitioners and DNPs and DNPs,
I'm pretty sure both,
but definitely the doctor, the DNP,
I'm pretty sure both though can prescribe
medication.
So also like they can prescribe
medication.
So who cares about the doctor label?
They're doing some major role in the
healthcare system that physicians also do.
That takes a lot of training and
understanding and you have to know
pharmacology and all, you know,
side effects and contraindications and all
that.
So it's like,
Who cares?
Because the physicians allow the PAs to
look exactly like themselves too.
I'll tell you who cares.
Well, two sides.
The practitioner,
because we are hierarchical in this world,
right?
Yep.
It's just ego.
It's just ego and status.
Yeah, that's it.
It is not about protecting the consumers
at all.
It's not.
But from the consumer perspective,
I'll tell you,
because I've gone through the health care
system, not a lot with myself.
I've been relatively healthy up to this
point with my parents, though.
The question is always like,
are we getting the doctor or are we
getting there?
Like, are we getting the second one?
Are we like,
are they just in their office?
So it's not a knock on the person
in front of you, but it's like,
why am I not getting the person?
Because if there's an error,
I'm going to go back to this moment
as the fork in the road and go,
why didn't I have that other person in
front of me?
I'm paying the same rate, right?
Wouldn't you be pissed?
It might not be the same rate.
I don't know.
If you didn't get the mechanic,
but you got the mechanic's assistant who
went through five hundred hours of
training and not ten thousand hours of
training and something goes wrong with
your car and you crash, you'll be like,
we didn't get the assistant.
That's where the thing was.
So I think that that's the thing for
me.
Both my parents like who when the person
would come in, give their spiel and leave.
Is that who who is that?
What's their qualifications?
There's unclarity there.
And the title doesn't clear it up.
That's a problem for me.
I won't say that's the problem,
but that's a problem.
We want to understand.
Look, now more than ever,
who am I taking advice from?
Well,
there's a guy giving advice on medication
right now that, as far as I know,
has no minutes worth of medical training
but a very large podium and just told
a bunch of people that nothing bad can
happen.
Only good can happen.
And he's not Yoda.
He's the president of the country.
giving medical advice.
And we're saying, okay,
well that sounds legit.
That is a scary thing to happen.
Going back to one of the things that
Dave said about like,
I remember this conversation happening
years ago, you know,
physical therapist assistant in the
hospital based outpatient,
either they weren't wearing their name
badge or their name badge was always
flipped over and
I mean, the reality is,
I'll take this in two directions.
From the sales and marketing perspective,
why don't they correct the patient when
the patient says doctor or therapist or
whatever?
Because you get better buy-in with some
patients.
So you're going to leverage the name.
You're going to leverage that with the
people who care about it.
And there are people who care about it.
Like Jimmy said,
there are people who want the doctor,
the medical doctor.
I'm going to say...
Yes, they're here in my clinic.
I don't want differentiation between me
and my assistant.
Why don't I want differentiation between
me and my assistant?
Why don't I think it even matters?
Because the reality is what is being
delivered,
the service that is being delivered,
my assistant is equally qualified,
equally educated,
equally licensed to deliver the
intervention.
After your evaluation?
I'm not going to say that he is
the therapist doing an evaluation because
he is not licensed to do an evaluation.
There's going to be differentiation when
it's a physical therapy evaluation.
But when we take it to treatment,
delivery of the intervention,
he is equal to me in all capacities
relative to education, licensure,
experience, all of that kind of stuff.
So it doesn't help him do his job
any better if the patient thinks, oh,
I'm getting a lesser person.
And this goes to Jimmy's point,
where the PA or the medical doctor,
in what they're actually doing at the
moment,
they are probably equally trained and
equally qualified to deliver that.
So I do think that we're dealing with
an uneducated population in the
terminology of
Um, so of course, like, shoot,
if I could get a premium, you know,
the highest expert in the land to paint
my bathroom, I've said this before,
like Pablo Picasso could come paint my
bathroom or I could get John down the
street.
Both of them are equally qualified to
paint a bathroom,
but I can't get John to paint,
you know,
a masterpiece that's going to hang in a
museum.
Like these are different things.
But you do bring up a point,
which is actually the reverse,
which is a lot of times you're so
educated,
you've gone so far up the ladder,
you're so removed from doing the everyday
tasks that a lot of times John the
painter is better.
Because Picasso's over here whining and
dining people to get in the Louvre.
I don't know if he was ever in
the Louvre,
but John's the guy doing the thing.
So it might actually be reversed.
You're looking for that person with the
qualifications,
but they've spent so much time in
classrooms getting the qualifications.
Maybe they're not doing stitches.
So the PA next to you is actually
the best person.
But we are stuck on those labels
because...
That's the only thing we can,
that's the only star we can check off.
There's no other thing to Yelp people
about, right?
It's just, well,
what are your letters after your name?
Which goes back to why we chase letters
after our name, because we're big,
dumb animals.
I mean, another major PT organization,
which surfaced,
and if memory serves me right,
they were all about advocacy,
are now releasing their own continuing
education units.
Oh, boy.
Are you serious?
Guys, the carousel does two things.
The carousel does two things.
It goes up, down, round, and round.
This is all the same thing.
This is my shocked face.
We knew this was coming.
You knew this was coming.
A little bit of a quick story.
A week or two ago,
we took our son.
He's fine,
but we took him to a local urgent
care.
And one of the so the first person
that came in announced themselves as like
the medical assistant.
So, you know,
like some subjective questions and,
you know,
like height and weight or whatever,
like that type of stuff.
Then a provider comes in.
It says the provider didn't announce,
like they kind of mumbled their name.
I was like,
I think that was the first name,
but it was just like one name.
It'd be like Dave or, you know, Kittle.
I don't know.
She like mumbled her name.
She mumbled her first or last name,
but just one word and did like,
you know, looking in his mouth,
looking in his ears and like kind of
like an exam.
Great.
Awesome.
Like that's and then I know we've talked
about this other times,
like I'm just there for.
I don't really care if it's a physician
or an NP or a DNP or whatever,
or I don't know,
a nurse or a PA.
We don't know.
I don't know who it is.
And the badge says the woman's first and
last name and it says provider.
And I'm like, that's a weird,
I hate that title, but keep going.
Yeah, I know.
Right.
So because I'm in health care and then
I'm like, I asked it anyway,
but I know I'm like this.
This woman's probably going to get
offended because like it's I'm a male and
she's a woman and I'm and I'm I'm
nice.
I'm not challenging what she is,
but it's kind of like your company should
have.
the NP or PA or MD,
just put a couple of those letters there.
I'm just curious.
I'm just curious who's looking in my son's
ears.
I just want to know, hey,
this is awesome.
Great.
There was no wait.
It was a Saturday.
This is awesome.
You guys are places clean.
Wonderful.
Everyone's smiling.
I had no problems at all.
I was just curious.
I was like, hey,
are you one of the physicians here or
PA or NP or RN?
And she said a PA.
But she held up her badge like,
it's right here.
And I'm like, no, it's not right there.
It says provider.
But I didn't say that.
But I was kind of like,
I don't know.
It's just like another ridiculous aspect
of health care.
Or at least this company.
Why have provider on there?
Is that, again, so that maybe,
like Tony said,
patients don't ask for the physician or
the DNP or whatever.
And it's the PA or an RN or
someone that's coming in to do that.
lot of basic stuff i'd say that's more
misleading than anything i mean right i
mean exactly exactly the front desk can
provide some things i mean we all provide
i i get the provider payer sort of
conversation that shouldn't be in an exam
room that's a weird weird use of words
there and she held up her badge like
almost like it's right here mister and i'm
like no it's not there it says provider
that could be anything
So Ryder could be an RN or whatever.
I think we agree this is never going
to end.
This will just, again, carousel.
So let me pose this question to you
guys.
Will this spread?
Will the DNP, so two questions.
Will the NPDNP being barred,
will it happen in other states?
One first question.
And then will it eventually trickle over
to PT and be barred in California or
some other states?
Um.
Using doctor, if you're not a physician.
It's funny because when I read this
article,
they were framing this under a First
Amendment issue, which First Amendment,
getting a lot of press these days.
It's every couple of years,
the First Amendment.
So what they're really doing is they're
framing this as commercial speech versus
First Amendment protected speech.
So let's be very clear.
If it's commercial speech,
it's not protected under the First
Amendment.
So that's where I don't think it will
gain legs.
I don't know if it'll,
I don't think it'll spread to another
state.
And I don't think it'll spread to other
professions only because there's no money
in it.
Like,
I don't see someone like getting all in
a tizzy, unless it's the AMA,
which did not start this,
unless it was the AMA,
which to my knowledge,
according to this article,
weren't the ones who initiated this.
I don't know why it wouldn't gain traction
because, you know,
if you paid hundreds of thousands of
dollars for those letters,
you want to protect those letters.
This irony in this,
as we saw from Lifetime Family Fitness,
we can't even protect DPT.
I could be a dynamic personal trainer
tomorrow.
There's no lawsuits have been won.
Nobody has stopped using those letters
like DPT.
So, I mean, this just goes back to,
I understand the desire to know who am
I talking to?
Who am I listening to?
Where is this information coming from as a
consumer?
I understand the desire to protect your
credential as a person who paid six
figures for it.
Hey,
I bought this just because it's two
letters.
I don't want anybody else to use it.
So I can see it on all fronts,
but then it still goes back to,
society and language,
it's constantly changing,
constantly evolving, you know,
so at some point,
it's just going to be worthless to have
those letters or to use that word or
to do any of that stuff.
So, you know,
the reason why it's still a topic is
because there's still probably some
inherent value,
whether it's the university selling the
doctorate,
they want to protect the value of that
six figure education and label.
Or it's, you know,
the business selling the impression of
expertise to the consumer.
And again,
I say the impression because we all know
plenty of doctorate level professionals
who are not experts in any way.
You know,
either they've been in it too long or
they haven't been in it long enough.
But there's plenty of craziness and stuff
going on out there.
Yeah, this is about money and ego.
I mean, Lizette.
summarize that's a little bit of a long
long comment but can we admit this is
all about money and md fears i want
to make sure i have my i it's
just ego and status you know respectfully
we all know physicians we know we all
know many of them i have many you
know physician buddies and friends uh
some physicians that were like,
I'm actually on first name basis with like
in the area.
So that's, that's pretty quiet.
I thought that was like refreshing.
Um, but yeah,
and not all of them are like this,
but there is like the whole God complex
and you know, that, you know,
they are at the highest point of the
hierarchy, Jimmy, like you said.
So, um,
Yeah, but again, just to recap,
these nurses in this article in
California, as far as we know,
they're not telling patients that I'm your
MD.
They're not telling patients I'm your
medical doctor.
They're saying I am Dr. Smith.
I'm Dr. Johnson.
So, and I agree, Tony, like,
I'm Dr. Kittle, your physical therapist.
When I text patients, I use Dr.
Dave Kittle.
When I email them on my business cards,
on my website, Tony,
that means you haven't looked at my
website, on the About Us page,
all of my therapists are listed as doctor
if they have a doctorate.
But it says doctor of physical therapy.
Nowhere on any of our correspondence or
anything, anywhere ever,
are we saying physician, doctor,
chiropractic physician whatever that is uh
we're not saying md we're not saying
medical doctor we're not saying medical
school nothing nothing to you know it's
very clear delineation yeah clarity should
be king i i am a little bit
irked about the grammar of doctor of
chiropractic
it feels like there should be a word
after that, like chiropractic,
something doctor of chiropractic is a
title.
And I'm like,
that's why they call themselves car.
Some say chiropractic physicians.
Yeah, that I'm sorry, but that,
that one feels like it's,
is it the state that determines if they
use the label physician?
Most likely.
I think so.
So that's why I think it's interesting
that this started in California.
It could be a sign that they're trying
to,
because I think if you can get traction
in California, New York, Florida,
I think you might be able to challenge
this other places.
But did it say in the article who
initiated this?
I don't know.
It just said a federal judge has ruled
that.
I would want to know who actually
initiated this.
I'm sure the AMA dropped off a briefcase
of cash to this judge.
I'm half joking, half serious.
These days, you never know.
You can't track cash.
Maybe there's barcode numbers or whatever,
but
So let me pivot just a little bit.
I had an interesting experience yesterday.
Longtime patient.
This was an individual.
I've probably worked with this individual,
let's say a decade now, on and off.
This individual has ties to my family.
We've known each other since before this
person needed physical therapy.
This particular individual is on a
Medicare Advantage plan and had a twenty
visit limit for the calendar year.
That's horrible.
Had a procedure, had a procedure,
came to us.
We did physical therapy,
utilized the twenty visits.
This individual continues to need therapy
services.
So we invited this person to our non
cover or non covered maintenance program.
Some people would call it a wellness
program.
We're like, look, hundred dollars a month.
You come in twice a week.
You have access to all of the equipment.
You have access to us.
We'll make sure you're doing everything
right.
And, you know,
this was an affordable alternative option
for this individual.
It's not a money driver for us.
We make a little bit of money.
It's fine.
But it's more just to keep engagement,
keep the community coming.
You know,
somebody who has made the effort to get
in their car and drive to our clinic.
I'm never going to say you can't come
because you can't afford it or your
insurance doesn't cover it or whatever.
So this is something we offer a lot
of post discharge patients.
I got a call yesterday.
This person was so upset and I understand
it.
This person was like, Tony, I'm so sorry.
My doctor said I have to go to
their therapy.
This was a local hospital doctor and
they're like,
you need therapy for this other condition
and you have to come to us.
I'm like, hey, that's totally fine.
I totally get it.
Listen, it's really not a big deal.
I think it's great for patients to see
other therapists.
I'm sure those therapists are going to be
great.
I said,
but I want you to understand you've
exhausted your twenty visit limit for the
calendar year.
It's a hospital based outpatient clinic.
You are going to be charged two to
three hundred dollars a session.
She was like, I totally get it.
I know.
But I feel like there's nothing I can
do.
I was like, you always have a choice.
You're free to choose.
But I totally understand the pressure.
Listen, don't worry about it.
But I'm just curious.
So what are they doing there?
Well, you know,
the therapist had me sucking in.
Yeah.
What was the first thing you said?
The therapist had me sucking in my tummy
and pumping my ankle and lifting my leg
and bending over,
but it really hurt when I did it,
but I did it anyway.
And so in my mind, obviously I'm thinking,
you know, okay,
she's getting the standard of care.
Like she's not getting what the standard
of care would consider bad therapy.
It's what everybody's going to do.
She's going to walk away with thousands of
dollars in, you know, bills.
She could come to us here.
She was doing all sorts of, you know,
function based.
I've got videos,
published videos of her getting on the
floor, getting off the floor,
doing functional transfers.
There's a whole bunch of stuff.
But I'm just like, once again,
we talk about the power of, you know,
influence.
Whoever the medical doctor is,
I don't know.
I have no connection to this physician.
But I'm like, one thing is said,
likely because they're being pressured by
upper management to keep all the referrals
in-house.
And now potentially this individual is
going to have five years,
ten years of medical bills that are
probably never going to get paid.
Because they have access to me,
but they're not,
they think they can't come to me for
a hundred bucks a month and they're going
to go to this hospital outpatient clinic
where the therapist probably has no idea
they're charging three hundred dollars a
session.
You know,
any thoughts on that whole kind of
experience?
It's a wrecking ball.
How do we change it?
How do we stop it?
How do we make it better?
Well,
one thing that I think you floated to
her,
you kind of said that you always have
choice.
Yeah.
I think you said to her directly,
it sounds like you said to her directly,
you don't have to go there.
You can come to our clinic.
You can go to some other place down
the road.
You have choice.
But she's trusting and believing in the
MD, the medical doctor here,
the main physician.
They're saying you have this other
condition.
You need this treated immediately.
and you have to go to this hospital-based
practice that is i don't say it's not
fraud what i mean it's wrong it's the
physician the patient has choice the
healthcare consumer has choice they can go
anywhere they want to go they can go
to a household-based clinic and you know
rack up that bill of five grand or
whatever if they want to of their own
volition this doesn't sound like it was
under her own volition it sounded like she
was pressured to do so which is ridiculous
I mean, the thing is,
you look at the most influential people.
Now,
I think we probably have a different
perspective on anyone in healthcare.
I fully admit it.
I am biased.
You, Dave Kittle,
who I respect implicitly,
come to me and say, Tony,
you should be doing this.
I'm generally going to disagree.
My immediate response is,
Dave's probably wrong.
Dave doesn't understand.
He doesn't know my context.
He doesn't know what's going on.
I'm always going to go against anyone in
authority who tells me to do something
just because that's my nature.
I'm always going to second guess what you
say until you prove that I am wrong
in second guessing you.
But so many of our patients are like,
look, my priest and my doctor,
that's who I listen to, like nobody else.
And so even with our history of over
a decade of working together and family
connections and knowing each other,
the doctor said, do this.
There is no way this person is not
going to do it,
even if it's to their detriment,
even if she gets worse,
even if she has a negative experience,
a negative outcome and wastes a ton of
money.
she cannot go back in her mind to
that doctor and say,
I didn't listen to you.
We don't realize the impact and the power
that physicians,
but even we at a certain level,
have over these individuals.
And it's scary.
I mean, it's shockingly scary.
I know I have told people things off
the cuff that I thought had zero value.
And they come back and tell me how
impactful that was.
And it blew my mind.
Yeah.
How would you fix it?
If you were in charge and you could,
and you can wave a magic wand,
I have an idea,
but I want to hear from you guys.
Well, how would you fix it?
Dave, any ideas?
I have no idea.
I'm out of ideas.
I, I was going to say, I don't,
I don't know how to fix it.
I think it's extremely challenging because
a lot of the individuals that Tony is
referring to, like, it's not, it's,
it's not, it's not, it's not, it's not,
it
the more likely they are to like just
just bow and listen and do whatever the
physician says, regardless, like,
you know, Oh, I need,
I need a new statin.
I, you know, I got,
I need a new stat and I got
to get it on a new stat and
like, like no pushback, no research, no,
let me try to change my diet and
exercise.
And let me, you know, just, just like,
I will do that.
Like,
it's very robotic for the older
population.
And I think the opposite for the twenty,
thirty year olds,
forty year olds that are like questioning.
So they're like, Tony, you know, Tony's a,
uh you know a little bit a little
bit older than that but tony still has
like that younger mindset of like uh
questioning and pushing back and i'm the
same way and so i don't know if
there's any way to change it but the
younger population the younger generation
now will continue to be that way they're
going to question things they're going to
do research they're going to ask friends
and colleagues and do you maybe do you
know a physician or a physical therapist
to speak with and there's just more
I don't know if it's because of social
media or the internet or YouTube or just
available information that's readily
accessible anywhere.
The younger population is more likely to
challenge things,
even push back a little bit or do
some other research before they make a
decision.
Whereas someone who's sixty, seventy,
eighty,
ninety is not going to do any of
that stuff.
It's just like, oh, I heard it.
I heard this.
This is it.
I'm taking it basically as gospel and
there is no pushback.
Yeah,
the example that I thought of is I
just got a new car a couple months
ago, and it's really cool on the inside.
Looks really slick.
It's Toyota Camry hybrid,
in case you guys were wondering.
But I'm not much of an aesthetic guy,
but there's part of the inside of that
car that is absolutely ruined.
And it's the part of the visor that
shows.
And there's a warning on it.
It's not a sticker.
I can't pull it off.
Like I saw the warning.
God, I can't pull it.
It is painted on there.
I have no idea what it's even about.
Probably airbags or wear your seatbelt or
I don't know.
But it's printed on there.
Do you, Tony,
have to have signs posted in the break
room at your clinic?
Things about like FMLA or FSLA or EEO?
Yeah,
I'm looking across it right in front of
me right now.
And there's all these Ohio Labor signs.
federal posting requirements all this
garbage so if this really was an issue
if this was important like so it sounds
like if i get a referral from the
hospital i just have to go to the
outpatient i don't they said go talk to
karen down the hall and you just feel
like you're ushered down the hall i feel
like you should have to be given a
yellow piece of paper that says like stop
These are your rights.
And I know hospitals give you – probably
they participate in a little bit of what's
called malicious compliance, right?
Well, I have to give you some paperwork.
So I'm going to give you seventy-two pages
of paperwork.
So I'm going to dilute everything that you
have to do.
But if we said you have to post
this poster,
this has to be handed in card form
to every single person you're going to
give a referral to to –
the Ten Commandments of your rights as a
patient,
you do not have to actually go to
where this place is.
You can, but you don't have to.
If it was that big of a problem,
that's the thing I would march to
Washington and say,
if I were a profession,
we're getting smoked.
I mean, Tony's idea the other day was,
you know what?
Just let them have it.
Let them have that.
We'll do everything else, right?
I understand that.
Like...
never retreat, never leave a man behind.
Well, no, sometimes they leave men behind.
Sometimes you retreat to fight another day
or this isn't the hill I want to
die on.
So if this was actually important,
either do something about it big enough to
make change or don't.
So that would be my simple but not
easy solution,
which is you have someone's going to write
that letter of the law and it has
to be handed out.
And if not, there's a fine.
There's got to be some sort of
consequences for not doing it.
I'm going to go a different direction,
but real quick, Ray's here,
Stephen's here,
Will Boyd was here earlier.
Okay,
I'm going to go a different direction,
though, because like you just said,
you have that massive warning over your
visor.
You don't even know what it says.
I've got employment records on the wall.
Nobody who works for me knows what they
are.
Going to the government once again to
protect, you know, it never works.
It never works.
The same doctor, I would bet,
the same doctor who said you have to
go to our physical therapy clinic probably
said you shouldn't eat McDonald's,
and yet the consumer will continue to eat
McDonald's.
Shout out to my McCafe, right?
It's not about forcing people to do
something.
It's about...
finding the motivation that makes them
choose to do what they want to do
ultimately.
Why is she going to therapy there?
Not because she wants to go to therapy
there,
not because the doctor is forcing her as
much as she wants to please the doctor.
There is an inherent,
I want to get affirmation from you,
doctor,
to tell me that I'm doing the right
thing.
So I think the way you change that
is direct-to-consumer marketing.
This is where you get the messaging in
hand.
Again,
you sacrifice the label of physical
therapy, which who even cares anymore?
Those words have very little value in
today's market,
especially if we're talking outpatient
orthopedic.
And we pivot to what are the things
these consumers are buying anyway?
What are the things that they want?
What are the things that they desire?
Let's bring that out.
Let's develop and harness that.
And then I think it doesn't matter what
the doctor says.
It doesn't matter if they're going to
therapy at the other place.
I've had plenty of patients that go to
therapy at one place and then come to
me because they want what I have.
They know that I can make them feel
good.
You know,
and so I don't think government
intervention is going to do anything to
fix a problem like that.
The law already exists that you have to
give patients choice.
They don't do it.
There's all these laws on the books that
are pretty much useless.
I think you have to get the patient
to want to come to you,
whether however you do that.
But I think it's marketing.
The handout, Jimmy, I love the idea,
but also the incentives and the money with
these health systems,
with these hospital systems and the AMA,
the American Medical Association,
like all that in terms of, I mean,
they would just block it.
They would just block it,
like to make that,
they would figure out ways to have
lobbying and just block that.
I mean, that would be a great start.
But then to push back a little bit
on Tony's thing, like,
Yes,
there are some of those patients that want
to just please the physician.
They want to do whatever they say.
But again,
that's kind of what I was saying.
Many of them,
that's just the way they've been raised.
And that's what their parents did and
their parents did.
And that's just the way it has always
been.
And so, yeah, overall,
at the end of the day,
I think it's a shame.
It's a shame that these physicians...
are not being clear and truthful to these
patients and saying that you actually have
choice you can go to our physician-owned
practice or our hospital-based practice
that's you know right here attached to our
hospital or you can also go to total
therapy solutions down the road and you
know also have a great experience and
they'll take your insurance unless you use
your
twenty Medicare Advantage plans and visits
for the year, then, you know, whatever.
So, I don't know.
It's just a shame that when there's some
of this money and incentives involved that
they're not going to say that.
They're not going to tell the patient.
They're not going to disclose something to
them.
Now, here's the question real quick, Tony.
If that physician instead said to your
patient,
You have a choice.
You have this other condition.
Oh,
and she tells the physician that my
therapist, Tony Meritato says, you know,
I can continue to come out of pocket
and go there and do my therapeutic
exercise or whatever,
because I already burned up my twenty
Medicare Advantage visits for the calendar
year.
If that physician had said to her, oh,
that's awesome,
I know him or I don't know him
or whatever, you have the option.
You could go to our hospital-based clinic,
outpatient clinic,
for this other condition and be treated
there,
or you could also stay there with him,
or you could go to some other clinic,
any other clinic down the road.
I think you just need movement,
you need some physical therapy or
supervision by a physical therapist or
whatever.
If that physician had said that to her,
you knowing her,
would she still be in your practice or
would she be going to the office?
A thousand percent.
So that's a shame, right?
That's ridiculous.
Yeah, yeah.
But even on that front,
and I'm sure you guys have seen it
too,
like I've seen the shift in physician
culture.
I've seen the shift in referrals.
Twenty five years ago when we started,
like we were getting all of the referrals
with very specific,
you're going to do this and you're going
to do that and you're going to do,
you know,
they would tell us what to do.
And talking to,
they were old physicians back then,
many of them probably aren't alive
anymore, but talking to them,
the culture and the mindset of the doctor
was, I am the doctor,
this is what the therapist does,
you do what I tell you to do.
Now, as that culture has shifted out,
I talk to a lot of younger MDs,
younger than me, and they're like, oh,
you guys are professional.
You know what to do.
I worked with a lot of great therapists
during my rotations,
and you guys know more than me when
it comes to this and that.
You guys take the reins.
So I do see a shift within the
mindset and the culture of the medical
doctor and how they view themselves on a
team approach and
um i think it's positive i think it's
positive for all allied healthcare not
just us but so maybe maybe i would
revise my thing from saying okay direct to
consumer marketing to we also have an
element of marketing to physicians and
student physicians you know residents and
letting them know and see and understand
kind of
what, what our role in the ecosystem is.
And, and, and being collaborative.
Like I, did I tell you, Tony,
that I was a week or two ago,
I went with my, one of my,
one of the only patients that I'm seeing.
And I took him to a pain,
a pain orthophysician,
non-surgical physiatrist.
And I went to the visit.
I went to the visit.
I didn't tell you guys this.
No, I don't think so.
I totally, totally forgot to tell you.
And when I did,
I did my Tony Maritato.
I got the patient's permission ahead of
time.
I even told the physician,
texted the physician, hey, you know,
he already knew I was sending this patient
to him.
And I just want to get his permission
just because I haven't done it before.
And I just, whatever.
I'm just like,
let me run this by you.
You know, if that's cool.
You know,
the patient already gave permission.
And so it was great.
So like that,
like I know you've been doing that, Tony,
for years.
But more collaboration now,
less of the top-down hierarchy and,
you know,
the –
all knowing, all being, you know,
physician from, you know,
fifty plus years ago.
So how'd it go?
Tell us about it.
We have a couple of minutes.
Yeah, well, yeah,
he was he gave maybe twenty or something
minutes in terms of, you know,
in the exam room and all that.
So that was great in terms of time.
Twenty minutes,
maybe even twenty five minutes.
It was great in terms of time.
We did have to wait like an hour.
And I almost, I almost,
I said to my patient,
now the patient I have a great rapport
with,
cause I've been treating him for like a
year and a half with a, you know,
neuro situation.
And I said, I said,
should I go outside?
Like, I think like,
is it possible that they forgot us?
And he said, he said,
if my wife was here,
she would have already been outside.
I was like, oh man.
Yeah.
So, but now he came in,
it went well.
And also going through the exam and the
subjective and you know,
uh in the middle and then towards the
end the physician was kind of turning to
me after i gave some subjective in the
in the beginning but then in terms of
the plan and you know setting up imaging
and going from there uh the physician was
turning to me and was kind of like
is that almost was like is that what
you guys were kind of looking for like
any other questions then anything else i
can help you with or like are we
on the same page here and i'm like
yeah totally that exactly what i wanted
like he's got you know multiple
orthopedic issues on top of a neurological
condition.
So there's a lot going on here and
that's why I was referring him to you.
So yes,
we're on the same page and everything that
you mentioned in terms of
potential next steps,
like right on the same page,
exactly what we're looking for.
So then he kind of looped me back
into this three-way conversation between
he and I and the patient right there
in the office.
So it went well.
And we'll see, we'll see, you know,
how many more of those I can do,
but that would, oh, I did,
I did message you guys because I did
say about the weight and you- I remember
now, yeah.
Yeah, yeah.
So historically you said, you know,
you gotta be prepared for, you know,
like a two or three hour window sometimes
with like the whole,
experience you know so that's it's all
good just like building relationships and
um but that's kind of where i'm at
in terms of physician marketing and that
whole you know collaborative approach
which again i i would never i don't
think i would do it you know historically
but now i'm doing it more as i
kind of see the vibe of other physicians
and you know things that work so you
know it was just part of like the
marketing strategy and just again building
relationships
So again, this is, you know,
Dana Strauss and value-based care and
having a seat at the table.
And there's different approaches to how we
get there.
You can go the route of, um,
I don't even know.
I don't know what everybody else is doing.
When I want a seat at the table,
when I want to build a relationship,
we used to bring lunch in or breakfast
for the entire office.
We'd get a couple minutes.
We were a nuisance to the medical
practice.
Nobody wanted to deal with us.
But now...
I go with my patient.
I haven't done it in a couple of
years, but still the opportunity is there.
You go there and you sit down.
The doctor is getting paid for that time.
I'm representing the patient.
I'm saving the physician some time.
I'm communicating.
I'm building a rapport.
I'm making the connection.
Once you do it a couple of times,
they get to know you on a personal
level here where we are.
The doctors still will very,
very rarely send me patients in
Middletown.
Now,
Middletown is about five miles up the road
from where I am right now.
Right now, I'm in Monroe.
But every single patient in Monroe comes
to me.
And that is because...
Those doctors know me on a personal level.
We have a relationship.
We've talked to each other.
We kind of have a sense for what
we're doing and who we are.
The only way I could build that is
by attending those follow-up visits with
my patients.
And the docs who don't want to do
it, they're not going to do it,
but it doesn't matter.
Just like any other networking,
there's people you connect with and people
you don't.
So yeah,
I just think it's such a missed
opportunity for so many.
And I would say it's really should be
a paid opportunity.
I don't know if you did it,
but for other therapists listening,
like it should be a paid session.
It's not covered by insurance.
It should be paid out of pocket.
I bet the family would be willing to
pay to send you,
somebody the patient knows,
likes and trusts,
to be there as a representative.
Jimmy,
you've been in that world with your dad.
Like having somebody who understands the
system, speaks the language,
being there with somebody you care about,
probably more impactful than, you know,
a spouse being there who doesn't know what
to do.
Three things, time, money, headache,
and averting crisis.
I mean, I have someone.
I have a former nurse who's a medical
advocate, a nursing advocate,
a geriatric advocate.
You know how many times that I've been
like,
should I bring my dad to the doctor,
the urgent care, the emergency room,
or wait?
And she'll ask me two or three questions
and then say,
it's my recommendation that you do this.
And I'm like, great.
But I can go around with her.
I can say, well, I don't understand that.
Can you explain it?
She's like, sure.
Do you want me to explain it now?
Do you want me to write it down?
And I'm like, sure.
Just explain it to me now.
time, effort, money,
pain and averting crisis like these things
are valuable.
So this goes back to a conversation I
was just having with someone the other
day.
We typically devalue the things we know
because they're easy.
We know that even someone stupid like me
knows that everybody must know it.
So we devalue what we know.
But I look at my buddy who I
reference him a lot down the street who's
a mechanic.
I'm like, you're like a wizard, man.
I don't know how to make the car
stop doing the noise and make sure it's
safe to drive.
I have no idea.
I could not begin to watch a YouTube
video.
It's easy.
I'm like,
I don't even know what parts you're
talking about, man.
I wouldn't even begin to scratch the
surface.
I wouldn't even open the textbook.
That's valuable.
That's why people pay for that.
So, yes, it is of value.
What I think is interesting there is you
said medical advocate and then you said
nurse.
And so if you had originally and both
would do the same thing.
I think any nurse that you hired would
function as a medical advocate.
But as soon as you say the words
medical advocate, the consumer is like,
yes, that's exactly what I need.
I don't need another nurse.
I've got a nurse.
I need a medical advocate.
I need somebody who's going to advocate
for me, be on my side,
be my representative,
speak a language and fight for what I
need.
Um, so once again, that, that name,
that word,
that sound coming out of your mouth has
significantly higher value in the context
of what the consumer believes they need
than just saying nurse,
even though technically I would imagine
anybody in the world can hang a shingle
saying medical advocate,
but you have to go through extensive
training and education and licensure to
hang a shingle that says nurse.
Right.
So she did both.
She was a nurse for twenty something years
in a bunch of different settings.
And then she's like,
now I want to do this.
So she's, you know,
her pitch is essentially a family member
founder for me online.
The pitch was I've been that provider and
I know how people can get lost and
I sort of know how to cut through
the BS.
She's annoying.
At hospitals.
Not to me.
Yeah.
No, I need this paperwork.
I will get it to you.
I'm not leaving until it is.
This is his right.
He has a right to have this paperwork.
We will not leave.
Oh, what's your supervisor?
What's your name?
I'm going to write down that we can't.
It's nine twenty four.
We requested it and I'll write down when
we get it.
And I get to just be guy in
the corner who's just like, hey, dad,
let's watch the Yankee game on TV while
we're in the emergency room.
So it was it valuable?
Hell, yeah.
Yeah.
Let's think about parting shots.
I don't know if you guys caught it
over the weekend.
The Mets went down in a blaze of
glory and the Reds.
The Reds are in.
The Reds are in, baby.
Congratulations.
I don't know what's going to happen
against the Dodgers tomorrow.
Tomorrow?
Tonight.
I think it's tonight.
That could get ugly, but hey,
we're going to celebrate while we can.
Good for you.
How's my parting shot?
What do you guys got?
Other than Go Phillies,
we got the two seed first round buy.
Other than Go Phillies, yeah,
just going back to this whole shenanigans,
I think this whole topic is just crazy
that we just covered today.
And so if, I don't know,
if there's NPs and PAs that...
have their name badge and they're
displaying it.
And then like Tony said,
they're not flipping it around.
They're not hiding it.
Just do the right thing.
Then I don't see how anything could be
misleading or misrepresentation or
whatever.
And also, yeah, I don't know.
I'm not sure if it'll make that big
of a difference either way,
but patients are definitely...
uh influenced and sometimes positively
surprised when i hear that we have doctors
in physical therapy like i mentioned it i
don't like sell it hard but like i
think it's cool to mention because that's
what my diploma says that's what i got
licensed you know with and all that so
like why wouldn't i use it in like
the most respectful way and we're not
saying physician or medical doctor or
anything like that so um
Hopefully,
this is not an ongoing trend with other
states barring nurses from saying doctor
if they're DNP or NP or whatever.
Because if that's the case,
then it could certainly trickle down or
trickle over to physical therapists as
well.
So we'll see.
Yeah, I'd say in the end, clarity wins.
The person who is most clear wins.
And I know if you're saying, hey,
the AMA is doing this because of hierarchy
and ego, don't do the same thing.
Aim for clarity,
and I think you don't miss.
I think people want to default to, like,
I need to win every single conversation
and argument.
You never win every single conversation
and argument.
I think the person who communicates
clearly, concisely,
consistently is the one who wins.
But you got to decide what winning looks
like.
All right, gentlemen.
Right on.
Love it.
Have a great week.
We'll see you back on Thursday.
I'm sure something insane will happen in
the healthcare world in our profession
between now and Thursday for us to
discuss.
But if you have any topic suggestions,
feel free to hit us up online and
we will bring it to the show.